North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742Areas such as ECC also have an Associate Clinical Charge Nurse to support shiftmanagement in acute, changeable situations.There are a number of nursing positions with responsibility for the training, supportand professional development of nurses. These include 11 Clinical Nurse Educatorsand 33 Clinical Nurse Specialists in North Shore Hospital‘s Adult Health Service, andClinical Coaches who, since 2006, have particularly supported new graduate nurses inECC and other departments.Experienced enrolled nurses known as Accomplished Enrolled Nurses work inassociation with the registered nurses rather than under their direct supervision.Bureau nurses are usually DHB employed casual staff rather than agency nurses andtherefore their supervision and accountability is the same as for permanent nursingstaff.Team nursingIn 2007, only ECC formally used team nursing. 25 This involves nurses with differentlevels of experience and seniority working as a team instead of being individuallyresponsible for specific patients. Under this model, a nominated team leader hasoverall responsibility for all the patients in the area and prioritises and directs the careprovided by the various nurses. Waitemata DHB explains that this means care isprovided ―by the right nurse so that care is done by the right person at the right time toachieve the right outcome for the patients‖.In ECC the model applies primarily to the 25 cubicle Acute Zone where the nurses aredivided into two areas — north and south — with one of the nurses in each groupidentified as team leader for each shift. They are expected to communicate to ensurethat care is provided as required, especially when there are less experienced nursesworking. In other areas in ECC the nursing teams have a senior nurse as team leader.ECC patients‘ care needs are tracked on whiteboards. During a shift, regular caseconferencing with all the team members is the means by which the delivery of care isco-ordinated and re-prioritised, and plans of care reviewed.In 2007, medical wards 10 and 11 did not have team nursing and instead used theindividual patient allocation model.North Shore Early Warning System (NEWS)In April 2006 Waitemata DHB introduced a scoring system (rolled out at North ShoreHospital over six months) to help staff to more quickly recognise when a patient isdeteriorating on the wards and to reduce delays in referring these patients to ICU.Known as NEWS, it relies on the accurate recording of simple physiologicalvariables, such as heart rate, blood pressure, respiratory rate, neurological status,oxygen saturation, and urine output. There are various triggers that signal the need forfurther action. For instance, all patients with a score equal to, or greater than, 1 must25 It is now used more widely across North Shore Hospital.April 2009 13