Critical care orientation program hits its target
A shortage of critical care nurses was avoided at the University of Pittsburgh Medical Center thanks to the quick action taken by ICU directors. They recognized data depicting a critical care nursing shortage was not a fluke but a trend. The directors moved rapidly to prevent a shortage, implementing a recruitment and orientation program that provided nurses with the educational support to be competent in the ICU and with the organizational support to retain them.
The census in the medical center's ICUs had been decreasing steadily, mainly because of managed care and patients receiving treatment in alternate settings. But, in the last six months, it experienced an unexpected increase.
"This increase caused us to evaluate our staffing on all seven units and move toward an aggressive recruiting program for critical care nurses," says Kathy Guentner, RN, MSN, unit director of the medical ICU at the University of Pittsburgh.
When she and the other ICU directors noticed the steady increase, they decided to compare the average daily census to historical data for a few months, she says. The data showed an increase from the budgeted 85 patients per month to 90, 92, and even 94 patients per month during the period studied.
"We decided we had to do something, or we would be caught understaffed," Guentner says.
The shortage was showing up in other ways as well. Guentner says she was scheduling 400 hours a month of overtime. This meant, on average, nurses were working an extra 12 hours a month.
The ICU directors shared this information with hospital administrators, who approved the hiring of additional staff. The directors were involved in the hiring process throughout. They worked with the education department to develop the orientation curriculum and participated in the interviewing and hiring processes. Each director contributed a list of competencies needed for nurses to function on the units and were responsible for assigning the preceptors for each unit.
Combining classroom and experienceThe medical center's orientation program for critical care nurses combines classroom learning with clinical experience through a preceptorship program. Courses focus on new technology and specific illnesses that nurses will encounter. After each course, nurses are tested on their competency and must take an exam. To observe and assess skills directly, nurses are evaluated on identified competencies, such as medication administration and demonstration of procedures.
In addition to hiring for specific ICU units, the medical center hired nurses for its resource unit: a pool of nurses that cover all ICUs, which offers the hospital flexibility in scheduling. These nurses require a more extensive orientation program that includes more classroom time and a preceptorship on each of the seven units in the hospital.
As a result of the action taken by the ICU directors, the medical center increased its budget to accommodate a higher census and moved it from 14.5 patients to 16 a day.
"This gave me the flexibility I need to staff for even 18 or 20 patients," says Guentner of her 20-bed ICU. The ICU directors will continue to monitor the census and adjust the budget if data show cause to do so.
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