The philosophy of the Department of Nursing, consistent with the mission statement of the Wyckoff Heights Medical Center, is to provide excellence in care through Prevention, Education and Treatment in a Safe environment. This philosophy is based upon the belief that the goal of modern dynamic, collaborative health care is the attainment of a satisfactory resolution of patients’ health problems.
Scope/Complexities/Types of Patients Served
The practice of Nursing at Wyckoff Heights Medical Center is defined by the New York State Practice Act, the Hospital’s Mission Statement and corporate values, standards, practice guidelines promulgated by various professional nursing and regulatory bodies, and a variety of policies, procedures, protocols, job descriptions, guidelines and standards of care. The framework within which care is provided is the Nursing Process, i.e., assessment, planning, intervention and evaluation. The Department of Nursing is responsible for the practice and quality of nursing care wherever it is provided throughout the Hospital. Nursing care, as described above, is provided in collaboration with other members of the health care team to patients of all ages in inpatient, outpatient and emergency settings. The scope and complexity of the patients’ care needs are such, that the delivery of nursing care is organized as follows:
Medical and Surgical Nursing: Adult inpatients, from the age of eighteen through 100+ years, requiring pre and post-operative care, general acute care, specialty services and alternate level of care.
Critical Care Nursing: Acute and convalescent adults, from the age of eighteen through 100+ years with complex medical and surgical needs. Services include ICU/CCU, Telemetry Unit and a 4-bed Step-Down Unit.
Emergency Nursing: Adult (eighteen years of age through 100+ years) and Pediatric (neonate through eighteenth birthday) Emergency care.
Ambulatory Nursing: Multispecialty services for adult and pediatric outpatients.
Maternal/Child Nursing: Women from adolescence on with gynecological and obstetrical health needs (including normal and high-risk antepartum, intrapartum and postpartum care); newborn care, including intensive care; and children from birth to adulthood with acute health problems requiring general and intermediate care.
Perioperative Services: Perioperative, intraoperative, surgical and recovery services for all ages of inpatient and ambulatory patients. Perioperative Services has an indirect report to the Vice President of Nursing.
Methods Used to Assess and Meet Patients’ Care Needs
Patients are initially assessed by a Registered Nurse upon admission to the patient care setting and a plan of care is initiated. This plan utilizes Standards of Care and protocols which are developed and approved by the appropriate bodies within nursing and identifies nursing care needs of patients. The plan is revised as indicated by changes in the patient’s condition. In addition, certain high-risk screening criteria are in place for the nurse to utilize in order to facilitate appropriate and timely referrals to other members of the health care team, including the areas of nutrition, functional mobility, psychosocial and discharge planning needs. Learning needs are assessed at the time of admission in order to initiate appropriate and timely educational interventions.
Patient care assignments are made by the Registered Nurse, based on the identified nursing care needs of the patient and the competency and skill levels of the available staff. Nursing care is directed by Registered Nurses, who are responsible and accountable for prescribing, delegating and coordinating all nursing care provided in inpatient and outpatient areas. Only the Registered Nurse may establish care goals based on patient assessment, plan the care for the patient and evaluate the patient’s progress or lack of progress toward achieving goals. Licensed Practical Nurses, Technicians and Nursing Assistants provide care to patients as appropriate to their levels of training and under the supervision of the Registered Nurse.
Availability of Necessary Staff
Each nursing unit’s/area's budgeted positions are determined at the time of the preparation of the Hospital’s annual budget and modified when new programs or new patient populations or new unit configurations are introduced. The Director responsible for the area prepares an annual departmental personnel budget in collaboration with the Patient Care Manager and is responsible for its overall implementation. The Master Staffing Plan for inpatient units is based on a budgeted average daily census/visits, patient acuity and nursing care hours to be provided. Consideration is given to a unit’s method of patient care delivery system and physical environment. Patient Care Managers are responsible on a 24-hour basis for coordinating the planning, implementation and evaluation of the staffing programs within each clinical nursing unit within the department. Staffing patterns and schedules are based on census, acuity and budget allocation for the units. Patient Care Managers and Administrative Shift Supervisors adjust staffing according to changing need and availability of staff on a shift-to-shift basis. When necessary, staffing is supplemented through contracts with approved agencies.
Extent to Which Level of Care/Service Provided Meets Patients’ Needs
Indicators which measure various components of the patient and organization functions, as defined by the Joint Commission, are used to assess current performance and improve patient care. Patient satisfaction surveys are also utilized to identify opportunities for improvement. The quality of patient care is monitored on a regular basis in accordance with the Department of Nursing’s Performance Improvement (PI) Plan.
A full complement of support services is available to the Nursing Department. Consultation with specialty and sub-specialty Attending Physicians is available through the consultation process. In addition, there is support from:
|• Radiology||• Pharmacy||• Engineering & Maintenance|
|• Infection Control||• Patient Advocate||• Security|
|• Registration & Admitting||• IT||• Food & Nutrition Services|
|• Health Information Management||• Respiratory Therapy||• Purchasing, storeroom, & CSR|
|• Social Work||• Laboratories||• Environmental Services|
A variety of contracts exist for additional support services including: Hemodialysis (acute inpatient), Home Care Services, supplemental staffing agencies, etc.
Recognized Standards/Practice Guidelines
Nursing Care Services are provided according to the Joint Commission Accreditation Manual for Hospital, American Osteopathic Association regulations and New York State Department of Health Article 28 Guidelines. The Generic Standards Manual outlines standards of process, structure and care, policies, procedures and guidelines for Department of Nursing. Other departmental manuals, including diet and nutrition, fire/safety and disaster, administrative policy and procedure, pharmacy formulary, laboratory, etc., are available as references and resource material for the Department of Nursing.
In addition, practice guidelines of professional nursing organizations such as the American Association of Critical Care Nursing (AACN), Emergency Nurses’ Association (ENA), American Women’s Health Organization and Neonatal Nursing (AWHON/NN) and Neonatal Nursing Association, Academy of Pediatrics Neonatal Board (Nursing guidelines) and the American Operating Room Nurses’ Association (AORN), among others, are referenced, when appropriate, for standard of care development.
The Emergency Department utilizes the New York City Regional Emergency Department Revised Sixth (6th) Edition Standards.
The Performance Improvement Program for the Department of Nursing is developed in accordance with the mission statement. Components of the P.I. Program include the development of protocols, monitoring of practice, identification and resolution of problems and identification of opportunities for performance improvement. The Nursing P.I. Committee monitors and evaluates the quality and appropriateness of patient care and practice in all aspects of patient care within the Department of Nursing. The P.I. Plan is “unit-based”, wherein fundamental P.I. issues are unit-generated and problem resolution is sought utilizing the P.I. process of Find it, Fix it, Check it. Each unit conducts P.I. activities that interface with the Nursing Department Plan, related to the scope of care specific to the individual unit or area.
Margaret Pelkowski, RN, MSN
Vice President of Nursing
Tel: (718) 963-7181 or 7182
Fax: (718) 821-2497