PrintVila Health Human Resources· Introduction· Emergenc

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Vila Health: Human Resources
· Introduction
· Emergency Room
· PICU
· Hospital Conference Room
· Conclusion
· Credits
Introduction
Human Resources
St. Anthony Medical Center (SAMC) is the third largest hospital
in the Minneapolis-St. Paul metro area. Not only does SAMC
serve as the main teaching hospital in the area, it also offers
care to the community's most vulnerable populations, including
low-income and uninsured residents.
Like many hospitals across the country, nursing shortages and
revenue shortfalls make staffing a particular challenge.
Today, a chemical spill caused by a train derailment is
highlighting some already tight staffing levels, and so are some
other patient situations. Explore the various locations in St.
Anthony Medical Center (SAMC), paying attention to how
staffing issues are affecting the staff nurses and the nursing
leadership.
Emergency Room
Caleb Harvey, the ER nurse manager, has to address the
apparent "turfing" of a pregnant patient by another hospital and
other concerns during a very busy time.
Caleb deals with staffing issues.
Caleb Harvey, ER Nurse Manager: I called Ramona about
getting more staff, but I had to leave a voice message. Until she
gets back to me, Emilio, I need you to go with Dr. Cartwright to

get Mrs. Kalombo up to Labor & Delivery. Tell Juan that I need
him on triage until you get back. Victor is already on beds 1-4
and Juan can go back to covering 5 – 8 when you're back on the
floor.
Emilio Boggio, ER Nurse: Got it.
Robert: Agreed.
Nathan Cartwright: Emilio, they just called down from L&D,
they're ready for us to bring her up.
Sarah Kalombo, a patient who speaks French but not English,
tries to make herself understood.
Sarah Kalombo (Originally in French): Don't send me away
again. I am not going to have this baby in the middle of the
street. I'll push this baby out now if I have to. Don't send me
away.
Nathan Cartwright (Originally in French): Of course not. You
need to stop pushing and try to relax. We need you to slow
down and let your baby come in its own time.
Sarah Kalombo (Originally in French): You won't put me out on
the street?
Nathan Cartwright (Originally in French): No. Of course not.
What gave you such an idea?
Sarah Kalombo (Originally in French): The others. At Regency
Hospital. I told them I have no insurance and the doctor told me
I had to leave and come here.
Nathan Cartwright (Originally in French): He what?
Sarah Kalombo (Originally in French): He said I wasn't ready,
so I should come here. The nurse, she didn't agree, I could tell,
but he said no, I was not ready and I had to leave.
Nathan Cartwright: Caleb, this doesn't make sense to me. Mrs.
Kalombo says that Regency sent her here when she told them
she didn't have insurance.
Caleb Harvey: Sorry, but I'm not shocked. Nathan, tell her she
needs to stop pushing.
Nathan Cartwright (Originally in French): Mrs. Kalombo, you
need to stop pushing. I promise, we will help you deliver your
baby, but try to not push.

Caleb Harvey: Welcome to your first turfing. Now, go ask
Maria where the heck the OB doc is. If we don't get this woman
up to L and D quick, you're going to be doing your first delivery
before you finish your first shift.
Informational Materials
The informational materials on the computer are optional, but
will inform your understanding of the situation:
· Staffing Policy and Procedures
· Staff Utilization Memo
PICU
The PICU is experiencing an unexpected surge because of a
train derailment, so Jackie Sandoval is looking for ways to best
use the staff she has.
Jackie explains how she is addressing acuity and patient load.
Jackie Sandoval, St. Anthony Medical Center's Chief Nursing
Officer: Okay, I've pulled three beds from med-surg to handle
the pediatric overflow. We've already transferred two patients
from pediatrics to med-surg, so once we get that last patient
transferred you should have three pediatric beds to move Dr.
Adams' patients out and make room for any new admissions
from the ER.
Staffing is extremely tight. Once you move those three kids out
to pediatrics, your acuity should drop somewhat. How does your
staffing look?
Phoebe Hemsworth, PICU Nurse Supervisor: We're short 2
nurses for evening and 3 for the night shift. I've called everyone
in who's available, but we're still short. And that nurse you sent
up from med-surg took one look around and left. She said she
wasn't trained for this kind of work and didn't feel comfortable
accepting the assignment—particularly under these
circumstances. Can you get somebody with PICU, or even just
ICU training?
Jackie Sandoval: I'm sorry about that! I thought Anita would be
fine up here. I'll see what I can do. Have you heard anything

from the ER regarding possible new admits to PICU?
Phoebe Hemsworth: I've only heard of one possible admit so
far… maybe coming up in 15 minutes or so. We may be
catching a little breathing room.
Jackie Sandoval: I wouldn't count on it. There were three
ambulances on the way in when I came up here. Let me touch
base with them... Wait a sec. I've got a text from med-surg. Let
me call Mary and see what's up.
Phoebe Hemsworth: Sure. I'll give the ER a call and see what's
pending.
Email to the Nurse Managers
To: SAMC *Nurse Manager List
From: Jackie Sandoval, Chief Nursing Officer
Subject: Scheduling for All Shifts
Good morning,
Please review your staffing for the next three shifts and let me
know if you have any room for me to make shifts available to
the three units that are currently very short-handed (ER, PICU,
and Adult ICU).
Use the ANA Staffing Utilization guidelines as much as
possible, but remember that we are dealing with surge
conditions.
Thank you for your help!
Email from Ramona Mitchell to Phoebe Hemsworth
To: Phoebe Hemsworth
From: Ramona Mitchell
Subject: FW: Scheduling for All Shifts

