Crisis Nursing & Midwifery Model of Care Western Health April - - PowerPoint PPT Presentation
Crisis Nursing & Midwifery Model of Care Western Health April 2020 Situation & rationale for change There is a need to establish workforce models that will be able to respond to both the anticipated increase in the number of
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Area of care Activity Hygiene
dentures, mouth wash/toilet
Toileting
drainage Manual handling & Mobility
Nutrition
adjusting table and opening packages Environment
place – call bell, phone, bedside table in reach, bed lowered, trip hazards removed Communication
concerns to supervising registered nurse/s
calls/intercom Documentation
and urine output and report to RN Maintenance
between use i.e. – infusion pumps, bed frames Other duties
Examples of COVID-19 Support Staff Role Activity List:
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Possess in-depth clinical knowledge and experience
reasoning and expert intuition
proactively and holistically
among bedside RNs, RMs & COVID-19 Support Staff roles
2019 Advisory Board
Move to a team model that is under the delegation and supervision
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The ‘Future State Escalation 2a Model identified there would be insufficient ICU staff to maintain 1:1 ratio with the above bed configuration, as demonstrated in displayed graphs.
WWH - [13 beds / PL 20%] – 1:1 ratio WSH - [12 beds / PL 20%] – 1:1 ratio
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The ‘Future State Escalation 2b Model includes 1 ICU nurse + 1 RN to two patient ratio, therefore decreasing the reliance on ICU staff.
WWH - [13 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio) WSH - [12 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio)
Hospital Department Unit Budget EFT
Western Health ICU WSH 12 Beds ANUM $812,811 6.05 12 Beds ICU staff [1:2] $3,990,360 35.98 12 Beds RN Staff [1:2] $4,368,480 36.58 NUM $137,694 1.1 Totals
79.72
Hospital Department Unit Budget EFT
Western Health ICU WWH 13 Beds - ANUM $835,412.7 5.99 13 Beds ICU staff [1:2] $4,758,217.1 41.76 13 Beds RN staff [1:2] $4,368,479.8 36.58 NUM $136,432.7 1.1 Totals
85.43
Department Unit Current State - 12hr Roster- EFT Current State - 12hr Roster-$ Future State Escalation 2b- EFT Future State Escalation 2b- $ EFT Variance $ Variance
ICU WSH 12 Beds ANUM 6.05 $812,811
12 Beds ICU staff [1:2] 35.98 $3,990,360
12 Beds RN Staff [1:2] 36.58 $4,368,480
Access Nurse 5.23 $650,916 5.23 $650,916 ANUM 5.26 $696,586 5.26 $696,586 Clinical 47.81 $5,436,405 47.81 $5,436,405 Equipment Nurse 1.1 $115,079 1.1 $115,079 NUM 1.1 $137,694 1.1 $137,694 ICU WWH 13 Beds - ANUM 5.99 $835,413
13 Beds ICU staff [1:2] 41.76 $4,758,217
13 Beds RN staff [1:2] 36.58 $4,368,480
Access Nurse 5.18 $604,147 5.18 $604,147 ANUM 5.19 $696,501 5.19 $696,501 Clinical Nurse Roster 12Hr 46.65 $5,440,739 46.65 $5,440,739 Heart Failure CNC 0.84 $101,494 0.84 $101,494 NUM 1.1 $136,433 1.1 $136,433
$14,015,993 165.15 $19,407,887
Additional 45.67 EFT required
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The ‘Future State Escalation 3a’ Model includes the flexing up of beds in separate areas. This results in the addition of I/C ANUM role whilst maintaining the 1 ICU nurse + 1 RN to two patient ratio. The aforementioned staffing configuration is not achievable at Footscray with the flexing of 6 beds. WWH - [13 + 6 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio) WSH - [12 + 4 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio)
