Midsemester Self Review and Analysis

Mid Semester Self Review and Analysis

Course Clinical Objectives
1)Function as a client advocate through collaboration with health care providers.
I felt that I had the opportunity to advocate for the patient when I was able to attend a policy review committee meeting. In this meeting I had the opportunity to verbalize patient concerns specifically, regarding food brought in from the outside to the patient by family and friends. There was an issue regarding where the food would be reheated and who was responsible for patients keeping personal items in their room. Some staff were refusing to heat up the food in either the staff microwave or in the unit kitchen where there was a microwave to heat up patient’s food. The idea is that the kitchen was clean, and food brought from outside of the hospital was dirty, therefore food should not be heated up in the unit’s kitchen. The policy really didn’t address the issue, but several unit managers felt that staff should not reheat patients food on the unit, truly, in effort to discourage them from bringing in outside food. I was able to advocate for the client in reminding the managers that our dietary service does not cater to specialized diets such as vegetarian diet, or various foods specific to certain cultures that we service. After discussing the limited service that we offer to patients when it comes to their diets, the committee, made up of unit managers, decided that there was no know specific research that supported their concerns and would recommend clarifying and expanding that particular policy regarding food kept and served on the unit.
2)Communicate effectively, both verbally and in writing, with individuals,
groups and health care providers.
I felt I achieved this objective when I attended a meeting with the DON and all of the unit managers in the hospital. The meeting was a collaborative effort to request medication carts for all of the hospital units. I had used the equipment that they were requesting at a different hospital and I was able to give my opinion and views, as well as, discuss how that unit adapted to the change after implementing the use of the medication carts. The purpose of bringing all the unit managers together was to give everyone a chance to give input on how to word the request. The had made the request several times before and it was rejected. I had the chance to work with the nurse manager in charge of writing the request on behalf of the nursing department with the blessings of all the unit managers. I had the opportunity to take an active role in writing the request, suggesting key words and ideas. It was a great opportunity and I was glad the my preceptor respected my input.

Personal Objectives
1)Evaluate barriers of time management and select ways to decrease stress
and increase performance.
I had a wonderful preceptor. She was very organized and managed her time well. She was very technologically savvy and it was readily apparent. She had a routine that she tried hard to stick to. She was able to take on various duty with skill because of her time management ability. She was always moving. But the minute she wasn’t she was doing several things at once, following up on emails, returning emails, checking telephone messages, returning calls, scheduling interviews, reading mails, checking her calendar, reviewing discharge paper work, and intending to make discharge follow up phone calls. She even created a census form for all the units to use to make sure that bed control had all the needed information. So from her, I learned how to stay on task, how to prioritize, and the importance of using technology. Constant interruptions is a way of life for any nurse in any position.
2)Analyze person-position fit.
After spending time with the nurse manager, I concluded the position wasn’t for me. It seems to me that you have to be a very organized person and be detailed oriented. I think you also have to have a desire to be in this position, willing to take on the complexities, often with limited support and training preparing you for the position itself.

Review
My main objective was to gain insight into the world of hospital management. I wanted to know what really goes on. Is it comparable to long term care. Is management really management no matter where you go. Working with my preceptor, and gaining an understanding in the complexities of this role, I think an individual must be formally prepared for this position to be really successful. There are skills that are required beyond just good people skills. I think one must really be computer savvy not just computer literate. I think you really must possess good communication skills that flow from the top to the bottom and maintain professionalism at all times, knowing when to be light hearted and knowing when to be serious. You can learn a routine, but a person in this position has to able to use critical thinking skills, as well as, be knowledgeable about evidenced based practice and hospital policy. Overall, I think I have accomplished my objectives.

Discussion of professional growth
I have grown this semester professionally because I have a greater understanding of nursing from several points of views. And I think the turning point for me more than anything, was when I attended the meeting in the DON’s office with all the unit managers. I saw how hard they were fighting on our behalves. How they were trying to sway the ‘powers that be’ to create a better work environment for us. I saw their dedication. I heard their commitment to the staff. It all really came together for me. I was impressed with the support and positive energy that they gave to each other. They worked well together as a team. And they way the worked together, noting all their personality difference, ages and races, it inspired me to be more committed to my unit and want to help. Because I knew they cared, when they asked me what I thought about this or that, I didn’t feel the need to just whine and complain, but objectively identify the problem, discuss the root of the problem, and offer a solution.

