Skip to Main Content

Nurse Ahead Program

Structural Empowerment

Nurses in the UHealth/University of Miami Health System are committed to providing high-quality, patient-centered care. Their commitment resonates across the organization and is evident from initial employment at the new nurse competency-based orientation and continues through participation in ongoing educational opportunities. These opportunities prepare nursing staff embrace new responsibilities, showcase their initiative, and explore new and innovative approaches to care. The UHealth/University of Miami Health System Department of Nursing is committed to educational opportunities that facilitate the professional and personal development and growth of the nursing staff while meeting the care needs and dynamic nature of patient care.

The Progressive Care Unit (PCU) at UHealth Tower, located on the 7th Floor, provides direct care to acutely ill patients. PCU patients are moderately stable but have a potential risk for instability because of their condition or diagnosis. PCU patients require frequent monitoring, often have respiratory compromise requiring artificial airway management, and have had complex surgical approaches for complex health needs. The unit's nurses inherently practice at a high acuity level and are skillful in caring for seriously ill patients. Their exceptional clinical judgement, clinical knowledge, and caring approaches—built on the Watson Caring framework—afford the climate of success for the PCU. The success of PCU nurses also offers the opportunity for professional nursing staff to develop skills to move into the ICU setting to provide direct care for critically ill patients who are at high risk of developing life-threatening health problems. PCU nurses can gain clinical knowledge that can extend to their roles in the ICU or prepare them for clinical leadership in the PCU setting.

At UHealth, nurses advance their careers in a variety of settings requiring new knowledge and skills. One such program is the Nurse Ahead initiative launched in May 2020 to meet the needs of variable staffing demands and the high acuity of the patients in the ICUs. The Nurse Ahead program provides classroom and clinical learning opportunities for nurses working on the Progressive Care Unit to prepare them to cross over to provide staffing support in the ICU when the patient census or staffing demands require this flexibility The environment of care in the PCU offers a more acute level of care than the medical-surgical unit, but less intensive than the ICU setting. The nurse manager of the PCU, Melinda Edmonds-Raines, and clinical educator Lauren Caldevilla led this initiative understanding the extensive commitment that the PCU staff bring to their professional nursing efforts as well as commitment to expanding their clinical knowledge, thus meaningfully contributing to the care of ICU patients.

The PCU nurses participating in the Nurse Ahead program attend four-hour didactic presentations once per week provided by the Clinical Educator and are matched with an ICU nurse preceptor to complete a competency-based validation of skills. Upon completion of the orientation process, they are assigned to patients in the ICU under the guidance of the unit's Charge Nurse. Consideration is given to each nurse's patient care assignment to align the nurses' skills and experience with the patient’s needs. Once the PCA nurses have completed the training, they are assigned to work at least one shift weekly in the ICU to assure that their clinical skills, clinical judgement, and competence are at the highest level for optimal patient care.

The nurses from the PCU who cross-trained for the ICU were empowered and flexible in caring for patients across both units—attesting to the importance of continuing professional education at UHealth/University of Miami Health System. Many nursing staff members expressed renewed confidence and a deeper understanding of the rationale for flexible staffing and patient outcomes in their home unit and the ICU. Several staff have subsequently enrolled in the ICU Residency Program. A unique and important outcome was the opportunity for PCU and ICU staff to share their commitment to patient care across units and build the institution’s capacity for success in patient outcomes across units.