A Reflection of Five Weeks of the Co-Operative Nursing Experience free essay sample

A Reflection of Five Weeks of the Co-operative Nursing Experience Rebecca Tutt, RN University of Texas at Arlington In partial fulfillment of the requirements of N3300 Specialized Topics in Nursing (Co-Op) Beth Mancini, RN, Ph. D. March 7, 2013 Online RN to BSN Introduction The co-operative nursing assignment has given me the opportunity to use my critical thinking, decision-making, leadership, and clinical nursing expertise learned throughout the RN-BSN program. The fostering of critical thinking as one of the terminal learning goals of nursing education based on the idea that critical thinking is important not only in the nursing workplace, but also in nursing education† (Shin, Jung, Shin amp; Kim, 2006, p. 233). My critical thinking skills have been enhanced throughout the program due to class assignments and the use of professional nursing journals. Critical thinking was used to set the three goals that will be reviewed in this paper, from data-gathering skills to decision- making skills. Leadership and communication skills are essential for my role as nursing supervisor in an ambulatory primary care clinic. The RN-BSN program leadership and management class has been valuable in my growth as a leader. Nurses in management roles â€Å"must be skilled communicators and relationship builders, have knowledge of the health care environment, exhibit leadership skills, display professionalism, and demonstrate core leadership competencies (Sullivan, 2012). I used these leadership skills while completing my team dynamics goal that will be reviewed in this paper. Throughout the last five weeks of the co-operative nursing experience, I have seen my skills, behaviors, and attitude change. Prior to starting the three projects for this class, I was still lacking confidence at times when coaching members of my nursing team. I became timid and listless, which became obvious since it was not my normal behavior. All three of these characteristics have improved while working on both the professionalism and team dynamics goals. In coaching a medical office assistant last week for not meeting the expectations of her job, I kept a professional attitude and remained confident. The medical office assistant corrected the issue immediately and has continued to meet the expectations of her job since the coaching session. Evidence Based Practice The evidence based practice goal that I set was to identify one patient education topic in my primary care clinic that needed improvement. I planned to monitor incoming patient telephone calls and survey the patients after visit summaries for two weeks to identify the topic. I was able to quickly identify my topic as patient education regarding an accurate medication list and understanding the completion of medication reconciliation at each office visit. In the outpatient setting, safe medication management presents a greater challenge† (Leonhardt, Bonin, amp; Pagel, 2007, p. 8). While speaking with patients on the phone, I found that we were not doing a good job of educating them about the importance of an accurate medication list. A significant number of patients were taking over- the-counter and herbal medicati on that could have interacted with some of their prescriptions, but they were not on the current medication list in the electronic medical record [EMR]. These conversations reinforced that additional patient education was needed. I collaborated with staff; researched patient education of medication list, and read peer reviewed nursing journal articles to compile an appropriate resource guide for the nursing staff to use as an educational tool with our patients. A key strategy recommended by national and international patient safety experts is to engage patients in the medication process through a collaborative relationship with their providers (Leonhardt, Bonin, amp; Pagel, 2007). I collaborated with the Clinical Staff Assistant [CSA] supervisor to start engaging the patients about the medication from check-in through their office visit. To do this, we implemented giving the patient a copy of the current medication list we had on file and asking the patient to review and make corrections to the list as needed. When patients are brought back for rooming, the nurse or medical office assistant will review the printed list with the patient prior to documenting in the EMR. During the office visit, we will review polypharmacy and are adding a document to our resources section of the EMR egarding polypharmacy and accurate medication list that will be given to all patients. I have always been aware of the importance of accurate medication list, but was not reviewing this often enough in our patients EMR. As a result of this project, I have made an audit tool for myself as nursing supervisor to complete every two weeks. I will check the EMR to make sure the medication list was reviewed accurately and I will check to make sure the patient education tool added to the resources is being given to all patients. Improvements in patient safety in the clinic setting require physicians, nurses, and administrators to commit to identifying structural and process changes that make it easier to provide consistently safer care† (Schauberger, amp; Larson, 2006, p. 421). Professionalism The professionalism goal that I set was to develop a