Medical Hematology & Oncology (1 West); Medical Units (1, 2, 3 East); Surgical Units (2, 3, 4 West); Pediatrics; Intensive Care Nursery; Birthing Pavilion; Post Anesthesia Care Unit; ICCU; Surgical Intensive Care Unit; Medical Intensive Care Unit; Neuroscience Units.
1, 2, 3 East Medical Specialties
Medical Specialties is a 61-bed, 3-floor inpatient unit. We care for adults typically on the inpatient medicine service who suffer from acute and/or chronic illness. Our patient population is very dynamic and challenging, however, our team approach and changing environment make it a great place to learn and build/expand on nursing assessment, delegation, prioritization, critical thinking and time management skills.
On 1 West (Hematology/Oncology/Bone Marrow Transplant) the typical experience for senior practicum students involves working with hematology/oncology patients in addition to some experience with bone marrow transplant patients. A senior practicum student on our unit will work with a single designated preceptor who will be exclusive to that student. All preceptors have completed the DH Preceptor course and frequently we assign newer preceptors to the senior practicum students with some variation. We have found it helpful to have a newer RN to DH (about 2 years’ experience) to develop very strong relationships with our senior practicum students because these preceptors are new enough to remember what it is like to be a student, and also experienced enough to offer significant clinical insights and expertise to the senior practicum student.
About 80% of our patients have some sort of cancer diagnosis. A small subset of these patients are also surgical patients which exposes the student to some surgical pathways. The remaining patients are general medicine, surgery and other medical type diagnosis. The student who will be successful on 1 West is someone who is intellectually curious, communicates effectively, is an active listener and appreciates a deep patient and family relationship.
1 West is a great place to work because the student will be surrounded by staff who are passionate about their patients and the patients’ families, and the teamwork is remarkable. We have many RNs who have graduated within the last 2 years as well as a good mix of RNs with many years of experience. Our staff have chosen the specialty of Oncology and are passionate about their work and the care they provide. Whilst some might consider Oncology to be a sad place to work, most staff find it incredibly rewarding and stay for many years within the specialty. To quote one of our more experienced RNs ‘it might sound strange to say coming from an Oncology nurse but I have the most fun in my job that I’ve ever had’.
2 West Inpatient Surgery
2 West inpatient surgery is a 12-bed surgical unit. We have a 4 to 1 nurse to patient ratio with an “out of assignment” charge nurse or clinical nurse supervisor. The clinical nurse supervisor is utilized as a practice expert at the bedside. They also run the daily operations and patient flow of the unit. The population we serve is mostly surgical oncology, surgical urology and adolescent pediatric overflow. We currently perform Safety Rounds with each nurse on every patient Monday through Friday to ensure we are keeping our patients free from harm. We have a robust Practice Area Council (PAC) that together with leadership, addresses practice concerns and makes suggestions for improvement.
3 West Inpatient Surgery
3 West is a 36-bed unit that specializes in orthopedics, traumatic injury and plastic surgery. We also have two negative pressure rooms that can accommodate patients who are being ruled out for tuberculosis or who have a diagnosis of active tuberculosis or shingles. In addition, we are the medicine overflow unit for patients with Cystic Fibrosis, so our population can be varied.
The majority of our focus is orthopedics and trauma patients, so we have a great emphasis on getting people up, moving and recovering from their injuries and operations. Our unit is a great place to work because we pride ourselves on teamwork and a nurturing, team-friendly environment. We have implemented unit initiatives to improve safety, reliability and team-based patient care. A senior practicum experience on 3 West will give a student experience with a 1:4 RN to patient ratio, a fast paced environment, and a variety of surgical conditions, allowing a student to build fundamental skills. An energetic student who is a strong team player, interested in caring for surgical patients in a busy, active setting, will be most successful in a senior practicum experience on 3 West.
4 West Inpatient Surgery
4 West is a 35-bed Inpatient Surgery Unit. We care for Vascular, Thoracic, Colorectal, Transplant, and General Surgery patients. Our patients are complex surgical patients, many with acute illnesses. 4 West is fast paced, and a great learning opportunity for Senior Practicum students, as you will see a variety of acutely ill patients. The 4 West team is supportive of new learners, and is focused on team work.
Intermediate Cardiac Care Unit (ICCU), Cardiac Special Care Unit (CSCU) & Cardiovascular Critical Care Unit (CVCC)
- ICCU is a 27-bed Intermediate Cardiac Care unit that provides progressive care to cardiovascular medicine and cardiac surgery patients.
- CSCU is a 9-bed Cardiac Special Care Unit that provides step down level care to cardiovascular medicine and cardiac surgery patients.
- CVCC is a 12-bed Cardiovascular Critical Care Unit that provides critical care to cardiovascular medicine and cardiac surgery patients.
