Problems merging units

[Hayden]

Just looking for advice.

Recently, due to major hospital renovations, our High dependency Unit (HDU) and Intensive Care Unit (ICU) were merged. This combined the staff of both units. The problem is that despite being together for several months there is still very much an "us and them" mentality. There exists a great deal of tension.

Some staff from the HDU refuse to care for ICU patients and most of the ICU staff refuse to care for the HDU patients. With the merger the HDU charge nurse was "reallocated" and the ICU NUM now has responsibility for the merged staff and patient load.

What can we do to try and break down the barriers?

[mustangsheba]

Hey, Hay: I can't imagine why anyone would try to merge ICU with anything! The powers that be need to reconsider. Merge HDU with something else.

[ballyk]

I can relate to this! A few years ago I worked in a hospital taht merged with another, what a nightmare!

It may take soem arguments but tell your colleauges how you fee. Encourage everyone to act like the adults they are meant to be, talk to your NUM no matter how hard it is.Maybe even put down some objectives in writing for you yearly review taht you want to gain more experience in ICU pts. Talking and yes sometiems yelling and tears are the way to go, Sometimes an external facilitator to a frank and open discussion can help. The NUM is probably feeling as frustrated as you. Go higher if neccesary.

Good luck

[PeaceRN]

I can understand your frustration. We merged with another unit last summer and it was a nightmare, at first. Most of the difficulty was a result of poor communication between management and staff. Once this problem was identified, we began having staff meetings every two weeks to discuss problems and possible solutions. A list of "absolutes" were given to the staff. (For example, you must have competency to care of all patients admittd to the unit and the unit will not be divided up again). Staff was encouraged to voice problems in a positive way and to think of possible solutions to the problem. We discovered through these discussions that most of our problems stemmed from fear of the unknown. Once proper orientation and education was given, the transition moved smoothly. By involving the staff in change process earlier, we probably could have avoided many of our problems.

We are about to merge with another unit again. We have already started the change planning process with involvement from staff members. The attitude of the staff is remarkably different. I hope this helps.

[Stargazer]

Some years ago we merged our ICU and CCU. The ICU nurses were apprehensive about taking care of "ticking time bombs" (cardiac pts) and the CCU nurses were nervous about taking care of "gooey" pts (surgeries, MSOF's). We cross-trained starting several weeks ahead of time, with various nurses teaching 30-min. classes on taking care of specific pt populations and videotaping the classes so people could watch later. We also stayed available as resources for each other for help & questions, and there was an expectation that after the first month or so, everyone should be able to independently take care of any critical care patient, which proved not to be a problem.

The ICU nurses then held a "farewell" party. We had a potluck at someone's house and formed a circle where we all went around and shared a favorite memory or funny moment from the "old" unit. Then we wrote our best wishes for the new unit on balloons and let them fly away in the wind. This may sound corny but it really gave us a feeling of working through our "grieving" for the old unit and a sense of closure. The CCU nurses were also nice enough to staff the unit that day so we could all get away, which created a lot of positive feelings.

It definitely won't go well without strong staff involvement. All of the above ideas were suggested and implemented by staff nurses, not administration, which is why they worked. :-)