EAMCEast Alabama Regional Medical Center

Bridget Bordelon, Celia Bynum, Kimberly Childress, Meredith Gean, Baylee Smith

Las Muchachas

Meet Kate Ruud!Unit Manager, EAMC CVICU

A Brief History of EAMC…

• Construction of EAMC began in 1950• 228 Beds• One of the “Top 100 Heart Hospitals in the

U.S.”• “100 Best Places to Work in America”• CVICU has 8 beds

• Mission – High Quality, Compassionate Health Care

• Vision– To be a national leader in quality, cost and service

• Values– Excellence --Integrity—Compassion—Respect--

Teamwork

Staffing• 18 RNs• 4 MCTs Full Time• 5 Advanced Practice Nurses (Clinicians)• Director of Critical Care• Nurse ManagerThe staff makes group decisions for patient assignments

Charge Nurse Responsibilities-Audit (check beds, check crash carts, perform glucose controls on accu-check machines)

• Used to go directly to manager (tattling)

• Now they are encouraged to talk to each other first

• If there is a safety issue, then staff are encouraged to go directly to the manager• the manager listens to each

side of the conflict and helps determine a plan of action using EAMC’s discipline plan

Conflict Resolution

National Patient Safety Goals

• Prevention of central line infections• Use full drapes during insertion (and

hold physicians accountable)• Wear mask, hat, and gowns

• Ventilator associated pneumonia• Extubation times and

reintubation rates.

Safety Goals (cont.)• Strict glucose control

• Rated by online cardiovascular service• 6 o’clock glucose post-operative days 1 and 2

Financial Concerns

• Problems with Reimbursements

• Recombinant Advisory Committee (RAC) examines charts for correct documentation

• Important to chart everything carefully• Medicare/Medicaid

coverage• Don’t over-staff

Change Needed

• Losing nurses to graduate schools and other opportunities

• Majority of nurses are new graduates– They lack experience– May not understand all

aspects of CVICU right away

Patient Delivery Care Model

• “Family Nursing”– Each nurse has ~2 patients

but everyone works as a team to take care of “fresh hearts” and new admits

– No such thing as: “that’s not my patient…”

– The patients are critical! “Can’t do it alone!”

Patient Assignments

• According to patient acuity and nurse skill level– One nurse will not have 2

“fresh hearts”– More experienced nurses will

take care of more critical patients

– It is important for the nurses to be comfortable with their patients. When the new nurse is ready they can take care of sicker patients

Scheduling

• Day shift and night shift hold scheduling meetings

• 3 nurses per shift• Night shift may choose to do “6 on, 8 off”• After schedules are written the staff can

switch shifts if necessary

Motivation

• Every staff member is motivated differently– Recognition– Self-motivated– “Whip-cracking”

• No matter what kind of motivation they require, each staff member wants to give the highest quality of care.

• “We want our unit to be the best!”

Recruiting

• No active recruiting from outside the hospital at this time

• Earn & Learn• Getting nurses from step down unit• Scholarship program

Attrition Rate

• In the last year 3 staff RNs were lost– 1 moved– 2 went to CRNA school

• No nurses lost due to job dissatisfaction

Encouraging Staff Retention

• “Family” atmosphere• Provide opportunities for

advancement• Make them feel valued

and important• Excellent teamwork– “works like a well-oiled

machine”– Everyone knows their role

Questions??