Seattle Children's Hospital Nurse Staffing Plan€¦ · staffing plan and partners with nursing and hospital leadership in assuring safe staffing for all patients. Furthermore, each

CoverPage

ThefollowingisthenursestaffingplanforSeattleChildren’s,submittedtotheWashingtonStateDepartmentofHealthinaccordancewithRevisedCodeofWashington70.41.420.

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2020 STAFFING PLAN

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NURSE STAFFING PLAN PURPOSE

This plan was developed for the management of scheduling and provision of daily staffing needs for the hospital, and to define a process that ensures the availability of qualified nursing staff to provide safe, reliable and effective care to our patients. This plan applies to all parts of the hospital licensed under RCW 70.41. STAFFING PLAN PRINCIPLES The following principles guide staffing at Seattle Children's (SC):

• At all times, each patient admitted to the hospital is assigned a registered nurse (RN) who is accountable for the patient's care. This responsibility includes making assessments, creating and carrying out a plan of care, teaching, seeking consultations, communicating problems to the medical team, and evaluating the effectiveness of care.

• The optimal staffing plans represent a partnership between nursing leadership and direct care staff.

• All staffing plans are designed to minimize the risk of unplanned overtime (OT). • Staffing plans include allocation for direct care and for indirect time such as planned and

unplanned time away from work (i.e. sick time or family medical leave) and responsibilities such as committees, staff meetings, education, and shared governance councils that allow for nurse representation at the operational level.

These principles correspond to The American Nursing Association Principles of Safe Staffing and are implemented as follows: Unit-Related Appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate patient needs. The budget allocation of direct and indirect care nursing resources at Seattle Children’s is determined annually. Multiple factors are analyzed and considered:

• benchmark data • census • acuity • staff qualifications • turnover • patient safety outcomes • new technology • throughput outcomes

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• trends for seasonality and time of day when patients present for service • anticipated needs of new or changing patients • meal and rest breaks for staff

Each department/unit confirms their numbers of nurses to schedule for each 6-week schedule in the upcoming 6 months. These targets are based on the factors stated above, as well as historical sick use, and more current patient care and safety considerations of resources anticipated. Schedule targets are also adjusted based on seasonal patterns and trends in acuity and patient volume. SC can see considerable variation in census across winter viral season and summer surgical season. To cover staffing shortfalls during unpredictable times of high census, we utilize our float pools, implement voluntary on call systems and may hire traveling RNs for temporary assignments. The goal is to care for the patients and families who present themselves to us. Staff meal and rest breaks are in accordance with WSNA and SC bargaining agreement and Washington State laws. Charge RNs partner with clinical staff to identify and schedule appropriate times for staff to take their meal and rest breaks. Staff use their identified chain of command to escalate real-time barriers so that appropriate coverage can be obtained for the break/meal period. Unit functions necessary to support delivery of quality patient care must also be considered in determining staffing levels. To support a high level of staff involvement in shared governance, unit staffing allows protection of meeting and work time through proactive scheduling. Staff and unit-based schedulers work together to plan schedules that incorporate staff time commitments to council work. Schedulers are aware of standing meeting times and committee membership. There are times when patient care takes precedence over meeting attendance, but our scheduling processes generally support a high level of involvement in shared governance activities. Seattle Children’s maintains a hospital wide Nurse Staffing Committee that develops the nurse staffing plan and partners with nursing and hospital leadership in assuring safe staffing for all patients. Furthermore, each unit has a Unit Based Staff Committee (UBSC). The UBSC is defined in the Agreement between Seattle Children's and the Washington State Nurses Association as follows: "Unit Based Staffing Committee (UBSC): The purpose of the UBSC is to increase involvement of staff in the process of scheduling, staffing decisions and periodic evaluation of unit patient care models. This will be achieved through a committee structure on each unit, which will receive direction and input from the manager, unit staff and the Conference Committee. Unit

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managers are responsible for making the decisions for unit-based outcome and the overall direction of the unit. Outcome: While significant census fluctuations characterize the Employer's business, it is anticipated that collaboration will improve the ability to manage response to these fluctuations in a manner that supports the care of the patients and minimizes ongoing, undesired, prolonged, no-pay and overtime. Each UBSC will review outcomes on at least an annual basis to measure their success. Administration: There will be between two (2) and six (6) RN members on each UBSC. Volunteers will be sought for each UBSC. Each UBSC will keep minutes describing the topics discussed at each meeting. A copy of those minutes will be forwarded to the Nurse Conference Committee no later than ten (10) days after a UBSC has met. Agenda for UBSC meetings: Each UBSC will determine its meeting schedule and agenda, but it is recommended that each UBSC meet at least bi-monthly (once every two months). The agenda for each UBSC meeting shall include, but is not limited to, review of applicable Assignment Despite Objection forms. Management shall provide reasonable work time for participation on the UBSC. Each UBSC shall be invited to present to the housewide staffing committee at least once each year, and review of current openings and hiring plans.”

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UNIT DESCRIPTORS AND SUMMARY OF STAFFING Inpatient Nursing Units Inpatient Nursing Units consist of the Critical Care and Acute Care Divisions. Each department has included a more detailed description of the type of care provided in their area. The staffing grid is the goal for staff scheduling per day and shift based on average daily census and budgeted hours of care. For daily staffing needs, the Charge RN determines the number of staff needed based on a calculation of the unit census and budgeted hours of nursing care. The Charge RN then reviews any additional factors such as acuity, admissions, discharges, and transfers, geography, and skill mix needs in order to determine the total number of staff needed to safely care for the patients. Units also have a huddle structure that can be used to inform the CN and potentially make necessary adjustments to patient assignments. Staffing needs are reviewed in four-hour blocks and adjustments made for areas that are open 24 hours a day. The majority of inpatient staff work 12-hour shifts, but staff can be scheduled into 4, 8, or 12 hour shifts depending on their FTE and other indirect time. Shifts start at 7am, 11am, 3pm, 7pm, or 11pm. Charge RNs partner with unit leadership to better understand trends that may lead to nursing needs over what is expected. SC has a centralized staffing office that coordinates the staffing needs of the inpatient areas and assure the staffing needed to support their staffing plans. Both the acute care and critical care divisions also use staff within a float pool that are deployed through a centralized staffing office to the areas that identify staffing needs. Unit based staff may also float to another department who has a staffing need. Critical Care Division The Critical Care Division is comprised of the Neonatal Intensive Care Unit, Cardiac Intensive Care Unit and the Pediatric Intensive Care Unit for a total of 90 beds. Each individual department within the division develops their own staffing plan. However, the three ICU Charge RNs work together throughout their shifts to best utilize the available ICU RN's and maximize utilization of ICU RN resources to meet current and anticipated patient needs. In the ICUs, when making assignments, the American Association of Critical Care Nurse's Synergy model is utilized: the needs of the patient and family and the complexity of therapies and interventions are

