Ambulatory Nursing Surge Staffing Plan - Advocate …...2020/04/10 · Ambulatory Nursing Surge...

1Level Escalation ELT Summary | March 23, 2020 | Draft, for discussion purposes only

April 10, 2020 | Suzanne Weiss, Cindy Nordstrom, Megan Glenn

Ambulatory Nursing Surge Staffing Plan

Created by Megan Glenn, Cindy Nordstrom, Sue Weiss| Created 4/10/2020 | Approved by Sharon Quinlan


Objectives

• Understanding Duty to Care and need for surge staffing

• Identify strategies to continue providing safe patient care with Lean staff

• Apply considerations for redeployment

• Completion/Utilization of Reassignment Spreadsheet

• Understanding of Surge Orientation Support Training (S.O.S.)

• Identify Steps for Call to Action

• Review Available Resources


Duty to CareEthical responsibility during a pandemic

Assume new responsibilities


Ambulatory Nursing Surge Staffing

Surge Level 1Internal surge management

Identify, redeploy and train clinic staff to support Clinical Contact Centers:• Triage trained or triage-ready RNs that have been identified by clinic leadership for deployment to the

Contact Centers – in process • Utilize furloughed and zero hour nurses who are triage trained or triage-ready • Secure contingent labor - Gary Weller, Contingent Labor Director has potential sources• Daytime support to CCCS by in-clinic nurses as time allows - minimizes disruption to clinic ops• Recruit trained nurses for extra shifts.

Surge Level 2Identify non-

essential RNs for deployment to inpatient care

Deploy non-essential and furloughed RNs to support inpatient care demands• Identify furloughed RNs for deployment to inpatient care

• Clinic closures• Decreased clinic volume/workload demands

• Identify essential/non-essential RNs for deployment to inpatient care• Identify RNs with risk factors precluding direct care – deploy to other areas of need

Surge Level 3Critical inpatient

RN needs

Deploy ambulatory nurses to meet critical inpatient care needs by prioritizing essential RN duties to free up more RNs for inpatient care• Essential/Non-essential RN duties (see appendix)• Centralization and consolidation of services• Reduction in frequency of routine follow-up and monitoring • Reorganization of RN activities to other people


Guiding Principles for Surge Staffing• Remain at Pandemic Level 3 and not advance to Pandemic Level 4

• Critically evaluate staffing needs at the clinic level

• Identify and prepare team members for redeployment

• Guide for use – may not be all inclusive


Strategies for Safe Patient Care


Essential Duties

RN LPN/MAAnticoagulation Immunizations

Urgent Care Staffing Other injections in face-to-face visits

TCM Calls Prescription Refills

Follow-up w/High Risk Population Rooming for face-to-face visits

Holter/Pacemaker Checks Support core clinic functions

Urgent/Emergent Procedure Support

Cancer Infusion

Triage


Non-Essential RN DutiesRe-assign Duty To:

Re-scheduling/cancelling of special procedures PSR or MA

Medication Management• Med titration

Physician/APC

Medication Administration• Depo-provera

MA w/physician/APC

Medication Refills MA w/physician/APC support

Forms• Work excuse• FMLA• Prior authorization

MA w/physician/APC support

Annual Medicare Wellness Visits Delay scheduling


Possible “Lean” solutions

• Regionalize resources

o One specialty/primary care RN covers for a group of clinics

• Supervisors and Lead RNs replace RNs

o Evaluate impact on other leadership responsibilities

• Virtual care framework reduces RN workload demands

o More efficient to have clinician handle the visit comprehensively

• Consider moving triage to the clinical contact center (in WI)

• Move TCM and other high risk population calls to Enterprise Population Health

• Consider reduction in frequency of device checks for stable population

• Transfer diabetes education to endocrinology department


Possible “Lean” Solutions (cont)• Consolidate clinical services to consolidate staffing

• Transfer LPN duties to MAs

• Hold on non-essential work

• Paperwork (i.e. handicap sticker, school forms, etc.)

