Surgical Acute Care
Patient-Centered Partnership: Nurse and Physician Leaders Create New Surgical Care Unit, Together
The opportunity has been exciting for Beverly Dukes, R.N., M.S., and Patricia L. Turner, M.D., to lead the creation of a new surgical acute care unit at the University of Maryland Medical Center -- in a brand new tailor-made space.
This new unit opened in June on the recently completed fifth floor of the Harry and Jeanette Weinberg Building. It brings together patient populations formerly cared for in different units.
"Weinberg 5" includes general surgery, as well as cancer, bariatric, oral-maxillofacial, otorhinolaryngology (head and neck surgery), thoracic and urological surgery.
Dukes - the patient care services manager - and Dr. Turner - the medical director - are building a team of nurses on this floor who come from different specialty areas. The patients who undergo surgery in those areas actually have similar needs when they are healing, says Dukes.
"Grouping them on one floor allows the nurses to excel in the kind of care these patients need," Dukes says. And to make sure each population gets the specific care required, Dukes will be assigning a "nurse champion" to each specialty area to be responsible for staff education on those topics. Turner agrees that patients on the unit will be more alike than they are different in the care they need. She specializes in general and laparoscopic surgery, and is an assistant professor of surgery at the University of Maryland School of Medicine.
"The nurses are going to have complex cases, but they are complex in similar ways," Dr. Turner says. "The nurses can get really facile with the complex patients rather than trying to be a jack-of-all-trades. What we hope to have here is a lot of cohesion."
As medical director, Dr. Turner's role is to facilitate the relationship between the nursing staff and the medical staff.
"When you have a medical director who is so involved with the unit, it does give the feeling the nurses are appreciated," Dukes says. "It's not a 'them and us,' it's a 'we,' because we're all here for the patient." The "we" includes other professionals, such as therapists and a clinical pharmacist, in a satellite pharmacy on the floor -- something that allows for easier and faster access to medications that are specific to surgery patients.
The communication between nurses and doctors will be enhanced by the pocket phones nurses will carry with them, so that when they page a physician, the call-back comes right to the nurse, rather than to the station. It means nurses won't have to miss a call-back, or wait around for one. All the floors in the Weinberg building have this feature.
Dukes is increasing her staff, and her current team of nurses will be caring for some types of patients for the first time, so staff development is key.
"That's probably one of the most exciting opportunities we have," says Senior Partner Bret Anderson, R.N. "A lot of post-surgical nurses have been in the profession for 10 years and never been inside an OR."
He recommends his unit to new graduates, for the broad base it gives them as they begin their careers. The fact that all rooms in the new unit have monitoring capabilities means that the nurses can keep patients during a slight or temporary increase in acuity, without having to transfer them to intermediate care, only to bring them back a few hours later. It allows nurses to give more continuous care.
"This is, to me, the most interesting kind of nursing," Anderson says. "You have experience with a lot of different types of patients. I consider that a strength of ours."