Thursday, November 19th, 2009

Today I observed the behavioral interviewing approach. They are implementing a new interview process at the hospital. It is composed of 3 separate hour interview with behavioral interview questions. I learned more about HR role of prescreening canidates for interviews.

The night before my clinical the was a code called. The morning in at the am meeting they were discussing preventive strategies. This hospital is not staffed for that level of care. They have a PICU team that observes the children in the ER and on the inpatient floors for increasing signs of distress so that they can be transported to larger hospital downtown before immediate distress occurs.

I was also able to follow the nursing supervisor around in the morning while my preceptor was at a meeting downtown. I got to see what her roll is which was really busy and interesting. She takes care of staffing the unit for all shift so she deals with admission, discharges and sick call in to make sure the floor runs smoothly.

November 2, 2009

It was nice to have my clinical preceptor back from his mission trip in Africa. Today was supposed to be my last day, but I will have a make up day since he was gone November 19th. Today we met with a new hire to talk about her orientation schedule and vacation before working on the floor. We also had an AIDET meeting to discuss how to educate employees with communication. We looked at the overall patient satisfaction scores and talked about the areas of weakness and what reasons they might have occured. The graphs have shown a decline in communication between nurses and patients, and with increased wait times in the ER, patient are complaining about never being seen by a provider. There has also been an increase in left without being seen rates. We discussed how we would implement education for the staff about communication to families to resolve this problem.

Mid-Term Evaluation

Midterm Evaluation:

• 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.

I have worked a lot on the goals as far as communication. I have watched my preceptor work with other staff to promote employee satisfaction and patient satisfaction. The managerial staff have patient rounds for patient satisfaction. They visit each patient on their floor to ask how everything has been for them and if they needed anything. This greatly improves the satisfaction of their patients because if they have a problem it can be solved more readily instead of falling through the cracks. Employee satisfaction is done through employee surveys. I was really impressed that the management staff jumped right in when the nurses were busy. They were asking how to admit and dischard on epic so that they can help out with staff nursing.

I have also worked with managerial staff in reguards to budgeting during this flu crisis, trying to get more physicians and nurses working during this time. My preceptor doesn't make the budget but does work with the business manager for hiring new staff. I hope to talk with the business manager part of one of my days there to work with him on the making of their budget.

I personally have really enjoyed having clinicals with this hospital. I believe I found a very flexible and interesting assignment. With the h1n1 flu crisis I have gotten to see a lot about staffing of both physicians and nurses and all about the obstacles management goes through to make sure hiring staff fits into rules and regulations.

• An overall review of your personal objectives and reflection on how you have/have not accomplished them, support either with reasons and/or examples

I do wish I could learn more about the budgeting and I haven't been able to talk to the business manager about how they budget for supplies and staffing in the hospital. I have not been able to accomplish this part of my clinical yet and I plan to follow up on this before my clinical is over this semester.

• Statement and discussion of one way these items have fostered your growth as a professional nurse.

I believe that I have learned more about the hospital and how it functions which is important for a nurse. You have to know how something works to be able to work and be an advocate for the patients in the hospital. I do know that I do not want to go into management, but not because I haven't found this class interesting. I really have enjoyed learning about this side of the hospital and nursing, I just find myself wanting to care for the crying baby down the hall when I am stuck in a meeting about staffing. I can't help it, I love being a staff nurse!

October 23, 2009

I worked with another person in the management team today and i wish I could say I had a good experience, but I pretty much work on research today and had a study day. She told me in the morning that she had 300 emails to respond to, so i worked on research. I plan to change my clinical day next week hopefully to when my original preceptor is back from Africa, where he is doing a medical mission trip. Until then....

Tuesday, October 13, 2009

Today was a calmer day and staffing so I got to sit down with my preceptor and ask more questions. There were some interviews for the new job positions that opened and new hires to get staffed with preceptors. I got to see the implementation of the behavior interview approach which was interesting.
The main issue we delt with today were hook-ups in the epic system. There was a patient trying to be discharged from the floor for a doctor's appointment and the physician was not able to access the epic discharge program. We talked to chief nursing officer to work out the problem with the physician.
We discussed the interview topics so that I could complete my interview paper requirements.

Wednesday, October 7th, 2009

Today at clinical we worked on obtaining more doctors to the ER for help during the flu season since there is such an increase in patients and an increase with patients left being unseen. The nurse practitioners are working well and helping talk care of flu clinic patients, but the restrictions only allow them to take flu symptom patients above the age of two. Staffing for nurses is working better now and we have coverage for the ER so far including physicians so this was a huge improvement since last week.
We also went downtown for an epic meeting, working out the kinks of the 'go live!' It was interesting to see all the people it takes to make a change take action with nurses from all different departments working to make a new computer system work.
Throughout the day we discussed patients that were transfered in through the access center downtown to see if patients being sent were appropriate patients for the level of care this hospital was caring for. There were some questionable patients to staff talked to doctors to discuss theyre opinion. I really appreciate how this hospitals works together. I like their management style.

September 30, 2009

Wow, what an interesting day. I have been running around today meeting after meeting. Today I have been working on one of my objective dealing with staffing. The H1N1 season is causing a major impact on our hospitals and after having conferences call with another hospital, we were not the only ones. We are having to work out staffing to provide patient safety, which is becoming more and more difficult. While the budget for the hospital will allow more staff, where to find them is the key factor! H1N1 is causing huge delays in patient's arriving in the ER. Patient waiting time are increasing and sick patient are waiting in the waiting room where more are exposed. I spent the day working with Doctor's offices to regain doctor staffing and NNP's to cover the ER so that wait times are decreased.

This clinical is really interesting because as a staff nurse we complain when certain problems arise and from this clinical I can see that there are a lot of approvals and politics that take play in making decisions.