catalyst

First I say a small hospital is a very wild animal and good luck. I am a manager and find this type of situation hard to manage, it is a eal balancing act. A well seasoned staff could probably handle your situation fairly well, especially if a CNA or Unit Clerk could be called in to assist with the admission chaos. This could be a disaster for a young nursing staff. We call agency for fluctuations if "home staff" are not able to keep up. We have a house supervisor who will take up the slack or reassign a nurse from a slow-low acuity area. Placing people on call is a very good solution as well. If this situation is a rare thing, you might think of activating your disaster call list for back-up. Just last week my 28 bed med/surg unit went from 9 patients to 17 patients in 14 hours. I was able to float two nurses in, one did assessments and the other took a patient load. The trick is to realize that we are in the business of making decisions and helping the sick, so prioritizing the needs of the unit (all the patients in mind) usually allow for a safe outcome. I would follow the chain of command if your really concerned. A manager who only staff's a unit based on yearly numbers is makeing poor judgement. Seasons and trends should be taken into account. The usual staffing guidelines on medical surgical unit is about 8 hours of care per patient per day, but should be adjusted up or down based on acuity. Staffing decesions are usally made by taking allowed hours of care per day (8) times the number of patients. Now divide up the hours of care based on the activity performed on each shift. usually heavy on days while the unit is busy, lighter on nights when the patients are asleep. Say you allow 4.5 hours for days and 3.5 for nights (12 hr shifts). Staffing example for 20 patients: 20 x 4.5 =90. now take 90 and divide by 12 (12 hr shift) for a total of 7.5, which is the amount of staff you should be allowed to take care of 20 patients on that shift. Usually divided between manager, rn, lvn, cna, and unit clerks. Anyway, just staffing the same way reguardless of patient volume and acuity is not appropriate. I hope this help.

I think you will be able to find a job in the OR. I would advise you to work medical floor or surgical floor first, but if your hart is in the OR, go for it. You will learn more than you ever thought you would. Good luck.

I have 5 years management experience in ED and ICU and have recently become the manager of a 28 bed medical surgical unit. Current situation: Typically we have 1 unit clerk, 2 RN's, 2 LVN's, 2 CNA's, and a charge RN (who rarely takes a patient load). Monday through Friday we have a clinical supervisor RN who handles clinical issues, makes the schedules, performs evaluations and assists in the general flow of things. The usual patient volume on the unit is a total of 14-18 patients. Other than a unit clerk from 6am to 10 pm, Usual assignments on both 12 hour shifts are: charge RN, no patients; 2 LVN's, 4 to 5 pts each, 2 RN's, 4 to 5 pts each; two CNA's who split the patient load. Also, ther is no clear involvement of an RN in every patients care on every shift except at admission. The LVN's work very liberally under a charge RN who does not appear to have much involvement in the care. My productivity shows I am at least 4 people overstaffed every day. I know that drastic changes will result in extreem upset with the staff. I also have about 5 new RN's (2 with 1 year exp, 3 with less than 6 mos exp). My thoughts are to streamline the unit clerks role by implementing systems to be more organized and teach new tricks to be more supportive (there is a lot of problems currently with this). Then to reduce the amount of re-work in all ways possible (like not having to chart things twice and walk the entire length of the unit for washclothes). Our CNA's are excellent and provide great patient care. I have been meeting the staff and introducing myself in an attempt to form new relationships. I also manage the house supervision group and have great support from them. My first concern is the RN involvement in each pts care. Secondly, I am overstaffed. I feel a team approach is best and I am thinking of changing the care to a real team approach. My thoughts are: 7a to 7p (75% of addmissions and 68% of discharges occure here) 1 unit clinical supervisor (8-5, mon-fri) 1 Unit Clerk (in at 6am) 1 RN admission, discharge nurse who would be responsible for: Charge responsibilities when the clinical supervisor is off the unit Comprehensive admission assessment Begins standard diagnosis based patient education Assist in discharges when available Acts as resource nurse to other staff Makes admission bed assignments Each team for 8 to 10 patients: 1 RN-Overall care manager (team leader) 1 LVN-assigned duties like meds, dressing change, focused assessments 1 CNA (shared by 2 teams)-vitals, meals, assist with ADL's As census drops I would keep a team of 1 RN, 1 LVN for 8-10 pts and another RN to take up to 4 patients with charge responsibilities (keeping the admission nurse as long as the census is at least 14). 7p to 7a would not have the unit supervisor or admission nurse but would have a unit clerk till 11pm and a CNA as long as the census stays above 15 This matrix will keep us close to guidelines (slightly over) How does this sound? Any suggestions? Any suggestions on getting staff buy-in? thanks in advance for sharing your thoughts.

