2 Course Clinical Objectives and 2 Personal Objectives so far in the course; relate your progress on these objectives to your work in your specific clinical site:
2 clinical course objectives:
1. Leadership skills-I feel I have met this goal because of the knowledge and wisdom that has been passed on to me by my preceptor. My preceptor has truly inspired me to be a great leader. I have learned that effective leadership involves loyalty, respect, trust, and effective listening. A leader must be self motivated and committed to whatever change or situation that takes place in their department. An effective leader also motivates, educates, and empowers others to see that vision and give them opportunities to express their feelings about the change.
For example, The ED department at DRMC is currently trying to be a level 3 trauma center and in order for them to achieve this goal, they must first be up to date and compliant with the trauma documentation. My preceptor has educated the staff on the items that are being overlooked or not documented like hourly vital signs. He posts the trauma checklist on all the computers to remind the staff. He also offers suggestions in ways to keep improvement and encourages feedback. He also recognizes champions who are documenting 100% in front of their peers and ask those champions to assist him in helping the other staff members improve in their documentation. As a result of this effective leadership, they are currently 100% on their trauma documentation.
2. Communication-I feel I have met this goal because I effectively communicate with my preceptor during all my clinicals. I ask questions and give my emergency expertise when it is appropriate. My preceptor respects my 9 year experience as an emergency room nurse and he is always asking my opinion about the flow of the ED and ways to improve patient satisfaction. My preceptor has also shown me how to de-escalate situations and effectively communicate in group meetings.
2 personal objectives:
1. One of my personal objectives was to be able to identify the effectiveness of managerial decision making in health care settings. I have successfully observed the effectiveness of decision making by my preceptor on several occassions. We all know that emergency rooms can be chaotic because you never know what is going to happen and my preceptor actually has order to this chaotic department. His willingness to step in and help out in critical situations has actually increased the moral and attitude of the department. Everyone works together as a team and he is always ready to make split second decisions effectively.
For example, A patient presented to the ED with chest pain and there were no available beds. There were patients waiting to go the floor and the triage nurse was backed up as well. My preceptor immediately stepped in and assessed the chest pain patient, performed the ekg, and started taking the admit patients upstairs to create empty rooms for the patients in triage. The staff was very appreciative.
2. Another one of my personal objectives was to be able to familiarize myself with the clinical facility, personnel, policies, procedures, and the goals and philosophy of the agency by the end of the second week of clinicals. I actually met this goal the first week of clinicals. The staff has been very friendly and cooperative. Administration kindly acknowledge me when I go to meetings and my preceptor has shown me the policy and procedures in the ED, especially their Core Measures. DRMC is Commited to Excellence in Service and they use a team centered approach by collaborating with one another in order to increase patient safety and satisfaction.
For example, I attended a meeting with all of the directors of the hospital in regards to the flow of patients in the hospital and the reasons for delay. The directors received constructive criticism from one another and they respected each others opinion. They focused on a common vision to solve this problem and ended the meeting with a positive attitude to improve the flow of ED and improve patient care.
An overall review of your personal objectives and relection on how you have/have not accomplished them, support either with reasons and /or examples:
So far my clinical experience with my preceptor has been rewarding. I feel I have successfully accomplished most of my personal objectives as evidenced by the ones listed above. I have 16 more hours of clinicals because I have not been able to do 8 hour days. I am looking forward to completing my change project and my preceptor has been very supportive with my project.
Statement and discussion of one way these items have fostered your grown as a professional nurse.
I have learnt so much about leadership and the effectiveness of managerial decision making from my preceptor. I have been a staff nurse for 9 years and I never understood the decision making of certain managers, especially when it involved staffing. I know have the knowledge about understaffing and overstaffing as related to budgeting. I understand that leaders must be committed to their staff, loyal, respectful and communicate effectively. A leader must be an advocate for their staff. Just as the bedside nurse is the voice for their patients, the manager is the voice for their employees. I feel this class as empowered me to be a better nurse and to continue my education as a nurse professional. I am going to pursue my master's degree and maybe even my doctorate degree. I may even want to go into management one day. This has truly been a wonderful experience.
Statement and discussion of one way these items have fostered your growth as a professional nurse.
Saturday, October 31, 2009
Tuesday, October 20, 2009
Communication is the Key Journal 5
Well everyone,
I have done 8 hours of clinicals this week. The director started off his day as usual with checking his emails and voicemails. He also had to follow up with a couple of patients via telephone in regards to the care they received in the emergency room and questions regarding their bill. The manager has the responsibilty of maintaining staff and patient satisfaction. I also attended a "door to balloon" meeting yesterday. The Emergency Department is really progressing in their door to balloon time with their STEMI patients. This is the time it takes for the patient to go from the ED to the Cath Lab because we know that time is muscle.
