LOCATION : Moses Cone Hospital, MHC-Div 3100 - Neuro ICU
CITY : Greensboro
JOB DETAILS :
FTE: 0.9 (36 hours/week)
Schedule: WEO Days (Sat, Sun, and 1 extra shift per week)
On Call: NO
JOB SUMMARY :
Assesses, plans, implements, documents, organizes, prioritize, delegates, supervises and coordinates the care of neonatal, pediatric, adolescent, adult, geriatric patients as prescribed within the parameters of the NC Nurse Practice Act and hospital complex.
Graduate of a School of Nursing. BSN required or with approval of the VP of Nursing, experienced RN's with an AD or Diploma with an active plan to obtain their BSN within four years from date of hire may be considered.
RN - Registered Nurse licensed in North Carolina or a Compact state.
BLS (CPR) - AHA Health Care Provider BLS
Advanced Cardiovascular Life Support
Pediatric Advanced Life Support
MOSES CONE HEALTH SYSTEM
Moses Cone Hospital
3MW Trauma-Neuro ICU
Scope of Service
1. Department Structure
Department 3MW is a 14 bed Intensive Care Department with 14 ICU beds. The Trauma Neurosurgical Intensive Care Department provides care primarily to Neurosurgical, Neurological, and Trauma patients. The Department is located on the third floor of the hospital in the central section. It is a U-shaped department with private rooms and has two central monitoring stations. The unit is also supported by eICU monitoring.
2. Population Served
High volume populations for the Trauma Neurosurgical Intensive Care Department include patients with closed head injuries, craniotomies for tumor, aneurysms, subarachnoid hemorrhages, closed head injuries, seizures, multiple trauma, transphenoidal pituitary tumor resection, Arnold Chiari malformation, strokes, spine surgery, and patients with seizures. Low volume populations for the Neurosurgical Intensive Care Department include patients with spinal cord injuries, Guillilan Barre', organ procurement, and self- inflicted drug overdose.
Age groups served are adult, geriatric, and older pediatrics.
3. Services Provided
Nursing care is provided 24 hours, 7 days a week by RN staff that is supported by an ancillary staff of Nurse Technicians and Nursing Secretary/Monitor Technicians. Nursing care includes physiological and neurological assessment and monitoring, pharmacological support for hemodynamically unstable patients, chronic ventilator
weaning, and interventions for patients with neurological emergencies. ICU patients will have vital signs and/or neurological assessments completed every 2 hours unless patient's needs, identified problems, or physician's orders require more frequent assessments. Services also include patient and family education relating to neurological diseases and procedures, recovery from traumatic injuries, and rehabilitation.
Criteria for patient admission to the Trauma Neurosurgical Intensive Care Department include one or more of the following:
Physiologically unstable patients who require continuous monitoring, observation and assessment, and frequent medical and nursing interventions to achieve physiologic stability and prevent complications. Active titration of continuous IV vasoactive drugs and/or frequent ventilator changes may be required to maintain physiologic stability. Patients whose condition requires the following specialized services, technology or treatments:
• Invasive monitoring (ICP, blood pressure, cardiac output, ventilation, and oxygenation)
• Mechanical ventilation
• Rapid transfusion
• Emergency cardiac rhythm interventions (drug management according to medical protocols, defibrillation, temporary and permanent pacemaker therapy)
• Frequent neurological assessment
Criteria for patient transfer or discharge from the Trauma Neurosurgical Intensive Care
Department include one or more of the following:
Transfer to a lower level of care should be considered when physiologic stability is restored and any specialized technology or treatment requirements have been discontinued or could be provided safely in a lower level of care. Continuous monitoring/observation may still be necessary, but the risk of physiologic instability is no longer high.
Transfer to a lower level of care should be considered when treatment has failed so that prognosis is poor, and there is little likelihood of benefit from continued intensive treatment. For example, this may include:
Patients of advanced age with three or more organ system failures who have not responded to 72 hours of intensive therapy.
Patients who are brain dead or who have non-traumatic coma leading to permanent vegetative state and very low probability of meaningful recovery.
Patients who have had formal limits placed upon their care indicated by
"comfort care only".
Patients with protracted respiratory failure who has not responded to initial aggressive efforts and who are also suffering from hematological malignancy.
Patients with a variety of other diagnoses (advanced COPD, end-stage cardiac disease, or widespread carcinoma) who have failed to respond to intensive therapy whose prognosis are also extremely poor and for whom no potential therapy exists to alter that prognosis.
Physiologically stable patients who are at low risk of requiring ICU treatment.
Examples of such low-risk monitor may include, but are not limited to: stable
surgical patients recovering from carotid endarderectomy and aorta femoral bypass grafts,
4. Staffing Plan/Ratios
Registered Nurses, and Nursing Secretary/Monitor Technicians (NSMT) are scheduled 7 days a week, 24 hours a day. Nursing technicians provide support 24 hours per day. Patient assignments are based upon patient acuity and staff skill. In the ICU, the nurse/patient ratio is 1-2 patients per RN on days, evenings, and nights. NT and NSMT are assigned in both areas. A minimum of one NSMT is assigned for 16 hours/day.
The staffing schedule consists of a 6-week period. Staff is scheduled based upon anticipated daily and shift census, PAL, and staff experience.
Staff competencies and skills to provide services
Current NC licensure
CPR (BCLS) ACLS
Life Safety to include fire safety, infection control, and general safety
Completion of a competency based orientation program specific to NICU
5. Competency/Education Plan
• rientation/Initial Competency - Each role is a defined orientation pathway or competency validation checklist that is completed prior to the person taking an independent assignment. Key competencies are validated by direct observation of the individual preceptor or experienced staff. The Department Director/Assistant Director determines, with input from the preceptor(s) and by observation, when the orientation is complete.