I have 5 years management experience in ED and ICU and have recently become the manager of a 28 bed medical surgical unit. Current situation: Typically we have 1 unit clerk, 2 RN's, 2 LVN's, 2 CNA's, and a charge RN (who rarely takes a patient load). Monday through Friday we have a clinical supervisor RN who handles clinical issues, makes the schedules, performs evaluations and assists in the general flow of things. The usual patient volume on the unit is a total of 14-18 patients. Other than a unit clerk from 6am to 10 pm, Usual assignments on both 12 hour shifts are: charge RN, no patients; 2 LVN's, 4 to 5 pts each, 2 RN's, 4 to 5 pts each; two CNA's who split the patient load. Also, ther is no clear involvement of an RN in every patients care on every shift except at admission. The LVN's work very liberally under a charge RN who does not appear to have much involvement in the care. My productivity shows I am at least 4 people overstaffed every day. I know that drastic changes will result in extreem upset with the staff. I also have about 5 new RN's (2 with 1 year exp, 3 with less than 6 mos exp). My thoughts are to streamline the unit clerks role by implementing systems to be more organized and teach new tricks to be more supportive (there is a lot of problems currently with this). Then to reduce the amount of re-work in all ways possible (like not having to chart things twice and walk the entire length of the unit for washclothes). Our CNA's are excellent and provide great patient care. I have been meeting the staff and introducing myself in an attempt to form new relationships. I also manage the house supervision group and have great support from them. My first concern is the RN involvement in each pts care. Secondly, I am overstaffed. I feel a team approach is best and I am thinking of changing the care to a real team approach. My thoughts are: 7a to 7p (75% of addmissions and 68% of discharges occure here) 1 unit clinical supervisor (8-5, mon-fri) 1 Unit Clerk (in at 6am) 1 RN admission, discharge nurse who would be responsible for: Charge responsibilities when the clinical supervisor is off the unit Comprehensive admission assessment Begins standard diagnosis based patient education Assist in discharges when available Acts as resource nurse to other staff Makes admission bed assignments Each team for 8 to 10 patients: 1 RN-Overall care manager for patients 1 LVN-assigned duties like meds, dressing change, focused assessments 1 CNA (shared by 2 teams)-vitals, meals, assist with ADL's As census drops I would keep a team of 1 RN, 1 LVN for 8-10 pts and another RN to take up to 4 patients with charge responsibilities (keeping the admission nurse as long as the census is at least 14). 7p to 7a would not have the unit supervisor or admission nurse but would have a unit clerk till 11pm and a CNA as long as the census stays above 15 This matrix will keep us close to guidelines (slightly over) How does this sound? Any suggestions? Any suggestions on getting staff buy-in? thanks in advance for sharing your thoughts.

I'm trying to find a benchmark for patients who left without being seen by the physician and patients who left against medical advice. Currently my LWBS volume is between 3% & 5% and AMA is 1.5%. I have been told by my CFO the average is 0.3% LWBS & AMA. I just can't see that. We see approx. 12,600 pts per year. Any help would be greatly appreaciated.

When I became the manager in my ER I interviewed all the staff using the following questions. I also interview new applicants with these questions. Emergency Room Questionnaire 1.What role does the emergency room play in community service? 2.What role does the emergency room play in customer service? 3.Do you see the emergency room as a tool to gain community respect for MCHD? 4.How can you affect the community outlook and confidence in our emergency room? 5.What one change in the emergency room could make the biggest difference in customer service? 6.What one area of the emergency room would you be willing to take ownership in? 7.How do you feel about having volunteers help in the emergency room? 8.What role does the emergency doctor play in customer satisfaction? 9.What can we do to enroll the emergency room doctor in increasing customer service? 10.In your opinion, what percentage of emergency room visits relate to: ØPain ØSOB ØDrug seekers ØPoor judgement 11.How can we make triage work better? 12.What is your feeling about the amount of phone calls received in the emergency room? Is there a way to decrease the amount of calls? 13.What is the best way to keep the emergency rooms stocked? 14.Are we wasting any supplies? 15.Do you have any unanswered questions about patient charges? 16.How do you deal with customer complaints? 17.Do you have any ideas or suggestions that would improve documentation of patient care? 18.How do you feel about taking call? 19.How do you feel about floating to other departments? 20.How do you feel about self-scheduling? 21.Do you have any ideas that could streamline any aspects of the functioning of the emergency room? Comments: I have this in Word format if anyone cares to have it. \ Good Luck

My first day in the ER...... I have been a nurse for 6 years working in ER, ICU, OR, and nursing supervision. I have just signed on as the ER manager and was shocked at the mess i walked into. Any input from others, especially small town ER's that see 950 to 1200 patients per Month, would be greatly appreaciated. I found that my new office is the chart break down room. Usually 3 to 4 days of charts waiting to be taken apart, t sheets copied, pt charges put into meditec,pt discharged from meditec ect. We then sort the charts (take them apart) and put them into three stacks. One copy for the referred to MD, one copy to the emergency md billing services and finally the medical record. How is it done everywhere else???? Another question is about staffing. Is there any minimal staffing requirements?? We generally see 25-45 pts per day. My FTE's show I need to staff 3 on days, 3 on evenings, and 1 on nights. (1.68 per visit)Is anyone staffing only one RN on nights?? I feel its to dangerous and have refussed. I'm looking for justification for being over my FTE's because of low volume on 11-7 shift. Finally, does anyone have any hints on finding missing stats. ie blood pressure checks, triage of OB patients, Breath-a-lizer tests, trama codes (level 3) doing EKG's & breathing tx's after 6:00pm, calling in the x-ray tech on call after hours ect.. Any comments or suggestions will be greatly appreaciated. [ May 31, 2001: Message edited by: catalyst ]