Good morning,
Phoebe-
I just spoke with Jackie and we're still trying to get you some
help for the remainder of this shift and for the evening shift.
Anita Hanson is on her way over. She was assigned to med-surg
and floats to the ER on occasion. I think she'll be fine.
Hospital Conference Room
In a Hospital Conference Room, the leadership discuss the
staffing and language issues that hospital employees are
struggling with.
Jackie tries to explain the organizational problems that are
impeding quality care at the hospital.
Jackie Sandoval, Chief Nursing Officer: I've got some issues
that are really dragging us down. Which do you want to talk
about first?
George Fink, Director of Clinical Operations: Let's start with
staffing—where are we? We should be better off once all the
chemical spill patients are stabilized, right?
Jackie Sandoval: Well, the spill caused a surge in patients, but I
want to make something very clear: Even if it hadn't, we still
would have been stretched thin. I called in additional staff for
most of the units today, but I've had to do that several times in
the last few weeks. Even before the chemical spill, I had to pull
3 beds in med-surg for pediatric overflow because we're short
on pediatric nurses. Acuity is up on all units and we have 23
beds left.
George Fink: Sounds like you have a pretty good handle on it.
Jackie Sandoval: For now, yes. But we regularly exhaust the
PRN nurse pool, and I've been leaning heavily on the temporary
staffing agencies in the area for months. It is just not enough.
We could and probably should look into identifying nurses and
health care staff from other facilities who could come over and
help in crisis situations like this, but I'd argue that that's a good
strategy for emergency conditions. We need more resources
during ordinary conditions!

Geoffrey Vaughn, President and CEO: Well, I don't know.
Budget for new staff isn't really available right now. The staff
for the new diabetes outpatient center added considerably to our
payroll outlays, and I'm not sure what we can do.
George Fink: In theory, shouldn't that center and others like it
lighten the load at the ER? I think that was part of the rationale
for shifting budget over to the center in the first place.
Jackie Sandoval: In theory, yes, but I don't know. The diabetes
center doesn't keep ER hours, does it? People will continue to
come to us when the center isn't open or available, and patients
with diabetes-related symptoms are only one segment of our
overall traffic.
George Fink: Well, and there's also a pretty long wait time for
appointments at the center. We're up to our elbows in baby
boomers with chronic conditions in this city!
Jackie Sandoval: Exactly. And if those people are waiting for an
appointment and have foot problems or other associated
conditions, they're coming to the ER. Not to mention things like
DKA or a stroke!
Geoffrey Vaughn: That's not good. We don't want to lose
business to other hospitals in the area because the center is
understaffed. Or is this a capacity issue?
George Fink: Good question. I don't know whether the center is
operating at peak capacity, or if there's space that's going
unused because they don't have the staff yet.
Geoffrey Vaughn: All right, so what's the language problem?
Jackie Sandoval: Yes… it's always a problem; it's one of our
weakest areas, quite frankly. CLAS guidelines are perfectly
clear, but we still run into problems with LEP patients. Last
week we had an elderly Hmong woman who had her grandson
interpreting for her. The problem was that she was presenting
with gynecological issues—she didn't want to be examined in
the first place and both of them were embarrassed and were
unwilling to actually say what was going on. Juan offered to
page the interpreter, but she insisted that she wanted her
grandson and since he wasn't a minor, we had to accept her

wishes.
We got lucky with a patient who was about to give birth – she
spoke French and so did the nurse. But today we're getting a
flood of calls from Regency, and Maria is the only admin person
who speaks Spanish. She's getting pulled in twenty different
directions. Obviously, I can help with some things, but …
Geoffrey Vaughn: Do we have a process in place for finding
interpreters?
Jackie Sandoval: Yes, but what we need is an aggressive effort
on hiring multilingual nurses—particularly for our Hmong and
Somali populations. Those are two groups that are really not
being well served.
George Fink: Are there that many multilingual nurses out there?
Jackie Sandoval: I don't know. We would find out if we made a
point of hiring them, though.
Geoffrey Vaughn: Do you mean hiring to replace, or new hires?
Like I said earlier, we may or may not have any budget for that.
Email from Geoffrey Vaughn
To: Owen Welch
CC: Jackie Sandoval
From: Geoffrey Vaughn, President and CEO
Subject: Staffing analysis
Owen,
We need to take another look at staffing numbers. I don't think
we have a handle yet on traffic at the ER and our outpatient
diabetes center. We've got some high temp staff usage at the ER
and a long wait at the center, so an analysis of our projections
and how they're matching up with reality is in order. How