• ngoing Competency - Ongoing competency of staff members to provide care on 3100 is determined by direct observation and record review by the Department Director/Assistant Director/Educators/RN IV, and shift leadership. Competency is also maintained by skills fairs, routine review of low volume and problem-prone procedures, and EKG revalidation.
6. Education Plan 2011
The following education activities are planned:
• ngoing pharmacological updates on new medications.
Individual instruction at critical care skills fairs, presented twice yearly. Educational presentations by staff after attending TNCC and AANN/AACN and other Unit Specific Conferences.
Ongoing Neuro/Trauma/Stroke updates.
ACLS is required for all RNs working in the following departments
across the MCHS: PACU, Outpatient Surgery, Adult Critical Care units, Step-down units, Telemetry departments in which standing emergency orders are utilized, Maternity Admissions unit, Emergency Departments, and Endoscopy. ACLS is required for family practice and internal medicine residents, CareLink staff, Administrative Coordinators,
Cardiac Cath Lab techs, and Cardiac Rehab RNs.
o ACLS certification must be completed within 12 months of hire date.
o Recertification is required every two years.
MAJOR WORK ACTIVITIES :
Provides nursing care via the nursing process for the development, implementation and evaluation of nursing care. Collects and analyzes patient/significant other data. Completes an admission database and ongoing assessment to include collaboration with patients, significant others and other health care providers. Implements a plan of care for each patient (utilizing clinical pathways where applicable) and individualizes to meet the age specific needs of patients/significant others. Identifies variances and makes adjustments in the plan of care based on evaluation of the plan and effectiveness of nursing interventions. Documents and updates the plan of care, nursing care, nursing interventions and patient response to care, and keeps healthcare team, patients and significant other informed. Contributes to the discharge plan by identifying homecare needs. Recognizes changes in patients conditions and revises the plan of care appropriately. Demonstrates advanced competencies and critical thinking skills in day to day practice. Identifies and implements educational needs for patients/significant others. (30%)
Establishes a caring and therapeutic nurse/healthcare team/patient/significant other relationships. Recognizes communication barriers, identifies resources and establishes plans to resolve barriers to communication. Demonstrates respect for diversity and cultural differences in patient/significant others related to age, ethnicity, gender, religion, socioeconomics, education, personality, or other unique variable. Formulate individualized plans to address individual needs related to diversity, cultural difference or other unique variables. Advocates for the patient/significant other. Demonstrates skillful responses to customer needs based on particular context of the situation. (25%)
Supports an environment of evidence based practice/research/quality improvement. Demonstrates knowledge of Shared Governance accountabilities and principles, supports DSGC directly as a council member or indirectly by keeping informed of council activities/supporting council decisions, brings forth issues to council. Demonstrates knowledge of how to access reference documents containing policies, procedures, standards, and additional resources. Participates in QI/ Research activities based on role and major work activities as outlined in the research point system guidelines. Demonstrates knowledge of department QI plan. Demonstrates understanding of resource management and implements opportunities. Collects QI data and participates in analysis and action plan development, incorporates changes into practice. Facilitates ongoing activities to meet and adhere to regulatory standards (TJC, DFS, OSHA). (20%)
Supervises other members of the team. Contributes to a supportive and healthy work environment. Holds self and others accountable for complying with policies, procedures and standards. Participates in learning needs assessments. Provides input into and supports the precepting and mentoring process. Delegates appropriate tasks to support staff, ensure completion of delegated tasks and provides feedback as needed. Demonstrates team spirit and collegiality. Supervises select personnel in performance/patient care. (15%)
Demonstrates effective conflict resolution/negotiation skills. Promotes positive, supportive, and professional work environment free of disruptive behavior. Practices, in all professional relationships, with compassion and respect for the inherent dignity, worth and uniqueness of every individual. Follows Chain of Command for assistance with issues related to unresolved/problem-solving and/or conflict resolution. Provides, seeks and receives constructive feedback. Provides peer to peer feedback and seeks mediation as necessary. Promotes effective conflict resolution. (10%)
CONDITIONS OF EMPLOYMENT :
* Annual flu shot
* Annual TB test (if applicable to your job location)
* Annual HLCs (Healthstream, formerly CBL)-Safety at Work and Corporate Compliance
* Maintain licensure/certification/registry/listing (if applicable to your job)
ABOUT CONE HEALTH :
Cone Health is a state of the art network of facilities providing patients access to the latest developments in medical care from their first moments of life through later years. Our network offers the most breakthrough treatments and technology available in healthcare today. As a teaching hospital, we offer employees the opportunity to become leaders in the industry and continued growth from their first day on. Extraordinary patient care is about being "high-touch" as well as "high-tech". Community service and superior patient care are the cornerstones of our organization, a philosophy that is demonstrated by each and every one of our valued team members. We are proud to be the largest private, not-for-profit employer of choice in the Piedmont, NC area community. Additionally, as one of the region's largest and most comprehensive health networks, Cone Health has more than 100 locations, including six hospitals, three ambulatory care centers, three outpatient surgery centers, four urgent care centers, a retirement community, and more than 100 physician practice sites. Our tagline - "The Network for Exceptional Care" - highlights our commitment to excellence, which is shared by our more than 11,000 employees, 1,300 physicians and 1,200 volunteers.
Cone Health is an equal opportunity employer. If you require assistance with our online job submission process, please contact our Talent Acquisition team at 866-266-3767 to request an accommodation.