St. Jude Children’s Research Hospital is a not-for-profit hospital located in the heart of Memphis, Tennessee. It is an internationally recognized hospital that pioneered research finding cures and saving children with cancer and other catastrophic diseases. It treats patients from all 50 states and around the world, without regard to ability to pay, never requiring families to pay for treatment not covered by insurance (St. Jude Children’s Research Hospital, 2010). St. Jude remains the first and only pediatric cancer center designated as a Comprehensive Cancer Center by the National Cancer Institute (St. Jude Children’s Research Hospital, 2010). It is currently ranked first in Children’s Hospitals for cancer care (U.S. News and World Report, 2010).
St Jude Children’s Research Hospital encompasses an extensive and impressive mission, vision, and set of values.
The mission of St. Jude Children’s Research Hospital is to advance cures, and
means of prevention, for pediatric catastrophic diseases through research and
treatment. Consistent with the vision of our founder Danny Thomas, no child is
denied treatment based on race, religion, or a family’s ability to pay. (St. Jude
Children’s Research Hospital, 2010)
St. Jude has a vision to be a world leader in the treatment and prevention of catastrophic diseases in children (St. Jude Children’s Research Hospital, 2010). They aim to meet this by providing exceptional patient care and extensive clinical research to better understand the catastrophic diseases of childhood, enhance outcomes of treatment, prevent diseases, minimize deleterious consequences of treatment, and educate healthcare and research professionals on such findings (St. Jude Children’s Research Hospital, 2010). The overall goal of these tasks is to find a cure and enhance the quality of life for the children they treat. To reach a larger portion of the affected population, they work to expand and share this knowledge to enhance the treatment of children with catastrophic diseases worldwide, working towards a strategy for disease prevention (St. Jude Children’s Research Hospital, 2010).
St. Jude highly values their patients, families, and donors that enable them to act out their Mission. To adequately espouse their Mission and vision, the organization has outlined an explicit set of values and standards to guide their daily actions and decisions. To ensure adherence, ongoing training and evaluation is conducted (St. Jude Children’s Research Hospital, 2010). The values include: promoting ethical behavior, providing the highest quality of medical and supportive family-centered care, respecting ethical, cultural, religious, and lifestyle differences of all those involved in the hospital, promoting wise spending of every dollar donated back to the care and research for the patients it treats, maintaining a commitment to a culture of excellence, innovation, and creativity in all that they do, having a drive and sense of urgency to succeed, being honest and accountable for actions and decisions, and cultivation of an environment of trust, teamwork, and respect (St. Jude Children’s Research Hospital, 2010). St. Jude does a fantastic job adhering to their Mission, vision, and values as noted through their increased survival rate of all pediatric cancers, high quality care, repeated ranking of the number one hospital for pediatric cancer care, and meeting financial requirements of the establishment with never asking families to pay for treatments that insurance fails to cover. This last portion has remained extremely important to the hospital since first opening as most patients who enter through hospital doors have already maxed out their lifetime insurance caps and lack the funding to continue paying for the seemingly endless hospital bills (St. Jude Children’s Research Hospital, 2010).
To be accepted as a patient at St. Jude, a child must have a diagnosis specific to a current disease in study and be referred by physicians. The patient must be no older than 18 and generally not have received extensive treatment elsewhere. (St. Jude Children’s Research Hospital, 2010). While the St. Jude Children’s Research Hospital campus is an independent health care system, their top-notch research integrates them with children’s hospitals throughout the world (St. Jude Children’s Research Hospital, 2010). St. Jude conducts all research and primary studies within their campus but freely shares this research with hospitals throughout the world (St. Jude Children’s Research Hospital, 2010). Because of this cooperation, there is minimal competitiveness from other facilities but rather a system that works together for the sake of the children suffering from catastrophic diseases. St. Jude is the national coordinating center for the Pediatric Brain Tumor Consortium and the Childhood Cancer Survivor Study (St. Jude Children’s Research Hospital, 2010). On top of the exceptional research and care provided for pediatric cancer, St. Jude is a leader in sickle cell disease research and has become a primary research center for influenza throughout the world (St. Jude Children’s Research Hospital, 2010).