The Change Process

I have done lots of researched during this change project. I have learned alot on change management. The "change management" is a familiar one in most healthcare facilities today. But, how facilities manage change (and how successful they are at it) varies enormously depending on the nature of the change and the people that are involved. The key part is how well the people understands the change process. Not everyone is open for change, many people don't want to put forth the effort to change even though the change is for the better. It takes teamwork for any organizational change to be successful. This experience has been one to remember.

Coming to an end...

This course has been beneficial in that I had the opportunity to see management in a different light. I had the opportunity to view committees in action and really see how the process really evolves. My clinical experience was an opener.

Wrapping Up---almost

The end of the semester is almost here. I just participate in a community intervention project in another course, and only have the Change paper to finish up. It was really cool to go out into the community and make a visible difference in people's lives...papers and postings are important, but they get tiresome after awhile and it was neat to put all of that knowledge to use! I still haven't really jumped on the bandwagon for this blogging thing, but it serves as a unique forum; a little different than the Blackboard DB we use I suppose. The Change Project Paper. I vacillated for awhile on my Change paper topic; I had one I was really excited about, but then my preceptor had to go out on extended sick leave and I wasn't able to complete it. Next, I planned on implementing a second topic at the High School with the students there. That didn't work out because after I placed 5 phone calls with voicemails and sent 6 emails (literally), the Health supervisor for the DISD still did not make contact with me. Finally, I found a preceptor who was willing and able to meet with me for the interview, etc. My change project ended up being something I helped to design and implement where I work; something I was doing on the side and I didn't make the "change project" connection with it at first. It is a new Nursing Assessment flowsheet for the Extended Recovery patients we receive on the floor. Instead of having the same amount of paperwork for a patient we care for for 3 hours as one that we have for 3 days, we now have a shortened form that saves time, money, and the nurse's charting load. I am very proud of it and very happy with it; we all worked hard to design something that would work well for everyone and it has!

Looking ahead...

As the semester is ending, I am focusing on completing all outstanding projects and assignments this week. I have noticed that I have been meeting other students in the workplace with similar goals and that has beetn inspiring.
This week I sat down with my supervisor to discuss posting and introducing evidenced based practice articles on the unit. The idea didn't seem to go over as well as I had hoped. I thought that if nurses really understood the purpose behind the policy they may see more value in it, and be more apt to follow it, rather than just dismissing it because...

Meeting c the Chief

Hello cohorts...

Today I had the opportunity to sit down and talk WITH my chief nursing officer at her invitation. She had set up meetings to hear staff ideas and concerns. The one thing that I would really like to comment on is how this course and our discussions help prepare me for that conversation, in that it was positive and very professional. I am still riding high and all inspired from our conversations about being a professional and getting involved in politics at all levels. I am reminded of the nurse who courageously invoked safe harbor, and was HEARD. I took a dose of my own advice. And I came prepared considering all that we had discussed about what we could and should do to make a difference where we could in our profession, especially, when had the ear of a power player. I thought about the references that were cited throughout our conversations, about the importance of getting involved, not being apathetic, and in general, just being professional. I took all of that today with me to this meeting. I went prepared with my ideas and suggestions considering our most recent discussions 'efficiency vs excellence' and 'changing technologies.' Having had the opportunity to shawdow my preceptor and be apart of committee meetings, I was prepared to offer solutions and with valid rationale or at least, what I thought was valid. I came with a dream list of what I thought would make our unit more efficient. Then I demanded one single thing, a COW(computer on wheels) that worked the entire shift. I explained how a working COW was essential and the greatest stressor and source of inefficiency which translated to a certain level of customer dissatisfaction on our unit. And you know that really matters to administration.

I remembered one of the statements I made earlier in one of our discussions about administration being more concern about the bottom line than they were about nurses, trying to squeeze every drop out of us. I don't know exactly what is going to come down the hill, but I really felt like my welfare and my ability to perform mattered to administration. I felt like I had a 'voice' and was heard.

Thanks you guys because I took yawl with me. And I am really glad I had an opportunity to think intellectually about those kinda issues that affect our day to day professional lives. Because of those topics I went in prepared to affect change and not just to moan and groan helplessly.

VN Educators

Hello Everyone...

