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PROFILE
Bigelow 14 is the center for vascular surgical
nursing, including a twenty-seven bed adult inpatient unit and the
unit-based MGH Vascular Home Care Program. Patients on this service
usually undergo vascular surgery or interventional radiology procedures
to improve arterial blood flow. At the time of discharge, patients
who live within a 20-mile radius of Boston may receive home nursing
services, if needed, from our vascular nurses who have been cross-trained
to provide home care through a partnership program with the corporate
home health agency, Partners Home Care.
UNIT FOCUS
The primary focus of the unit is specialized
care of patients who undergo carotid endarterectomy, open and endoluminal
repair of |
| aortic aneurysms, and lower
extremity arterial reconstructive procedures,
including arterial by-pass grafts, thrombolytic therapy, angioplasties,
and stent placements. The majority of patients are elderly men and
women with complex medical problems, including hypertension, coronary
artery disease, congestive heart failure, diabetes mellitus, and chronic
renal failure. State-of-the art approaches are offered to prevent
and manage pain, wounds, graft failure, and peri-operative complications.
A multi-disciplinary team meets weekly to examine opportunities to
enhance care on the service. Some of the team outcomes have included
development of clinical pathways for high-frequency subsets of patients,
a unit-based specialty transitional home care program, and, more recently,
implementation of an aggressive computer-based algorithm to achieve
rapid anticoagulation with warfarin.
PATIENT CARE DELIVERY MODEL
The patient care delivery model is a patient-focused
model, supported by primary nursing. Patient-focused care is high
quality, comprehensive, accessible, supportive and personalized
care.
TEAM MEMBERS
The RN staff is supported by a leadership
triad, which includes the Nursing Director, Clinical Nurse Specialist,
and Operations Coordinator. On a daily basis, a designated senior
staff nurse serves as a Resource Nurse, managing adjustments in
scheduling of staff, assignment of patients to beds on the unit,
and assisting with bedside emergencies. Direct care providers including
nursing assistants and nursing students support the RN staff in
their clinical care of patients. Other professional resources include
a unit-based nurse case manager, home care coordinator, pharmacist,
social worker, physical therapists, occupational therapists, and
speech-language pathologists. The support staff of the unit also
includes operation associates, unit service associates and pharmacy
technicians. To inquire about positions available on this unit,
contact Bev Lasovick at blasovick@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. The Home Care Coordinator collaborates with
the Nursing Director and Resource Nurse to develop the schedule of
nurses, who practice in the joint acute care-home care role.
STAFF ORIENTATION
All staff attends a one- week nursing orientation
program. Unit orientation is preceptor based, individualized and
determined by the Nursing Director, clinical nurse specialist and the
new employee. The length of orientation is also individually determined.
New nursing graduates participate in the New Graduate Mentorship
Program.
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. Each year, financial support is provided
to two or three staff nurses to attend the annual national symposium
of the Society for Vascular Nursing. Periodically, staff are also
supported to attend national wound care conferences or medical-surgical
nursing conferences. In addition, financial support has been provided
to a number of staff to complete the Advanced Cardiac Life Support
(ACLS) course, enhancing their comfort with bedside emergencies.
Clinical Nurse Specialists provide educational
support to staff on the nursing units. 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 team leader or a preceptor for new staff members. RNs may advance
in their clinical practice and demonstrate proficiency through the
Clinical Recognition Program. Membership of staff on Committees
of the collaborative government structure is also supported. Currently,
Bigelow 14 staff nurses are members of the following departmental
committees: Staff Nurse Advisory Committee, Quality Committee, and
Skin Care Committee. Each year, staff members precept undergraduate
nursing students, which is an effective mechanism for recruitment
of new staff members and opportunities for staff to take courses
courtesy of the designated universities. Over the years, the unit
has welcomed clinical groups from the MGH Institute of Health Professions,
Boston College and the Red Cross Nursing Assistant Program. The
staff and Clinical Nurse Specialist have collaborated to plan several
annual regional continuing education programs related to vascular
nursing. Their efforts to implement innovative wound care for patients
with diabetes and arterial disease have been recognized by a patient's
creation of the Edna Alizio Fund to support vascular nursing research
related to wound management. A research team, which includes the
Clinical Nurse Specialist as the principal investigator and a staff
nurse from Bigelow 14, has received a small grant to conduct cutting-edge
research related to the patient's experience with the vacuum-assisted
closure (V.A.C.) dressing.
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