Today, I attended a director's meeting. The meeting was lead by the ED medical director in reference to the increase in occurrence reports on patients that were sent to the floor. The ED medical director felt tha this could have been handled better with effective communication as opposed to writing occurrence reports. There were a series of barriers that ED was encountering from the floor in regards to admissions. Effective communication is one of the main qualities that a leader/manager should possess. Having a positive attitude is also another important quality of a leader because this can have a major affect on the attitude of the staff and can also affect patient satisfaction. Therefore, the medical director wanted to discuss the change of attitude amongst the different departments in the hospital. For example, the ED has an Angina Pathway implemented by the hospital that is being rejected by the medical floor because the nurses are saying that it doesn't meet criteria which is causing a major delay in patient flow and patient care. This has caused animosity amongst the hospital staff. The floor is stating that they don't do Chest Pain patients until they have 2 cleared troponins in the ED. The ED medical director stated that they are not admitting Chest Pain patients to the floor. For example if a patient is diagnosed with pneumonia and the patient has a history of CHF then they will order lasix and write the orders on the Angina Pathway. The problem seems to be the title of the orders which read Angina when admitting these patients. Another main issue is that if a patient goes to a floor that doesn't require that level of care then the hospital does not get paid. This is due to managed care by the insurance companies. The ED director stated that this past month ER patients stayed 1600 hours total in the ED waiting on admission beds. This can have a major impact on patient care. She believes that the departments need to have a common goal: the best quality patient care possible. The medical charge nurse stated the medical floor is med/oncology and the nurses on that floor does not have ACLS nor can they read EKG strips. The rest of the department managers seemed to be unaware of this. So they decided that education was one of the ways in solving this problem and decided to make this meeting a regular monthly meeting until this issue is resolved. The directors decided that they needed to move forward in a positive manner to improve flow of ED and improve care of the patients through education and communication. This was a very informative and productive meeting. It was good to see the directors respect each other, handle constructive criticism, and come together and collaborate with one another to come up with a common goal: Patient care.
I have done 8 hours of clinicals this week. The director started off his day as usual with checking his emails and voicemails. He also had to follow up with a couple of patients via telephone in regards to the care they received in the emergency room and questions regarding their bill. The manager has the responsibilty of maintaining staff and patient satisfaction. I also attended a "door to balloon" meeting yesterday. The Emergency Department is really progressing in their door to balloon time with their STEMI patients. This is the time it takes for the patient to go from the ED to the Cath Lab because we know that time is muscle.
Today, I attended a director's meeting. The meeting was lead by the ED medical director in reference to the increase in occurrence reports on patients that were sent to the floor. The ED medical director felt tha this could have been handled better with effective communication as opposed to writing occurrence reports. There were a series of barriers that ED was encountering from the floor in regards to admissions. Effective communication is one of the main qualities that a leader/manager should possess. Having a positive attitude is also another important quality of a leader because this can have a major affect on the attitude of the staff and can also affect patient satisfaction. Therefore, the medical director wanted to discuss the change of attitude amongst the different departments in the hospital. For example, the ED has an Angina Pathway implemented by the hospital that is being rejected by the medical floor because the nurses are saying that it doesn't meet criteria which is causing a major delay in patient flow and patient care. This has caused animosity amongst the hospital staff. The floor is stating that they don't do Chest Pain patients until they have 2 cleared troponins in the ED. The ED medical director stated that they are not admitting Chest Pain patients to the floor. For example if a patient is diagnosed with pneumonia and the patient has a history of CHF then they will order lasix and write the orders on the Angina Pathway. The problem seems to be the title of the orders which read Angina when admitting these patients. Another main issue is that if a patient goes to a floor that doesn't require that level of care then the hospital does not get paid. This is due to managed care by the insurance companies. The ED director stated that this past month ER patients stayed 1600 hours total in the ED waiting on admission beds. This can have a major impact on patient care. She believes that the departments need to have a common goal: the best quality patient care possible. The medical charge nurse stated the medical floor is med/oncology and the nurses on that floor does not have ACLS nor can they read EKG strips. The rest of the department managers seemed to be unaware of this. So they decided that education was one of the ways in solving this problem and decided to make this meeting a regular monthly meeting until this issue is resolved. The directors decided that they needed to move forward in a positive manner to improve flow of ED and improve care of the patients through education and communication. This was a very informative and productive meeting. It was good to see the directors respect each other, handle constructive criticism, and come together and collaborate with one another to come up with a common goal: Patient care.
Sunday, October 18, 2009
Journal 4
Well, unfortunately I was able to be with my preceptor this week. The days that I was available, he had to be the unit clerk on the floor and he had ACLS the other 2 days. He was very apologetic about not being available this week either, but I let him know that it was ok and I was looking forward to learning from him in the weeks to come. This gave me the opportunity to work on my change project. I have learned so much in this class. I understand how important communication is with my coworkers especially when I am in a leadership position. I know that as a leader I must have the right attitude because it can affect and infect my entire staff. A positive work environment means better quality care for the patients which is our ultimate outcome.