Hospital Department Unit Budget EFT Western Health ICU WWH 13 beds ANUM $828,976 5.99 13 beds ICU [1:2] $4,882,882 41.77 13 Beds RN staff [1:2] $4,368,480 36.58 Addit 6 beds ANUM [1:2] $824,386 5.98 Addit 6 beds ICU staff [1:2] $2,078,841 17.9 Addit 6 beds RN staff [1:2] $2,184,240 18.29 NUM $136,433 1.1 Totals
127.6 Hospital Department Unit Budget EFT Western Health ICU WSH 12 Beds ANUM $817,053 6.05 12 Beds ICU staff [1:2] $4,124,627 36.92 12 Beds RN Staff [1:2] $4,368,480 36.58 Addit 4 beds ANUM $817,053 6.05 Addit 4 beds ICU [1:2] $1,455,723 12.93 Addit 4 beds RN staff [1:2] $1,456,160 12.19 NUM $137,694 1.1 Totals
111.83
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Models of Staffing 19 ICU beds
WWH - [13 + 6 beds / PL 20%] – ICU nurse (1:3 ratio) + RN non ICU (2:3 ratio)
WSH ICU 12 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 2 RN -2 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 2 RN - 2 Budget FTE: 31.2 Total Cost: $3.73M PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 6 RN – 6 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 6 RN – 6 Budget FTE: 79.5 Total Cost: $9.31M
WSH ICU 4 Beds 12/12hr Rosters 1:1 Ratio WWH ICU 13 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 2 RN -4 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 2 RN - 4 Budget FTE: 42.3 Total Cost: $5.08M PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 5 RN - 8 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 5 RN – 8 Budget FTE: 84.6 Total Cost: $10.05M
WWH ICU 6 Beds 12/12hr Rosters 1:1 Ratio
Models of Staffing 16 ICU beds
WSH - [12 + 4 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio)
Hospital Department Unit Budget EFT Western Health ICU WWH 13 Beds ANUM $828,958 5.99 13 beds ICU staff [1:3] $3,398,358 29.83 13 Beds RN [2:3] $5,824,640 48.77 Addit 6 beds ANUM $824,368 5.98 Addit 6 beds ICU staff [1:3] $1,348,599 11.93 Addit 6 beds RN staff [2:3] $2,912,320 24.39 NUM $136,433 1.1 Totals
127.99 Hospital Department Unit Budget EFT Western Health ICU WSH 12 Beds ANUM $817,053 6.05 12 Beds ICU staff [1:2] $4,124,627 36.92 12 Beds RN Staff [1:2] $4,368,480 36.58 Addit 4 beds ANUM $817,053 6.05 Addit 4 beds ICU [1:2] $1,455,723 12.93 Addit 4 beds RN staff [1:2] $1,456,160 12.19 NUM $137,694 1.1 Totals
111.83
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Additional 120 EFT required
Department Unit Current State - 12hr Roster- EFT Current State - 12hr Roster- Budget Future State Escalation 3b- EFT Future State Escalation 3b- Budget EFT Variance Budget Variance ICU WSH 12 Beds ANUM 6.05 $817,053
12 Beds ICU staff [1:2] 36.92 $4,124,627
12 Beds RN Staff [1:2] 36.58 $4,368,480
Access Nurse 5.23 $650,916 5.23 $650,916 Addit 4 beds ANUM 6.05 $817,053
Addit 4 beds ICU [1:2] 12.93 $1,455,723
Addit 4 beds RN staff [1:2] 12.19 $1,456,160
ANUM 5.26 $696,586 5.26 $696,586 Clinical 47.81 $5,436,405 47.81 $5,436,405 Equipment Nurse 1.1 $115,079 1.1 $115,079 NUM 1.1 $137,694 1.1 $137,694 ICU WWH 13 Beds ANUM 5.99 $828,958
13 beds ICU staff [1:3] 29.83 $3,398,358
13 Beds RN [2:3] 48.77 $5,824,640
Access Nurse 5.18 $604,147 5.18 $604,147 Addit 6 beds ANUM 5.98 $824,368
Addit 6 beds ICU staff [1:3] 11.93 $1,348,599
Addit 6 beds RN staff [2:3] 24.39 $2,912,320
ANUM 5.19 $696,501 5.19 $696,501 Clinical Nurse Roster 12Hr 46.65 $5,440,739 46.65 $5,440,739 Heart Failure CNC 0.84 $101,494 0.84 $101,494 NUM 1.1 $136,433 1.1 $136,433 Totals
$14,015,993 239.83 $28,450,464
The ‘Future State Escalation 3b’ model results in a change in the model of staffing at Footscray due to inadequate ICU nurses. There was an Increase reliance on non ICU RNs who take an increase patient load. The overall ratio of 1:1 was maintained.
