Case Study: Pruitthealth

PruittHealth is a nursing and rehabilitation center located in Blythewood, South Carolina. PruittHealth is more than one company. It was established in 1969 as the Toccoa Nursing Center. It expanded to include more than 90 post-acute, skilled nursing and assisted living locations, as well some supplementary resources. PruittHealth also offers an assortment of business-to-business services. Construction started on the one in Blythewood in 2009 and it opened its doors at the beginning of January 2011. It offers long-term services, respite services, hospice services, physical therapy, acupuncture occupational therapy, speech therapy, out-patient therapy, and an IV team. It also has a water exercise pool and an outside garden for therapy. They

started with three patients in 2011, nursing staff, CNAs, OTTP personnel, a doctor, kitchen staff, laundry staff, environmental staff, director of nursing, assistant director of nursing, psychologist, staff coordinator, beautician, secretary, and nursing supervisor.
They have 20 private rooms and the rest of the rooms are double rooms. They have two beauty salons, one for men and one for women. They have three main dining rooms, a bar, a gym, two therapy rooms, a movie room, and a playroom. The organizational patient census is approximately 1,440 per year.
They receive six to eight admissions a day. Patients’ stay is between one week and one month in the rehabilitation center. Respite usually lasts five days.
They foster relationships by establishing open communication, respect, and professionalism. The primary goals of patient care include taking care of all patients that come to be admitted. They are equipped to take care of heart patients, track patients, COPD patients, post stop patients, isolation patients, cancer patients, obese patients, dialysis patients, stroke patients, dementia patients, anorexia patients, anxiety disorder patients, and epilepsy patients.
PruittHealth has a staff of 200 employees that comprises of an administrator, director of nursing, assistant director of nursing, two nursing supervisors, registered nurses, licensed practical nurses, nursing assistants, secretaries, staffing coordinators, human resources, activity department, pharmacy personnel, admitting officers, business office manager, payroll department, wound nurses, physical, occupational, and speech therapy, food services, environmental department, staffing educators, infection control, respiratory therapists, MD, nurse practitioners, MD’s assistants, and risk management. “Risk management focuses on limiting an organization’s financial risk associated with the delivery of care, particularly related to lawsuits, hopefully before incidents occur,” (Finkelman, 2012, p. 483). The RN’s responsibilities are comprehensive medical nursing assessment for the development and implementation of patient treatment. Both RNs and LPNs are responsible for patient teaching, admission, discharge, med pass. Patients’ families, if available, are always included in the teaching and care plans meetings. All nursing cares are rendered by competent healthcare providers who use current standards of practice. All nursing personnel are obligated to provide safe therapeutic care to all patients. Nurses also serve as patients’ advocates. The secretary serves different purposes. She is mainly responsible to greet patients and families when they come in the door. The nurse practitioners and their secretaries are in house six days a week. The doctor makes rounds once a week. After hours, we use the answering services to get in touch with the doctors and nurse practitioners. Nurse managers oversee and enlist nurses; collaborate with doctors; accommodate patients and their families; manage finances; oversee paperwork; pinpoint patient service requirements by instituting personal rapport with potential and actual patients and other persons in a position to understand service requirements; maintain nursing instructions by writing and updating policies and procedures; ensure quality of care by reinforcing hospital and nursing division's philosophies and standards of care; offer emotional, psychological, and spiritual support to patients, friends, and families; form patient care goals; educate patients and health care teams; ensure operation of medical and administrative equipment; sustain nursing supplies inventory by studying usage reports; and maintain professional and technical knowledge. ("Nurse Manager"). The activity department is responsible for daily activities of the patients and taking them on trips. Physical therapists can treat various issues in a wide range or focus on a certain type of care. They assess the needs of a client before making individual treatment programs, usually involving people close to the client. They form endurable relationships with patients and are rewarded by seeing their hard work pay off. A deep understanding of the human body as well as a compassionate nature are necessities to their job ("Nurse Manager").

Organizational Structure

PruittHealth is a profit organization. Their vision is to be a five-star institution and the company is based on love, respect, and compassion, making it the patient’s chosen hospital.

