Last Clinical Day

I completed my last 4 hours of clinicals today. I had the opportunity to attend two meetings. The first meeting was held in the CNO's office. The people who attended the meeting was the CNO, the ER director, and the ER assistant administrator. The meeting was about the throughput initiative in the ED to increase patient flow. Being familiar with a lot of the initiatives, I was able to give a lot of input in this meeting and everyone actually took my advise. They are even going to hire a disposition/discharge nurse after I informed them of how effective it was because I have personal experience with the effectiveness of having a dispo nurse. It felt really good knowing that they valued my opinion as a professional nurse as opposed to being a nursing student. I also attended a meeting that discussed the use of omnipaque versus gastrografin contrast for patients needing a cat scan of the abdomen. Apparently omnipaque is suppose to digest and work through the bowel alot quicker than gastrografin and more palatable to the patients. It was suggested by the manufacturer that it should shave off approximately 45 mins of the patient's ED visit time. Some of the members, particularly the ED doctor is reluctant about using the omnipaque for fear of rescanning the patient and putting them at risk for more radiation. They decided to give it a 30 day trial period and document well on patients who would have to be rescanned. I thanked my preceptor for taking the time out to educate and mentor me during this semester. I had a great experience and learned alot about effective leadership. This was a great semester and I am glad I was afforded the opportunity.

Clinicals 8

Hello everyone,

I completed 8 hours of clinicals on Wednesday and I have 4 more hours to go. My preceptor started his day off with checking his voicemail and emails. We attended a Nurse Leadership Council Meeting that discussed the manager's role in Shared Governance. Shared Governance is a concept that can be used in any discipline. Shared Governance teams are decisional for the discipline. The meeting also discussed the characteristics of an effective team which include; competent team members, unified committment, a collaborative climate, results-driven structure, and clear and defining goals. The members of the Shared Governance partnerships with the manager. There is equity, ownership, accountability, and shared decision making. Effective teams require double-loop communication. Double-loop communication is a process whereby the manager is involved in listening to the staff and encouraging feedback. There is back and forth dialogue between the manager and the staff. The manager must possess the characteristics of a transformational leader which include; coaching, role modeling, and goal setting. Manager's must have a thorough understanding of principles of Shared Governance and must be able to routinely engage in personal reflection in order to attend to own issues of power and control. The meeting was actually on Webinar, which is an online interactive website that allows different hospitals to be involved in one meeting. The room consisted of all of the nurse managers in the hospital. The meeting also defined the difference between the manager's role: traditional vs. current, manager's role in discussing Return On Investment (ROI), education of self and staff, and key elements of a leader. Leadership means knowing where your power comes from. I was thoroughly impressed and enlightened by this meeting. I never really understand all of the intricate details of Shared Governance and never had an interest in becoming involved until now.

Clinicals 7

I spent 4 hours with my preceptor today because he had to leave early. We attended a patient flow committee meeting. The meeting consisted of nurse managers, registration manager, and environmental services manager. The meeting was led by the VP of quality improvement. She directed the flow of the meeting and allowed the department managers to express their concerns regarding patient admits and discharges. The patient to discharge/admit goal is 130 minutes from door to admit/discharge. This was a very interesting meeting and I was happy to be able to attend because my change project is based on patient flow in the ED. My change project is called the ER Faxed Reporting Change Project. Initially, the ED nurses were waiting until the bed was cleaned before they faxed the report to the floor and the floor nurses either didn't have time to review the report or they were too busy and this would cause a delay in ED patient stay. This also occupies a well needed bed by triage or ambulances. I suggested that instead of waiting for the bed to be clean, why not fax the report once the orders are written and that way once the bed is clean,the patient could go to the floor. The ED director really liked this idea and allowed me to implement this in the ED. I am looking forward to comparing the data and evaluating my project.

Clinicals 6

My preceptor started this weeks clinicals off with checking his emails, going to paperwork, and returning phonecalls. We attended a trauma meeting on Tuesday morning. They just discussed the current performance on trauma documentation and as of August, they are 100%! My preceptor has worked really hard in finding ways to encourage the staff to comply with the trauma documentation. He stated that one of the main reasons some of the areas were being missed was because of lack of communication amongst the previous manager and the staff. The staff informed my preceptor that they were never educated about the new documentation. I also went over budgeting with my preceptor and as of right now the emergency room is not in the red for staffing and budgeting.
We also interviewed a potential employee for the director position for NICU. DRMC is trying to expand their NICU department and provide a level 3 NICU for the Denton community. The interviewee was very impressive. She had over 20+ years of Women's Services and NICU managerial experience. She also help expand a NICU department from a 6 bed unit to a 42 bed unit. So she is definitely experienced in the change process. She is currently pursing her master's degree at TWU (which I was excited about). My preceptor did not have to ask her any questions because she was really prepared and knew exactly what to say. At the end of the interview, my preceptor stated that this was a rare situation and most interviews don't go that way. He and several other managers were very interested in having her become apart of the DRMC team because they needed someone who had experienced in this change process. Prior to having the interview, my preceptor reviewed her application and educated me on key things to look for on a resume. First, it should not be more than one page long. Second, look for red flags like gaps in employment or a person who goes from a manager/director position to a staff position. The interviewee explained that the reason for going back to a staff nurse was because of school and family and now that her children are out of high school, she is ready to go back to her passion.
I learnt alot during this interview. Number one, presentation is the key. The interviewee looked very professional, confident, and astute. I also learnt how to review resume's and key things to look for on a resume.
I accomplished 12 hours of clinicals this week. My preceptor had to get a lot of paperwork done and he is working on the trauma information. I assisted him in going over the trauma documention. He explained to me that a manager truly has to be sufficient in time management because there a so many day to day tasks and issues that arise. He stated that management goes beyond paperwork and meetings and in order to be an effective leader, a person must be able to handle the multiple demands that is placed upon them.