Acute Care Services - Research Paper Example

In my capacity of the Chief Nursing Officer of my hospital I am responsible for recruitment, hiring and retention of nurses for the acute care units of the hospital. Mosby's Medical Dictionary (2009) defines ‘acute care’ as a pattern of health care in which a patient is treated for a brief but severe episode of illness, such as that after an accident, trauma, and post-surgery recovery. In this context the ‘Acute Care Units’ (ACUs) of the hospital can be described as units for emergency care, intensive care, coronary care, cardiology, neonatal intensive care, accident, gastrointestinal episodes such as food poisoning, insect bite, and many general areas where the patient could become acutely unwell and require stabilization. The hospital’s ACUs have complex and sophisticated technical equipments and materials, and involve intensive emergency care. Unlike regular chronic care, this pattern of care required in ACUs is mostly for short time and patient is either discharged after cure, or after stabilization of condition transferred to specialized care departments for further treatment. Acute care services are generally delivered by teams of trained nurses and physicians from medical and surgical specialties. With the above background, the fulfilment of my responsibilities for the various tasks is discussed below: A. Strategy for Recruiting Nurses for Acute Care Units: The hospital has a well thought strategy for recruitment of nurses in the hospital. The strategy is a part of hospital’s overall staff recruitment policy which recognises the importance of nurses in the quality healthcare provided by the hospital. The hospital recognises recruitment as a basic function that holds key to proper functioning of the hospital in healthcare delivery. Therefore, recruitment is not an isolated but a central function that almost affects everything in the organisation. The over-riding objective of the recruitment strategy is to attract competent and committed individuals who will make nursing a career and also stay for long period in hospital service, in effect resolving the problem of frequent resignations leading to increased retention of nurses in ACUs of the hospital. Thus, recruitment of nurses for ACUs is based on an internal recruitment policy to recruit the best of qualified nurses and the strategy comprises the following strategic actions: (i) Recruitment of nurses is an on-going biannual activity to fill available vacancies. Under this strategic mechanism, the required strength of 30 nurses for all ACUs should be maintained in any case so that the functioning of the hospital does not suffer. Under this approach applications are welcome from all interested qualifies nurses to register with the hospital database or submit an application in paper of on the website. The hospital conducts regular monthly reviews of all potential candidates fitting the requirements and invites them to the hospital for personal discussion. (ii) The areas of interest and required qualifications for ACUs are prominently displayed on the hospital website under a separate link, ‘Open vacancies for ACUs’. Any visitor to the hospital website can easily find out the link and seek details and apply on website, or submit a paper application in the required format. In addition, regular advertisements for nurse positions appear in newspapers and nursing journals (Fig.1) Fig.1. Advertising open position of nurses is a regular activity. (iii) The focus of recruitment policy is on nurses from the local community or the state. In case the needs be more acute recruitments can be effected even at the state, national, or international levels. Nurses from developing countries trained in the USA are the obvious choice in the latter category. (iv) Recruitment of the best staff is facilitated by announcing on hospital’s website, its policy to appreciate nurses’ contributions in healthcare through financial benefits, recognitions, awards and honours. The webpage builds a positive image of the hospital’s recruitment policy for nurses and the opportunities they receive. This greatly helps in developing interest and taking a job at the hospital. Fig.2.The recruitment policy recognises nurses’ retention as a strategic component of recruitment policy. (v) The recruitment process starts with the engagement of nursing students and registered nurses. Both are encouraged to visit the hospital and see the hospital facilities and speak to existing staff. This gives interested nurses first-hand knowledge and experience about the existing policies and their implementation concerning nurses’ career, future prospects, and opportunities. The hospital’s recruitment policy has a built-in strategy which encourages nurses’ retention (Fig.2). (vi) Recruitment strategy recognises that quality of staff is linked with service conditions on offer. Therefore, to recruit the best of candidates in our hospital it is necessary they are offered attractive terms and conditions of service and overall benefits. Higher financial gains are not the only factor that will attract the best of candidates. The strategy will have to be a combination of competitive salaries, opportunities for professional development, support for relocation, residence in hospital campus and flexible 12- hour day and night shifts. B. Job description for open position of Staff Nurse (12-hour shift): The hospital’s acute care units (ACUs) require nurses for critical care of patients reporting in emergency, cardiology, paediatrics, psychiatry, geriatrics, gastroenterology, and other specialities for treatment. The reporting patients are acutely unwell and need immediate interventions to treat and cure or stabilize their conditions. The patients are cases of trauma, injuries, accidents, acute depression, epilepsy, stroke, cardiac