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matched with the skills and abilities of the RN. The Critical Care Float Pool (CCFP) is comprised of nurses trained in the PICU, ICU, and NICU and provides floating coverage to any of the three ICUs that have a staffing need. Scheduled call shifts are also used to address the times when staffing needs exceed what is scheduled. The daily schedule is posted each shift across the ICU division (NICU, PICU, and CICU). This includes charge nurses for each ICU who oversee the nursing care in the unit and facilitates flow in and out of the unit. Charge RNs typically do not have a patient assignment. ICU Techs (CNAs) support the delivery of supplies, linen and equipment to the bedside RN 24/7 in the PICU and CICU. They can help the bedside RN with care activities such as turning and weighing patients, giving baths under the RN's supervision, and assisting with the transport of patients. Respiratory Therapists also support nurses in the Critical Care Division. Neonatal Intensive Care Unit The Neonatal Intensive Care Unit is a 32-bed quaternary care unit and the only Level IV NICU in Washington that receives referrals from four states: Washington, Alaska, Montana, and Idaho (W AMI). Patients in the NICU are neonates up to 50 weeks post-gestational age. It is unique from a traditional NICU as many of the patients have congenital diagnoses requiring specialized pre-operative surgical and postoperative surgical care. Critically ill neonates with complex medical issues are also cared for in this unit. Specialized care provided includes ECMO/ECLS, cooling, in-room surgical procedures, high frequency oscillatory ventilation, use of inhaled nitric oxide, and infant ground transport. The NICU charge nurse responds to all Code Blue events in the hospital. Besides the Charge RN, the NICU uses a resource RN that can provide additional support to the bedside RN such as coverage for breaks, lunches, assist with care or procedures, and can place peripherally inserted central catheters.

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NeonatalIntensiveCareUnit

Additionally, the NICU has 56 hours of Certified Nursing Assistant support across the week supporting unit stocking tasks. Pediatric Intensive Care Unit The Pediatric Intensive Care Unit (PICU) is a 38-bed quaternary care referral center for four states: Washington, Alaska, Montana, and Idaho (WAMI). Patients care for are infants up to young adults and have a wide range of clinical conditions. Examples of medical conditions include septic shock, acute and chronic respiratory failure, diabetic ketoacidosis, and metabolic diseases. Our team also manages patients from a wide range of surgical and medical services to include Neurosurgery, Solid Organ Transplant, Craniofacial/Plastics, Hematology/Oncology and Bone Marrow & Stem Cell Transplant patients. Specialized care provided in the PICU includes cerebral oximetry monitoring, high frequency oscillatory ventilation, use of inhaled nitric oxide,

Numberofbeds 32

Budgetedaveragedailycensus 28

RNhoursperpatientday 18.37

Averagepatients/RN 1-2

TotalRNFTEneeds(includesdirectandindirectcare)

115.17

DirectCaregiver

Shifts Monday Tuesday Wednesday Thursday Friday Saturday Sunday

6:30a-7p 2 2 2 2 2 2 2ChargeRN

6:30p-7a 2 2 2 2 2 2 2

7a-7:30p 23 23 23 23 23 25 25RN 7p-7:30a 23 23 23 23 23 25 25

ResourceRN 7a-7:30p 2 2 2 2 2 2 2

7p-7:30a 2 2 2 2 2 2 2

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continuous renal replacement therapy (CRRT) and intracranial pressure monitoring. Extracorporeal life support represents a highly specialized form of cardiopulmonary support. The PICU charge nurse responds to all Code Blue & Code Green events in the hospital. In addition to the Charge RN, the PICU uses one RN that can assist in care of patients immediately post OR procedure or assist with additional admissions. They are also an additional resource that can assist with breaks and lunches and may take a patient assignment as needed to cover changing needs of the department.

PediatricIntensiveCareUnit

Cardiac Intensive Care Unit This CICU is a 20-bed unit quaternary care referral center for four states: Washington, Alaska, Montana, and Idaho (WAMI). Patients cared for are newborns up to young adults with acquired and congenital heart disease. The CICU supports robust mechanical circulatory assist and cardiac transplant programs. Specialized care provided in the CICU includes cerebral oximetry monitoring, inhaled nitric oxide, oscillatory ventilation, temporary pacemakers, open chest procedures and continuous renal replacement therapy (CRRT). Extracorporeal life support represents a highly specialized form of cardiopulmonary support that includes the use of ECMO

Numberofbeds 38

Averagedailycensus 33




162.59

DirectCaregiver


6:30a-7p 4 4 4 4 4 4 4ChargeRN 6:30p-7a 3 3 3 3 3 3 3

7a-7:30p 27 27 27 27 27 27 27RN

7p-7:30a 28 28 28 28 28 28 28

7a-7:30p 4 4 4 4 4 4 4CNA(CoversPICU,

CICU) 7p-7:30a 3 3 3 3 3 3 3

ResourceRN 7a-7:30p 1 1 1 1 1 1 1

7p-7:30a 1 1 1 1 1 1 1

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and ventricular assist devices, The CICU charge nurse responds to all Code Blue & Code Green events in the hospital. Patient assignments are typically 1-2 patients per RN. Examples of 1:1 assignments would be those requiring ECLS, continuous monitoring of vital signs, multiple arrhythmias, unstable airway, or metabolic instability requiring frequent blood work or tests. When patients are unable to be transferred to the acute care floors due to bed unavailability, nurses may care for three floor status patients.

