of hemodynamic monitoring and associated therapies (i.e., arterial, central venous and pulmonary artery pressures, use of vasoactive medications) are utilized as appropriate to provide optimum resuscitation and management. Continuous Renal Replacement Therapy (CRRT) is also available for those critically ill patients requiring ultrafiltration and/or dialysis, as is peritoneal and hemodialysis.

Both medical and nursing staff provide immediate post anesthesia care to those patients who return directly from the operating room. These patients include renal, renal-pancreas transplants and longer-term allograft recipients who require other surgical procedures. Additionally, selected liver transplants are admitted to the Blake 6 ICU immediately post-operatively. Cardiac and Lung Transplant patients are cared for on Blake 6 following transfer from the Cardiac Surgical and general surgical ICUs (where their immediate post transplant care is delivered). Pediatric patients > 6 years of age are transferred to the Transplant Unit after receiving initial post-operative care in the PICU. (Pediatric patients < age 6 will be transferred to Ellison 17 for their post transplant care after PICU discharge.)

UNIT FOCUS
The major focus of care in the Transplant Unit is the assessment, prevention and treatment of allograft rejection. A variety of immunosuppressive protocols are utilized based on the patient's condition and need for aggressive treatment. Diagnostic assessments utilized may include ultrasound-guided percutaneous needle biopsies (PNB) of the kidney, bedside PNB of the liver, radiological examinations such as CT Scans, MRI and ultrasounds of the transplanted organ. Cardiac transplants undergo sequential transvenous cardiac biopsies in the cardiac catheterization laboratory. In addition, lung transplant recipients undergo bronchoscopies and lung biopsies.

Infection control and prevention is a major focus for all providers who work on this unit. This encompasses meticulous adherence to the policies designed to protect this high risk population. For patients and families, education regarding rejection and infection is a high priority. Aggressive patient teaching begins prior to transplant. The understanding and compliance with immunosuppressive therapy is constantly monitored both during the in-patient stay and then during outpatient follow-up.

PATIENT CARE DELIVERY MODEL
The patient care delivery model is a patient-focused model. Patient-focused care is high quality, comprehensive, accessible, supportive and personalized care.

TEAM MEMBERS
Unit leadership is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Each member of the triad has a unique role through which to provide support to the RN's and patients. The Nursing Director is ultimately responsible for all aspects of the unit. Operationally the Nursing Director handles all administrative issues, while the Clinical Nurse Specialist is responsible for practice. This includes orientation, education, staff development, patient outcomes as well as system support. The Operations Coordinator is accountable for the environment of care and support staff (eg. operation associates, unit service associates) The RN staff is also supported in direct patient care by patient care associates. To inquire about positions available on this unit, please contact Elizabeth Behrmann at ebehrmann@partners.org.

SCHEDULING PRACTICES
Staff schedules are driven by patient need. The scheduling process is staff driven and flexible to accommodate personal and educational needs. Once the schedule is posted, the staff manages changes with the approval of the Nursing Director.

STAFF ORIENTATION
All staff attend a one- week nursing orientation program. Unit orientation is preceptor based and competency driven. The first phase of orientation to Blake 6 is to the non-ICU populations. The plan and length of orientation is individualized by the Nursing Director, clinical nurse specialist, preceptor and the new employee. New nursing graduates participate in the New Graduate Mentorship Program. Following completion of orientation, staff work with the non-ICU populations until they begin critical care orientation. The time for critical care orientation is determined by the Nursing Director and Clinical Nurse Specialist in conjunction with the employee, based on the CNS's assessment of practice. Critical Care orientation is 8 weeks in length. It is also competency based and includes didactic content provided by the ICU Consortium. Following orientation, the nurse will spend concentrated time in the ICU, but is expected to maintain competency is care of the non-ICU patients, working on both areas of the floor.

EDUCATIONAL AND DEVELOPMENT OPPORTUNITIES
Staff education and development is supported by The Norman Knight Nursing Center for Clinical & Professional Development. Full and partial day programs are offered. Staff may also access outside educational opportunities. The teaching environment provides staff with a daily opportunity to discuss patient care related educational issues with members of the graduate medical education program and with other members of the care-delivery team.

Staff has time allocated and the necessary support to offer educational programs to other staff members. Nursing Grand Rounds programs are offered on a regular basis.

Staff RNs have the opportunity to participate as a nurse preceptor. RNs may advance in their clinical practice and demonstrate proficiency through the Clinical Recognition Program.