Information for Prospective Staff

The Box Hill Hospital Intensive Care Unit is a seven-bed level III Intensive Care Unit caring for critically ill patients from all disciplines (except for cardio-thoracic surgery and neuro-surgery). We pride ourselves on a multidisciplinary team approach with the first priority of high quality patient care. Our team comprises medical, nursing, physiotherapy, pharmacy, ward support persons, secretarial and other staff. The contributions of all members of this team are essential and equally valued.

Who's Who in ICU

Medical Staff

Nursing Staff

Intensive Care Unit Philosophy

We believe that the primary purpose of Box Hill Hospital is to provide excellent patient care. The Intensive Care Unit, as part of this organisation has this same purpose.

We believe that nursing is the art and science of caring. We care for the patient, we extend care to relatives and the staff care about one another.

Patient Care

We believe that:

1. the patient has the right to the highest possible standard of nursing care, privacy and maintenance of dignity
2. the patient can expect the ICU nursing team to have the educational and/or experiential qualifications to deliver the highest possible standard of nursing care
3. the patient has the right to recognition as an individual who has physiological, psychological, sociological and spiritual needs
4. the patient has the right to feel safe and protected
5. the patient, whilst critically ill should maintain independence, if possible, by being informed of treatment and involved in the decision making process on an ongoing basis.

Relatives

We believe that:

the family of our patients are also in a stressful situation which requires recognition and support from skilled staff, including information sharing and time for questions.

Nursing Staff

We believe that:

1. all nursing staff need acknowledgment of any stresses they are experiencing
2. the promotion and maintenance of an atmosphere of open communication and innovative nursing practice will assist staff in recognition and respect of individual dignity and rights
3. the nursing staff should have an advanced level of skill to provide safe and excellent patient care
4. staff learning and personal development is enhanced by an atmosphere of teamwork, including other professional groups and that this will improve standards of care.

Environmental Issues

We believe that:

1. we have a responsibility to maximise cost effectiveness and resourcefulness
2. we have a responsibility to minimise waste generation

Nursing Ratios and Support

Nurse Staffing

We function on the basis of one Registered Nurse (RN) per ICU patient, and one RN per two high dependency patients. Currently shifts are on an 8 hour rotation on day and afternoon shifts and 9 hours on night duty. 12 hour shifts are currently being reviewed. They won’t be mandatory.

Staff support

Each shift has a Shift Co-ordinator who is supernumerary. There is also a Clinical Resource Nurse rostered as appropriate for most shifts. Both the Shift Co-ordinator and the Resource Nurse are senior experienced Critical Care Nurses.

ICU also has an Equipment Nurse. He is a senior, experienced Critical Care Trained Nurse.

Whilst the hospital has a large excellent library we also have one, with many Critical Care texts.

Ongoing Education

All staff and students are also supported by a full time Clinical Nurse Educator whose hours are dedicated to the ICU. BHH is affiliated with nearby Deakin University. In conjunction with the University, we offer a Post Graduate Diploma Nursing - Critical Care. Students taking part in this course rotate through the ICU, Emergency Department (ED) and the Coronary Care Unit (CCU).

We also have an Intensive Care Unit Specialist Program which runs on a regular basis. This involves lectures and supernumerary experience.

The education program within the ICU is collaborative with the Medical Staff. We also share education sessions in a forum format with ED and CCU on a regular basis.

Research and Quality Activities

We are currently involved in a number of clinical trails and have nursing staff involved in co-ordinating research and quality activities.

Facilities

Our ICU currently has eight beds. There are plans well under way to extend to 12 beds within 6 months. All the major equipment items are very modern and up to date. For example the monitors are Philips Intellivue plasma screen technology, Drager Evita 4 ventilators and Agilent Bi-phasic defibrillators.

Our Patients

Patient Numbers

The Intensive Care Unit at Box Hill Hospital has a maximum physical capacity of 8 patients and rosters 6-7 nursing staff for direct patient care. This means that if the patients all require 1:1 nursing care we can care for a maximum of 7 patients. If patient acuity is less, then some patients may require only 1:2 nursing care. We can then potentially care for up to 8 patients.

An average of 38 patients is admitted per month and these patients are predominantly (>80%) emergency admissions. It is envisaged that a 4 bed HDU attached to the Intensive Care Unit will be opening in 2003, extending our physical capacity to 12 beds.