CardiacIntensiveCareUnit

Additional resources for the Critical Care Division The three ICU Charge RNs work together throughout their shifts to best utilize the available ICU RN's and maximize utilization of ICU RN resources to meet current and anticipated patient needs. In the ICUs, when making assignments, the American Association of Critical Care Nurse's Synergy model is utilized: the needs of the patient and family and the complexity of therapies and interventions are matched with the skills and abilities of the RN. Scheduled call shifts, floating, and moving staff from indirect care (ie meetings/projects) to direct care are used to address the times when staffing needs exceed what is scheduled.

Numberofbeds 20



Averagepatients/RN 1-2TotalRNFTEneeds(includesdirectand

indirectcare)85.67

DirectCaregiver


6:30a-7p 2 2 2 2 2 2 2ChargeRN

6:30p-7a 2 2 2 2 2 2 2

7a-7:30p 18 18 18 18 18 18 18

7p-7:30p 18 18 18 18 18 18 18

RN

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Specially trained RNs who provide care for ECMO and CRRT patients are also scheduled each shift. They also have the ability to flex the number of RNs based on additional patient’s needs through use of call and posting additional available shifts.

Critical Care Float Pool and RISK RN Critical care float pool staff can be deployed to the one of the three critical care areas to cover needs related to census, acuity, sick calls, etc. A RISK (Recognized Illness Severity in Kids) nurse is trained to the critical care division. They will participate in proactive huddles twice daily with each acute care unit and perform evaluations for potential clinical deterioration or concern as available.

Critical Care Transport Seattle Children's provides a 24-hour Critical Care Transport Service with Medical Control Physician (MCP) direction. The MCP is a physician from ICU's or the Emergency Department based on the baby's diagnosis, clinical needs and planned placement post transport. The Critical Care Transport Service is a regional critical care inter facility transport team that provides ground (ambulance) transport to the appropriate level of care for ill and injured neonates and infants that weigh up to 7 kg as well as patients of all ages pre or post operatively. The Critical Care Transport Service also provides return transports (back-transports) to referring facilities as required. The transport service is staffed with 2 RNs and 2 Respiratory Therapists 24 hrs/day, 7 days/week. 2 EMTs are also staffed through AMR.

Role Shifts Monday Tuesday Wednesday Thursday Friday Saturday Sunday

7a-7:30p 2 2 2 2 2 2 2CRRTRN(CoversPICU,CICU,NICU) 7p-7:30a 2 2 2 2 2 2 2

ECMORN 7a-7:30p 1 1 1 1 1 1 1

7p-7:30a 1 1 1 1 1 1 1

Role Shifts Monday Tuesday Wednesday Thursday Friday Saturday Sunday

7a-7:30p 2 2 2 2 2 2 2FloatRN

7p-7:30a 2 2 2 2 2 2 2

RiskRN 7a-7:30p 2 2 2 2 2 2 2

7p-7:30a 2 2 2 2 2 2 2

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Acute Care Division The Acute Care Division is comprised of the Medical Unit, Surgical Unit, Cancer Care Unit, Rehabilitation Unit, and Psychiatry and Behavioral Medicine Unit and for a total of 270 beds. Each individual department within the division develops their own staffing plan. However, with help from the centralized staffing office the units Charge RNs work together to deploy staff and maximize utilization of resources to meet current and anticipated patient needs. The Acute Care Float Pool (ACFP) is comprised of nurses trained in the acute care areas (and Emergency Department), and provides floating coverage to any of the areas that have a staffing need. Scheduled call shifts are also used to address the times when staffing needs exceed what is scheduled. The daily schedule is posted each shift in each area. Charge RNs for each area oversee the nursing care in the unit and facilitates flow in and out of the unit. CNAs support the delivery of supplies, linen and equipment to the bedside RN. They can help the bedside RN with care activities such as turning and weighing patients, giving baths under the RN's supervision, and assisting with the transport of patients. Respiratory Therapists also support nurses in the Acute Care Division.

Medical Unit The Medical Unit is a 78-bed unit that is further subdivided into two areas that care for patients (newborn to 21 years) from medical specialty services. Medical River 4 is 47 beds comprised mainly of endocrine, neurology, rheumatology, GI service patients, and general medicine. Medical Forest 3 is 32 beds and comprised mainly of pulmonary, cranio-facial service, and general medicine patients. Staff in this area also care for patients with tracheostomies and ventilators and staff receive additional training to support this care. RN's are typically assigned two to four patients. The Medical Unit uses RNs, Certified Nursing Assistant (CNA) and, at times, Nurse Technicians. The percent of skill mix for the Medical Unit is approximately 80% RN and 20% CNA.

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MedicalUnit–River4

MedicalUnit–Forest3

Numberofbeds 47





82.02

DirectCaregiver


6a-6:30p 2 2 2 2 2 2 2ChargeRN 6p-6:30a 2 2 2 2 2 2 2

7a-3:30p 17 17 17 17 17 17 17

3p-11:30p 17 17 17 17 17 17 17RN–Med

11p-7:30a 17 17 17 17 17 17 17

7a-3:30p 4 4 4 4 4 4 4

3p-11:30p 4 4 4 4 4 4 4CNA 11p-7:30a 4 4 4 4 4 4 4

Numberofbeds 32





76.97

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Surgical Unit The Surgical Unit is a 78-bed unit that cares for patients (newborn through 21 years) from all surgical services. The unit is further subdivided into two units. The 33-bed River C 5 area serves primarily Neuroscience (including EEG), Orthopedics, Plastic Surgery, Urology, and Otolaryngology patients The River C 6 45- bed unit primarily cares for cardiac surgery, cardiology, solid organ transplants, nephrology and neonatology patients. . Nurses on both teams care for general surgery patients. In general, RNs on the Surgical Unit are assigned one to four patients, or if working with a LPN, the RN or may be assigned three to five patients. CNAs work on all shifts supporting patient care delegated by RNs. The percent of skill mix for the Surgical Unit is approximately 85% RN, 1 % LPN, and 15% CNA.