quickly can you get this done?
– Geoffrey
Email from Jackie Sandoval
To: SAMC *Nursing Staff
Subject: CLAS Standards and Cultural Competency
Everyone:
Please remember that quality health care depends on clear
communication. Both from the standpoint of delivering the
highest quality care and of liability, we need to be consistent in
providing culturally competent care, particularly in terms of the
right of our LEP patients to interpretation services.
If you are unsure about how to provide culturally sensitive care
or how to obtain interpreter assistance, please review the CLAS
standards and the appropriate sections of the hospital policy and
procedures manual. If those don't answer your questions, please
meet with your nursing supervisor.
Email from Jackie Sandoval
To: SAMC *All
Subject: Hospital Interpreters
Everyone:
In light of several recent incidents, it is clear that we need to
increase our readiness to better serve our LEP patients. Many of
our employees could help with this effort by self-identifying
their proficiency in languages other than English.
We will soon be sending out a survey to determine which staff
members have proficiency in languages other than English.
Please fill it out and return it as soon as possible, so that we can
work toward providing better care for all of our patients.
Thank you for your assistance.

Conclusion
You have visited all the locations in this activity. You may
revisit the locations or you may leave Vila Health and return to
your courseroom.
To: From: Re: Nurse Managers Jackie Sandoval, Chief Nursing
Officer Utilization Staffing issues are an ongoing issue in our
profession and they have grown more complex for many
reasons, including shortages of practicing and teaching nurses.
Combined with that, the aging of both nursing and patient
populations, increasing health care costs, and competition for
financial resources put more pressure on the profession. Such
pressures to provide quality nursing care to increasingly sicker
or older patients require that we continue to look for increased
efficiency and strategy for our staffing issues. One resource that
will help with these questions is the ANA Staff Utilization
guide. If you do not have access to a hard copy of this
publication, the ANA makes it available online:
http://www.nursingworld.org/MainMenuCategories/ThePractice
ofProfessionalNursing/workpl
ace/NurseShortageStaffing/UtilizationGuide.aspx If there are
questions, please feel free to contact me at 612 944-1993.
Welcome to the Vila Health Challenge!
First, view the Vila Health media activity. When complete,
return here to answer the questions.
Refer to the media activity as much as needed to help you
answer the questions.
Scenario Vila Health: Human Resources
Today, a chemical spill caused by a train derailment is
highlighting some already tight staffing levels, and so are some
other patient situations. Explore the various locations in St.
Anthony Medical Center (SAMC), paying attention to how
staffing issues are affecting the staff nurses and the nursing

leadership.
Vila Health – Human Resources
Knowledge Check
Now that you have completed the Vila Health scenario and
reviewed the resources, write a short answer for each question
in the box. Once you have finished writing your answer, select
Submit for feedback. Compare your answer to the feedback.
You can always review the Vila Health simulation again, or the
study resources, for further clarification.
Question 1 of 4
Describe the role of human resources in health care settings.
This question has not yet been answered.
The human resources department manages the processes by
which the health care organization identifies, recruits, manages,
and trains staff. Human resources also manages employee
payroll and benefits, and conflict resolution.
Question 2 of 4
Explain the benefits of having an employee workflow plan in a
health care setting.
Employee workflow is the process of completing tasks from
start to finish. In a busy health care setting it is important that
employees understand the steps and processes involved in
completing tasks, including the delivery of high-quality patient
care. Typical tasks in a hospital setting, for example, include
making rounds, scheduling ADLs for patients, discharge
planning, and patient information entry into the electronic
health record system, among others.
Question 3 of 4
Explain why employers need to pay close attention to the health
care setting’s workforce.

Often, worker shortages can create backlogs in health care
settings. External variables, such as the aging population or
growing population centers, create increased demand on health
care organizations, especially hospital settings. It is important
that managers have a workforce plan in place to ensure staff
shortages are easily or quickly resolved or avoided altogether.
Question 4 of 4
Why is it important to work with the human resources
department on workforce?
The human resources team is trained to handle recruiting and
staffing issues. Managers do need to work very closely with
them, however, to ensure human resources personnel understand
the specific job duties, credentials, and requirements for open
positions.
Print
·
Introduction
·
Emerge
ncy Room
·

PICU
·
Hospit
al Conference Room
·
Conclusion
·
Credits
Introduction
Human Resources
in the Minneapolis
-
St. Paul
metro area. Not only does SAMC serve as the main teaching
hospital in the area, it also offers
care to the
community's most vulnerable populations, including low
-
income and uninsured
residents.
Print

ergency Room
Introduction
Human Resources
in the Minneapolis-St. Paul
metro area. Not only does SAMC serve as the main teaching
hospital in the area, it also offers
care to the community's most vulnerable populations, including
low-income and uninsured
residents.

PrintVila Health Human Resources· Introduction· Emergenc

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