block, coronary blockage, neonatal intensive care, diarrhoea, gastrointestinal episodes such as food poisoning, insect bite, and many general problems needing immediate attention for medical interventions. The hospital’s ACUs have sophisticated technical equipments and materials which nurses must make optimum use of to ensure availability of best available care to reporting patients. The nurses posted in ACUs are specially trained nurses for independent critical care and are guided and supported by team of expert nurses and expert physicians. The nurses in ACUs are actively engaged in nursing processes of assessment of reporting patients and feeding of pertinent data relating to the patient into computerized system, followed by problem identification and diagnosis to identify the patient’s problems or diagnoses, needs, and resources. Expected outcomes are individualized to the patient and documented, as measurable goals, and this provides direction for continuity of care. They plan care by deciding about diagnostics, interventions, and outcomes. The plan is individualized to the patient and priorities set for care reflecting current practice followed by outcome identification along with time estimates for attainment of treatment results. They have to carry out implementation of interventions of medication, surgeries, replacements etc. and document them in the hospital’s internal medical information system in a timely manner. Patients treated and cured are discharged and those whose condition is stabilized are transferred to their speciality for further care and management and care. All nurses in ACUs are required to be aware with the use of regular equipments used in critical care, and must be ready to work in 12-hour flexible day and night shifts. C. Guide of open-ended questions for Interviewing Candidates: (i) Tell us, what do you know about this hospital, and how did you come to know about it. (ii) Define acute care and its special needs. What do you believe should comprise an effective and efficient acute care set-up? (iii) You have applied for the position of nurses for acute care units at this hospital. Why are you the right person for this nursing job? Give an idea of your training and experience that makes you the best candidate for this specific nurse job. (iv) You are expected to report 15 minutes before the duty starts, and you come from a long distance. Tell us how you will plan your time so that you are never late. Also, if by chance you are expecting to reach late what shall be your immediate action. (v) Do you plan to advance your knowledge in the field of nursing by further education or training? If so, let us know your plans. (vi) In your belief and experience what is the role of communication in relation to the nurse-physician-patient interaction. (vii) While attending to a patient you come across a situation where you have committed an error that can be fatal to the patient, what will be your response and what measures you will undertake. (viii) A patient reports to the acute care unit, he has symptoms like mild fever, diarrhoea and vomiting. What measures you will undertake. (ix) All hospitals are moving to electronic medical records (EMR). What are the advantages of EMR to the hospital, to nurses and to patients? (x) Have you worked with an electronic medication administration (EMA) record? Bar coding? What are the important features and importance of EMA in hospital medical care? D. Strategy for retention of staff nurses in Acute Care Units: For devising an effective strategy for retention of nurses it is essential to understand the underlying causes for low nursing recruitment and retention. In recent years, there has been a trend for low retention due to a variety of factors, such as, rapidly aging nursing workforce and lower enrolment in nursing occupations due to perceived risks and high demands of the profession, such as possibility of exposure to infections and health hazards, long duty hours, and work in shifts. Besides, in the past, due to lack of opportunities in other areas more women opted for nursing causing their dominance in nursing profession. Women have other career options and are opting for them thus creating the present situation. Therefore, any strategy for retention of nurses must take the current situation into account, and efforts must be made to make the profession attractive and rewarding. A well thought off strategy will be integration of the elements of retention needs with the recruitment process for nurses. A relationship between those strategies is depicted in Fig.3. Fig.3: An effective strategy for retention begins with recruitment through recognition. Some salient features of the hospital’s retention policy are described below: (i) Hospital’s image building: For effecting good retention of nurses the hospital need to have: Firstly, the positive image of the hospital as a professional set-up of high order which provides good working conditions and opportunities for career progression. (ii) Recruitment- Retention Policy: Recruitment must take into account weather the candidate holds the potential to stay in the hospital over a period of time. If there are individual needs of a candidate, and, or if those can be met such as accommodation, may be provided. Recruitments must be preferably made from local community, and if not locally available, then from the outside. Even if the candidate is not up to the required standard but holds the promise for development through training the candidate may be selected on provisional terms for a short period, and exhaustively trained. Once the candidate acquires the required mark the recruitment letter may be given. (iii) Professional Development Opportunity: Provide opportunities for professional development through on-job training in new technologies, by