DirectCaregiver


6a-6p 2 2 2 2 2 2 2ChargeRN 6p-6a 2 2 2 2 2 2 2

7a-3p 16 16 16 16 16 16 16

3p-11p 16 16 16 16 16 16 16RN–Med

11p-7a 16 16 16 16 16 16 16

7a-3p 2 2 2 2 2 2 2

3p-11p 2 2 2 2 2 2 2CNA 11p-7a 2 2 2 2 2 2 2

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SurgicalUnit–RiverC5

SurgicalUnit–RiverC6

Numberofbeds 33



Averagepatients/RN 3


61.93

DirectCaregiver


6a-6:30p 2 2 2 2 2 2 2ChargeRN 6p-6:30a 2 2 2 2 2 2 2

7a-11p 12 12 12 12 12 12 12

11p-7a 12 12 12 12 12 12 12RN

7a-3p 3 3 3 3 3 3 3

3p-11p 3 3 3 3 3 3 3

CNA 11p-7a 1 1 1 1 1 1 1

LPN7a 1 1 1 1 1 1 1

LPN3p 2 2 2 2 2 2 2Other

LPN11p 1 1 1 1 1 1 1

Numberofbeds 45



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Cancer Care Inpatient Unit Seattle Children's, Fred Hutchinson Cancer Research Center and University of Washington Medicine bring together their oncology programs on the Cancer Care Unit. The inpatient unit includes a 48-bed unit caring for patients from birth through adolescent and young adult care. The Cancer Care Unit cares for patients who are being treated for hematology or oncology diagnosis, including Hematopoietic Stem Cell transplant (HSCT). RN's are initially trained to either the Hematology/Oncology service or the HSCT service. Within the first year, these staff completes their training by cross training to the other area. All staff on the Cancer Care Unit have completed training as Chemotherapy and Biotherapy Providers. RN's on the Cancer Care Unit are typically assigned between two and four patients. CNAs work on all shifts supporting patient care delegated by RNs. The percent of skill mix is approximately 70% RN and 30% C.N.A. Assignments may include patients from either the Hematology/Oncology or HSCT Service.

Averagepatients/RN 3


82.45

DirectCaregiver


6a-6:30p 3 3 3 3 3 3 3ChargeRN 6p-6:30a 3 3 3 3 3 3 3

7a-11p 15 15 15 15 15 15 15

11p-7a 15 15 15 15 15 15 15RN

7a-3p 3 3 3 3 3 3 3

3p-11p 3 3 3 3 3 3 3

CNA 11p-7a 2 2 2 2 2 2 2

LPN7a 1 1 1 1 1 1 1

LPN3p 2 2 2 2 2 2 2Other

LPN11p 1 1 1 1 1 1 1

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Additional resources available to staff and patients include a Transition RN focused on teaching related to their disease or home care needs, as well as discharge planning and coordination. Based on unit census and time of day, 2-4 Charge RNs also support RN staff on the unit.

CancerCareUnit

Rehabilitation Unit The Rehabilitation Unit is a 12-bed unit, providing inpatient evaluation and care of children up to 21 years of age with disabilities due to illness, injury or congenital causes. Additionally, they

Numberofbeds 48





118.48

DirectCaregiver


6a-6:30p 3 3 3 3 3 3 3

7a-7:30p 1 1 1 1 1 1 1

6p-6:30a 2 2 2 2 2 2 2

ChargeRN

7p-11p 2 2 2 2 2 2 2

7-7:30a 18 18 18 18 18 18 18

7p-11p 18 18 18 18 18 18 18

11p-7:30a 18 18 18 18 18 18 18RN

7a 6 6 6 6 6 6 6

3p 6 6 6 6 6 6 6

7a 6 6 6 6 6 6 6

CNA

11p 3 3 3 3 3 3 3

Other

TransitionRN07:30-4p

2 2 2 2 2 1 0

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may care for general surgery and general medical patients. Collaborating with a cross disciplinary team, care is provided to children with traumatic brain injury, spinal cord trauma, burns, and neurological disorders as well as physical or cognitive disabilities. As care coordinators for patients and families, Rehab RNs help to organize the family's experience and prepare them for the transition back to their community. In general, RNs care for three patients. LPNs/CNAs work on all shifts supporting patient care delegated by RNs or provide coverage for patient watches. The percent of skill mix for the Rehabilitation Unit is approximately 82% RN, 4% LPN, 14% CNA. Assignments include an array of complex procedures, treatments and physical rehabilitation skills. A CRRN (Certified Rehabilitation Registered Nurse) is present on day and evening shifts to oversee plans of care for rehab trauma patients.

