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Clinical Log: NGR 6723LStudent Name: Jessica BerlinPreceptor Name: Gina McGinnClinical Location: Saint Vincent's Medical Center SouthsideThis clinical log is a confidential personal journal and intended only to document participation and facilitate student/CON faculty communication/evaluation. This lab requires a total of 135 clinical hours completed and the log submitted no later than Friday, April 24.Both evaluation forms are due at the same time.Review the course objectives and develop objectives specific to your learning environment in collaboration with your preceptor. This activity is to be undertaken no later than the first week of the semester and individualized objectives must be approved by your course instructor.Course Objectives:Evaluate the role of the nurse leader in ensuring that the philosophy and structure of nursing services provides for the delivery of effective nursing care.Determine strategies used by the nurse leader to maintain proficiency, communicate and collaborate effectively, participate in policy and decision making, and serve as an advocate for both staff and the recipients of nursing care.Evaluate the role of the nurse leader in the administration of fiscal resources and the acquisition, allocation and utilization of fiscal resources.Assess the use of the nursing process as the supporting framework for direction of patient care services including data acquisition, records and record-keeping, planning, implementation, evaluation and provision of resources to optimize use of this process.Help implement processes used to ensure that the practice climate enables nurses to practice in accordance with their professional education, promotes professional growth and fosters a participative working environment.Identify the components of the quality assurance/quality improvement program, the mechanisms to resolve problems and improve care, and evaluate outcomes.Participate in implementation of procedures and processes which guide nurse participation in ethical decision making.Demonstrate understanding of the mechanisms used to promote evidence based administrative and nursing practice, including the use of research.Analyze personnel and practice policies to determine their effectiveness in promoting equality and continuity of nursing services and cultural competence in the provision of client care.?(Insert Individualized Objectives Here)1. Demonstrate effective leadership strategies to improve patient care by attending hospital engagement network (HEN) meetings and quality improvement (QI) meetings.2. Effectively communicate, integrate and serve as a leader in departmental meetings alongside my preceptor.3. Oversee and manage departmental funds in order to aide in providing cost effective care by reviewing income statements and participating in justification of spending meetings with hospital administration and my preceptor.4. Evaluate patient safety data collection though QI and leadership meetings.5. Attend CNO advisory meetings and unit base council meetings in order to aide in the promotion of professional growth among units.6. Evaluate policy and social forces that impact patient care delivery through route cause analysis with my preceptor.7.Participate in the implementation and development of policy and procedures needed for ethical decision making, by attending ethics committee meetings and care management team meetings.8. Influence healthcare design using evidence based practices for policy and procedures by assisting in the implementation of the basin-less bath plan and the updated time and attendance policy.9. Review and analyze departmental practices to determine their effectiveness in cultural competency towards vulnerable populations.Week(insert date of participation)Hours Completed (Running Total)ActivityAnalysis of Experience(Insights, Lessons Learned, Leadership Techniques Observed)Week 1 (1/15/15;1/21/15) 11/135Original meeting with preceptor; attended daily huddle meeting with hospital leaders; attended monthly operating revenue meeting; met with hospital educators; attended leadership meeting involving all St. Vincent's campus'; attended daily staffing meeting with hospital directors, mangers and nursing supervisorObjectives: 2, 3, 4, 6Staffing is a major issue this organization. Many of the meetings consisted of cost analysis and budgets related to staffing and retention. Another area of concern in the hospital, is associate morale and ways to improve morale. In the meeting with nurse educators we used RCA to evaluate c-diff occurrences. We also discussed the issue of wound care charting (does the WCON chart this, or the staff RN?). Attending the leadership meeting with all campus via teleconference was very enlightening as it touched on quality and PI, the patient experience and associate engagement (turnover rates). Week 2(1/26/15;1/29/15)28/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; attended the glycemic control meeting; attended the hospital directors meeting; attended the nursing leadership meeting with hospital directors, managers and CNO; met with the infusion center to review and collaborate on job description; attended unit based council meeting; met with preceptor and CNO to update on units; attended EPars meeting on new software to track unit charges; participated in journal club; attended EKG meeting with cardiopulmonary staff; met with clinical resource coordinators to discuss employee concernsObjectives: 1, 4, 5Staffing continues to be an issue therefore impacting associate morale. There was an impromptu visit from JCAHO the previous week regarding biomed, results were shared at huddle and no major issues were discovered. In the directors meeting, the directors took time to sit down and discuss and coordinate their schedules and any issues