encouraging participation in conferences and workshops, and through opportunities to hold leadership positions in the hospital’s management system. The benefits could also include tuition fee reimbursement for formal degree-granting programs. The hospital’s support to staff development through education is a strategy that benefits both, the hospital and the staff. (iv) Financial Support for Nursing Students from local community: The hospital can run a programme to support nursing education of local community students. Under this programme the hospital identifies a group of students from the local community for nursing education. The selection process involves a committee consisting of local professionals, community leaders and government authorities. The selected students receive loan or financial support from the hospital which is waved when the student serves hospital for a period of time. The strategy helps the hospital discharge its corporate social responsibility, and build hospital’s image in the community. Thus, trained nurses from community have every reason to serve the hospital for long time, and be a role model for others. (v) Proactive approach for engagement of nursing students for ready stream of nurses: The strategy involves creation of affiliations with local nursing schools, and encourages students to perform clinical rotations at the hospital. This provides students an opportunity to familiarize themselves with the hospital working. In their junior or senior year, students may apply for a nurse mentorship program that provides one-to-one mentorship with an experienced staff nurse. After the course, nursing students are encouraged to continue their relationship with the hospital in a part-time position of clinical assistant until their graduation from nursing school. (vi) Communication & Engagement of Nurses in Recruitments & Promotion Policies and Hospital Management Systems: The strategy gives recognition and importance to nursing personnel about their concerns regarding their career, and invites their input and engages them in consultation for policy making. (vii) Accommodation for Nurses: Sometimes a major stumbling factor related to the critical role of nurses in healthcare is commuting from long distances. Reporting in time, and for night shifts, nurses are faced with a daily ordeal. This along with other factors like family issues of nurses, such as very young children or old parents, pose serious problems, compelling them to choose work place nearby. Therefore distant housing is a critical issue in most cases, and therefore campus housing is desirable. Campus accommodation along with fringe benefits is therefore an attractive strategy to hold nurses for long time in the organisation. (viii) Strategy evaluation: An important aspect of the recruitment-retention strategy is regular monitoring of the effect of strategy implementation by quantifying appropriate indicators through a period of five years. Evaluation will employ measurable performance based indicators including: increased nursing ‘workforce stability’ as measured by greater median time in postings; reduction of nursing vacancy rate; increase in skill profiles; and increase in number of local nurses in the hospital. E. Mentoring programme for newly hired nurses: Fresh graduates from nursing schools are filled with enthusiasm for the profession, are anxious about their ability to meet the profession's expectations, and are ready to learn. In the set-up of ACUs, critical care is the essence of the job, and therefore specialized and comprehensive nursing knowledge is necessary. Besides it is essential that all new staff nurse are aware about the hospital’s working and facilities. The hospital takes care of this need by a four week mentorship or orientation programme which includes two-week orientation about the hospital’s overall system and two-weeks training in the designated ACU. This entire four week period of mentorship or orientation is paid job. The mentoring programme comprise four phases: Phase I: The first week of the program covers lectures about the hospital’s mission, goals, policies, rules, regulations, infrastructure and facilities. The nurses are distributed information, guidelines, and manuals for successful mentoring. During this period they are also explained about the importance of various qualities and attributes which nurses must possess in order to be successful in their job. Some of the skills they must acquire are: Interpersonal skills: Communication, feedback, assertiveness, service behaviours, conflict management, relationship building, dealing with difficult, people/situations. Management skills: Delegation, motivation, team building Organization culture: Networking, self-management, self-care Organizational skills: Project management, goal setting, time management Hospital policies & violations: Compliance process The period also covers exposure about the documentation procedures in the hospital. The hospital has a well organised Meditech based health information system (HIS) and UHealth information systems. These facilities are very important and must be understood by the nurses: Meditech: It is software designed to capture, store and display administrative and clinical data in a hospital environment or medical practice. Developed by Massachusetts based Medical Information Technology Inc. (MEDITECH,), it is used by hospitals of all sizes to provide well integrated applications, such as: Administrative: Applications used to register, admit, schedule appointments, and manage Medical Records. Clinical: Applications are used by clinical staff to order, manage, document and report clinical test results, and physician’s orders. Patient care or advance clinics: Applications that are used by nurses and doctors to document treatments and to view Electronic