Written: September, 1991 Policy: Reviewed: 4/01 Divisional Policy Manual Revised: 6/92, 7/94, 5/95, 4/98, 2/01, 10/03, 1/04, Ambulatory Care Division 9/06, 5/09, 10/12 LSU Health Sciences Center-Shreveport, LA Page 1 of 8 NURSING PLAN FOR THE PROVISION OF SERVICES MISSION STATEMENT To meet the community's need for an organized system of outpatient health care for both the sick and the well. To deliver the highest quality of care in an environment filled with compassion for those who come for care; leadership in preparing future\generations of health care professionals; and an environment that encourages employee participation in effective problem resolution. To provide the most comprehensive set of services possible, in efficient, attractive, locations, offering convenient, timely care. A. Nursing Plan for the Provision of Services 1. The Hospital Administrator (CEO) has given the Assistant Hospital Administrator for Ambulatory Care the responsibility and authority to provide for patient care services in the Ambulatory Care Division of the hospital. The Assistant Hospital Administrator for Ambulatory Care responsibilities include, but are not limited to, developing operational plans and policies, assisting with the development of new and expanded services, renovation and improvement of facilities, works closely with the clinical chairs and clinic Medical Directors in assuring that each area is maintaining compliance with all applicable state, federal, and JCAHO requirements. 2. The Ambulatory Care Division Administrative Staff consists of the following: a) a RN Director who reports to the ACD Assistant Hospital Administrator, b) a RN Manager who takes direction from the Director and is responsible for coordinating staffing on a daily basis, c) an Administrative RN Supervisor who coordinates the division's review/revision of policy and procedures, JCAHO activities and staff in-service with the divisional Educational Committee and Patient Care Support Education, coordinates staff orientation, staff competency training, documentation and review, MED/CED compliance and special projects, d) an Administrative Manager and e) an Administrative Clerk.
Nursing Plan for the Provision of Services Page 2 of 8 3. The Ambulatory Care Division staffing consists of RN Clinic Supervisors, RN staff nurses, LPN staff nurses, Nursing and Dental Assistants/Medical Specialists, and Clerical Staff including Hospital Admission Technicians and Medical Record personnel. 4. The RN Director for the Ambulatory Care Clinics delegates the authority and responsibility for nursing care to the clinic RN Manager. In the absence of the RN Director, the department is managed via the RN Manager or the Administrative RN Supervisor and, if they are both absent, the responsibility is delegated to a RN Clinic Supervisor. Ambulatory Care Clinics The Director of the Ambulatory Care Division is responsible patient care in the following clinics: Clinic 1. Comprehensive Care Scope Provides comprehensive health care management to the entire family. 2. Children s Health Provides evaluation and treatment of acute and chronic illness, growth and development, consultative and diagnostic services to children. 3. Endoscopy Provides diagnostic therapeutic endoscopies and related procedures. 4. Infusion Recovery Area Provides infusion therapy (IV fluids, medications, and blood products) to all clinic patients. Exception: FWCC Hematology/Oncology Clinic. 5. Medicine Provides primary care to patients with acute and chronic medical conditions. 6. Medicine Specialty Provides consultative, diagnostic, therapeutic and referral services to the various medicine sub-specialty patients. 7. Neurosurgery Provides diagnostic, therapeutic, referral, pre and post-operative services to patients with neurological conditions. 8. Ophthalmology (Eye) Provides diagnostic and therapeutic services to patients that have eye pathologies. 9. Oral Surgery Provides consultative, diagnostic, and therapeutic services to patients with maxillofacial problems. 10. Orthopedic Provides consultative, diagnostic, and therapeutic services to patients who experience bone, muscle, and nerve pathology. 11. Otolaryngology (ENT) Provides diagnostic services and management to patients with acute and chronic conditions of the ear, nose, and throat. 2