preceptorship program for my clinic that would provide socialization, team support, and clearly defined expectations of professional behavior and performance for new nursing staff. To achieve this goal, my plan was to seek guidance from the American Academy of Ambulatory Care Nursing [AAACN] and the clinical nurse educator assigned to the clinic through the administration. I also used nursing journals for reference and research of nursing preceptorship programs. â€Å"The importance of nurse preceptors in helping to educate new nurses cannot be overemphasized as they mentor new nurses and help them to visualize the range of roles they will perform in a variety of clinical settings† (Paterniti, 2006). The preceptorship program was a large task to tackle. I started by meeting with LaBecca Doyle, RN, BSN, MA, clinical nurse educator. She was insightful and gave me tips on how to research preceptor programs. At that point, I started researching program styles and looked to see if any of the clinics in our building had a program that could be modified to fit my clinic. I then began looking at the current staff to see who had the right skill set to be a preceptor in the ambulatory setting. After selecting three nurses, one from each POD, I set up a meeting to collaborate on this project. I brought all of the articles and outlines regarding preceptor programs to the table. The collaboration with the nursing staff was contributory to achieving the goal of implementing a preceptorship program within our clinic. We all agreed on making a binder with an outline of the program, which would include the description of the preceptor’s role, position relations, role responsibilities, an orientation agreement between the preceptor and the orientee, an agreement between the preceptor and the nursing supervisor, and instructions to the preceptor. I began working diligently on the project and was able to complete the binder prior to a new nurse starting on May 7, 2013. As a result of pursing this goal, my leadership skills, collaboration skills, communications, and relationship skills have been enhanced. The support by the preceptor’s colleagues and the nurse-manager are imperative to meeting the organizations expectations to prepare the new nurse to function independently (Paterniti, 2006). Additional changes to my role after the implementation of this program will be to meet weekly, when we have new hires, with preceptors and new nursing staff. The preceptor will remain with the new nurse for four weeks, but â€Å"time, environment and expertise† (Modic amp; Schloesser, 2006) will also play a factor in the orientation time. A nurturing environment is essential for optimal growth† (Modic amp; Schloesser, 2006), so making sure each nurse is given to best scenario to success will be my job as the nursing supervisor. All of this will allow me to build important relationships with the staff as well as to review the program and see if changes are needed. Team Dynamics The team dynamics goal that I set was to identify the nursing role of team empowerment and the relationships between team members, team environment, and job satisfaction within POD 3 of my clinic. I planned to achieve this goal by observation, interaction, and a survey to empower the team members with clear and jointly developed goals. I wanted to make sure there was an appropriate mix of skills and expertise within the team, and reward team performance appropriately. In completing the observation phase of my goal, I was able to look at the POD 3 team, as I had not done before. I not only observed their nursing and medical office assistant skills, I also looked at their interaction with each other. During this time, I was able to see that communication was not always accurate. When providers came out of patients rooms and directed the wrong nurse to complete a task, they became frustrated because they had their own provider to support. This experience, even though trying, was still contributory to my end goal. To have a team that is truly working together, we had to have the physicians on board as well. My initial thought was to only look at nursing; I realized I needed to look at the physicians as well. I went back to my original goal and decided to add the physicians in the mix of team dynamics. I plan to collaborate with the nursing staff to see what they think will help resolve this problem. â€Å"When nurses are able to contribute to practice decision-making, including policy development and equipment selection, they are likely to have a stronger connection to their work setting, thus promoting retention† (Friese, amp; Himes-Ferris, 2013, p. 153). I have also planned a lunch for the end of May with all of the nursing and provider staff from POD 3 to collaborate on how we can communicate better as a team. In assessing job satisfaction of the nursing staff in POD 3, I made a survey to be completed anonymously and placed it in a sealed box. I read many nursing articles regarding job satisfaction and based the survey from those articles. The results were overwhelmingly positive with great comments about their peers and provider. One nurse stated, â€Å"This is the best team I have worked with in a long time and it makes me look forward to coming to work each day† (C. P, personal communication, May 3, 2013). Although the majority of the survey results were positive there did seem to be a problem with