RehabUnit

Numberofbeds 12





23.58

DirectCaregiver


0630 1 1 1 1 1 1 1

1430 1 1 1 1 1 1 1ChargeRN

2230 1 1 1 1 1 1 1

7a-3p 4 4 4 4 4 4 4

3p-11p 4 4 4 4 4 4 4

11p-7a 2 2 3 3 3 2 2RN

7a-3p 1 1 1 1 1 1 1

3p-11p 0 0 0 0 0 1 1CNA

11p-7a 1 1 1 1 1 1 1

Other(LPN)

1430p-2300p 1 1 1 1 1 0 0

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Psychiatry and Behavioral Medicine Unit

The Inpatient Psychiatric and Behavioral Medicine Unit (PBMU) consists of 41-beds. A portion of these beds may be designated for Involuntary Treatment Assessment. Care is provided on a 24-hour basis, 7 days a week. The Inpatient Psychiatric Unit is committed to the evaluation and behavioral stabilization of children (ages 2 through 18) with emotional, behavioral and neuropsychiatric disorders. Depression, developmental delays, attention deficits, anxiety, pervasive developmental disorders, conduct disorders, oppositional-defiant disorders, anorexia/bulimia and psychosis are among the disorders commonly diagnosed. The unit is also invested in treating children with unique concomitant problems such as hearing impairments, chronic medical illnesses, or physical developmental disabilities. The Psychiatric Program utilizes a model of care that emphasizes an interdisciplinary approach. Registered nurses, child and adolescent psychiatrists, psychologists, social workers, pediatric mental health specialists (PMHS), special education teachers, occupational, recreational, and speech therapists, and students from these various disciplines participate in the development of individualized treatment plans. Care includes the provision of behavior management in a milieu setting; parent and patient education; group activities; supportive family and individual support; psychotropic medication management and limited medical nursing services. RNs work together with their PMHS partners to run the structure and routine of the day. There is a charge nurse assigned each shift who determines the number of staff needed to safely implement care, depending on patient and group acuity. In general, PMHS/patient ratios are 1: 3 to 5 with an RN in charge of the unit and a "resource nurse" and an admission and discharge RN who is available to support the staff as needed. The Inpatient Psychiatry staff prioritizes teamwork and works to develop staff so they can utilize skills as allows to the fullest extent of licensure. Additionally, one PBMU RN is assigned as the behavioral support RN and can provide assistance and guidance to bedside RNs related to the behavioral needs of their patient if requested.

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PBMU

Other Resources for Acute Care Acute Care Float Pool (ACFP) and Vascular Access Service (VAS) The Acute Care Float Pool and VAS consists of RNs who provide coverage for unexpected absences and peaks in census. The staffing assignment mirrors that of the unit to which they are

Numberofbeds 41



Averagepatients/caregiver 3-5


36.57

DirectCaregiver


7a-7:30 2 2 2 2 2 2 2ChargeRN 7-7:30 2 1 1 1 1 1 1

7a 3 3 3 3 3 3 3

3p 3 3 3 3 3 3 3

11p-7a 1 1 1 1 1 1 1PrimaryRN

7a-3p 19 19 19 19 19 19 19

3p-11p 19 19 19 19 19 19 19PMHS

11p-7a 4 4 4 4 4 4 4

DischargeRN

0930-1800 1 1 1 1 1 1 1

AdmittingRN

7a-7:30p 1 1 1 1 1 1 1

7p-7:30a 1 1 1 1 1 1 1

2020 STAFFING PLAN

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deployed. In addition, VAS service RNs are staff who respond to vascular access needs and place peripheral intravenous lines, port a cath access, or dressing changes on central lines.

ACFPandVAS

Certified Nursing Assistant Float Pool The Certified Nursing Assistant Float Pool consists of CNAs who provide coverage for unexpected absences, peaks in census, and patient watch. They may be deployed to the inpatient areas and Recovery Room. The staffing assignment mirrors that of the unit to which they are deployed and is based on RN delegation of appropriate tasks. Respiratory Care

Children's Respiratory Care Therapy Team provides a full range of services associated with neonatal and pediatric respiratory therapy practice. Our highly trained and skilled team of clinicians and support staff provide around-the-clock service to all inpatient areas, the Emergency Department, the Infant Ground Transport Team, the ECMO team, as well as discharge coordination and education for the children dependent on respiratory therapy procedures and equipment.

Numberofbeds N/A

Averagedailycensus N/A

RNhoursperpatientday N/A

Averagepatients/caregiver Dependsonunit


59(50ACFP,9.56)

DirectCaregiver


7a-7:30p 7 8 9 9 10 7 6RN 7p-7:30a 7 8 9 9 10 7 6

7a-7:30p 2 2 2 2 2 2 2

11p-7:30a 2 2 2 2 2 2 2VASRN

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The Respiratory Care clinical team is led by our clinical supervisors who are here 24x7. They offer advanced critical care respiratory therapy including conventional and high frequency ventilation, airway management, intubation, special gas therapies, tracheostomy care, inhaled medication therapy, various forms of enhanced airway clearance techniques, pulmonary function studies, indirect calorimetry, capnometry, transcutaneous monitoring, cardio-pulmonary resuscitation and care of the chronic technology dependent respiratory population.

The number of staff used per shift includes a supervisor and varies based on the respiratory needs of the patients admitted to the hospital. The team has the ability to flex to meet additional needs through use of call and additional shifts.

Operative Services Division Main Campus Operative Services Operative Services includes the operating room, cardiac catheterization laboratory, admission areas and the recovery room. The Operating Room has a total of 15 rooms. Operative Services provides care for patients undergoing surgery and procedures 24/7 with on site staff or call staff. The OR is staffed with surgical technologists, RNs, and perfusionists. Services include all pediatric surgical procedures: general surgery, urology, neuro surgery, cardiac surgery, solid organ transplant (kidney, liver, heart, and small bowel), otolaryngology, ophthalmology, orthopedic surgery, plastic surgery, dental and oral surgery Two nurses or one surgical tech and one nurse are staffed in each OR. Surgical Tech IIs (anesthesia techs) provide coverage for three to four rooms supporting the anesthesia providers. For each cardiac case requiring cardiopulmonary bypass, two perfusionists provide coverage. The OR has a charge nurse who works in conjunction with an anesthesiologist to manage patient flow in the OR and may take patients depending on the need. The PACU has 12- Phase 1 PACU bays, 22 Ambulant Surgical Bays, and 2 Mobile Anesthesia and Sedation Teams. Direct patient care is provided by RNs 24 hours/day and is supported by CNAs during peak times.