Mission Statement
At PruittHealth, we respect the value of every person and are conducted by our dedication to virtue and leadership.

We demonstrate this by: providing ideal care for each of our patients and their families; collating the ongoing duty to the care of the poor and those most in need with the provision of highly specific services to an immense community; maintaining a work environment where each person is valued, respected and has the freedom for personal and professional advancement; encouraging quality in health services education; protect a culture of discovery in all of our activities and supporting outstanding health sciences research; reinforcing our relationships with universities, colleges, other hospitals, agencies and our community; showing social liability through the honorable use of our resources. The liability of our staff, physicians, volunteers, students, community partners and friends to our mission allows us to preserve a quality of presence and tradition of

caring.
The budget is handled by the director of nursing and the business office. Information among management and staff is transmitted through various communication portals. Collaborative departmental meetings, and bulletin boards are examples of these departmental portals. The integration of ancillary department and an open line of communication aid the emergency department in providing high quality care.
PruittHealth complies with the South Carolina Department of Health and Environmental Control rules and regulations. All activities meet the standards they set.
Communication between management and staff is offered in many ways. Meetings, in-services, monthly nursing meetings, bulletin boards, the PointClick computer system, and direct communication are some of the methods used.
Some of our patients are unable to afford medical treatment. The recent provisions in Medicaid and Medicare have effected reimbursement. These factors have contributed to many financial revisions in our institution. They have also increased the need for patient education.
The company feels like they are at a loss right now because of understaffing. Employees are forced to work overtime, which to them, is a loss. They are working diligently on hiring full time workers to cover the slots that are open.
PruittHealth does provide employees with awards for good work, such as Employee of the Month, special parking spaces, and rewards certificates. Every once in a while, they get a special breakfast or dinner. Nurse managers and nurses’ salaries go from $52,000 to $80,000 depending on years of experience. LPNs get paid 14 to 24 dollars an hour based on years of experience. Nursing assistances get from 7 to 11 dollars per hour based on years of experience. Evaluation is done three months after employment and yearly thereafter. During the evaluation, employees’ strengths and weaknesses are discussed, along with expectations and ways to improve. The following evaluation, they review the previous evaluation to see where improvement has taken place. Attendance and skill are very important as part of the evaluation. There is cultural diversity among the staff. They come from different backgrounds and locations.
The rehabilitation unit is mostly equipped with one RN on every shift and LPN and CNAs. RNs are responsible for all assessment, while LPNs are responsible for other tasks. CNAs are responsible to help patients with feeding, ADLs, and ways of motion. The nursing manager is mainly responsible for overviewing the responsibilities of the nurses and sometimes covering staffing. Scheduling is done for six weeks. Any requests of time must be in writing by the 15th of each month before the next schedule comes out. Patients do evaluation of the institution or staff, if they choose to, when they are leaving. Some of them do request for names so they can send special letters of recommendation. Chart review is done on a monthly basis. Meds review is done on a monthly basis by pharmacy. Social workers do follow up with patients and families.
Human resources quarterly conduct a staff satisfaction survey, questioning every staff on things such as how they doing, if their expectations are met, and are they getting along with their coworkers.

Educational pamphlets are posted by human resources as further education information for those who are interested.

On a monthly basis, the accounting department time punch in and punch out, sick calls for them to review. They are working on getting staffing more accurate in order to prevent mandatory overtime.

During staff meetings, discussions such as absenteeism, tardiness, dress code, and staff involvement are discussed and new ideas or suggestions are presented. If staff are unable to attend meetings, they are responsible for getting the information that was discussed during the meeting. Standards and policies are also discussed. Employees are always given the option to voice their concerns and opinions on how things can be changed for the

better.

References:
Finkelman, A. (2012). Leadership and Management for Nurses: Core Competence for Quality Care (Second ed.). Julie Levin Alexander.
Nurse Manager. (n.d.). Retrieved April 11, 2016, from https://www.discovernursing.com/specialty/nurse-manager#.Vwu2oI-cGM8