the location of nursing staff to providers. I looked at the seating assignments and feel like a few adjustments can be made. I also believe that this change may help with the problem of the provider seeking out the wrong nurse to assist him. As a result of pursuing this goal, I have enhanced my observations skills as well as my leadership skills. After the first observation of POD 3, I realized that I too walked around with blinders on. I was solely focused on if the nursing staff was completing the tasks they were assigned, and if they were using the EMR correctly. By stepping back and observing, I learned that this team is empowered by each other. Their skills sets are complimentary of each other allowing them to assist each other in various ways without having to seek out additional help from other POD’s. The lead nurse in this POD is interactive with all of the team members and appears to communicate effectively with everyone. I think pursing this goal has increased my knowledge as a team leader and I have built better relationships with all of the nursing team. Conclusion and Impact on Practice I found that reflective journaling of each day made me stop and look at how I was performing as a nursing leader. I gained insight and confidence from journaling because it let me see my accomplishments for each day and it allowed me to see that I was leading by example. It also showed my continued growth in professionalism, which was seen on many occasions while interacting with staff on all levels. At first, writing goals to achieve in a five week period made me nervous. I have continuously incorporated healthier time management skills using Covey’s Model, which I learned about in Professional Nursing Aamp;B. I have been successful at managing my time, but I had no idea where I would find time to complete the three goals. By using this model and other time management skills, I was able to complete the three goals and maintain my daily nursing supervisor tasks without a lot of extra stress. This increased my confidence as a nurse and a leader. I believe the experience gained from setting goals of evidenced based care, professionalism, and team dynamics has helped expand my organizational skills as well as my nursing knowledge. My philosophy of nursing has only been enhanced from all of the RN-BSN program classes. I believe the core of nursing is the actual care and caring for the patient. In my opinion, patient-centered care allows nurses to give the highest quality care. Patients want nurses who are engaging them to be involved in their own care as well as being caring, compassionate, trustworthy, and advocates for them. â€Å"The nurse strives to provide patients with opportunities to participate in planning care, assures that patients find the plan acceptable and supports the implementation of the plan† (American Nurses Association [ANA], n. d). While searching for my patient education topic for this paper, I found many of our clinic patients wanted to be more engaged in their care. They wanted to understand the importance of possible interactions of over- the-counter medications with prescription medications as well as why they should tell their healthcare team when they are adding and deleting medications from their daily regimen. Each step in the co-operative nursing experience as well as all of the other RN-BSN classes has influenced my nursing practice in a positive manner. My effective listening skills were enhanced while speaking with patients and members of my nursing team. I have gained a better foundation and understanding of evidenced-based practice through the research articles, which has reinforced my philosophy of quality care for the patient. I have become a better leader for my nursing team by being more knowledgeable of professionalism in nursing. I enhanced my knowledge of team building skill and activities through the successful completion of my team dynamics goal. Over the last five weeks, I have grown as a nurse and a person, which will allow me to continue to be an effective nursing supervisor as well as a competent individual contributor to nursing. References American Nurses Association. 2010). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld. org/MainMenuCategories/EthicsStandards/ CodeofEthicsforNurses/Code-of-Ethics. pdf Friese, PhD, RN, AOCN, FAAN, C. R. , amp; Himes-Ferris, MPH, L. (2013). Nursing practice environments and job outcomes in ambulatory oncology settings. THE JOURNAL OF NURSING ADMINISTRATION,  43(3), 149-154. Retrieved from http://deepblue. lib. umich. edu/bitstream/handle/2027. 42/96543/Nursing practice environments and job outcomes in ambulatory oncology settings. pdf? sequence=1 Leonhardt, MD, MPH, K. , Bonin, RHIA, CPHQ, D. , amp; Pagel, RN, BSN, P. 2007). How to create an accurate medication list in the outpatient setting through a patient-centered approach. Retrieved from http://patientsafety. org/file_depot/0-10000000/20000-30000/24986/folder/65244/medtoolkit. pdf Modic, M. B. , amp; Schloesser, M. (2006). Preceptorship. journal for nurses in Staff Development,  22(1), 39-40. Paterniti, T. (2006). The successful nurse preceptor. Pulse,May, 25-29. Retrieved from http://www. hypnosisdfw. com/PULSE0506. pdf Schauberger, M. D. , M. S. , C. W. , amp; Larson, R. N. , M. S. , P. (2006). Implementing patient safety practices in small ambulatory care settings. Joint Commission Journal