Self-Assessment of Nursing Standards - BSN Portfolio



Self-Assessment of Nursing StandardsCarola SchlatterFerris State UniversityLeadership in NursingNURS 440Rachel O. AdeyanjuNovember 28, 2013AbstractThe American Nurses Association (ANA) sets high standards for professional performance of nurses. Healthcare organizations also provide nursing guidelines that reflect the ANA standards to ensure that clients are receiving a competent level of care. It is important for nurses to regularly reflect on their current behaviors as they relate to the ANA standards, and to set a professional development plan that outlines five and ten year goals.Self-Assessment of Nursing StandardsDescription and Analysis of Current BehaviorsIn my current scope of nursing practice, I work day shift in an inpatient hospital setting providing direct client care. At Covenant HealthCare (CHS), located in Saginaw MI, I am a team member of the Resource Team which is a float pool comprised of registered nurses (RN), nursing care assistants (NCA), and unit secretaries (HUC) for both day and night shifts. The Resource Team divides the patient service units into clusters: critical care, cardiac telemetry, medical/surgical, and rehab. My clusters include critical care and cardiac telemetry units. I have worked on the Resource Team for the past year and a half. Prior to joining the Resource Team, I worked in the Coronary Care Unit (CCU) for five years.My attitude is the driving force behind my nursing practice. My motto, “Be Therapeutic” is something that I discuss with nursing students or nurses that I mentor or train. In explaining my motto, I tell them that I make a decision even before my work day begins that I will try to be therapeutic in my actions and words with the client, their family, my peers, physicians, and any other multidisciplinary personnel that I come in contact with during my day including ancillary staff such as housekeeping because we are all there “for the clients.” When I explain the plan of care to the client and their family, I always add, “Please let me know if you have any concerns, or if there is anything else that you feel needs to be addressed.” This statement has helped me tremendously because, by empowering them, I have in turn given myself empowerment by their trust and openness with me.Standards of Nursing PracticeThe Resource Page link on Covenant HealthCare’s intranet is where I searched to find the Clinical Practice Manual. Nursing standards include Quality of Care, Performance Appraisal, Education, Collegiality, Ethics, Collaboration, Research, and Resource Utilization. I have described each professional practice, and analyzed my strengths and weaknesses. Quality of Care“Each nurse shall participate in the systematic evaluation of the quality and effectiveness of care as directed by the Covenant HealthCare Organizational Quality Assessment and Improvement (QA&I) Plan” (CHS, 2012). Nursing staff at CHS are encouraged to initiate changes for evidence-based practice. They are also petitioned to assist with developing new policies or guidelines to improve the quality of client care. Recently I have brought an issue to the attention of the managers of the critical care units at CHS. I expressed that, as a Resource Nurse, I notice that every critical care room has a fabric stool for RNs to use at the computer. I asked them to consider getting the chairs re-upholstered to a washable covering. It concerns me because I know how often the rooms are placed in contact isolation related to infectious diseases such as C-diff. The existing chairs cannot be adequately cleaned. Patient pillows are often tossed on the chairs, and family members who are not always compliant with isolation contact precautions sit on the chairs when not in use by the RNs. Nurses inadvertently contribute to spreading the very infections they are trying to contain. Management is currently working on making the necessary changes to improve the quality of care for our clients.A weakness of mine is that I tend to be very task oriented, focusing on my own checklists and care plans when delivering care to my clients. In order to contribute to quality improvement, I need to look beyond my individual assignment to observe and identify ways that can improve quality standards for all clients. Yoder-Wise (2011) suggests interviewing or surveying clients about their healthcare encounters or any unmet quality care standards (p. 395).Performance Appraisal“Each nurse evaluates his/her own practice in relation to relevant statues regulations, and professional practice standards” (CHS, 2012). Annual evaluations have been an ongoing practice at CHS. Performance appraisals consist of self evaluations of job expectations, competence, decision making, dependability, and time management. Each area is rated with “needs improvement,” “meets expectations,” or “exceeds expectations.” Nursing staff is also expected to complete a performance appraisal for a peer.Annual performance appraisals are important to me because it is an opportunity to get feedback from my manager and to discuss suggestions for improvement. In my November, 2013 performance appraisal, it was noted that I have exceeded expectations for every practice area. This has helped build confidence for my nursing profession. This past year, our hospital has allowed the peer review appraisal to be filled out by the nurses’ choice. This is unfortunate because I handed my performance appraisal to a peer that was a friend of mine. It is most likely that my peer did not provide the constructive feedback to improve my overall nursing practice.Education“Each nurse shall acquire and maintain current knowledge and competency in nursing practice” (CHS 2012). CHS has mandatory online nursing education that nursing staff are expected to complete at work during spare time or outside of the hospital environment from any computer with internet access. Other expectations are skills competencies and/or in-services, and for attendance of at least 8 out of 12 monthly unit meetings. Michigan Nursing licensure requires 25 CEUs every two years. The primary reason that I chose to join the Resource Team was to expand my knowledge base. Covenant HealthCare has four ICUs with 50 beds that