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Models of Staffing 23 ICU beds
WSH ICU 12 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 3 RN -4 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 3 RN -4 Budget FTE: 50 Total Cost: $5.92M PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 4 RN - 8 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 4 RN – 8 Budget FTE: 67.6 Total Cost: $9.38M
WSH ICU 7 Beds 12/12hr Rosters 1:1 Ratio WWH ICU 13 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 2 RN -4 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 2 RN - 4 Budget FTE: 42.3 Total Cost: $5.12M PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 5 RN - 8 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 5 RN –8 Budget FTE: 84.6 Total Cost: $10.14M
WWH ICU 6 Beds 12/12hr Rosters 1:1 Ratio
Models of Staffing 19 ICU beds
WWH - [13 + 6 beds + 4 beds / PL 20%] – ICU nurse (1:3 ratio) + RN non ICU (2:3 ratio) WSH - [12 + 4 beds + 3 beds / PL 20%] – ICU nurse (1:3 ratio) + RN non ICU (2:3 ratio) PM Shift 0700-1900hrs 1 ANUM Crit Care RN - 2 RN -2 ND Shift 1900-0700hrs 1 ANUM Crit Care RN - 2 RN - 2 Budget FTE: 30 Total Cost: $3.66M WWH ICU 4 Beds 12/12hr Rosters 1:1 Ratio
Total 42 ICU beds
Hospital Department Unit Budget EFT Western Health ICU WSH 12 Beds ANUM $814,891 6.05 12 Beds ICU staff [1:3] $2,744,036 24.93 12 Beds RN Staff [2:3] $5,824,640 48.77 Addit 3 Beds ICU staff [1:3] $770,996 6.94 Addit 3 beds RN staff [2:3] $1,456,160 12.19 Addit 4 beds ICU [1:2] $1,423,714 12.93 Addit 4 beds RN staff [1:2] $1,456,160 12.19 Addit 4+3 beds ANUM $814,891 6.05 NUM $137,694 1.1 Totals
131.16 Hospital Department Unit Budget EFT Western Health ICU WWH 13 Beds ANUM $828,956 5.99 13 Beds ICU staff [1:3] $3,489,767 29.83 13 beds RN staff [2:3] $5,824,640 48.77 Addit 4 beds ANUM $827,166 5.98 Addit 4 beds ICU [1:2] $1,383,073 11.93 Addit 4 beds RN staff [1:2] $1,456,160 12.19 Addit 6 beds ANUM $827,166 5.98 Addit 6 beds ICU staff [1:3] $1,383,073 11.93 Addit 6 beds RN staff [2:3] $2,912,320 24.39 NUM $136,433 1.1 Totals
158.1
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Additional 170 EFT required
The ‘Future State Escalation 4a’ Model includes the flexing up of an additional 7 beds in separate areas. This results in a change in the model of staffing with each ICU nurse working 1:3 ratio and non ICU RNs working 2:3 ratio. The overall ratio of 1:1 was maintained, but there was a significant skill mix variance.
Department Unit Current State - 12hr Roster- EFT Current State - 12hr Roster- Budget Future State Escalation 4a- EFT Future State Escalation 4a- Budget EFT Variance Budget Variance ICU WSH 12 Beds ANUM 6.05 $814,891
12 Beds ICU staff [1:3] 24.93 $2,744,036
12 Beds RN Staff [2:3] 48.77 $5,824,640
Access Nurse 5.23 $650,916 5.23 $650,916 Addit 3 Beds ICU staff [1:3] 6.94 $770,996
Addit 3 beds RN staff [2:3] 12.19 $1,456,160
Addit 4 beds ICU [1:2] 12.93 $1,423,714
Addit 4 beds RN staff [1:2] 12.19 $1,456,160
Addit 4+3 beds ANUM 6.05 $814,891
ANUM 5.26 $696,586 5.26 $696,586 Clinical 47.81 $5,436,405 47.81 $5,436,405 Equipment Nurse 1.1 $115,079 1.1 $115,079 NUM 1.1 $137,694 1.1 $137,694 ICU WWH 13 Beds ANUM 5.99 $828,956
13 Beds ICU staff [1:3] 29.83 $3,489,767
13 beds RN staff [2:3] 48.77 $5,824,640
Access Nurse 5.18 $604,147 5.18 $604,147 Addit 4 beds ANUM 5.98 $827,166
Addit 4 beds ICU [1:2] 11.93 $1,383,073
Addit 4 beds RN staff [1:2] 12.19 $1,456,160
Addit 6 beds ANUM 5.98 $827,166
Addit 6 beds ICU staff [1:3] 11.93 $1,383,073
Addit 6 beds RN staff [2:3] 24.39 $2,912,320
ANUM 5.19 $696,501 5.19 $696,501 Clinical Nurse Roster 12Hr 46.65 $5,440,739 46.65 $5,440,739 Heart Failure CNC 0.84 $101,494 0.84 $101,494 NUM 1.1 $136,433 1.1 $136,433 Totals
$14,015,993 289.26 $34,511,936
