Journey Toward Orthopedic Specialty Unit Long But Rewarding
Sunday June 1, 2003
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In 1985, the sixth floor of Gwinnett Medical Center, a 175-bed facility that is the biggest part of the 479-bed system, opened as an orthopedic, neurology, neurosurgery, and urology unit. The history of this unit has proven to be tenuous at best. Combining these specialties created unrealistic expectations for the leadership and staff on this unit. The care requirements of the orthopedic, neurology, and neurosurgery patient were tremendous, both physically and psychologically for
the staff.
These factors led to low morale and high turnover for management and staff. The resulting effect culminated in less-than-quality patient care, low patient satisfaction, and the overall perception that the "sixth floor is not where you want to be." Once this perception was established and embedded in our culture, it was difficult to overcome.
In November 2000, the Center for Neuroscience opened, so neurology and neurosurgery population moved from the sixth floor to this specialty unit. This had a positive impact for staff members and allowed them the opportunity to focus exclusively on orthopedic and urology patients. It was at this time that the hospital leadership met again to explore the establishment of a focused unit for the orthopedic population.
Community Need
Gwinnett Hospital System is located in Gwinnett County, which has been one of the fastest-growing counties in the country since the 1980s. There is an enthusiasm for Gwinnett County's economic outlook, and it has a population ranging in age from infancy to geriatrics. Due to this population, we have an influx of people who want to maintain a healthy lifestyle. This includes joint-replacement procedures.
Gwinnett Hospital System patient-care responsibilities are divided into service lines. The sixth floor operated under the direction of Mary Nash, RN, BS, CNOR,
surgical services line director. Nash had successfully led the development of two focused units: the Short Stay unit and the Center for Neuroscience. Both of these focused units have achieved positive clinical outcomes and high patient-, staff-, and physician-satisfaction scores.
With the demand for managing joint disease for patients in our community and the outcome of our patient, physician, and staff satisfaction scores, we decided that the next step should be to develop a focused care unit for orthopedics. We needed to improve the delivery of orthopedic care.
Development Stages
In the past few decades, orthopedics has benefited from an explosion of research and technology that have brought innovations in surgery, implant devices, and rehabilitation techniques. The goals of orthopedic surgical interventions today are to reduce pain and to improve mobility and functional status to return patients to their highest level of wellness.
A collaborative multidisciplinary team approach was used in planning an orthopedic unit designed to meet these goals. Team members consisted of our hospital and nursing administration, sixth floor staff nurses, nursing educators, orthopedic physicians, performance-improvement specialists, rehabilitation services staff, construction services, marketing specialists, and financial-planning associates. The team's main objective was to plan and renovate the current sixth floor to achieve a functional area to manage orthopedic patients.
This team set the foundation to establish an orthopedic center of excellence that would help increase the quality of care orthopedic patients receive at Gwinnett Hospital System.
Unit Benefits
Nurses and the care they give are key strategic resources for our hospital. Ensuring that all nurses deliver a consistent high level of care or "impeccable clinical practice" is a surgical services division priority. We value nursing practice and therefore researched the literature to determine and develop best practices. The intent of our research is to focus on understanding our nursing approaches in caring for orthopedic patients. We believed a small unit for the management of orthopedic patients would provide the following benefits -
· Dedicated professional nurses and support staff who have specialized skills and certification to meet the unique needs of orthopedic patients
· A focused orthopedic unit that would will foster physician partnering
· Development of a shared-governance process where staff has ownership and participation in unit operations, patient standards, clinical outcomes, and satisfaction scores
· Staff opportunities for community education and increased community relationships
Overcoming Obstacles
We identified two challenges in the development of our specialty unit. The first was the renovation of the sixth floor while managing our current patient population. We struggled with high noise levels. Our nurses also cared for patients with diverse med/surg needs, which did not allow them to focus on the unique acute care and rehabilitation needs of our orthopedic patients.
Our nurse-to-patient ratio was high compared to our other specialty units, and this was our second challenge. Like other hospitals across the US, we are not excluded from the nursing shortage. According to the Nursing Executive Center, a research organization that serves nursing executives, surveys suggest that unrest is worse among core med/surg nurses. In our system, med/surg nurses are more dissatisfied than specialty nurses in such units as the ICU or the ED. Not only did we want to focus on retaining our existing nurses but we also needed to recruit from the outside. We had to offer a renewed focus of orthopedic nursing as a specialty - hence the development of our Center for Orthopedics.
What's Best for Patients
The 18-bed Center for Orthopedics opened in late 2002 following renovation, physician partnering, staff education, and many process changes. We now have classes for patients scheduled for orthopedic surgery and their families directly on our unit. The goals of these classes include reducing patient anxiety, managing postop pain, preventing complications, and eliciting the patients' full participation in the rehabilitation process.
In a consumer-driven healthcare system, the orthopedic nurse educators will be able to determine patients' needs from their point of view as customers and develop and/or modify programs/plans of care to meet these needs. We plan to have orthopedic staff nurses transition into teaching these classes. Again, our strategy to acknowledge our experienced med/surg nurses and their years of experience is a major retention endeavor.
As healthcare providers, we have many challenges in the delivery of best practice for our patients. The practice of orthopedic nursing as a specialty is exciting and demanding. The development of an orthopedic specialty unit on an existing med/surg unit was both exhilarating and frustrating. However, we were dedicated, creative, and collective in our planning, and we look forward to measuring our outcomes. We want what is best for our patients: earlier mobility, successful rehabilitation, and a return to a more active and productive lifestyle as a result of orthopedic interventions.
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