Caregiver Shifts Monday Tuesday Wednesday Thursday Friday Saturday Sunday

7a-7p 18 18 18 18 18 18 18

7p-11p 18 18 18 18 18 18 18RespiratoryTherapist

11p-7a 17 17 17 17 17 17 17

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PACU

In addition to a Charge RN and scheduled RNs, OR and PACU each have 1 float RN to assist with tasks and breaks and lunch relief. Bellevue Surgery Center Bellevue Clinic and Surgery Center includes 3 operating rooms and 11 individual recovery rooms.

Bellevue Surgery Center provides care for patients undergoing outpatient surgery and radiology procedures requiring anesthesia Monday through Friday from 0730-1730 with onsite staff. The Bellevue Surgery Center is staffed with surgical technologists (ST), anesthesia technologists (AT) and RNs. Services include outpatient pediatric surgical procedures: otolaryngology, urology, general surgery, ophthalmology, orthopedic surgery, plastic surgery, dental surgery, and dermatology procedures. Two RNs or one surgical tech and one RN are staffed in each OR. The OR has a charge RN who works in conjunction with an anesthesiologist to manage patient flow in the OT.

The Recovery Room has 11 rooms and all patients who undergo anesthesia are recovered in a private room and are then discharged home. The PACU has a Charge RN who works in conjunction with the OR Charge RN, anesthesiologist, and Radiology Technician to manage patient flow in and out of the PACU. The patients are staffed at a 1 patient to 1 RN ratio in PACU from admission to discharge.

NumberofbedsPACU:12

AmbulantSurgicalZones:22

Averagepatients/caregiverPACU:1-2

AmbulantSurgicalZones:2-3MobileAnesthesia&SedationTeam:1

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BellevueSurgeryCenter

Emergency Services The ED is a 38-bed unit. The ED is a 24/7 service managing the spectrum of mild to critically ill and injured patients presenting for care. The ED follows EMT ALA guidelines so all patients presenting to the ED for care have an evaluation and treatment as indicated to stabilize if transfer is needed. ED patients are managed by a team which includes: Security presence in lobby and

Numberofbeds3operatingrooms11recoveryrooms


RNhoursperpatientday N/A

Averagepatients/caregiver 1

DirectCaregiver

Shifts Monday Tuesday Wednesday Thursday Friday

6:30a 1 1 1 1 1ChargeRNorPACUCN

6:30a 1 1 1 1 1

RNOR

7a 7 7 7 7 7

9a 1 1 1 1 1

RNPACU 7a 5 5 5 5 5

7:30a 2 2 2 2 2

8a 2 2 2 2 2

8:30a 2 2 2 2 2

6:30a 1 1 1 1 1

8a 1 1 1 1 1AT

ST

7a 4 4 4 4 4

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ED as needed, ED Coordinators who register patients and facilitate communication, RN's, CNAs, Nurse Technicians, Nurse Practitioners, Residents, Fellows and Attendings. Child Life, Social Work and Mental Health Evaluators also support our patient population. RN Tech skill mix is 85% RN, 15% tech who supports patient care activities and transport. RN's typically care for 3-4 patients, assigned based on area and acuity. There is seasonal variation to staffing and by time of day to correlate with predicted arrival patterns. Census is tracked daily, weekly and monthly to watch for trends and adjust staffing needs as appropriate. A real time dashboard is available for continuous staff view of resource matching to patient demand. An on call system is in place with standard criteria for the Charge RN to call-in staff for response to a surge in patient volumes.

Emergency

Urgent Care

SCH provides same day appointments for urgent care services at multiple locations; SCH main campus, North Clinic in Everett, South Clinic in Federal Way, and Bellevue. Staffed hours for each site are as follows:

• 4p-midnight Monday-Friday • 11a-11p Saturday, Sunday

Urgent care is for illnesses and injuries that are not medical emergencies or life-threatening. RNs are paired with an Urgent Care medical provider to meet the care needs of the patient. Two to 3 RNs are scheduled at a time and RNs care for 2-4 patients at a given time. Medical assistants are also available to support nursing staff. Ambulatory Areas

Dialysis Unit The dialysis unit consists of RNs who provide care for both the inpatient and outpatient dialysis patients. To meet the child's needs, our dialysis services include a multidisciplinary team that

Numberofbeds 38


Averagenumberofpatientvisitsperday 150


68.25

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includes physicians, nurses, school programs, support from child life specialists, social work services and nutrition education. Nurses generally care for one to three patients on dialysis determined by the type of dialysis, and developmental and/or clinical needs of the child. Dialysis RNs can be deployed to admitted patients who require dialysis, those patients seen in the dialysis unit, as well as to patients in a home care program. Dialysis techs support RNs and maintain water and equipment setups. Dialysis has one RN on call overnight to accommodate urgent dialysis needs. Acute care RNs can be deployed to assist with tasks in the dialysis area to account for census above expectations.

Dialysis

Infusion Unit and Center for Cancer and Blood Disorders (CBDC) The ambulatory infusion unit is located within the Center for Cancer and Blood Disorders. It serves children and young adults needing infusions that last less than 12 hours and have certain health conditions, including blood disorders, cancer gastrointestinal problems, genetic disorders, immune system disorders and rheumatology disorders. There are multiple RN roles within the infusion unit and staff are trained to these areas and then are assigned based on the need for that day. Staff rotate between lab room, procedures, triage RN and infusion. The CBDC also maintains one procedure suite and staffs two RNs in this area per day. Staff in infusion care for

NumberofbedsN/A-dialysiscaresforinpatientsandambulatory

patientsneedingdialysis




17.58

DirectCaregiver


CN 6:30a-7p 1 1 1 1 1 1 1

RNdialysisunit

6:30a-7p 3 3 3 3 3 3 3

RNinpatient 6:30a-7p 1 1 1 1 1 1 1

Homeprogram

6:30a-7p 2 2 2 2 2 2 2

OncallRN 7p-6:30a 1 1 1 1 1 1 1

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2-4 patients depending on the nature of the monitoring required for the infusion. The unit is open 7 days a week with hours of 07:30-8p Monday through Friday, 07:30-6 pm on Saturday and 07:30-4pm Sundays and holidays. Infusions can also be provided at SCH Bellevue and South (Federal Way) Clinics. The inpatient Cancer Care Unit and the Infusion/CBDC areas share multiple staff that can then be deployed to either area depending on the staffing needs for the day. Floating, voluntary call, and any of 14 RN Care Coordinators may be utilized to meet unanticipated staffing needs.

