The day began with a sense of anticipation for a group of new graduate resident nurses at University of Colorado Hospital. They couldn’t have anticipated the way the day developed.
The group, numbering 51, arrived at the hospital on Aug. 27 dressed up for a ceremony to mark the completion of their one-year residency program. They would soon be headed back to their units to don scrubs and pitch in to help the hospital deal with a capacity crunch.
An early look at the day showed that unless the hospital expedited discharges, the day would end with 25 patients waiting for beds, said Cathy Ehrenfeucht, RN, MS, the hospital’s vice president of nursing and associate chief nursing officer.
That meant all hands on deck, including the nurses ready for a graduation celebration, said Ehrenfeucht. They left the orderly ceremony for the controlled chaos of their packed units, hurriedly pulling off high heels and dress shoes in preparation for short shifts to fill staffing gaps.
“We thought they were joking when they told us originally,” said one of the grads, Ashley Mill, RN, who works on the Medical Intensive Care Unit (MICU).
It was a less than ideal but unavoidable situation, Ehrenfeucht said.
“Plan D is an emergency situation that requires everyone to be available,” she said. The hospital set up a command center, and all members of management cleared their schedules of meetings to ensure they were available to meet the capacity challenge, she added. “Our main goal was to ensure patients were being cared for and that units had help if it was needed.”
The extra help from the nurse grads helped to ease a difficult situation, said Roxanne LaRochelle, RN, associate nurse manager on the Surgical/Trauma Intensive Care Unit (STICU), where all 24 beds were filled. New grads Suvi Caton, RN, and Loren Peterson, RN, simply got into their scrubs and asked LaRochelle and the unit charge nurse what jobs needed to be done and how they could help. Both filled in for a couple of hours. Kailyn Hinrichsen, RN, went home to get a couple of hours of rest before returning to work a full 12-hour shift, LaRochelle said.
“We saw the new grads as an asset,” LaRochelle said, noting the STICU played a “waiting game,” as the charge nurse worked with hospital managers and patient placement coordinators to move the unit’s patients one at a time to med/surg floors as beds opened up.
Whatever it takes
The new grads were flexible as they filled in on an emergency basis. On the MICU, Mill and fellow grad Traci Priebe, RN, pulled on shoes suitable for working that they found in the unit’s locker room, said Associate Nurse Manager Amy Hassell, RN. Mill, sockless for the completion ceremony, slipped on a pair used for patients. They assisted another nurse in intubating and documenting meds and other care for a patient during their short shifts, Hassell added.
Mill said she stayed to help for three or four hours on a day that wouldn’t have been unusual if she’d been scheduled for a normal shift. “Our unit is nearly always full and very busy anyway,” she said.
The need for extra hands was evident on the Medical Surgical Progressive Care Unit (MSPCU), where residents Julie Iverson, RN, and Jake Knarr, RN, helped to care for patients so other nurses could speed the discharges and transfers of 10 patients, said the unit’s nurse educator, Amanda “Max” Swedhin, RN, CMSRN. Iverson had worked the night before, but helped with two patient discharges before MSPCU Nurse Manager Justin Oeth, RN, sent her home to rest.
The MSPCU received an added boost from Caitlin Bittinger, RN, a new grad from the BMT Unit, who had previously worked on the MSPCU as an advanced care partner. Bittinger, “dressed to the nines in fancy shoes,” as Swedhin put it, helped her MSPCU colleagues care for a patient with an unfamiliar drain.
With the announcement of the ceremony cancellation, Shelbi Moll, RN, headed for the ED in her high heels, changed into clogs she’d stashed in a locker and put on her greens. She checked in with her charge nurse, Julie Tollefson, RN, then spent the next several hours as a float, helping to care for patients and transport others when beds opened up on the units upstairs.
The difficult situation left little time to acknowledge the efforts of the nurses, but several units tipped their collective hats. As thanks for the extra help, the MSPCU provided cake and drinks to “celebrate the accomplishments” of the new grads, Swedhin said. The MICU ordered a pizza and staged a “mini-celebration” in the break room, Mill reported, adding that she and Priebe each received a card and flowers.
In the ED, Moll and Ashley Grablin, RN, received cacti and congratulatory cards from the unit’s leadership and positive reviews of their work, said Brandi Schimpf, RN, CEN, now manager of the Mobile Stroke Unit Program. ED leaders also placed Moll’s and Grablin’s evidence-based projects in the staff break room for display, Schimpf said.
Still, Ehrenfeucht said the disappointment caused by the cancellation was “totally understandable,” particularly as it meant sacrificing presentation of the nurses’ evidence-based projects, the capstones of their one-year residencies. Moll, whose project studied sedation of intubated patients in the ED, said she had looked forward to presenting it, particularly with her mother, Cindy Taylor-Moll, RN, a nurse who has worked at UCH for 18 years, looking on.
“I know she was going to be proud to see me finish my first year as a nurse and follow in her footsteps,” Moll said. The timing of the Plan D was a difficult pill to swallow, but she was gratified by words of thanks from her colleagues.
“Many of them were sympathetic,” she said. “They knew how hard we all were working.”
“It was definitely disappointing because we had worked hard the whole year and were looking forward to the ceremony,” Mill said. “The cancellation shocked everyone, but I understood why they did it.”
Ultimately, the new grads were one part of a broad effort that allowed the hospital to call off the Plan D at about 5 p.m. on the 27th, Ehrenfeucht said. “I look at them as heroes that day,” she said.
“It takes a lot of teamwork to get through a capacity issue, including the primary and charge nurses, the hospital managers, and the command center,” LaRochelle added. “I’m proud of our new grad nurses for understanding the need we had that day.”