Medical and Surgical Intensive Care Units (MICU and SICU)
The MICU is a 20- bed adult critical care unit with a diverse patient population comprised of complex respiratory failure, sepsis, renal failure and multisystem organ failure to name a few.
The SICU is an 18-bed adult critical care unit providing complex care to the Adult Trauma and Neurosurgical population as well as the general, vascular and thoracic surgery population. It is a fast-paced, often intense environment.
Both units offer diverse learning experiences in a patient and family focused, multi-disciplinary, supportive environment.
5 West is located on the fifth floor of the west side of the north patient tower at DHMC. It includes the Neuroscience/ENT Unit and the Neuroscience Special Care Unit (NSCU).
Neuroscience/ENT is a 21-bed general Medical-Surgical level unit. The primary patient population includes neurology, neurosurgery, and ear, nose and throat (ENT) patients.
Neuroscience/ENT provides specialized nursing care for patients with: strokes, epilepsy, brain and/or spinal cord tumors/injuries, movement disorders, laryngectomies and tracheotomies.
NSCU is a 10-bed continuous care environment with full bedside monitoring capabilities. Patients require more nursing care than the general neuroscience/ENT unit can provide, but do not need acute critical care. NSCU nurses care for these higher acuity patients including:
- Post-operative neuroscience, ENT and trauma patients
- Traumatic brain injuries
- Acute strokes
- Complex ENT surgeries
- Continuous cardiac monitoring
- Cardiac drips
- External ventricular drains (EVD)
- Lumbar drains
NSCU staff also frequently manage patients with complex respiratory, medical, and multi-trauma needs.
Our units have a diverse patient population which provides an excellent learning environment to build a foundation for professional growth. We have a team approach and have a very active shared governance practice council. We also have an engaged group of preceptors, safety champions and charge nurses. We have two RN unit supervisors and a clinical nurse specialist who support the practice on the units. Our senior practicum nurses get priority for Nurse Residency slots and have proven to be most successful.
Post Anesthesia Care Unit (PACU)
The Post Anesthesia Care Unit (PACU) is a 22-bed unit where nearly all patients who have received general anesthesia come to recover from anesthesia if they will be hospitalized for at least one night. After a patient is recovered he/she is transferred to either an inpatient medical surgical or intermediate level of care bed. Intubated patients who come to the PACU are typically extubated within 4 hours, and if not, the patient is transferred to a higher level of care typically the Intensive Care Unit (ICU). We care for patients who have experienced all different types of surgeries with the top surgical services being Ortho, Vascular, and General.
Birthing Pavilion (BP)
Our Birthing Pavilion is a 21-bed Labor, Delivery, Recovery and Postpartum (LDRP) unit. We average approximately 1200 deliveries each year. Fifty-five percent of our patients are high-risk and are part of our Maternal Fetal Medicine service. We provide antepartum, intrapartum, postpartum care, normal newborn and focus care newborn, as well as perioperative and PACU services. Our unit includes two operating rooms. We triage our own patients.
Intensive Care Nursery (ICN)
The ICN is a 30-bed Intensive Care Nursery caring for acutely ill and premature infants from all over the state of NH and parts of the state of VT. The care we provide is patient and family centered, with the family encouraged to be present and participate in their baby’s care from the beginning. They are considered part of the care team.
Nurses provide care to infants who are critically ill as well as convalescing with nurse to patient ratios that range from 1:1 to 1:3. Primary nursing is encouraged and contributes to family satisfaction. There are many opportunities for professional growth from participation in our unit based practice council and one of our many quality improvement projects. In addition, there is a two person high risk neonatal transport team which includes an ICN RN who has been trained to provide this level of care along with a respiratory care practitioner.
CHaD Inpatient Unit
The Children's Hospital at Dartmouth-Hitchcock (CHaD) Inpatient Unit provides care for med-surg, stepdown, and critical care level pediatric patients. We care for patients from birth to 18 years old with a patient and family centered philosophy. We provide a wide variety of surgical services including orthopedic, ENT, GI, general surgery, neurosurgery, and trauma. We also care for patients with a wide variety of acute and chronic medical diagnoses including dehydration, failure to thrive, seizures, cystic fibrosis, oncology, respiratory insufficiency, and cardiac disease.
Our integrated care model is a great opportunity for learners interested in caring for general pediatric patients as well as patients with a higher level of acuity including critical care. This recently renovated unit features central play and family spaces with multiple nursing work stations that allow staff to remain close to patients. If you are looking for a fast-paced environment with a wide variety of ages, diagnoses, and multiple levels of care then you will love the CHaD Inpatient Unit!
Questions regarding the program, application process or required documentation should be addressed to ExternCoordinatingTeam@Hitchcock.org.
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