EAMC East Alabama Regional Medical Center

1. EAMCEast Alabama Regional Medical Center Bridget Bordelon, Celia Bynum, Kimberly Childress, Meredith Gean, Baylee Smith Las Muchachas

2. Meet Kate Ruud!Unit Manager, EAMC CVICU

3. 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

4. Mission • High Quality, Compassionate Health Care • Vision • To be a national leader in quality, cost and service • Values • Excellence --Integrity—Compassion—Respect--Teamwork

5. Staffing • 18 RNs • 4 MCTs Full Time • 5 Advanced Practice Nurses (Clinicians) • Director of Critical Care • Nurse Manager The staff makes group decisions for patient assignments Charge Nurse Responsibilities -Audit (check beds, check crash carts, perform glucose controls on accu-check machines)

6. Conflict Resolution • 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

7. 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.

8. Safety Goals (cont.) • Strict glucose control • Rated by online cardiovascular service • 6 o’clock glucose post-operative days 1 and 2

9. 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

10. 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

11. 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!”

12. 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

13. 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

14. 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!”

15. Recruiting • No active recruiting from outside the hospital at this time • Earn & Learn • Getting nurses from step down unit • Scholarship program

16. 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

17. 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

18. Questions??