InfusionUnit

Ambulatory Clinics The Ambulatory Clinics consist of 26 hospital based clinics including Adolescent Medicine, Biochemical Genetics, Craniofacial, Dermatology, Endocrinology, Genetics, GI, Infectious Disease, Neurodevelopmental, Nephrology, Neurology, Neurosurgery, Ophthalmology, Orthopedics, Plastics, Pulmonology, Rheumatology, Rehab, Surgery, Urology, Vascular anomalies, Pain Management, Pass, Transplant, Cardiology, and Hem/Onc. There are approximately 140 RNs. In addition, there are regional and outreach clinics in; Bellevue, Tacoma, Everett, Olympia, Wenatchee, South clinic, Tri-Cities, Alaska, and Montana.

DirectCaregiver


CN 7:30a-8p 1 1 1 1 1 1 1

RNinfusion 7:30a-8p 10 10 10 10 10 6 4

RNprocedures

7:30a-4p 2 2 2 2 2 x x

OffsiteProcedure&resourceRN

7:30-4p x 1 x 1 x x x

TriageRN 7:30a-6p 1 1 1 1 1 x x

RNlab 7p-4p 4 3 4 3 4 x x

Southinfusion

9a-7:30p X 2 x x 2 x x

BellevueInfusion

7:30-4p 2 x 2 x 2 x x

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In general, Ambulatory RNs are responsible for clinic staffing. Depending on the specific staffing model that each clinic has, there may be a paired MD and RN model, or an RN staffing clinic model that utilizes an RN to Patient ratio dependent on the number of providers, patients, and specialized teaching scheduled. Ambulatory RN’s are also responsible for coordinated care. This includes phone triage, prior authorizations, prescriptions refills, reviewing lab results, coordinating scheduling, and clinic specific responsibilities; for example seizure plans, diabetic teaching, 504 and IEP plans. The patient’s core team is comprised of physicians, nurse practitioners, physician assistants, registered nurses, and medical assistants. Daily membership of any patient’s team is based on today’s presentation and reported concerns or issues.

Ambulatory clinic staffing varies with each clinic. Some may have 100% RNs while other clinics may have an 85% RN and 15% MA model.

Ambulatory nurses have one UBSC committee with 6 members available and involved in staffing models and vacation coverage guidelines.

There is also an ambulatory RN float pool that can be deployed to support staff ill calls, but float staff can also be assigned to cover planned or unplanned leaves for RN clinic staff.

In addition, RNs from SC main campus may go to regional sites to support clinics who are understaffed.

Radiology

Radiology provides diagnostic and therapeutic services for patients utilizing digital X-rays (DX), magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine (NM), DEXA, ultrasound (US), and minimally invasive interventional radiology. A full range of imaging services is offered at the main campus. Radiology staff cover three areas, radiology recovery, endoscopy lab, and interventional radiology (IR). Monday through Friday 11-14 RNs are scheduled between 7a-3:30pm. There are staggered start times so that IR and radiology recovery will have nursing staff available until 6p and 7:30p, respectively. After hours is staffed by on call coverage. Saturday and Sunday there is one RN scheduled in radiology recovery with an additional 2 RNs on call to cover IR and endoscopy lab if needed for urgent cases. Each nurses care for one patient at a time.

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Minimum Requirements for Positions

Position Requirements for Position Charge Nurse

Required Education/Experience: • Graduate of accredited school of nursing. • Minimum 1-year experience as a pediatric nurse.

Required Credentials:

• Current Washington State RN License or other current state license that the RN is required to work in.

• Current PEARS certification within 6 months of hire and renewed every 2 years. BLS and/or PALS will be accepted at hire in lieu of PEARS

• Pediatric Advanced Life Support (PALS) is required within 90 days of hire for the following departments:

o Pediatric Intensive Care Unit o Neonatal Intensive Care Unit o Cardiac Intensive Care Unit o Critical Care Float Pool

• Specialty certification in area of practice may be required for specific departments.

• Prior experience in a pediatric related health care setting, or a specific area of nursing, may be required for specific departments. i.e. ICU, Heart Center.

Knowledge, Skills and Abilities:

• Knowledge of basic computer skills and ability to learn and apply new technologies and skills.

• Familiarity with lean processes and continuous performance improvement systems.

• Excellent communication, interpersonal and problem solving skills.

• Flexibility related to scheduling and clinical responsibilities is required, to meet patient, family, and program needs.

• Ability to work effectively in a team environment. • Ability to adapt to changes in the work environment and to

shifts in organizational philosophy and expectations. • Ability to identify personal opportunities for growth and

learning; ability to assume responsibility for continuous clinical and professional knowledge and skills.

Clinical:

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• Knowledge of human growth and development to modify care to the age and development status of the patient population served.

• Knowledge of patient safety according to the assigned department.

• Ability to identify and apply planning, care and/or intervention techniques appropriate to the physical, motor and sensory, cognitive and psychosocial characteristics of each patient population served.

Registered Nurse Required Education/Experience: • Graduate of accredited school of nursing. • Prior experience in a pediatric related health care setting, or a

specific area of nursing, may be required for specific departments.


• Current Washington State RN License, or other current state license that the RN is required to work in.

• Current PEARS certification within 6 months of hire and renewed every 2 years Current BLS and/or PALS certification will be accepted in lieu of the PEARS at time of hire.. Specialty certification in area of practice may be required for specific departments.