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Models of Staffing 23 ICU beds
WSH ICU 12 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN T/L - 3 RN -7 ND Shift 1900-0700hrs 1 ANUM Crit Care RN T/L - 3 RN -7 Budget FTE: 68 Total Cost: $8.1M PM Shift 0700-1900hrs 1 ANUM Crit Care RN T/L - 4 RN - 12 ND Shift 1900-0700hrs 1 ANUM Crit Care RN T/L - 4 RN – 12 Budget FTE: 104 Total Cost: $12.95M
WSH ICU 7 Beds 12/12hr Rosters 1:1 Ratio WWH ICU 13 Beds 12/12hr Rosters 1:1 Ratio
PM Shift 0700-1900hrs 1 ANUM Crit Care RN T/L - 2 RN -6 ND Shift 1900-0700hrs 1 ANUM Crit Care RN T/L - 2 RN - 6 Budget FTE: 54 Total Cost: $6.58M PM Shift 0700-1900hrs 1 ANUM Crit Care RN T/L - 5 RN - 13 ND Shift 1900-0700hrs 1 ANUM Crit Care RN T/L - 5 RN – 13 Budget FTE: 115 Total Cost: $13.78M
WWH ICU 6 Beds 12/12hr Rosters 1:1 Ratio
Models of Staffing 19 ICU beds
WWH - [13 + 6 + 4 beds / PL 20%] – ICU nurse (T/L 3 ratio) + RN non ICU (1:1 ratio) PM Shift 0700-1900hrs 1 ANUM Crit Care RN T/L - 2 RN -4 ND Shift 1900-0700hrs 1 ANUM Crit Care RN T/L - 2 RN - 4 Budget FTE: 42 Total Cost: $5.12M
WWH ICU 4 Beds 12/12hr Rosters 1:1 Ratio
Total 42 ICU beds
WSH - [12 + 7 beds / PL 20%] – ICU nurse (T/L 3 ratio) + RN non ICU (1:1 ratio)
Hospital Department Unit Budget EFT Western Health ICU WWH 13 Beds ANUM $828,919 5.99 13 Beds ICU staff [T/L-1:3] $3,491,581 29.85 13 beds RN staff [1:1] $9,465,039 79.26 Addit 4 beds ANUM $827,128 5.98 Addit 4 beds ICU [T/L-1:2] $1,383,017 11.93 Addit 4 beds RN staff [1:1] $2,912,320 24.39 Addit 6 beds ANUM $827,128 5.98 Addit 6 beds ICU staff [T/L-1:3] $1,383,868 11.94 Addit 6 beds RN staff [1:1] $4,368,480 36.58 NUM $136,433 1.1 Totals
212.99 Hospital Department Unit Budget EFT Western Health ICU WSH 12 Beds ANUM $814,891 6.05 12 Beds ICU staff [T/L-1:3] $2,744,036 24.93 12 Beds RN Staff [1:3] $8,736,960 73.16 Addit 3 Beds ICU staff [T/L-1:3] $770,996 6.94 Addit 3 beds RN staff [1:3] $2,184,240 18.29 Addit 4 beds ICU [T/L-1:2] $1,423,714 12.93 Addit 4 beds RN staff [1:2] $2,912,320 24.39 Addit 4+3 beds ANUM $814,891 6.05 NUM $137,694 1.1 Totals
173.84
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Additional 267 EFT required
The ‘Future State Escalation 4b’ model captures the change in the model of staffing with ICU nurses working as team leaders supervising 3 non ICU RNs working 1:1 ratio. The overall ratio of 1:1 was maintained.
Department Unit Current State - 12hr Roster- EFT Current State - 12hr Roster- Budget Future State Escalation 4b- EFT Future State Escalation 4b- Budget EFT Variance Budget Variance ICU WSH 12 Beds ANUM 6.05 $814,891
12 Beds ICU staff [T/L-1:3] 24.93 $2,744,036
12 Beds RN Staff [1:3] 73.16 $8,736,960
Access Nurse 5.23 $650,916 5.23 $650,916 Addit 3 Beds ICU staff [T/L-1:3] 6.94 $770,996
Addit 3 beds RN staff [1:3] 18.29 $2,184,240
Addit 4 beds ICU [T/L-1:2] 12.93 $1,423,714
Addit 4 beds RN staff [1:2] 24.39 $2,912,320
Addit 4+3 beds ANUM 6.05 $814,891
ANUM 5.26 $696,586 5.26 $696,586 Clinical 47.81 $5,436,405 47.81 $5,436,405 Equipment Nurse 1.1 $115,079 1.1 $115,079 NUM 1.1 $137,694 1.1 $137,694 ICU WWH 13 Beds ANUM 5.99 $828,919
13 Beds ICU staff [T/L-1:3] 29.85 $3,491,581
13 beds RN staff [1:1] 79.26 $9,465,039
Access Nurse 5.18 $604,147 5.18 $604,147 Addit 4 beds ANUM 5.98 $827,128
Addit 4 beds ICU [T/L-1:2] 11.93 $1,383,017
Addit 4 beds RN staff [1:1] 24.39 $2,912,320
Addit 6 beds ANUM 5.98 $827,128
Addit 6 beds ICU staff [T/L-1:3] 11.94 $1,383,868
Addit 6 beds RN staff [1:1] 36.58 $4,368,480
ANUM 5.19 $696,501 5.19 $696,501 Clinical Nurse Roster 12Hr 46.65 $5,440,739 46.65 $5,440,739 Heart Failure CNC 0.84 $101,494 0.84 $101,494 NUM 1.1 $136,433 1.1 $136,433 Totals
$14,015,993 386.83 $46,163,656
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