St. Jude is internationally recognized for pioneering the research and treatment of pediatric patients suffering from cancer and other catastrophic diseases (St. Jude Children’s Research Hospital, 2010). Because of the work St. Jude has done, research protocols have helped to push overall survival rates of childhood cancer from less than 20 percent when the hospital opened, to over 80 percent today (St. Jude Children’s Research Hospital, 2010). They have treated patients from across the globe that are accepted and respected without regard to ethnicity and cultural differences (St. Jude Children’s Research Hospital, 2010). St. Jude has impacted the families by providing hope to families with a grim prognosis, lack of financing, and nowhere else to turn.
St. Jude is the sole pediatric cancer research center that accepts patients without regard to ability to pay. Families are never asked to pay for treatment not covered by insurance, and no child is denied treatment because of inability to pay. (St. Jude Children’s Research Hospital, 2010). The American Lebanese Syrian Associated Charities (ALSAC) has been the exclusive fund-raising organization of St. Jude since 1957, helping raise funds to build the establishment with founder Danny Thomas and his vision (St. Jude Children’s Research Hospital, 2010). In the 2009 Fiscal Year, ALSAC raised $682 million through volunteers, corporate partners, and donors to meet the daily St. Jude operating cost of $1.5 million a day (ALSAC/St. Jude Annual Report, 2009). These operating costs include patient care services, research expenditures, education, training, and community services to accommodate staff and administration of the hospital. Patient care services include all care needed for active patients. This can include medical care and living expenditures for patients and families. Most patients are treated on an outpatient basis in the St. Jude clinics and are housed at one of the three housing organizations in Memphis affiliated with St. Jude (Target House, Grizzly House, Ronald McDonald House). Once remission is achieved treatment can be transferred to a doctor in the patient’s home community in collaboration with St. Jude protocols (ALSAC/St. Jude Annual Report, 2009). In addition to ALSAC, St. Jude has over 60 corporate partners including: Target, the NFL, The Memphis Grizzlies, Kay Jewelers, and Chili’s, (St. Jude Children’s Research Hospital, 2010). In addition to their corporate partners, individual donors and organizations help financially support the work of St. Jude (St. Jude Children’s Research Hospital, 2010). Additional influences on St. Jude Children’s Research Hospital include the American Medical Association and American Nursing Association who serve to guide the doctors and nurses employed by the hospital.
The policy and regulation of St. Jude is in accordance with research policies nationwide to ensure the safety of patients with the potential benefit of treatment outweighing the risk. The hospital adheres to set protocols in study and only deviates from them should extensive research prove the deviation to be more beneficial and scientifically supported (St. Jude Children’s Research Hospital, 2010). The system at St. Jude is highly supported by having the research institute under the same roof as the patients with the scientists actively involved in the patient plan of care. In addition to these regulations, St. Jude has policies in place to prevent infection spread to patients who are immunocompromised. These include not allowing visitors under the age of 12, screening for illness prior to visiting, proper hand-washing education, and not allowing visitors who have recently received the nasal flu vaccine or oral polio vaccine within the past four weeks. These policies ensure the safety and overall well-being of their patients (St. Jude Children’s Research Hospital, 2010).
The organization of St. Jude Children’s Hospital is based on the vision of founder Danny Thomas to create a hospital treating children with catastrophic diseases so no child has to die in the dawn of life (St. Jude Children’s Research Hospital, 2010). In partnering with ALSAC, Danny Thomas was able to obtain funding necessary to create this hospital from the ground up and work to create an environment welcoming to all who enter. His vision included a hospital where children didn’t feel threatened by care providers, where doctors and researchers ate alongside of patients, a hospital where patients were allowed to continue their childhood while battling catastrophic diseases (St. Jude Children’s Research Hospital, 2010).
According to Henry Mintzberg, an organization can consist of a maximum of six parts including the strategic apex (top management), the middle line (middle managers), the operating core (primary workers), the technostructure (workers who standardize and improve work), the support staff (those who work outside of the primary flow), and the ideology (beliefs, traditions, norms, values, and culture) (Value Based Management, 2010). The following diagram depicts the Mintzberg organizational structure of St. Jude Children’s Research Hospital and is explained below.
