WRITTEN ASSIGNMENT IN THE RNBS PROGRAM
ADEBIMPE BABAWALE
NUR 3110
WYCKOFF HOSPITAL MISSION STATEMENT: TO PROVIDE EXCELLENCE IN CARE THROUH PREVENTION, EDUCATION AND TREATMENT IN A SAFE ENVIRONMENT.
CAPACITY OG THE UNIT IS 50
CENSUS OF THE DAY 43 ON FEBRUARY 24, 2015
THINGS LEARNT ON UNIT 6 SOUTH: On arrival to the unit, the unit manager was reviewing staff time and attendance sheet for punctuality which she does every three months according to the facilities policy. The unit’s goal according to the manager are as follows: To decrease the rate of unit acquired pressure ulcer by 25% each quarter (in 2014, the unit had a benchmark of 16). To decrease the amount of falls by 20% each quarter (in 2014, the bench mark reported was 38). I asked the manager that based on the gender who had more falls over the years and the report survey shows that the male had more falls than the female on the unit. Later on we attended the discharge planning meetings with the social worker and physicians present. The nurses were busy at this time administering medication so they could not be present at this meeting. This was an interdisciplinary staff meeting that required the nurses to be present but because of time constraint on the part of the nurses, the unit leader said it has been difficult for the nurses to be pulled away from their work at the time medication needs to be administered to be part of this meeting which to her is a complex challenging issue she is trying to work on so that everyone can be present to discuss patient needs and health care issues appropriately.
At the meeting, all the team members discussed the stable and unstable patient, who should be discharge home, who needs homecare services or visiting nurse services, who is going for a procedure and some were referred to hospice. We made rounds as usual and the unit leader was pleasant towards the patient as she greeted the patient on entering each room, introduced herself, ask how they were doing and how the staffs have been treating them and if they had any issues to discuss. Most of the patient and their family member said something good about the staff and the service they have received so far since their admission. One elderly woman said a different thing. Her report on unit 6 south was okay but, she reported that the unit she was transferred from which was 9 south had nurses with bad attitudes towards her. The unit leader addressed the issues and complaints she received and told the patient she will follow up with 9 south unit leader so that Wyckoff Hospital can better serve the community. I admire her courage and her problem solving skills she used in handling the issues at hand and this is the same thing I would have done if am confronted with such a dilemma. There was no adhoc meetings nor task forces meetings held. I had two patients with CHF (CONGESTIVE HEART FAILURE).
I was able to discuss with one of the patient addressing the CHF readmission project where applicable, also using the time to do some teaching and there was a positive feedback from the patient at the end of our discussion. The other patient I had was having episodic breathing difficulty and the response team were in the room so I was unable to discuss anything with her. However, her granddaughter was available at the time and I used the opportunity to do some teaching while answering her questions regarding CHF and also gave support to her as she was crying seeing what her grandmother was going through. I later joined the unit manager who was talking to one of the maintenance / engineering staff in the hallway. She requested that the walls on the hall way need to be painted to uplift the unit’s appearance and she took the staff to one of the rooms where they completed a painting job that was satisfactory and what she wants done comparing another units hall way painting. I see this as necessary because you always want your unit to be welcoming, beautiful with attractive colors to the patients, I think colors says a lot to the environment in which care is delivered. Also there were couple of rooms who had no hand sanitizer that the unit leader observed and immediately she called the housekeeper on the unit assigned to replace new hand sanitizer at the door entrance for hygiene purpose. Prior to my leaving the unit, there was an issue of elopement with a male patient that is alert, verbally responsive and is very known in the hospital community as a drug abuser. The security were informed immediately and the plan for elopement were followed right away.
WHAT IS AIDET? This is an acronym that stands for the following:
Acknowledge
Introduce
Duration
Explanation
Thanks
The five steps are used to achieve satisfaction. They are the five fundamentals of service used in providing excellent care to patients and their families through active commitment of staffs. It is important in hospital line of business to acknowledge the customers in a friendly caring manner, introducing yourself, the unit and what you do to the customers, give customers an estimate of the waiting time or how long a procedure may take and if there is a delay, keep customers informed on how things work, about what will be done if there is pain involved or if they have questions to ask and finally, show your appreciation for the privilege of caring for your customer and for choosing to come to the institution where you work by thanking them.
