Case Study Application

The nursing team on the orthopedic unit has been struggling to adapt to the changes the unit has undergone in the last 4 months. The average age of the six experienced nurses on the unit is 52 years old, while at the other end of the spectrum, five newly graduated RNs have been hired in the last 18 months.

After renovations, the 30-bed orthopedic unit opened a new 6-bed trauma step-down unit for patients transitioning from intensive care (ICU) onto the orthopedic unit. Patients transferred to the step-down unit require a greater intensity of care than is available on the orthopedic unit and have need of vigilant observation due to their high potential for becoming unstable. The nurses implemented a new electronic tool, a hybrid of the ICU and orthopedic assessment tools, to capture the data collected from these patients. There have been ongoing issues with integrating this tool into the electronic health record.

All staff started new rotations to accommodate the higher levels of RN monitoring required for the trauma step-down patients. At the same time, RN hours for the 30 orthopedic beds were reduced and additional LPN and care aide support staff were hired. The nurses are concerned about the lower RN-patient ratio for the orthopedic beds and feel overwhelmed when they are designated charge nurse during evening and night hours.

Four weeks after the step-down unit opened, the unit manager departed due to a serious health issue and an interim unit manager was instated. She immediately identified a problem with the availability of equipment in the step-down rooms and altered the layout for improved accessibility. She also noted inconsistency with step-down unit documentation and is requiring all RNs to attend an education session to improve electronic documentation consistency.

There has been a spike in absenteeism this week and the staff’s energy level seems very low.

• What actions can the interim unit manager take immediately to stabilize her unit and address staff change fatigue?

• What approaches could be used to resolve current issues or prepare for future changes? i.e. initiating pandemic protocols