I have considered the idea of becoming an VN educator, but of course most places require a BSN. I taught Health Science Tech Ed at a local high school and it was fun, challenging in many ways that had nothing to do with content, nevertheless, fun. I do enjoy teaching, just as much as I love learning new things. I was trained as a VN in the Army and when I became a civilian LVN, I soon realize the differences in the training. I remember having to become IV certified in order to start an iv or to push iv medications that I had been admininstering for some time. There were big differences in what I had been doing in the US Army compared to what the Texas BON scope of practice allowed me to do. I would consider the idea of becoming a VN educator, but probably not anytime soon.

Progressing with change project

Hello,

This week with my preceptor has been interesting. I had the opportunity to monitor a walk through/inspection with my preceptor's boss. She is from the corporate office which is located in Florida. Basically, she wanted to see how the flow of the endo center was going and monitoring the profits as well as ensuring the guidelines of the policies and procedures is being followed. As I stated earlier, I am doing my project on infection control via surveillance screening of elderly patients specifically nursing home residents. This was also on the top of the list for corporate due to the department of health implemeting their policies and produres for the center recently. Amongst surveillance screening we are also ensuring that the staff are following infection control guidelines by ensuring the techs are cleaning the scopes properly and also replacing parts of the scopes that are now labled disposable. We are also monitoring the nurses that interact with patients to see if they are washing their hands and/or using the available hand sanitizer throughout the center.
I have read quite a few outpatient surgery journals and in almost all of them addresses the issue of infection control. I don't understand why infection control would be a big factor in healthcare facilities. As healthcare workers we know the outcomes of not following the guideline of infection control, would you not want healthcare workers to use sterile equipment,needles ect...it is sad that some healthcare workers makes most of us look bad by not following the rules. The endo centers have gotton so bad the government has given them funds to implement infection control procures to ensure patient safety.

Professional Nurse

Hello everyone,

I started my nursing career off as a LPN. I did this simply because I wasn't sure if nursing was something I wanted to do. After working a year in long-term care I got the hang of caring for patients, taking off orders, unclogging g-tubes, administering tube feedings amongst other things I did as a new nurse. At the time I thought I was doing it big. I can appreciate this job because I was recognized by the "higher up" that I was doing a good job. I finally decided to apply for the bridge program at a local community college. One reason being was that I was doing the work of two when it was actually one of me. I was put in charge of the facility on more than one occasions which was a RN supervisor position. It was only fair that I be compensated for doing the job. After graduating with my RN I was the proudest person, I was a Registered Nurse. Eventually after working for a few years I started hearing in random conversations that I wasn't recognized as a professional nurse. I didn't understand what they meant at the time because I was doing the same job as they were (very naive). I guess I should have thoroughly reviewed the nursing scopes of practice. Anyway, for years I kept hearing this comment in my head and it pushed me to seek my BSN so that I can finally be recognize as professional nurse. I still feel that we are the largest in the healthcare profession and continue to have the most problems. We still continue to "eat our young" instead of being leaders and making a pathway for our future nurses. I think we can treat each other with a little bit more respect than what we do. We should have each others backs at all times. Maybe one day we will come together and support our profession and what we stand for.

Future Plans

I am planning to embrace my profession. I want to experience nursing in all its grandness by attending professional seminars, attending nursing association meetings, and getting involved some way in the political scenes of nursing. As a teen I participated in political caucuses and competed in oratorical contests. I think that my personality would be well suited to some of these activities in some way. A great leader is a better follower. I would love to work behind the scenes and have professional nurses represented to our policymaking leaders, as well as to the people.
It's funny, I never felt this sense of pride about being a professional nurse. For the first time, I was asked to be a part of a committee at work. I didn't have to ask and it wasn't something delegated. It was because I made a statement denouncing negativism on the unit, and encouraging unity and supporting our nurse manager, offering solutions to identified problems.
The greatest thing about nursing, it is so diverse. And just like it takes all kinds to make this world, it takes all kinds to make our profession truly great.