Sunday, October 11, 2009
Journal 3
Unfortunately, I did not have clinicals this week because my preceptor went out of town to an ENA conference. I have truly enjoyed my clinical experience thus far. Having the opportunity to actually shadow a nurse director and to be involved in management decision making as made me a stronger nurse. I can recall the characteristics of my last nurse manager and those characteristics did not reflect an effective leader. My preceptor is very positive and encouraging to his nursing staff. He is an effective communicator and listener which are all the qualities I would like to possess as a leader. Actually, when I think of leadership qualities, I think those are qualities that we should have regardless of our hired position. When you have a positive attitude and are able to communicate and listen to your peers, it truly creates a positive enviornment. I am looking forward to meeting with my preceptor this following week and obtaining new knowledge for my professional career.
Friday, October 2, 2009
2nd Week of Clinicals
Hello everyone,
I had a really productive week with my preceptor. I had the opportunity to attend an ER staff meeting on Tuesday. There were several initiatives discussed in the meeting. Some of them were the Door to Balloon time on STEMI patients. These are Cath Lab patients that are needing stents placed. DRMC's goal is 45 minutes and they actually had a door to balloon time of 28 minutes on Monday! That was exciting to hear. They are also implementing online scheduling. The staff can view the schedule on the internet, including in the privacy of the home. One of the biggest issues discussed was patient satisfaction scores. DRMC patient satisfaction score is currently below satisfaction and the new director (which is my preceptor) is actually implementing new ways new improve those scores. He discussed customer satisfaction, where the nurse acknowledges the patient by name when entering the room and then the nurse gives them their name, credentials, and years of experience. When patients are discharged the nurse thanks them for choosing DRMC in addition to giving them their discharge instructions. My preceptor stated there will be a lot of changes made in the ER department but they will be priortized and not done all at once. I also had the opportunity to assist my preceptor in done statistics paper on the ER holding patients and their holding time. It was quite interesting.
What I really admire about my preceptor is that he is a team player and a motivator. Due to the swine flu pandemic, the ER has been extremely busy. My preceptor was on the floor helping the nurses transport patients, putting triage patients into the computer, reassessing patients, etc. I have been an ER nurse for 9 years and I have never seen a director step in and help out the staff the way that he did. To give you another example, one of the nurses came to him and said they were out of cups and one of the patients was requesting some water. Instead of my preceptor delegating that task to someone, he told the nurse that he will go to the cafeteria and get some cups because the staff would be more useful staying in the ER to help the patients. I know this may sound like something minor but it spoke volume to me.
After interviewing my preceptor this week, I was sharing my thoughts about this course with my preceptor about how I am truly enjoying seeing the management side of nursing and it has really broaden my knowledge about why things are thing in the ER department (since I am an ER nurse) and the hospital organization. He stated that he had no clue about management and leadership when he graduated from the BSN program. He stated they only offered a leadership course and how he wish they offered clinicals for management in addition to the other clinicals. Looking forward to next week.
I had a really productive week with my preceptor. I had the opportunity to attend an ER staff meeting on Tuesday. There were several initiatives discussed in the meeting. Some of them were the Door to Balloon time on STEMI patients. These are Cath Lab patients that are needing stents placed. DRMC's goal is 45 minutes and they actually had a door to balloon time of 28 minutes on Monday! That was exciting to hear. They are also implementing online scheduling. The staff can view the schedule on the internet, including in the privacy of the home. One of the biggest issues discussed was patient satisfaction scores. DRMC patient satisfaction score is currently below satisfaction and the new director (which is my preceptor) is actually implementing new ways new improve those scores. He discussed customer satisfaction, where the nurse acknowledges the patient by name when entering the room and then the nurse gives them their name, credentials, and years of experience. When patients are discharged the nurse thanks them for choosing DRMC in addition to giving them their discharge instructions. My preceptor stated there will be a lot of changes made in the ER department but they will be priortized and not done all at once. I also had the opportunity to assist my preceptor in done statistics paper on the ER holding patients and their holding time. It was quite interesting.
What I really admire about my preceptor is that he is a team player and a motivator. Due to the swine flu pandemic, the ER has been extremely busy. My preceptor was on the floor helping the nurses transport patients, putting triage patients into the computer, reassessing patients, etc. I have been an ER nurse for 9 years and I have never seen a director step in and help out the staff the way that he did. To give you another example, one of the nurses came to him and said they were out of cups and one of the patients was requesting some water. Instead of my preceptor delegating that task to someone, he told the nurse that he will go to the cafeteria and get some cups because the staff would be more useful staying in the ER to help the patients. I know this may sound like something minor but it spoke volume to me.
After interviewing my preceptor this week, I was sharing my thoughts about this course with my preceptor about how I am truly enjoying seeing the management side of nursing and it has really broaden my knowledge about why things are thing in the ER department (since I am an ER nurse) and the hospital organization. He stated that he had no clue about management and leadership when he graduated from the BSN program. He stated they only offered a leadership course and how he wish they offered clinicals for management in addition to the other clinicals. Looking forward to next week.
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