Waukesha Memorial Hospital is a community-based not-for-profit clinic located near Downtown Waukesha, Wisconsin. A healthcare facility was formerly founded in 1914 and relocated to its current location in 1930 after acquiring sponsorship through the neighborhood Kiwanis Club. A healthcare facility has now cultivated to over 300 inpatient beds and uses over 2, 700 staff members. A healthcare facility is part of a more substantial healthcare network known as ProHealth Treatment. ProHealth Care was created in 1998 when the Waukesha Hospital System and Oconomowoc Medical center joined forces. The organization is now comprised of 26 primary care and attention clinics, home health care, inpatient and home hospice services, long-term attention, senior residency areas, and a health center (Waukesha Region, 2010).
ProHealth Care has generated a worldview for an optimum curing community which includes their mission, eye-sight, and value affirmation. The mission of the organization is to "promote and deliver incredible healthcare in the communities it serves". The vision is to "continue to be the provider of preference in the market segments they serve as an maximum healing community recognized by high-quality, cost-effective good care and excellent service within an environment of protection, admiration, and compassion". The business values a reply of superiority service, admiration, and compassion. The mission, vision, and principles influence four tactical secrets to the organization's arrange for success: Value Proposition, Medical doctor Development and Relations, Employee Brilliance, and Collaboration with Patients and the city (ProHealth Good care, 2010). The espoused theory of the organization is that the influences of the mission, vision, and principles on the proper planning will create an optimal therapeutic community. The idea in action is apparently congruent with the espoused theory as Waukesha Memorial Clinic was called one of the top 100 private hospitals in this year's 2009 Thomson Reuters Health System Standard Research. Winners of the honor got better patient effects and fewer issues, fewer safety problems, and higher patient satisfaction rates than their peers (Thomson Reuters, 2010).
The management of Waukesha Memorial Hospital is structured into a specialist bureaucratic design. A Mintzberg style of the organizational composition can be found on web page 4. In the microsystem of a healthcare facility, there are extensive subsystems. Subsystems are grouped jointly in another of specialty areas: Medical Personnel Excellence, Clinical Brilliance, Operational Excellence, Patient Experience, or Environment. Each of these categories has a Main Operating Exec who then records to the Chief executive/CEO of a healthcare facility. Skills of specialists are standardized throughout the complete system; however, each subsystem functions relatively independently of the other subsystems of their category. The effectiveness of the support personnel in each subsystem creates the main of operating experts (as shown in the Mintzberg diagram). The techno-structure is present around the outside of the operating key; however, it does not have a solid effect on the core leadership.
The Waukesha Memorial Medical center system is affected by several regulatory companies including JCAHO (Joint Payment on Accreditation of Professional medical Organizations), CMS (Centers for Medicare & Medicaid Services), and the Wisconsin DHS (Condition of Wisconsin Division of Health Services). Accreditation of the system is obtained through JCAHO after an on-site evaluation/survey of the machine is completed. Studies happen every 18-39 months. During the study, a healthcare facility is assessed on compliance of specific criteria dependant on JCAHO for that accreditation time. These standards are driven to ensure that patients
receive attention in a safe and secure environment. While accreditation is not required for a hospital to be in procedure, there are benefits to accreditation through JCAHO; mainly it is required by CMS to be eligible for Medicare reimbursement (The Joint Commission, (2010).
CMS influences the system by determining which services provided by a healthcare facility meet the criteria for reimbursement through Medicare and Medicaid. CMS dictates key patient care methods by which a healthcare facility is expected to perform. If these goals are not met and there is not supporting documentation stating why the target wasn't satisfied, CMS may withhold reimbursement for servings of the hospital's billing. CMS also packages standards of attention that will no longer allow reimbursement for certain complications of the medical center stay, i. e. acquisition of a pressure ulcer or hospital-acquired contamination. Therefore, all services rendered in these circumstances must be payed for by a healthcare facility system. It has forced a healthcare facility system to initiate preventative and ambitious steps to ensure an increased level quality of treatment to all or any patients.
The Condition DHS Department of Quality Guarantee also influences the machine by developing rules and requirements for the improvement of quality of patient care and attention. Condition licensure and federal recognition are obtained through the DHS and required for procedure of the serious care center. Like JHACO, the DHS also works on-site studies to ensure patient safe practices and/or investigate any complaints resistant to the facility (Wisconsin Team of Health Services, 2008). The system in addition has been damaged by legislation at the local level. For quite some time, a competition system attempted to move into ProHealth's market area. Local municipalities transferred legislation that temporarily kept the competition from the area, but eventually, the competitor was permitted to build an serious care hospital within several miles of any ProHealth acute treatment system.