Their Problems

The Intensive Care Unit treats critically ill patients with a variety of conditions. These may include:

• Multiple organ failure and shock secondary to a variety of causes including overwhelming sepsis, severe pancreatitis, post cardio-respiratory arrest, massive blood loss/transfusion
• Respiratory failure requiring close monitoring or ventilatory support (this may be invasive or non-invasive support) secondary to severe pneumonia, exacerbation of COAD, acute severe asthma or other causes
• Poisonings (inadvertent or self-inflicted) with significant organ impairment, e.g. CNS depression or cardiovascular compromise, or risk of serious complications
• Acute renal failure requiring renal replacement therapy with continuous veno-venous haemofiltration
• Multiple trauma involving significant chest/abdominal/pelvic injury or massive blood loss but not involving neurotrauma
• Cardiovascular failure/cardiogenic shock requiring invasive haemodynamic monitoring and inotropic support or intra-aortic balloon counter-pulsation (IABP)
• Postoperative patients following major surgery, e.g. elective or emergency acute aortic aneurysm repair, or less major surgery in patients with significant co-morbidities
• Metabolic disorders requiring close monitoring e.g. diabetic ketoacidosis, symptomatic hyponatraemia, especially in the patient with significant other co-morbidities

Box Hill Hospital has no neurosurgical or cardiothoracic surgical services and no chronic haemodialysis facilities. This means that patients requiring:

• Neurosurgical management for serious neurosurgical conditions, e.g. subarachnoid haemorrhage, intra-cranial haematomas, neurotrauma, spinal cord injury
• Cardiac surgery for acute valve incompetence or thoracic aortic dissection or coronary artery disease
• Chronic dialysis

will need to be transferred to hospitals with the appropriate services. They may require admission to Box Hill Hospital ICU for stabilisation prior to transfer.

ICU Staff Responsibilities

• ICU Patient Care

• Referrals

• Medical Emergencies in the Wards

The ICU medical and nursing staff provide assistance in the care of rapidly deteriorating patients on the general wards. This care is intended to avoid further deterioration and subsequent urgent transfer to the Intensive Care Unit or to optimise the patient’s management while awaiting transfer to ICU.

Requests for assistance in the care of patients not requiring ICU admission may be made by ward residents especially overnight. If this assistance is urgent it should be provided, but the resident must also be informed that the covering registrar or night medical registrar must take over the ongoing care of the patient. The ICU registrar's first responsibility is to the patients in ICU.

• Arrests and Trauma Team Calls (Respond Blue and Respond White)

Patients requiring emergency calls commonly become patients in the Intensive Care Unit and early involvement in their care by ICU staff is advantageous.

All “Respond Blue”s in the hospital are attended by the ICU registrar. An ICU nurse also attends for all "Respond Blue"s in the hospital proper (not including the ground floor and adjacent buildings). All “Respond White”s in the Emergency Department are attended by the ICU registrar. The ICU consultant on duty will also commonly attend both.

• Tracheostomy Patients

The ICU medical and nursing staff provide ongoing assistance in the care of patients who have had percutaneous tracheostomies inserted in ICU and have been recently discharged from the Unit. In particular we provide advice regarding care of the tracheostomy (suctioning, dressings, humidification) and the timing of its removal. ICU nursing and medical staff may also be requested to provide advice or assistance in the care of patients with long-term tracheostomies.

• Trouble shooting

ICU nursing staff assist in the care of patients with central venous catheters (CVCs) and patients on humidified oxygen circuits on the general wards. We provide advice as to the care of the CVC, collecting blood from it and unblocking the lumens.

Wages and Conditions

Wages are paid according to the Registered Nurses award of Victoria. Further detail can be found at the Australian Nursing Federation: http://www.anfvic.asn.au

BHH offers salary packaging to optimise net income, this allows staff to package a percentage of their income tax free towards loans, household bills etc. Further details can be found at McMillan Shakespeare: http://www.sa.mcms.com.au

Full time staff accrue one day off per month and accumulate 6 weeks paid annual leave. Payment is fortnightly, direct to your account.

Nurses Board of Victoria

The Nurses Board is responsible for Nursing Registration in Victoria.

Where is Box Hill?

The website www.whereis.com.au will enable you to find an online map of Box Hill. Search for 'Nelson Road, Box Hill, Victoria'. You can use the link to see where the hospital lies within the metropolitan area and which are the local suburbs.

Box Hill is 13 kilometres from the Melbourne Central Business District. It’s well served by transport infrastructure. The Eastern freeway provides access to the city within 15 minutes, rail and light rail (trams) also service Box Hill, which has a major rail station within its shopping complex. It’s only a 5 minute walk to the hospital.

Box Hill itself has a very popular restaurant district and is served by 2 large shopping centres, Box Hill Central and Doncaster Shoppingtown.

Accommodation

Suburbs close to Box Hill include Kew, Hawthorn, Camberwell, Canterbury, Surrey Hills, Balwyn, Mont Albert, Bulleen, Box Hill North and South, Doncaster, Burwood, Blackburn, Nunawading, Mitcham, Ringwood.

Kew is 7 kilometres from the Central Business District and is most expensive (>$250 p/week for a 2 bedroom apartment) to Ringwood at 25 ks. ($150 - $200). Rents will vary of course but these can give some indication. They are usually unfurnished. The website www.domain.com.au will take you to rental advertisements in the whole Melbourne metropolitan area.

Contact Details

For any enquires please contact marisa.andreazza@boxhill.org.au