After analyzing five months of productivity reports, Debra Hernandez, BSN, MHA, RN, FACHE, CENP, COO/CNO of University Medical Center Brackenridge (UMCB); Sally Stutes, BSN, MBA, RN, Associate CNO, Director of Inpatient Services; and Pam Feeley, BSN, RN, Clinical Manager, determined that the acuity level of patients on the Intermediate Care Unit (IMC) were similar to the acuity of Intensive Care Unit (ICU) patients. To ensure that the unit classification properly matched the unit population, Sally led team efforts to transform the IMC to a medical intensive care unit (MICU).
Sally Stutes led the initiative by empowering Pam Feely and Robert Green, ICU clinical managers, to engage with their staff and elicit feedback. Several strategies were undertaken to implement the change, including:
- Working with finance to update the cost center so that all reporting bodies including Compass (Cerner EHR), NDNQI, PRC, Premier, NHSN, etc. were properly updated to reflect the unit change.
- Creating an education and training plan that achieved the unit’s budget and productivity goals. The education effort was led by IMC clinical managers along with Flavia Larson, BSN, RN, Clinical Educator, and IMC Clinical Supervisor Stephanie Stephen, BSN, RN. The education plan included the following components:
- Comparing the IMC orientation packet with the ICU orientation packet.
- Creating a competency checklist based on the skills and competencies needed for the IMC nurses to complete the ICU orientation program.
- Sending two paired clinical nurses at to the ICU to train for eight weeks. Those nurses then returned to the IMC, and sent the next set of clinical nurses for training. Based on feedback, Sally, Flavia and Pam determined that four weeks could be an appropriate amount of time for nurses to reach applicable competencies and skill levels needed to independently care for MICU patients.
- Floating nurses who worked in the SICU to the MICU as resources to support the MICU nurses educational transition.
- The unit successfully transitioned into a MICU in February 2016.
- The MICU has closed the variance in their productivity targets since implementing the change.
- After the full transition from IMC to MICU, the unit attracted experienced ICU nurses.
- Nurses gained full competency for independent practice and skill acquisition during this transition to appropriately care for the higher acuity patient.
- By implementing this nurse director-led change, staff nurses felt they were able to take care of complex patients and work at the top of their education.