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The critical care setting is always fast-paced and nurses haveto be ready for just about anything - but add to that a whole newhealth system, new facility and twice the staff, and you know whatit's like to work in the ICU at Einstein Medical Center Montgomeryin East Norriton, Pa.
The ICU nursing care team's journey began more than five yearsago as plans for their new facility began to take shape. Before,during and after the transition, the entire team came together totackle new policies and procedures; the new facility layout with a22-bed unit nearly the length of a football field; brand-new stateof the art equipment; a new electronic medical record system; anexpanded ICU patient population through the new cardiac surgery,neurosurgery, bariatric surgery, and general surgery roboticsprograms; and nearly double the staff - all while still providingthe best possible patient care.
All of these changes certainly presented many challenges for theICU staff, not the least of which was learning to use theelectronic medical record.
"The staff that moved over had gone from an entirely papermedical record to a completely new electronic medical recordsystem," explained Regina Salyer, DrNP(C), MSN, RN, CCRN, ICUclinical educator. "99.9% of what was in the old building did notcome over here, and staff literally had to learn the entire unitand hospital, from processes and supplies to pieces of equipment tothe cardiac monitors to the medical record itself."
Each member of the team put in at least 80-90 hours of trainingbefore the transition, according to Sandy Remaily, BSN, RN, nursemanager, and once in the new space they helped each other adjust tothe new environment - and the new faces. Augmenting what wasalready a cohesive team was nearly twice as many staff with amyriad of special talents.
"We should have had a great deal of challenges integrating allthe staff, but we haven't," said Tim Robbins, BSN, ICU staff nurse."The Montgomery staff as well as the people coming in have reallycome together in an incredibly quick fashion. I believe that hashappened for two reasons. First, the existing staff is incrediblywelcoming and flexible. The second is our manager's ability toselect talented people who are willing to fit into this group."
Everyone on the unit agreed that the key to their success wasthis commitment to teamwork that extended far beyond integratingnew members.
"Our unit transitioned very well by examining and accepting theuniqueness of the individuals and coordinating them into a team,"said Gina Braxton, RN, ICU staff nurse. "We are out of our comfortzone and we are still succeeding, and it is really exciting whenyou can take a group out of their comfort zone, throw all this newmaterial at them and still come out on top."
Because everyone was in the same boat when it came to learningthe new systems and procedures, new staff jumped right in.
"We had each other to rely on," Remaily explained. "We hadvarious individuals with different backgrounds who offered theirsets of skills . so I think all the new members definitely added tothe great team we already had."
No matter where they transferred from, new staff knew they couldcount on the ICU nurses for help. Tonya Pendleton, night shiftpatient care associate, transferred from the Montgomery HospitalOBGYN clinic to the new ICU, and couldn't be happier with hertransition experience.
"The nurses here have helped a lot with teaching; they arealways there to answer questions and explain things, and they madeit a really smooth adjustment for me," Pendleton said. "Their timeand their knowledge have been greatly appreciated on my end."
As focused on teamwork as these nurses are, it's no wonder theyare also pros at collaborating with other disciplines. The nurseslove the new daily rounding on each ICU patient with theintensivists, nutritionist, respiratory therapist, pharmacist, andeven the physical therapists and case management whennecessary.
"Rounding is a great patient and nurse satisfier because itgives us one individual to go to during the day to help take careof patients," Remaily said.
"The wonderful thing about the intensivists is that they reallywant our input because they realize we are there all the time andthey trust our judgment," continued Denise Pileggi, RN, part-timecharge nurse, ICU staff nurse. "Together everyone can work togetherto figure out the best plan for the patient."
Although the transition presented many challenges for the team,it has had its perks. While the nurses love their new communicationbadges and the electronic ICU, they also love the patient-centereddetails.
"We are in a brand-new facility and it has state-of-the-arttechnology and it's great for us as a staff, but more than that,they directed this state-of-the-art-technology toward improving thefamily and patient experience," Robbins said. "Every room isprivate and has the opportunity for a family member to sleep over,and every room has equipment that is quieter. Even the view fromthe rooms is pretty nice. It is all designed to enhance thepatient's and family's experience."
To help patients feel as comfortable as possible, the hospitaluses the Get Well Network, which provides Internet access, TV,movies and a multitude of educational videos - not to mentionongoing patient satisfaction inquiries.
"The Get Well Network also lets us know how we are performingbecause during the day, the TV will come up with a question, and itwill say: Are the call bells being answered in a timely manner? Areyour pain needs met?" Pileggi explained. "It is really good becausewe get good feedback from the patients about how they perceive weare doing as far as our nursing care."
Above and beyond the upgraded technology, one of the bestopportunities to arise from the move has been the chance toreevaluate and improve nursing care.
"Moving into the new site, we have had a chance, because of theculture that we are entering into and the staff that we brought in,to really re-examine what we are doing," Robbins said. "We areextubating faster, we are ambulating quicker . and I think that ishappening because of our ability to explore, in a fresh way, why itis that we are doing what we are doing, and how we are doing it.Then we are changing those behaviors for the good of thepatient."
The team's focus on care improvement isn't about to stop withthe new space, and they are already setting their sights on thefuture.
"We are looking at including other surgical procedures andmoving toward getting new programs in the near future," said SandyHorne, BSN, CCRN, ICU staff nurse. "So there are a lot of learningopportunities here and I think with the team that we have as wellas the team that is still going to be joining us, we are reallygoing to be looking for new challenges and new opportunities andjust continue to grow together and build this into a greathospital."
(See the video that accompanies this story here.)