specialize in renal, coronary, surgical, and neuro/trauma. Besides the required BLS and ACLS certification to work in the ICUs, I have had the opportunity to obtain NIH Stroke Scale and ENA trauma certifications. Unfortunately, because I am concurrently enrolled in the RN-BSN program, I have not taken advantage to join a professional nursing organization. Some of the benefits that I am missing out on include networking opportunities, information on conventions related to my specialty area, and career assistance.Collegiality“Each nurse shall interact with and contribute to the professional development of peers and other health care providers as colleagues” (CHS 2012). In my daily scope of practice, especially within the critical care units, I interact with multidisciplinary staff on all levels to meet my client outcomes. I have participated in mentoring nursing students and grad or new nurses, and I also have experience with being a charge nurse. Occasionally I serve as a Reach or Express Nurse to mentor or support nursing staff when they page me for concerns about their client’s decline in health status. If appropriate nursing interventions fail, I assist them in getting the clients transferred to a critical care unit.Participating in Keystone meetings is another way that I have been active in collegiality. Keystone Project, developed for a partnership with some Michigan hospitals, is an initiative that utilizes evidence-based practices (EBP) such as sedation weaning from ventilators and GI and DVT prophylaxis to achieve improved and safer patient care (Beaumont Health System, 2013). The meetings involve members from all areas of clinical roles—physicians, pharmacy, respiratory/physical/occupational/speech therapists, wound nurse, case management and social work, and the nursing staff that provide direct patient care. Because I work as a member of the Resource Team, I find that I stand somewhat apart from my colleagues because I don’t belong to any given unit that I work in. This requires a special effort on my part to extend an attitude of mutual respect and support to the nursing peers that I come into contact with. Ethics“Each nurse’s decisions and actions on behalf of patients are determined in an ethical manner” (CHS, 2012). It is an expectation at CHS that staff maintains HIPPA confidentiality at all times, and I feel that I have done well in supporting this policy. Because CHS is located in Saginaw, MI, I have had the opportunity to serve a very diverse client population which brings about social dynamics that require consulting with case management and social work. Examples are with determining medical decision makers, discussing concerns about possible abuse or neglect, or help with sorting through dysfunctional family situations that directly affect client care delivery. So far in my nursing career, I have not required any involvement with an ethics committee. One of the biggest challenges for me pertains to clients that get designated as comfort measures only. Physician orders most often include IV medications such as ativan and morphine to keep the client comfortable at end-of-life. One particular physician in my hospital demands that certain parameters are met such as keeping the heart rate under a particular number, and he advises nurses to medicate accordingly. This issue is particular sensitive to me because I feel that there is a fine line between keeping a client comfortable versus strictly following a physician order which makes me feel like I am overmedicating and inducing death. My belief is that the client’s family is also an integral part of the quality of care, and their advice is very important to me in evaluating client responsiveness. Collaboration“Each nurse shall collaborate with the patient, family and health care providers in providing patient care” (CHS, 2012). Within my scope of practice, I participate in problem solving on a daily basis. Each unit gathers the nurses together in a safety huddle at an assigned time in the morning for approximately 15 minutes. The charge nurse leads in reviewing unit-specific core measures, planned procedures, identifying clients in the unit who are impulsive or have a high fall or pressure ulcer risk, and to discuss any client that has the potential to decline rapidly. These safety huddles serve as an accountability and cohesiveness of the nursing staff. Everyone benefits when possible problems are identified in advance. In turn, I collaborate with physicians, PT/OT, speech therapists, etc., and delegate to NCAs to meet our quality improvement measures and keep client safety as the highest priority. At times it is difficult for me to communicate optimally with nursing care assistants. It is not that I don’t trust them, but most of my experience has been in critical care. With only one nursing care assistant working with 14 critical care clients, I have learned to take primary responsibility for my client care. When I work in cardiac telemetry units, it is not easy for me to adjust my thinking, and I tend to find myself automatically doing nursing care assistant duties out of habit instead of delegating.Research “Each nurse shall utilize research findings in his/her own practice as appropriate to the individual’s position, education and practice environment” (CHS 2012). Leadership in Nursing NURS 440 and other FSU classes have helped me understand the internal and external factors involved in healthcare and how evidence-based practice and quality improvement measures ultimately lead to positive client outcomes. By simply following the practice guidelines as outlined by Keystone, many improvements have been noted in areas such as bloodstream infections, ventilator-associated pneumonia, and decreased hospital days and mortality rates (Beaumont Health System, 2013). The clinical practice manuals available on our hospital’s intranet contain policies and procedures that are based on current best practices. My quality of care delivery directly impacts the hospital’s current HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) monthly scores. Nursing staff at CHS are encouraged to join a team that meets twice a month to discuss evidence-based practice issues for quality improvement. Unfortunately, in lieu of