Nursing

You know, Parkland has an RN position that is listed as "Call Center RN." The blog posted by Professor Anderson immediately reminded me of seeing this job title while I was job searching last summer. I checked again today, and there is a Call Center RN position available. Same one? I have no idea, but it was listed as open since Sept. 2009. While I don't necessarily think it is fair to exclude those individuals who lack manual dexterity or fine motor skills from being nurses, I don't really see any other options. Nursing by definition is, "the provision, at various levels of preparation, of services essential to or helpful in the promotion, maintenance, and restoration of health and well-being or in prevention of illness, as of infants, of sick and injured, or of others for any reason unable to provide such services for themselves" (Dorland's Medical Dictionary, 2007). The American Nurse's Association states that the "function of a nurse involves the physical intimacy of laying on of hands." The basis of nursing involves interaction with patients and acts (by the nurse) of healing and caring to some degree. Even if later on a nurse becomes a Call Center RN, or an Advanced Practice Nurse who is more removed from bedside nursing, he or she still has the previous experiences and the knowledge gained from hands-on caregiving to refer to when practicing. Training is an important part of being a nurse...would you want a doctor who had graduated from medical school without ever palpating an abdomen, giving an injection, or closing a wound with stitches? Would you want a lawyer to defend your life who has never been in a courtroom, practiced giving depositions, or been in a mock trial? The point is that certain professions have specific skill sets and duties that only people who hold that title can perform. Society expects some level of performance and mastery of these skills by those individuals within such a profession. No, I do not think that someone who cannot perform the physical duties of nursing should obtain the title of Registered Nurse. I think that their own knowledge, book learning, and unique personal experiences can provide them with great insight on nursing, but this is not the same as actually "being" a nurse.

WOW...

This week I spent sometime with my preceptor. I helped her write a capital expediture request for $150000.00 equipment. She and all the nurse managers got together to work on it. I was impressed with their collaboration efforts. This took up a great deal of time, because it had to be clear, concise and convincing. I was only discouraged by the sentiment that the benefit to the nurse was greatly under emphasized on purpose. I think that nurses sometimes undermine their own authority and value to other professionals and we generally suffer for it at the bedside. I am grateful for this experience.

I learned that I had to approach this project from a leadership position, using a politically correct perspective, instead of from staff nurse position. For example, I had to consider that if I emphasize the benefits to the nursing staff in way of efficiency, that leadership may consider ways to cut nurses on the other hand.

After it was all said and done, I thought about what a more experienced nurse told once, "When you go to the interview, don't just get interviewed, make sure you interview that person, to see if you are a good match to them." I want to work for a place that values my contribution enough to make sure I have what I need to do my job well, not just get it done.

Nursing and Publishing Our Perspectives

"We do not publish in newspapers, online lay journals, and books that describe healthcare from our perspective."

--Why not?
Maybe because we are unfamiliar with that venue. Technology is advancing rapidly, and seemingly so complex. Bottom line--if not desire, probably ignorance...

--How can we change?
Knowledge and networking. Get informed and learn to use the technology.

--...Consequently making waves?
I think nurse professionals may not be so readily to voice their views because, you can get fired from your job if you state something that might conflict with your place of employment mission statement or policies. Look at those getting fired for doing really stupid stuff on my space accounts. It can become really complicated.

--How can we manage those waves as individuals and as a profession?
I think that you must seek approval from your place of employment. Give them (their legal department) the opportunity to review any statements before publishing them. Work with various associations and community health organizations to make sure that you a publishing your opinions supported by indisputeable facts and peer reviewed reasearch. Make as few enemies as possible. Be careful not to get caught up in propaganda stuff. Make sure you have a lawyer on retainer.

Getting a BSN

This will not be my first 4 year degree, but it is a step towards my dream of becoming a nurse practitioner. When I joined the military in 1993, I was given the occupation of 'combat medic' an EMT-B. I ended up managing a multi-speciality clinic my first year as a Private First Class(PFC), because all other Americans ended up rotating out at the same time. I was surrounded by wonderful people, professionals who encouraged me to move forward with my career and education. I was a first generational high school graduate and the thought of college and a real profession seemed unattainable to me. After working with Physician's Assistants and Nurse Practitioners, I knew then I wanted to be a family nurse practitioner. I applied to the nursing program in the Army, became an LVN, and after exiting the military, I started my journey to that dream by becoming an RN. It has been a long and tedious journey. Nonetheless, I am excited and I still look on that day when I decided this was for me. I have been sidetracked, discouraged, and all that stuff...but I know, it's worth all of it. I believe that it takes a 'calling' to be in this profession. Though money is necessary, and the flexibility that nursing offers is second to none, I am proud in knowing that I have an honorable occupation that is gratifying to me.

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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