Hello everyone.

This week I spent a full day with my preceptor. She is a hospital nurse manager. We started the day out briefly discussing my course objectives, our duties and responsibilities as preceptor/student, and our mutual expectations. Next we went to a "bed meeting". It was brief, 15 minutes. It was interesting to see what people do with the information they collect from us as charge nurses. I really didn't expect that all the nurse managers in the hospital would meet together and discuss staffing and patient census in this manner. I don't know what I thought actually happened, but it just seem to me that there never really seem like there was a rhyme or reason to the way the hospital was filled. It always seemed chaotic to me. But witnessing the bed meeting, I realized it wasn't as chaotic as it seemed. I now know, the staff nurse on the unit is just usually the last to know the plan until it is upon them.

After that we came back to the 22 bed unit, and discussed briefly some staffing issues about documentation and an implementation issue of initiating tele in a timely fashion due to the lack of completed stickers. It is obviously admissions job, but they don't always have it done before the patient is admitted to the unit causing a delay. About 20 minutes was spent discussing general staff issues. Then, we started reviewing discharged patient charts for completion before sending them to medical records. This took about 15 minutes.

We then went on to review her scheduled meetings, she checked her email, and responded as needed. She took several calls, relating to various issues and I noted that she jotted her notes on sticky paper. We then headed to a task that was delegated to her from the Director of Nursing. She was to give the new physicians in orientation information from the nursing aspect. We went a little early to eat the breakfast that was being served to the MDs.

She reviewed the powerpoint presentation already set up. She gave general information. I thought it would have been helpful if she would have had sample documents that she could show as she discussed various topics. But I guess they go over that somewhere else in their orientation. She did really well I thought.
The only question that came to mind was, why don't nurses look more professional in dress? Next to the doctor, she didn't look the part to me, and when we talk about professional, I just think you oughta look professional. As a high school teacher, we had a dress code and the expectation that our dress would role model appropriate attire, and inspire learning, not destract from it. I was distracted for that moment. After giving a tour of the facility, we went to the next meeting already in section.

At this meeting there was little room for a newcomer. I was asked to sit in a space at the front of U shaped tables, between the two heads faciliting the committee meeting. They were discussing how to improve patient outcomes using a new audit tool focused on CHF, Acute MI, Pneumonia, and Surgical patients. The tool is to be initiated in the ER, then follow the patient. If the patient conditions changes and is given one of the previously mentioned diagnosis, the audit tool is to be initiated at the point, then the audit tool follows the patient until discharge. The tool had already been designed,and was going through the final phase of 'tweeking.' The only thing left to discuss after that was, implementation and a final start date. Considerations were: how long would it take 95% of staff nurses throughout the facility to be educated; how long would it take blackboard to get up and running; how many copies should be initially ordered and how many should each unit get; and who was going to place the order? After gathering this information, an implementation date could be set. It amazed me that it took a great deal of discussion before it was determined three weeks and my preceptor would place the order. The meeting finally ended. I was introduced to interested parties. That was really cool. I really felt proud to be going through this process.

We headed back to the unit, she reviewed emails, checked phone messages, made call backs and then started trying to read a bulk package of various policies before the next meeting, which was the 'policy review committee meeting.' We heated up our lunch and headed to the conference room. Everyone bought their lunch. The policies under review had to do with infection control, nutrition, and administration of certain cardiac meds. I was glad to be there because I had questions regarding policy and actual practice. And often the policy was broad and lacking, except infection control. Infection control section alone had 30 pages.

One item of interest to me, was the issue of heating up a patient's food on the unit in the unit 'galley.' Someone had said that the patients' food could not be heated up on the unit because it was considered dirty and to take it into the kitchen on the unit would cross contaminate. I personal thought it was stupid, and that it sends a negative message to the family and patient. One person suggested that we ask for a policy preventing patients and family from bring food from the outside altogether. I thought that was really crazy! I asked where did this logic come from, CDC or peer reviewed research? After that, everyone agreed that it was 'splitting hairs' and if there was a serious issue, it would be nationwide, and brought to the forefront. I don't know if it's really a big deal or not, can food become cross contaminated from microwave use? This meeting was the last big meeting for the day. My preceptor delegated the noon bed meeting to the charge nurse on the unit. So the next bed meeting would be at 3pm.

We went back to the unit, checked emails, reviewed applications for hire, answered calls, handled unit issues, and made rounds on the unit. Patient satisfaction was high. The issue she was keying in on was labelling iv's. We discussed my change paper, which is to the extent, improving tracking medications in the omnicell thereby reducing unit cost, and increasing medication availibility to the unit.

We ended the day by setting up a meeting with the Director of Pharmacy because he had recently sent another email hospital wide addressing the issue- lack of medication availibility in the omnicell.

Reflecting over the day, I can say, it takes a very organized person to be in this position. And the job is made easier by being more than 'computer literate.' I think that this nurse manager is so successful, is because she is technologically advanced. I think that taking a microsoft class is going to be in my near future, it's just a must-do.

Intro

Hello Everyone.
Looking forward to the beginning of a great semester.
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