THINGS LEARNT ON UNIT 11- NICU: The NICU unit is under lock down for safety and security reasons. The unit is divided into three components (intensive care unit, continuous care and newborn nursery). I met the unit patient manager Ms. Gloria Palma-Cardona, she has such a friendly and warm personality. From the moment I met her till I left for post conference, I observed a democratic leadership style. She interacts well with her staff and the unit physician Dr. Patel. Rounds were made before I got to NICU. There were no adhoc nor task forces meetings held. The unit had no CHF patients. The aim and objective of the unit is to promote excellence in care for newborns by involving and providing education to parents/caregivers through guidance in care and continuous education that will prepare and develop parenting skills. The unit manager read all pending email text and listened to phone call messages and she returned back the calls. I asked her questions like ( how does she manage to coordinate the affairs on the NICU Units, attends meetings and still get herself together with the pressure that comes with being a manager). The answer was summed up as planning and organizing your task ahead, reach out to your staff through effective communication and follow up on things when you delegate any work to those under your supervision. She motivates the staffs and everything done on the unit is under control. This is a good managerial qualities in my opinion. The unit is quiet and smooth which is therapeutic for all the babies. There was really nothing observed that I can point to against the managerial style used by Ms. Palma except for a meeting that came up abruptly that was mandatory for her to attend and she could not attend the previous scheduled meeting and she delegated someone to attend it since the two meetings were to start at the same time. As a manager, things happen and you have to deal with issues as they arise the best way you can as you cannot be in two meetings at the same time.
The methods used to orient new staff to the hospital and their assigned unit involves some steps. Once the new nurse has gone through the HRA (HUMAN RESOURCE ADMINISTRATION) in which involves submitting of resume to Mr. Charles and passing the on board exam, then on the last Friday of every month the hospital holds orientation for experience and un-experienced nurses. A week of orientation is for experience nurses and a week and half or more for unexperience nurses depending on their readiness level at the class room work shop. Afterwards, they are sent to the different units to observe how things are done and to apply their skills under supervision through preceptorship method for a period of three to four weeks for experienced nurses and about five to six weeks for un-experienced new graduate nurses so that they can learn and apply their skills and get comfortable. This means that the orienteers will follow the unit leader around, observe what the leader does and also tries to work in the leaders shoes by attempting to do or perform the task she or he observe the leader doing. They expect them to ask questions for clarity purposes and the preceptor they are assigned to evaluate their performance daily. Also during orientation period, the policies and procedures of the hospital are made known to the orienteers. During orientation skill performance like Foley and intravenous insertion are taught, use of PCA (PATIENT CONTROLLED ANALGESIC) intravenous pump for pain management are taught, using defibrillator and other vital hospital techniques and procedures are explained to the orienteers in the various units. The copies of training manuals were obtained from the unit manager at NICU. There are manuals for thoracotomy-chest tube placement, circumcision policy, nicu / newborn policy, pretesting policy etc. With the nursing responsibilities for each policy and procedure in place. There are different brochures available for nursing mothers and various magazine or pamphlets addressing different topics and issues in different languages for new and experienced mothers. I observed on the unit a language line solution notice and phone for interpretation service purposes to mother that speak other languages who are not proficient in English language. There was a “condition c” postal that states if you experience any of these signs or symptoms report immediately to staff and they are: sudden breathing problems, acute chest pain and change in mental status, weakness of the face/arm or legs, change in skin color( pale, dusky, gray, cyanotic), suicide attempt and bleeding from any part of body orifices. Also I observed that the pharmaceutical department has high alerts medication information posted by the wall on the notice board for safety purpose to decrease medication error. The unit also has AIDET signs in place, hand washing signs for all visitors and reminder to staffs to prevent spread of germs to the babies. I was asked to help in breaking down the number of infants by weight from January 2014 to March 2015 using the birthing logging sheet based on babies that had a birth weight below 1000grams, between 1000 to 1500grams, 1500 to 2500grams, 2500 to 4000 grams and above 4000 grams. It was an exciting experience for me as the unit leader, myself, a medical student and Dr. Patel started the counting and afterwards it was left to me and the medical student. I was supposed to go for a meeting at 11 a.m. and was unable to as I had to go to labor and delivery to observe a caesarian operation performed on unit 12. Unfortunately after changing into scrubs and proceed to the operating room, we were told the patient privacy was an issue and for some other reasons consent was not obtained from the patient for us to observe the procedure so we had to wait for another patient who would be going for C-section afterward. This did not happen because the case was not called in by the time we left the unit at past twelve. Anyway, while on unit 12, the unit manager engaged us in the teleconference meeting held where health care providers discussed venous thromboembolism risk assessment and prophylaxis. It was very informational and educating for me as the teleconference focused on safe motherhood initiatives from several studies. The unit manager handed a competency validation orientation paper for the labor and delivery/maternity unit for newly hired nurses and specific knowledge and proficiency must be demonstrated within the probationary periods in different areas.

AMBULANCE DIVERSION: This happens when a hospital’s ER cannot care for more patients. The ER goes “on diversion” and ambulances are redirected to another hospital or medical facility which is common today. Every minute of the day in the United States, an ambulance is turned away from a hospital due to ambulance diversion according to the Institute of Medicine. As reported in the annuals of the emergency medicine, common reasons for a hospital to go on ambulance diversion are as follows: if there are no appropriate inpatient beds, a high number of ER patients and complexity of patient cases. Staffing shortages and equipment failure were less common. The access to emergency medical services act if passed by the congress can help address the practice of ambulance diversion. This is because ambulance diversion can have a significant impact on patient care. Studies from New York City boroughs found that the mortality rate from heart attacks increased by 47% on days when hospital were on diversion.