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On a New Unit, Nursing Practice Diverges



Kathy Williams, NP, left, and nurse manager Eleni Doukakis on the hospitalist service.
For nursing staff, the routine will not be business as usual on the general medicine unit that is set to debut this month on Jefferson 2. For one thing, there will be no more calls to one of the four Osler firms, or to Nelson 4 or 5, or to the nurse practitioners on Halsted 5, to report problems. And, there will be no more waiting for orders while the resident checks with the attending on call. In fact-and here's a first for this teaching hospital-there will be no residents.

That's because this is the hospitalist unit. Here, four attending physicians will provide total care without house staff coverage. Unlike internists who traditionally see their hospitalized patients before or after clinic hours, or on a rotation of shared coverage, these board-certified internists make care in the hospital their prime focus.

Nurses can benefit because they will be practicing with experienced physicians. And they can all but forget those phone calls: The hospitalists' offices are right on the unit. A head in the door may be all that's required.

Experienced nurses from Halsted, Osler and Nelson will staff the unit for several months until new hires are in place. Nurse manager Eleni Doukakis envisions a highly skilled nursing staff that will play a part in decision making. Nurses will round right along with the physicians, as they do in the coronary care unit, where Doukakis practiced for six years. "With group rounds, nurses will be able to participate and hear the plan of care. This will win back lots of autonomy for the staff."

Nurses will care for patients with a variety of ailments, including pneumonia, GI-, HIV- and cancer-related problems, new-onset diabetes, hemotologic disorders and more. Monthly educational programs will aid nursing staff. "This will be a place where nurses can learn," says Kathy Williams.

Williams, who is the nurse practitioner on the hospitalist service, can do practically everything a resident can do. "But I think of myself as an advanced practice nurse who can work collaboratively with physicians," she says. "These doctors have far more training than I do. Because of my experience at the bedside, I like to look at the big picture. So I might think about social or rehab needs, and not just one hip fracture."

The hospitalist service was actually launched last fall. With no dedicated unit in place, patients were admitted throughout the house, from Meyer to Weinberg. At the time, few on the wards knew exactly what it was. What did it mean, that word hospitalist, posted on a patient's chart? Hospice? Hospital list? It was Williams, an 18-year veteran Hopkins nurse, who used her extensive network to help define the program. "Kathy has come to represent the liaison between nursing care and the doctors on the service," says Doukakis.

Like the hospitalist program that has been in place at Johns Hopkins Bayview Medical Center for six years (see article, page 5), the service at Hopkins Hospital was created in part because it made good business sense. It was viewed as a way to increase patient volumes without overloading house staff. Since care would be provided by physicians savvy in the ways of hospital routines, stays could be shortened, costs cut. It would ease the admitting process for community physicians and expand the referral base.

The service will be consolidated on the one, 10-bed unit on Jefferson 2 on May 7. Plans call for an expansion to 20 beds. With one service and one group of the same attending physicians, nurses will find themselves practicing as part of a cohesive force, Williams predicts. "Nurses will have a chance to build relationships and get a real sense of a team at work."

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