the time commitment that I need for my BSN studies, I have not taken advantage of an area that would enhance my professional growth and research skills. Resource Utilization“Each nurse considers factors related to safety, effectiveness, and cost of practice options in planning and delivering patient care” (CHS, 2012). CHS has encouraged nursing staff to actively participate in charging clients for supplies, blood products, IV starts, etc. for resource utilization. One of the wasteful things that I have brought to the attention of management is related to the inefficient use of time.? Specifically, one of the critical care units that I float to has had a tradition for many years where the nurses gather in the break room at the start of the shift.? The outgoing charge nurse gives “group report”, a verbal report of each client in the unit to the nurses in attendance.? After that, the incoming charge nurse would make client assignments. Whether it was the day or night shift, group report often took up to 15 minutes. Because of my experience as a float nurse and knowing how other units handled their client assignments, I approached the nurse manager. I recommended that the outgoing shift charge nurse make the client assignments for the incoming shift so that the nursing staff can promptly get RN to RN client reports at the start of the shift.? Nurses would be able to punch out much sooner and therefore save money for the hospital. My recommendation has already gone into effect and shift to shift reporting goes rather smoothly whenever I am assigned to that unit. A weakness of mine related to resource utilization is that I usually find myself taking more linen in my client rooms than necessary. It is not easy to guess what a client may need, and I realize that over time, this kind of practice is not cost efficient to my organization. Professional Development PlanFive Year Goals There are several goals that I plan on achieving over the next five years. The first goal is to obtain my BSN degree from Ferris State University (FSU). My next step will be to apply for an adjunct nursing clinical instructor at a nearby community college, and to further explore the graduate nursing programs at FSU. An additional knowledge base that I would like for my professional development is for experience in the emergency room (ER). The ER would help enhance my diagnostic skills and increase my overall understanding with emergency situations. It would also benefit me to join a professional nursing organization such as the American Association of Critical-Care Nurses (AACN) and/or join the nursing staff at CHS that meets twice a month to discuss evidence-based practice issues for quality improvement. (Appendix A)Ten Year GoalsWithin the next ten years, I plan on having my Master of Science in Nursing (MSN) degree with a preference concentration in education. The application to the FSU graduate program will be completed once my BSN degree is obtained. My career objective includes nursing education in a community college or university or within an organization such as my current place of employment. (Appendix A)Analysis and Action PlanIn pursuit of my primary goal of a BSN degree at FSU, I am currently taking Leadership in Nursing NURS 440 online. Once this class is completed, there are 15 credits or five classes that will bring my degree to completion. For spring 2014 semester, I have already enrolled in Nursing Capstone NURS 450, and I plan on enrolling for Sr Capstone Leadership Practicum NURS 495 during the fall 2014 semester. A Social Awareness class and two free electives 300+ level divided between spring and fall 2015 semesters will complete my action plan to graduate in December, 2015. My focus during the winter months of 2014 will be to complete my 20 hours of volunteer service at the Helen Nickless Volunteer Clinic for meeting the requirements of FSU’s Nursing Capstone NURS 450 class. Completion of the RN-BSN portfolio will be another important project during the spring 2014 semester. Once the Capstone NURS 450 class is complete, I will take the appropriate steps to get a position in the ER and to join the professional nursing organizations outlined in my five year goal section.EvaluationThere are plans set in place to meet my current educational goal of graduating with a BSN degree by December, 2015. My initial target date for RN-BSN completion was spring 2013, but I had taken an educational break for about two years to work on a book that I have co-authored. Even though my target date for completion was forced to be changed, I have gained valuable writing experience in the process. This was also the time that I joined the Resource Team at CHS and received the cross-training within the hospital units and for the Express Nurse role, along with the completion of certifications in NIH Stroke Scale and ENA trauma. All of these have given me invaluable experiences that will benefit my nursing education career goal. ConclusionThe ANA Standards of Professional Performance will continue to guide my professional nursing practice. By reviewing the practice standards on an annual basis, it will help me reflect on my behaviors and evaluate my strengths and weaknesses to maintain competency in my health care delivery. With dedication and consistency, my five and ten year goals are realistic and achievable. Appendix AFive Year GoalsExpected Completion DateDate CompletedBSN degreeDecember, 2015Apply for adjunct nursing clinical instructor @ Delta CollegeJanuary, 2016Apply for ER position @ CHSJanuary, 2015Join American Association of Critical-Care Nurses (AACN)January, 2015Join EBP team @ CHSJanuary, 2015Ten Year GoalsExpected Completion DateDate CompletedMaster of Science in Nursing (MSN) degreeDecember, 2020Apply for Nursing Education PositionDecember, 2020ReferencesAmerican Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MDBeaumont Health System. (2013). Keystone initiatives, n.d. Retrieved September 30, 2013, from HealthCare [CHS]. (2012 July). Patient services standards of professional performance. Retrieved November 7, 2013, from , P. S. (2011). Leading and managing in nursing?(5th?ed., p.395). St. Louis, MO: Elsevier. ................
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