Nursing Plan for the Provision of Services Page 3 of 8 Clinic Scope 12. Psychiatry Provides psychiatric consultation, evaluation and treatment to patients with psychiatric problems. 13. Surgery Provides consultative, diagnostic, and therapeutic services to pre and post-operative patients. Provides consultative, diagnostic, and therapeutic services to patients that have acute and chronic medical conditions of the upper and lower extremities related to diabetes. 14. Urology Provides diagnostic and therapeutic management of patients with urology problems. 15. Viral Disease Provides diagnostic testing and therapeutic services to all patients infected with the HIV virus. 16. Women s Health Provides diagnostic, gynecological, obstetrical, perinatal, postpartum, pre and post-operative, acute and chronic medical care to females. Feist-Weiller Cancer Center The Director of the Feist-Weiller Cancer Center is responsible for patient care in the following clinics: Clinic Scope 1. Adult Oncology Provides treatment for adults with acute and chronic blood diseases, various types of cancer, and adult sickle cell disease. 2. Pediatric Oncology Provides treatment for children with acute and chronic blood diseases, various types of cancer, and childhood sickle cell disease. 3. Surgical Oncology Provides care for patients with ASA Level 1 or 2 admitted for preoperative, operative/endoscopic, and post-operative care, which will be discharged the same day. Emergency Care Center The Director of the Emergency Care Center (ECC) is responsible for patient care in the ECC. Area Emergency Care Center Scope Provides 24-hour medical care to adult and pediatric services for emergent, urgent, and non-urgent patient care needs for the hospital service area. 3
Nursing Plan for the Provision of Services Page 4 of 8 B. Staffing Plans 1. As staffing needs move beyond minimum levels, float staff are assigned to clinics. The float staff are trained to work in all clinics. Permanent clinic staff may be reassigned to assist in other areas as staffing needs dictate. The Ambulatory Care Clinic staff is cross-trained. Licensed personnel may undertake any task unlicensed staff members perform. On-call staff coverage is utilized in the Endoscopy Clinic for emergency endoscopic procedures on evenings, nights, weekends, and holidays. 2. Ambulatory Care administrative staff maintain clinic competency in patient care. Administrative staff is assigned to provide direct patient care when other plans have been exhausted. As new services are added, staffing is assessed and additional personnel and positions may be created as needed. Staffing needs are continuously monitored and evaluated for any necessary adjustments. 3. The Director of Nursing for the Ambulatory Care Clinics is responsible for all activities related to the nursing staff in the clinics and for coordinating the activities of the medical staff and other hospital departments as they relate to the Ambulatory Care Clinics. C. Nursing Care Providers/Staff Coverage 1. Each clinic has a Registered Nurse Supervisor whose qualifications/requirements are appropriate to the number of staff to be supervised and the nature of care to be rendered. The composition and total number of staff present in each clinic varies according to patient population served in the specific clinics, the complexity of the tasks performed therein and the competencies of the staff. Assignments are made daily, based on overall staffing, to meet clinic requirements. "Float" nurses, and nurses assisting temporarily in clinics other than their primary clinic are limited to performing routine clinic nursing tasks in which their competency is documented such as giving routine medications and IV administration, and performing basic assessments. In order to perform any specialized procedures these nurses must be credentialed by giving a return demonstration and must have the skills checklists completed to document their proficiency. The clinical skills/competencies are evaluated annually on the performance appraisal. 2. RN Supervisors manage and coordinate the activities of the clinic staff supervision and perform professional nursing tasks. Due to the nurse/patient ratio, nurses are unable to have one-on-one contact with every patient; however, nurses do assist with patient education, primarily with instructions related to diagnostic testing and procedures. Physicians and ancillary staff from other disciplines provide patient/family education regarding the patient's disease pathology and treatment plan. 3. Nursing assistants perform non-professional nursing tasks in the care and comfort of patients (assist with patient flow, prepare patients for exams, take vital signs, transport patients, obtain specimens, etc.), assist physicians and order/obtain supplies and equipment. 4. Clerical staff act as receptionists, check patients in and out of clinic, order and organize patient records, facilitate inter/intra departmental communication, and perform clerical duties such as scheduling appointments, etc. 4
