Kristin Thurston and Heather Wall gave an update on the Medical-Surgical huddles taking place on each shift. The Charge nurses/facilitators from the medical-surgical units are gathering to discuss what staffing is like on their unit in the moment, if they have extra nurses/LPN's/CNA's, and if they need more. This is a work in progress and they hope to be able to start looking forward to the needs of the next shift. This concept is modeled after Women's Services Shift huddles.
Heather Wall presented the progress on Cross Orientation. Currently Kim Zenkere (Blair) and Master Student Andrea Morris (day shift staff nurse/facilitator in ICU) are working on a process for cross orientation to the units noted in the floating clusters. A lively discussion was had regarding whether nurses were being floated with actual cross orientation to the population served on the unit or if they were being floated to take care of Like Patient Populations without cross orientation to the patient population served in that unit. If this was a float without cross orientation the nurse should NOT be considered "oriented" to that unit. We touched on many aspects of this process including but not limited to: Volunteers first, number of units to be expected to float to, process for getting all staff cross oriented, how soon a new nurse should be expected to float, how do you stay competent, what happens when the nurse is pulled off of orientation to return to home unit, honoring the clinical decision of the nurse when they say they are not comfortable, the house supervisors role in this process, etc. Heather will ask Andrea Morris to present at next staffing committee on December 2nd. Please direct any comments or concerns to any member of the staffing committee or bargaining team.
If in the opinion of the direct care nurse the assignment given to you is not in your scope of your practice it is the responsibility of the direct care nurse to inform the charge nurse and the house supervisor. If a solution is not obtained the managers of the unit would like to be notified. Please let all managers know of your experience in writing and CC your own manager and Barb Kessler and ONA.
Margie Moore-Aten presented the new surge plan for the ICU. This document was revised based on events that took place in the unit that violated our current surge plan and physician/nurse/CHI input. The targets were revised/strengthened to give better language to the meaning of green (we can take more patients), Yellow (we are in caution area in accepting new patients) and Red (we CANNOT take any patients at this time). This document will be taken to higher leadership to get final approval.
A discussion took place regarding looking at the SRDF's. It was recommended by management that a subcommittee should be formed to look at the SRDF events. Management conveyed that they felt that the filling of these documents was a campaign of some sort from the nurses. Currently the process that should take place after a nurse files an SRDF is the manager is responsible to investigate what happened and respond to the nurse within 30 days. It was recommended by the staffing committee that we continue with this process.
Based on this year’s SRDF's, the nurse staffing committee, PNCC, and ONA executive team have met on numerous occasions and gave the management team our recommendations for the staffing crises at SHMC. We listed the problem/concern and asked for solutions that ranged from immediate (2 weeks), short term (2 months) and long term (6-8 months) fixes. We recommended that a response to this document be given to labor management. We have yet to receive an adequate response to our recommendations by management.
Corinne Ginet and Andrea McGarvey discussed some of the Kronos issues and possible solutions for this. Andrea has agreed to go to corporate with a request from nursing of what additional views we would like to see. Robyn Kenworthy and Pam VanVoorhis agreed to come up with a document to let corporate know what we would like to see. Andrea discussed how they were working with the ICU to make a folder at the unit level which would allow for more data to be accessible by the charge nurses.