• Pediatric Advanced Life Support (PALS) is required within 90 days of hire for the following departments:

o Pediatric Intensive Care Unit o Neonatal Intensive Care Unit o Cardiac Intensive Care Unit o Critical Care Float Pool


• Knowledge of basic computer skills and ability to learn and apply new technologies and skills.

• Familiarity with lean processes and continuous performance improvement systems.

• Excellent communication, interpersonal and problem solving skills.

• Flexibility related to scheduling and clinical responsibilities is required, to meet patient, family, and program needs.

• Ability to work effectively in a team environment. • Ability to adapt to changes in the work environment and to

shifts in organizational philosophy and expectations.

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• Ability to identify personal opportunities for growth and learning; ability to assume responsibility or continuous clinical and professional knowledge and skills.

Clinical:




• Demonstrated skills and ability to assess, plan, implement, evaluation, documentation, coordinate and provides teaching/counseling to clients and their families in a holistic manner.

Licensed Practical Nurse

Required Education/Experience: • Graduation on from an accredited LPN training program.


• Current Washington State LPN License. • Current BLS for Healthcare Providers. Current PALS

certification will be accepted in lieu of the BLS either at time of hire or as an annual competency. However, the incumbent is responsible for any costs (including time away from work) associated with obtaining PALS certification if it is not a requirement of the position. (ACLS will not be accepted as a substitute to the requirements listed above.)

Knowledge. Skills and Abilities:

• Knowledge of medical terminology. • Able to follow verbal and written instructions in a

multidisciplinary setting. • Able to maintain productive work relationships with others and

work in a team environment. • Able to work with children with special health care needs. • Able to organize, prioritize and perform multiple tasks. • Able to learn new techniques and procedures. • Sensitive to patient's and family's emotional, social, cultural and

mental health needs. • Good communication/interpersonal skills. • Computer literacy.

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• Exposure to infectious patients and unexpected conditions and hazards that are unique to working in a patient care clinic and unit.

Certified Nursing Assistant

Required Education/Experience: • High School graduate or equivalent.


• Current certification as a Nursing Assistant in the State of Washington.

• Current BLS for Healthcare Providers. Knowledge, Skills and Abilities:

• Good communication/interpersonal skills. • Basic math skills. • Able to read, write, speak and understand English to

communicate at a level necessary to perform duties; bilingual skills highly desired.

• Able to follow verbal and written instructions in a multidisciplinary setting.

• Able to work in a team environment. • Able to work in a multi cultural environment with a diverse

population and with children with special health care needs. • Self-directed and motivated within the scope of the job

description. • Able to effectively organize, prioritize and perform multiple

tasks.

Nurse Technician Required Education/Experience: • Currently enrolled in or have completed at least one academic

term (quarter or semester) of a nursing commission approved program approved by the commission (ADN or BSN). Term must have included a clinical component.

Required Credentials

• Current WA State Nurse Technician Registration. • Current Healthcare Provider BLS as certified by the American

Heart Association. Knowledge, Skills and Abilities:

• Must complete a formal generic and on-unit orientation including skills checklist and medication test.

• Must be able to work a predictable schedule with the Unit Director/Manager for the time employed.

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• Must provide quarterly documentation of attendance and evaluation of skill competency in the School of Nursing.

Clinical:



• Ability to identify and apply planning, care and/or intervention techniques appropriate to the physical, motor and sensory, cognitive and psychosocial characteristics of each patient population served.

Respiratory Therapists Required Education/Experience

• Associate’s degree in Respiratory Care from an AMA approved school of Respiratory Care.

Required Credentials: • Registered Respiratory Therapist or Registry Eligible with the

National Board of Respiratory Care • Registry Eligible must obtain the RRT credential from the

NBRC within 6 months of hire date. • Current Washington State Respiratory Care Practitioner license. • BLS for Healthcare Providers or current PALS certification.


• Good communication and interpersonal skills • Able to work independently and as a member of a multi-

disciplinary team • Frequently comes in contact with potentially hazardous

materials to include compressed gases, aerosolized medications, and cleaning solutions.

• Requires attending to patients with infectious diseases. • Exposure to blood borne pathogens, category “I” may occur • Frequently involves stressful and emotional situations dealing

with severely ill and/or dying children and their families.

Pediatric Mental Health Specialist I (Psychiatric Unit)

Required Education/Experience • BA or BS in psychosocial related field.


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• Agency Affiliated Counselor Registration in Washington State. • Registration as a Nursing Assistant in Washington State. • Basic Life Support (BLS).


• Communication and problem solving skills. • Able to work with multidisciplinary team and maintain

productive work relationships with others. • Able to understand and promote unit and department themes. • Possess or acquire knowledge of unit standards, policies,

procedures, and resources. • Skills to manage/lead children in group activities. • Skills and physical dexterity to assist a patient who is presenting

with behavioral challenges. • Able to move around the unit and hospital in a timely

Competence involves at least three different types of skills categories: cognitive, motor and interpersonal skills. Census and Patient Activity by Shift

Daily census activity, including number of patients on the unit on each shift and activity such as patient discharges, admissions, and transfers is tracked by Charge Nurses on a daily assignment sheets. This information can be found on white boards posted on each unit. Semiannual Review of Plan This plan will be evaluated on a semiannual basis against patient need and known evidence-based staffing information, including the nursing sensitive quality indicators collected by the hospital. Unit leadership and Unit Based Staffing Committees will be responsible for evaluating their unit plan and submitting to Housewide Staffing Committee, for review. The combined unit staffing plan will be submitted to the CEO on an annual basis. Contact Information If you have any questions about the daily staffing plan for a unit please consult the Charge Nurse assigned on each shift, or the Unit Coordinator who will assist you in contacting the Charge Nurse.

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Last Updated 12/12/19

Documents

Seattle Children's Hospital Nurse Staffing Plan€¦ · staffing plan and partners with nursing and hospital leadership in assuring safe staffing for all patients. Furthermore, each