• Routine labs delayed

• Rooming process completed by provider during virtual visits (may be more

efficient by preventing transferring patient)

• For MAs who are cross-trained, assume PSR/MA role to free PSR

• Hold on non-essential services, e.g. school forms, handicap parking, non-

urgent routine lab orders


Identifying Team Members for Reassignment

Wisconsin

Accountable Leader: Sr Director Administrator or Designee

1. Identify leader for Ambulatory Site Labor Command role (WI)/geographic region

• Send designee(s) to [email protected]

2. Access Google Document (tip sheet provided)

3. Populate Reassignment Spreadsheet by noon on Monday, 4/13 (tip sheet provided)

• Identify team members needed for essential clinic duties (non-reassignable)

• Identify re-assignable team members

• Identify team members already reassigned

** Illinois process completed by Jenna Elmore


Surge Staffing Intake Survey

Wisconsin and Illinois

Accountable: Clinic Site Leadership

1. Survey to identify team member clinical experience/skills and preferred geographic location

• Used to match skills/experience with reassignment

• Will be required of all team members

2. Utilize communication template to send survey to team members

• Reinforce in Huddles/team meetings

• Survey link and QR code to be provided

• Time to complete: < 2 minutes

• Completion by 5:00pm on Monday, 4/13

3. Information gathered will be populated into Reassignment Spreadsheets


Consideration for Reassignment


Eligibility for RN Reassignment

• Recent hospital experience (5 yrs)

• Recent RN grads

• Any hospital experience

• Experience as clinical instructors


Eligibility for MA and LPN Reassignment

• In nursing school

• Recent long term care experience (LPN)

• Prior experience as CNA (MA)

• Recent inpatient experience

• Any inpatient experience


Preparation for Reassignment

• Free team members for longer blocks of time

• Allows for training/orientation for reassignment

• Complete SOS training

• Furloughed team members due to low clinic volume/closure


Surge Orientation Support Training


SOS (Surge Orientation Support) Training

Anticipate reassignments for team members

Complete training according to:

• most recent background/skills

• their reassignment unit

Coordinated effort between clinic and hospital leadership

SOS tools available on COVID-19 Information Center

• Nursing Resources

• Orientation and Onboarding


Licensed Practice Nurse: Eligible Activities with Redeployment

• Pass oral meds

• Collect patient history/admission information

• Report patient changes to the RN

• Vital signs including BP, P, R, T, weight, Pulse Ox

• POCT, specimen collection (urines)

• Dressing changes

• Catheter insertion (depending on existing competency)

• Assist with tests and procedures (ECG, peak flow, spirometry)

• Personal care

• Sitter

• Trach care and suctioning


Medical Assistant: Eligible Activities Immediately with Redeployment

▪ Vital signs including BP, P, R, T, weight, pulse ox

▪ POCT (glucose, INR) and specimen collection

▪ Personal care

▪ 12 lead ECG

▪ Procedures (peak flow, spirometry)

▪ Oxygen

▪ Patient transport

▪ Clerical duties

▪ Runner


Medical Assistant: Eligible Activities with Redeployment Requiring Training/ Preparation

• Patient repositioning

• Ambulation

• Patient transfer to and from bed

• Toileting

• Sitter

• Intake and Output

• Drains

• Meal delivery and set up


Call to ActionIllinois Wisconsin

Jenna Elmore, Ambulatory Labor Pool Leader

Identify an Ambulatory Labor Pool Leader for each geographical area

Populate Reassignment Spreadsheet Populate Reassignment Spreadsheet

Ensure completion of Surge Staffing Intake survey

Ensure completion of Surge Staffing Intake survey

Plan to implement SOS training Plan to implement SOS training

Communicate reassignment plan with physicians/APCs and team members

Communicate reassignment plan with physicians/APCs and team members


RESOURCESCOVID 19 Information Center

• Team member resources• PPE• SOS training• Ambulatory Nursing Surge Staffing Plan webinar & presentation• Duty to Care• Human Resources COVID-19 Pay Practices

Tip sheet for Populating the Reassignment Spreadsheet

Google Docs tip sheet

Surge Staffing Intake Survey link and QR code

Survey Communication Template

Questions:• WI: [email protected]• IL Reassignment: [email protected]• IL SOS: [email protected]

mailto:[email protected]



Ambulatory Nursing Surge Staffing Plan - Advocate …...2020/04/10 · Ambulatory Nursing Surge...

Documents

Transcript of Ambulatory Nursing Surge Staffing Plan - Advocate …...2020/04/10 · Ambulatory Nursing Surge...