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ENT, Plastics, Urology & Oral Surgery Spotlight

Each month UAB Medicine spotlights a nursing unit to offer an understanding of each unit’s purpose and to recognize the dedication and good work of our care teams. This month we spoke with nurse manager Karen Harris about P7 (ENT, Plastics, Urology, and Oral Surgery).

Total staff: 35 Nurses, 10 PCTs

Nurse/Patient ratio: 1:4-5 acute floor; 1:2-3 step down

Number of beds: 29

Patient population: post-surgical mixed acuity, stepdown and acute care patients

Purpose of the unit: Facial or breast reconstruction for cancer patients, functional plastics, urology, post-trauma, oral surgery and head and neck cancer

Tell us about the purpose of your unit.

We have a mixed acuity post-surgical patient population. We provide care for reconstructive surgery for cancer patients, post trauma, and functional plastics, which is done to restore functionality to the portion of the body being reconstructed. Maybe a patient has lost an appendage in an industrial accident, perhaps a cancer patient needs facial reconstruction, or another has had orthopedic surgery after a motorcycle accident and now requires skin grafts. We are trying to put patients back together, you might say.

How would you describe the unique features of this unit?

One defining aspect is the range of patients we care for. After cancer surgery, ENT and/or plastics might make a nose, jaw, or ear for a patient who has gone through a long process of cancer treatment, or maybe a patient has suffered life-changing trauma in an accident. Caring for them requires not just technical skills but also a sensitivity to the psychological trauma their condition may cause. Each day our team will face a variety circumstances. On a regular day we will have ten patients with a tracheotomy, on average. Those patients can’t speak, so we are on high alert all the time. Unlike the ICU, we have these patients in their beds behind closed doors, so you can’t see everyone through the glass. Patients also move quickly; most are here just under four days, and we get between 10 and 15 admissions per day. Turning patients that fast and getting it right is a challenge for our nurses, but they do an amazing job. In our unit, we tell our new nurses that if you can do this, you can do anything. It’s a perfect place for them to get an excellent foundation and build their skills.

Give us some background about your staff.  

First, I have to say that they all make it so easy to do my job. They are high performing and very competitive. It’s important that everyone who comes to our unit is a good fit, so the staff are involved in the selection process. Seven of the team members have been here 30 years, retired, and come back to work with us. They have a genuine love of nursing and they also truly care for this particular patient population. This makes for a fantastic, close working relationship with our physician colleagues. It’s a real partnership with the 40 attending physicians plus resident staff assigned to this floor. These relationships have been built over years. It’s an environment of teaching, sharing, and open communication. We do an ENT conference each year, attending physicians come to some of our staff meetings. There’s a dialogue in which everyone is comfortable saying “I need this;” “We aren’t getting that;” “Here’s something new we would like to do,” because communication gets more comfortable with time, of course, but now it’s part of the environment. Our nurses are in a great position to build leadership skills, join professional organizations, publish, and give presentations at conferences or speak to groups. We have several Clinical Excellence Award Winners. We have new grads who will be here a couple of years while they finish graduate school. Our nurses go on to be NPs or CRNAs, travel nurses,  and work in the IC,  ER, or the OR procedure areas. A number of them go over to the clinic in leadership positions.

Is there a particular day or event that stands out for this unit?

There was a particular Friday on one hall when we had four code blues, all before lunch. It seemed like just as we would get one patient stabilized another would code. I was so impressed by the professionalism, the expertise, and the teamwork of the physicians and nurses, our pharmacists, techs, secretaries, the entire team that day.

What do you find most rewarding about managing this unit?

We have a policy of making an extra effort to ensure that patients feel we have selected them for special care, because it’s so easy to get the impression that they are just being guided through a big, complex system at random, and have not been seen as individuals. I have noticed that our team pays close attention to that. Also, with the patient population we have, with a certain number of them we are lucky that we get to build relationships. Many of our patients come back to the unit several times along their cancer journey, so we look at the admission board, and someone says “Oh, Mrs. Smith is back. Let’s make sure we say hello to her and her family.” Our nurses do this even if someone is not their patient for that visit. We see these folks we have cared for looking better, feeling better, and that’s a reward for all of our team members. I’m extremely proud of our group, because the work they do is extraordinary.