Waukesha Memorial Clinic is also influenced by other specialty and/or professional organizations. Involvement with an outside organization is normally determined by each category/subsystem within a healthcare facility system. For instance, the category Clinical Quality is affected by the American Nurses Connection and Wisconsin Nurses Connection. Nurses within a healthcare facility system may choose to become active participants in these societies to join forces to be able to influence healthcare related legislation and its own results on patients and nursing personnel. Within the subsystems categorized for Clinical Brilliance, the ICU is involved with the American Heart Association, the American Association of Critical-Care Nurses, etc, whereas the OR is associated with the Association of Perioperative Nurses. These nursing organizations help create higher requirements of care within their area of expertise area, promote continuing education to nurses, and offer recognition for nurses of their area of expertise. Nurses at Waukesha Memorial Medical center are encouraged to become professional in their area of work as a healthcare facility seeks to use for Magnet Status from the American Nurses Credentialing Center. Achieving Magnet Status testifies that the hospital demonstrates brilliance in nursing good care. Among the requirements for program for the documentation is a certain ratio of nurses within the organization pass a documentation exam of their area of care (med/surg, critical good care, etc).
The hospital system in addition has created partnerships with several community organizations such as the Kiwanis Club, the United Way and the Waukesha Memorial Basis. These partnerships promote the entire well-being of the community and a respectable general public image for the hospital. In a very now more competitive market, Waukesha Memorial's extended commitment to the city has helped maintain the public's devotion to the business.
The community bordering Waukesha Memorial provides a diverse payer-mix for services rendered, however, exact figures could not be found. A healthcare facility functions patients with private insurance, no insurance or governmental coverage (Medicare/Medicaid). No person is denied hospital care based on failure to pay. A healthcare facility does budget a substantial amount of funds annual to help cover costs to those who are uninsured and struggling to pay, however, the cost is not able to be deferred for all patients within these situations. While this patient group may acquire needed care, the price can be unbearable, forcing they to forego needed treatments. This negatively effects the community, so that it is more ill, fiscally strained, and under duress. As part of the strategic initiatives establish by a healthcare facility for 2010 2010, patient education and health campaign ideas were initiated to help reduce preventable medical center admissions and continue activity toward an optimal recovery community.
In days gone by calendar year, Waukesha Memorial Medical center has considered adding an Acute Treatment Nurse Practitioner role in the management of patients in the Intensive Attention Unit (ICU). Currently there is certainly one advanced practice nurse (APN) role given to the ICU and this individual functions as the unit Nurse Educator. As opposed to the Nurse Educator, the addition of the Acute Good care Nurse Specialist (ACNP) role would place the APN at the bedside. The role of the ACNP within the ICU would concentrate on direct patient care. This would include but is not limited to daily patient attention rounds, interdisciplinary patient rounds, family/patient conferences, ventilator management, and endotracheal pipe and vascular catheter placements. The ACNP would also be dependable to ensure that evidenced-based tactics are preserved within the unit's criteria of attention.
The ACNP in the ICU at Waukesha Memorial would be asked to maintain state licensure as a rn, documentation in critical health care through the North american Relationship of Critical Good care Nurses, and recognition as an ACNP-BC through the American Nurses Credentialing Centre. The ACNP would function within the ICU subsystem of the Clinical Excellence Category of the Command Organizational Chart. Key organizational human relationships would have to exist between the ACNP and the ICU director and director, the WMH Intensivist medical professional group, and the Performance Improvement medical committees within the ICU. Collaboration with staff nurses, nurse specialists, and interdisciplinary team members would be necessary to ensure quality, efficient, and safe patient care and attention. Nursing collaboration would include the Diabetes Nurse Specialist, the Heart stroke Nurse Coordinator, the problem Control Nurse, the Nurse Good care Coordinator/Discharge Planner, and the unit Nurse Educator. Collaboration with the Diabetic NP is vital as many patients in the ICU suffer from hyperglycemia which can inhibit recovery and promote disease. The Stroke Planner is vital to the ICU of your Primary Stroke Center (certified by JCAHO) and with cooperation brings best practice to the individual suffering from stroke. Partnership with the Infection Control Nurse will reduce rates of hospital-acquired microbe infections which will happen in the ICU. Alliance with the Nursing Care Coordinator allows for improved upon patient/family satisfaction in the emotional and spiritual areas of disorder. Finally, teamwork with the ICU Nurse Educator ensures advanced education of staff nurses and therefore improving treatment of the individual at the bedside.
Adding an ACNP role to the ICU collaborative team has the potential to greatly improve the ICU environment and patient results. Within an article printed by Kleinpell, Ely, and Grabenkort in 2008, studies completed on the utilization of ACNPs within an ICU demonstrate that the ACNP enhances cooperation and communication within the unit between medical, medical, interdisciplinary, and support staff. Patient management by ACNPs within the ICU shows to diminish overall span stay, times on mechanical ventilation, and total cost of care for the ICU patient. ACNPs will stick to best practice suggestions and ensure their implementation at the bedside. The increased autonomy of the ACNP permits a holistic, patient-centered care procedure over a far more curative care methodology often provided by your physician or physician's assistant. This approach has been proven to increase patient's satisfaction with their medical center stay. These studies validate the strengths of the ACNP role within the ICU.
The weakness of the ACNP role within the ICU is the extended lack of understanding of the role by the medical team, by patients, and by the city. There is still confusion regarding what an ACNP is and what they can do and what an ACNP is not and what they cannot do. It is up to the Advanced Practice Nursing community to continue to teach their peers, patients, and neighborhoods about the benefit of their role in the collaborative health team.