A little later than promised, here are the details on the hospital (pictured above).
The Basics. Schneider Regional Hospital is a government hospital that was opened in 1982 (a mere baby!) and has only had JCAHO accreditation for 5 years. It’s the only hospital on the island, so I’m not sure what they did for medical care beforehand. Patients from St. Croix and St. John’s (the other US Virgin Island islands) come via boat. There is a helicopter pad here, but no helicopter. There are 169 beds including one 8-bed ICU/telemetry unit, an 8 bed pediatric unit, labor & delivery and newborn units, hemodialysis, one medical unit, and one surgical unit. The facility has agreements with Washington Medical Center in DC and the Cleveland Clinic so that the island patients can be transported there in cases of medical necessity. (By comparison, UVa has 572+ beds and employs more than 1800 nurses.)
The Staff. The nurses on the units are primarily travelers (for example, 75% of the ED nurses are travelers). There is clearly a shortage of RN’s, as there is all over the U.S. In addition to hiring travelers, the hospital has tried to solve this problem by using a variety of personnel – LPN’s, CNA’s, and “nursing techs” who are people who have graduated from nursing school but haven’t taken their boards yet. There are seven (I think) unions at the hospital and the nurses are unionized. I have noticed that women really are running the show there. All of the presenters at our orientation were women and they were the directors of this or that department. The medical director is female. Of course, the President/CEO is male. But, he’s rumored to be nice and he knows all of the employees by name (first, middle, and last) and places a priority on being present to his staff. As does the CNO. Teamwork is huge here; we were told that not long ago a pipe burst on a Sunday afternoon flooding the dialysis unit and staff from housekeeping on through the leadership and the CEO himself worked together to mop up the water and get the unit ready to receive patients on Monday. That really impresses me.
Surgical Unit. The surgical unit where I work has 21 beds. I had my first day on the floor on Friday and it was labeled a slow day by the nurses. I would definitely agree; there were only six patients on the floor by the end of the day (plus two more were expected to come up to the floor from PACU). The unit handles “cruise victims” (had to smile at that one) who, in a drunken state, fall and break something, and locals (aka islanders) with their usual ailments (basic surgical needs, wounds, stabbings, broken bones, and much more that I will discover as time goes on). 75% of the population is of African descent and that means lots of hypertension and diabetes. Unfortunately, the hospital does not have a endocrinologist.
Interesting (to me, at least) tidbits.
-Security is huge here! All staff must have their ID in order to report to work. Visiting hours are strictly enforced (11AM-8PM on our unit) and visitors must surrender their driver’s license in order to obtain a pass, which clearly identifies the area of the hospital in which they are allowed to go. If they are visiting patients on two units then they must get one pass, visit the person, then go back and get the pass needed to visit the other. No children under 13 are allowed on the units. All units are locked (except one); staff enters a numeric code to gain entry and visitors must be buzzed in.
-No Smoking! I love it!! Not just inside, but outside either. Technically, they say you must be 50 feet from the facility, but given the landscape there is no real place to set up a smoking area. The joke is that you have to go to the airport if you want to smoke. Patients are told that they are not allowed to smoke and it is enforced. And they accept it! That’s the rule. Bottom line. Oh how this makes so many things easier!!
-Small island. This is a small island where they say everyone knows everyone and news travels fast. (Note that the island is 32 square miles and has about 55,000 inhabitants). When JCAHO came for a surprise visit, the inspector was welcomed on the overhead paging system before she even reached the elevators.
-Computer charting. All charting except meds are done on a Meditech computer system that has been in place for 7 years. I am amazed that they are “almost paperless,” which is more advanced than facilities I have seen. On the other hand, they are also behind in that they do not use computerized systems for physicians to place orders or nurses to chart medications.
-Very few IV pumps. When they taught us in nursing school how to calculate the rate using the drops per minute I thought it was silly and that I would never use it again. Not only do they not use IV pumps, they really don’t see the need to in the vast majority of cases. They do use pumps in the ER, ICU, and Peds. It is also interesting to note that when hospital equipment breaks, it needs to be sent off island for repairs, which can put equipment out of order for a long time.
-Breaks! Yeah! The facility recognizes that healthcare workers need breaks during their 12 hour shifts! We were told during orientation that we were entitled to a half hour lunch break and 2 fifteen minute breaks.
-Pt who are DNR are noted with a unique bracelet to help eliminate confusion in code situations. Seems like a good idea to me.
So, that’s the hospital! Let me know if I didn’t answer any of your questions!