Medical Records (EMR). Patient financials/Revenue cycles: Applications to bill for insurance and send statements. General financials: Applications used to manage hospital’s financial business. Decision support: Applications for hospital managements and administration with consolidated information to manage departments and hospitals. Continuing care: Applications for non-acute care, long-term care, behavioural health, home services, and services tailored to specific needs. Technical: Are system wide functionality like report writer, system management, administration and control functions. Meditech is used by nurses, doctors and various departments like pharmacy, radiology, diagnostic laboratories, etc. to enter their data in the system. Nurses carry out their assessment, documentation and other functions using this system. Doctors also enter their patients’ data through this health information system. UHealth: This is the University of Miami Health System which aims to deliver leading-edge patient care by the region’s best doctors. The UHealth combines patient care, research, and education to create a front-line approach in health care. Within the UHealth system, patients can participate in clinical trials and benefit from the latest developments that are fast-tracked from the laboratory to the bedside. UHealth’s comprehensive network includes several hospitals, outpatient facilities. By using the system the hospital is linked with the hospital systems in the USA. Using UHealth any interested client can seek information about the hospital, facilities and its services. International patients can have a healthcare coordinator who will take care of all aspects of treatment. The system allows coordination of care with all specialities and facilities, financial services and logistics services. Phase II: The orientees are guided through the nursing process, critical thinking, case-based activities, patient safety, infection control practices, blood counts, acute care principles, disease process, complications, characteristics of population served, medication calculation, IV therapy, common policies and procedures, standards of care, skills competency overviews, mandatory safety training, and chemotherapy policy. They also attend computer training, electronic patient identification and specimen labelling classes. Phase III: The nurse mentor or expert nurse guides the staff nurse through the working in the designated ACU, and imparts knowledge and skills to the mentee necessary for independent handling of patients admitted for acute care. She also explains use of equipments and facilities used in critical care. Experts monitor the progress of the nurse, and if need be the period may be extended by few days before allowing independent handling in the last phase (Phase IV). Phase IV: The mentee starts undertaking independent care of patients reporting in ACU, under close watch of the expert nurse. The mentee can seek opinion and support of the mentor and expert team in case of any crisis. By the end of this phase the nurse fully qualifies for independent handling of cases in the ACU. F. Orientation Guide for Newly Recruited Nurses The orientation for the hospital runs for four weeks with divided times for different types of awareness and learning: two-weeks for general hospital information, systems, facilities and procedures and two-weeks for the acute care unit (ACU). This guide aims to provide information about the objective and usefulness of the programme: (i) Since orientation is the only way that makes nurse aware of the hospital in general and the designated ACU in particular, the mentee must give serious importance to the mentoring or orientation programme and make notes, ask questions and make full use of the opportunity. (ii) Mentee must review notes and hand outs given each day and seek clarifications from experts before they leave. Never assume that you'll catch on later. (iii) Documentation is very important for nurses. It is therefore necessary that mentee clearly understand the Meditech system and how to use it efficiently for all documentation work. Use of computers in the facility is also important. In case anything is not clear it must be clarified immediately. (iv) Pay attention to where things such as the crash cart, fire extinguishers, central supplies, and linens are located. And later reassure yourself that you can quickly locate them. (v) Learn how your medication cart is laid out and how it works. Learn how medications or controlled substances are dispensed. You should know how to get a newly prescribed medication from the pharmacy. (vi) Learn how to obtain procedure trays and central supplies. How to charge the patient for the supplies you use? What to do if sterile tray is contaminated and you need to get another one? (vii) How to order the lab work, x-rays, diagnostic tests, or other tests the doctor has just requested for the patient? (viii) During orientation, you will be introduced to the policies and procedures for your facility. You will also be shown how to use the various pieces of equipment used within the facility. You will spend time on clinical issues and you may at this time begin being checked off on procedures. This is the time to ask anything if there are doubts and to speak up if there is something you are not comfortable with or have not done before. (ix) The policy and procedure manual are vital part of working and must be referred back quite often. There are manuals for hospital procedures, equipment and the ACU. The ACU facility manual is one which must be fully understood and strictly followed. G. References Mosby's Medical Dictionary (2009), 8th edition. Elsevier. Ihlenfeld, J.T (2005). Hiring and mentoring graduate nurses in the intensive care unit. Dimensions of Critical Care Nursing, 24 (4), 175-178 Read More