Nursing Plan for the Provision of Services Page 5 of 8 D. Inservice/Continuing Education Continuing education and in-service training is coordinated by the Ambulatory Care Division Education Committee. All nursing staff are required to complete annual Campus Education Day (CED), Mandatory Education Day (MED), Compliance Training and Quarterly Safety Training, etc. E. Staff Orientation and Performance Appraisal 1. Licensed nursing personnel are required to present a current license to the Ambulatory Care Administration upon employment and renewal on an annual basis. New nursing staff have a six week-six month orientation period, dependent on the complexity of the skills and the competency of the employee. At the end of the orientation period, the employee is evaluated for competency. Orientation periods are extended in more complex clinics and for float staff, as needed. Each Ambulatory Care Division nursing staff member is given a criterion-referenced job performance evaluation annually. Job related conferences are held as needed. 2. Job descriptions for all nursing personnel are written and maintained in the Ambulatory Care Division Policy and Procedure manual in each clinic. Each job description states the job summary of the position, the line of authority, qualifications of the position, the functions and responsibilities of the position, and ADA requirements. F. Standards of Care The Ambulatory Care Division Departmental Standard of Care is listed in the Division Policy/Procedure manual, Policy: S-80-DIV, Standards of Care Departmental. The Ambulatory Care Division Patient Standards of Care for the clinics are located under Standards of Care. Both Departmental and Patient Standards of Care may be viewed on the ACD Policies and Procedures website. G. Quality Assurance The Nursing Coordinator of Performance Improvement coordinates the Ambulatory Care Division Performance Improvement program. The Nursing Coordinator of Performance Improvement is under the direction of the ACD RN Director, the Administrative RN Supervisor and the Quality Leadership Team. The Quality Leadership Team is comprised of Hospital Administration, Quality Management and Medical Staff. The Assistant Hospital Administrator for the Ambulatory Care Division and the Administrative staff for Ambulatory Care meet with the clinic Nurse Managers monthly to discuss quality management issues. See the Quality Management Manual for Important Aspects of Care and monitoring activities. 5
Nursing Plan for the Provision of Services Page 6 of 8 STAFFING GUIDELINES The goal of staffing each Ambulatory Care Clinic is to provide quality and safe nursing care. The Ambulatory Care Division is composed of both licensed and unlicensed personnel. Registered Nurses and Licensed Practical Nurses shall maintain a current Louisiana nursing license; this license shall be verified on an annual basis. The qualifications and performance expectations for all skill levels, including RNs, LPNs, Nursing Assistants, Clerks and Hospital Admission Techs are outlined in the individual job Descriptions and in the hospital policies. 1. Core Coverage A. The minimum staffing need for each skill level (RN, LPN, Nursing Assistant, Administrative Assistant, and Hospital Admission Technician) is determined by nurseto-exam room ratio, patient care activities, and clinic volume. Core coverage staffing plans should be considered guidelines rather than absolutes. B. The minimum staffing levels may be adjusted up or down based on workload assessment which may include patient volume, acuity, staff skill level, and patient activities including procedures and admissions. 2. Staffing and Assessment and Adjustments A. Staffing is planned based on usual patient type and average daily census. B. Differences in actual versus targeted staffing is corrected using the float staff. C. When available personnel is insufficient to meet coverage demand, the clinic manager shall notify the Director of Ambulatory Care to provide coverage from the float staff pool. 6
Nursing Plan for the Provision of Services Page 7 of 8 STAFFING GUIDELINES CLINIC/AREA RN LPN NUMBER OF EXAM/TREAMENT ROOMS RECOMMENED NURSE-TO-EXAM ROOM RATION PRIMARY CARE Children s Health 9 3 31 1:3 Comp/Care & Primary Care 7 2 29 1:3 Family Practice 2 1 29 1:3 Medicine 5 4 18 1:3 Women s Services 5 6 26 1:3 SPECIALTY CLINICS Medicine Specialty 3 5 21 1:3 Neurosurgery/ Neurology 2 1 10 1:3 Oncology Adult Pediatric Surgical 8 3 3 Ophthalmology 3 1 25 1:3 Orthopedic 1 3 11 1:3 Otolaryngology 3 0 15 1:3 Surgery 3 3 15 1:3 Viral Disease 3 0 6 1:3 PROCEDURE CLINICS Endoscopy 8 0 6 1:1 Oral Surgery 3 1 9 1:1 Urology 4 1 15 1:1 Float Staff 12 0 4 0 1 *Does Not INCLUDE Faculty and Psychiatry clinics 18 5 11 1:3 7
Nursing Plan for the Provision of Services Page 8 of 8 STAFFING TOTALS CLINIC RN LPN NA/MEO/RT CLERICAL/ REGISTRATION TOTAL Children's Health 9 3 5 5 22 Endoscopy 8 8 1 17 Family Medicine Services Comp/Care - PCF 6 3 4 5 18 Family Practice 3 1 2 2 8 Infusion Recovery Area 2 1 3 Medicine 5 4 2 4 15 Medicine Specialty 3 5 1 2 11 Neurosurgery/Neurosurgery 2 1 1 2 6 Oncology - FWCC Adult 8 4 4 7 23 Pediatric 1 1 1 3 Surgery 3 3 3 3 12 Ophthalmology 3 1 5 9 Oral Surgery 3 1 2 2 8 Orthopedic 1 3 2 2 8 Otolaryngology 3 1 2 6 Psychiatry 3 3 Surgery 2 2 2 2 8 Urology 4 1 1 2 8 Viral Disease 3 1 1 5 Women's Health 5 6 7 6 24 Perinatal 1 2 1 4 Float Staff 12 8 29 49 Totals 87 38 58 87 270 8