(Proven Models, 2010)
The strategic apex of St. Jude consists of the Boards of Directors and Governors for ALSAC-St. Jude Children’s Research Hospital. The Board is responsible for governing the organizations by establishing policies and objectives, selecting, appointing, supporting, and reviewing the performance of the Chief Executive Officers, insuring the availability of adequate financial resources, approving annual budgets and strategic planning, and accounting for the ethics, compliance, and performance of the organizations (St. Jude Children’s Research Hospital, 2010). Below them St. Jude has the middle line operations consisting of the Chief Executive Officers, Senior Management Team, and the Executive Committee that directly oversee the operating core. At the heart of the hospital are the operating core of physicians, research and development team, advanced practice nurses, nurses, certified nursing assistants, child life specialists, psychologists, and families who collaborate to provide adequate family-centered care. The Support Staff of St. Jude consist of ALSAC as the primary fundraising organization, the administrative body, the environmental service employees, the cafeteria, the public relations department helping advocate for ALSAC fundraising endeavors, the Target, Grizzly, and Ronald McDonald houses and staff people, the ethical and legal committees, and volunteers who help throughout the hospital. The technostructure of St. Jude consists of the specially named Faculty and Adjunct Faculty that standardize research in collaboration with care provided to patients. It also includes the external advisory boards that help to standardize protocols and ensure they are accessible and clearly stated to be shared worldwide. St. Jude has a surprisingly large technostructure of employees who work to standardize care throughout the hospital with regard to uniqueness of each patient in the research studies. Any deviations from standardized care are backed through the research conducted on the St. Jude campus. Because of this, the hospital would be classified as a Machine Bureaucracy that has all components present and strong in their functioning and enactment towards the campus.
The nursing role that will specifically be analyzed is the role of the Pediatric Acute Care Nurse Practitioner. Unfortunately, this role is not currently available at St. Jude Children’s Hospital and therefore no specific job description or title is available for the specific role at St. Jude. According to the National Association of Pediatric Nurse Practitioners (NAPNAP), the Pediatric Acute Care Nurse Practitioner (PNP-AC) would function to provide direct patient care management, perform in-depth physical assessments, interpret lab and diagnostic tests, order mediations, and perform therapeutic treatments for children who are acutely, chronically, and critically ill (NAPNAP, 2005). The PNP-AC would be licensed as a registered nurse in the United States with a graduate degree in nursing through an accredited program, and certified by the Pediatric Nurse Certification Board as a Certified Pediatric Nurse Practitioner – Acute Care (PNCB, 2010). To become certified one must meet certain competencies and pass a board examination that meets the National Council of State Boards of Nursing APRN criteria (PNCB, 2010). To maintain certification, one must complete continuing education hours and/or re-certification every three to five years, or as deemed by the organization and state board of nursing (PNCB, 2010).
The role of the PNP-AC would fall within the operating core of the hospital. They would work in collaboration with other Physicians and Researchers at St. Jude to create a comprehensive plan of care for the patients. This would keep everyone working towards the same goal and ensure overall patient well-being. They would also work with the nurses, nursing assistants, child life specialists, and other therapists to keep them informed of progress or hardships the patient may encounter, and help them understand the cares that need to be provided to ensure success of treatment protocols. They would also work with unit managers and nursing directors should problems or questions arise. They will be able to consult with the middle line management or technostructure personnel should questions or concerns arise. They would also work with varying support staff members for outreach, dietary consults and education-oriented tasks. This role would directly interact with patients and families through their everyday tasks. They may do outreach into the community, and conduct education for consumers and payers on current advances the hospital is making. They would also indirectly work with human resources and the finance department to obtain their paycheck.
The role of the PNP-AC is very autonomous in impacting patient care and outcomes. They can diagnose and treat conditions, prescribe medications, obtain necessary consults and interpret results of ordered tests. They would oversee the progress of care and intervene should any alarming findings be made in response to the protocol under study. The role would be strong in the sense that they are an autonomous and an independent member of the healthcare delivery team that is capable of providing a high-level of care to patients. They have strong patient interaction skills and a comprehensive knowledge of care that should be provided by the nurses. They are best able to understand the role of the nurse and delegate appropriate tasks to other members of the healthcare team. The role weaknesses include the chance that they may not be as highly respected as physicians or physician assistants, and the lack of advanced training specifically in pathology and the physiology like physicians and physician assistants often have. Overall, the role of the PNP-AC would be a highly functioning advanced practice role that can provide comprehensive and thorough care to his or her patient’s and work as a productive member of the healthcare delivery team.
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