Moving into a new facility results in process improvements for the MICU
TEAM: MICU staff
ENTRY SUBMITTED BY: Ruben Castillo, MSN, RN, CCRN, manager, MICU
In December 2015, UT Southwestern Medical Center opened the brand-new William P. Clements Jr. University Hospital. A year has transpired since our organization moved into this larger, high-tech facility. Adapting to changes in our new environment was imperative as the medical intensive care unit (MICU) staff transitioned into our new home.
The MICU nurses experienced the transitional growing pains that can be difficult for teams to adapt to, but presented out-of-the-box options to address the unit’s management needs. Prior to the move, the MICU and the surgical intensive care unit (SICU) had been one combined entity.
Upon moving into the new building, MICU and SICU were split into separate units, dividing team members who had previously worked together. The SICU manager transitioned to become the new manager of MICU; while an assistant nurse manager was placed into the MICU manager’s position. Another assistant nurse manager took on the role of interim manager in SICU, and a MICU RN stepped into an interim assistant nurse manger’s position. Plans were made to hire 3 more assistant nurse managers, for a total of 5.
Whenever there are changes in environment, work flow, layout or personnel, it can be a catalyst for growth. By partnering with upper leadership and developing mentors, the new management roles offered the duel benefit of an administrative presence in MICU and training for the newly promoted management team. The adaptability of the MICU team to transition into official leadership roles when the need arose promoted an environment of trust among a staff whose routine consisted of constant change. By meeting the unit needs from within the organization, MICU staff was given a voice by which to express their concerns and needs.
With a new leadership team in place, the focus transferred to three concerns: supplies, staff retention and nurse satisfaction. Due to the new layout of the building, the storage and delivery of supplies was in a state of constant modification.
The rapid patient growth at the new facility led to the influx of new and contract staff. The MICU grew from 60 staff members to 93. Overall, this brought stability to the two units by having experienced personnel available; however, it required that experienced and new staff adapt to a new culture.
In order to adapt to the new culture of staff growth, unit and organizational involvement, and improving nurse satisfaction, the MICU management focused on high performers within the unit in order to learn about the staffs’ needs. The feedback obtained from these staff members focused on availability of equipment and supplies, flexibility with staff scheduling, increasing staff hires, and their expectations for the leadership team.
Once information was collected, monthly staff meetings became a forum to discuss these subjects. Areas of improvement were identified; and leadership and staff worked to develop changes, secure the staff members’ buy-in, implement changes, and perform follow-up. The adaptability of the MICU team over the past year has led to MICU having the highest staff unit.
Hiring new nurses gave us the wherewithal to take on new challenges. The MICU created a “skills fair” that was so successful, other departments and units requested that their staff attend for educational purposes. An “events and volunteer” subcommittee was formed to focus on involvement of both staff and community members.
The MICU staff formed task forces to focus on the issues of central-line associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), with the goal of reducing both. We formed a nurse practice council and a nurse residency council.
Our efforts had a positive, lasting impact. We increased our clinical ladder participation, increased our staff members’ certifications, and positively impacted our National Database of Nursing Quality Indicators (NDNQI) score.
Taking a team approach to the new challenges we faced forced the MICU team at UT Southwestern Medical Center’s William P. Clements Jr. University Hospital to be creative in developing a structure to fit the needs of our new environment and patient population. Our unit’s adaptability led to one success after another following our transition into the new facility.