they had on their units that may relate to other units. In the nursing leadership meeting it was very interesting to hear what other units are doing on their unit councils and others were able to provide feedback and hear feedback from the CNO regarding the changes implemented/requested. Journal club focused on hyperglycemia and the growing issue of it in hospitals. After attending the glycemic control meeting I was able to process how big of a problem it is especially on med/surg floors. Overall this week focused a lot on collaboration and time management with all of the meetings. Week 3 (2/4/15)37/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; reviewed the updated time and attendance policy with my preceptor; attended the first of four management system series at St. Vincent's Medical Center Riverside relating to recruiting and retaining new staff, select to fit technique for hiring and learned about a new program for associate evaluations.Objectives: 2, 8At the daily huddle meetings we discussed an employee injury related to an assisted patient fall, and the need for further education on minimal lift equipment. Hospital census has decreased related to previous weeks, so staffing issues have lessened. Orientation begins this week, allowing for additional staff. The new time and attendance policy will now assign employees points for tardies (1) and call outs (3). Employees with 15 points receive a verbal warning, 18, a write up and those with 24 points in a 12 month period will be terminated. In the management series, we learned about engaging staff and a new selection for fit process that will occur during the employee's application process. The screening tool will screen the employee for the likelihood of a cultural fit and their capability of performing in times of high stress.Week 4 (2/9/15; 2/12/15)54/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; reviewed the new policy with my preceptor in regards to meds administered via gastric tubes; attended the second of four management system series at St. Vincent's Medical Center Riverside related to finances and budget reports; rounded on units with my preceptor and reviewed applicants for a new floor manager; attended 2 webinar/tele conferences on new transport program, and an update on charting practices.Objectives: 2, 3, 6At huddle meetings we discussed "good catches" and downtown occurrences. We also discussed the new medication policy implemented by pharmacy via g-tubes, and need to revisit best practice. Staffing for PCT's was limited this week, however offers have been placed for 2 new PCT's. We reviewed the upcoming select to fit policy again. There are many new charting options that will be implemented for the floors which will require additional staff training. At the finance and budget meeting, we reviewed operating income budgets (roles and responsibilities), supply and staffing expenses, finance tools available as a nurse leader, and the importance of managing finances related to revenue.Week 5 (2/18/15; 2/20/15)71/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; attended kick off meeting for new Alaris IV pumps; sat in on and attended the monthly operating revenue (MOR) meeting; participated in round table Alaris IV pump meeting; listened in on webinar/phone conference for Alaris IV pumps; attended leadership meeting involving all St. Vincent's campus; attended MAPS meetingObjectives: 2, 3, 4, 9Over the next few months, with a go live day anticipated for May 2015, our organization will roll out new IV pumps. I was able to participate in the initial process of this with discussions on pump parameters for each units, and listened in on a phone conference with a sister hospital that is already using the newer pumps. The leadership meeting with all 3 campuses discussed QI/PI updates, and touched on the patient experience and promoted more associate engagement by encouraging participation in MAPS meetings. In the MAPS meeting we learned about how the Affordable Care Act is affecting acute care hospitals and the future of healthcare, and educated staff on the cultural changes ahead, especially to more vulnerable populations. It is the hopes of this organization to have 100% of employees engaged in this initiative by June 2015. Week 6 (2/24/15; 2/26/15)84/135Attended the third of four management system series at St. Vincent's Medical Center Riverside related to risk management; attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; attended a webinar/teleconference for the executive appeals decision team; attended the Southside Decon team meeting; met with new med/surg manager to discuss questions and concerns regarding new hires and her new roleObjectives: 1, 3At the management system series meeting, we used role play as a leadership strategy to evaluate how we would handle certain situations, we also discussed employment law and corrective action techniques.. Overall this part of the series was not as helpful as I had hoped for, but have learned of another, more in depth, class on "management landmines" that will take place next week. Learning how new products are evaluated for use in the hospital setting was very interesting. The team comprised of nurse leaders, physicians, and other hospital administrations collaborated via teleconference. Together they decide risk/benefit and cost incurred for each new product. Seeing how the hospital utilizes their funds and integrate new products into the organization was neat. Participation in the decon meeting was very different from a leadership perspective. This was the first meeting of the year and focused on awareness. Coming from an emergency background this was of interest to me and it was interesting seeing how different areas of the hospital work together on this team. Finally meeting with the new manager, we discussed the new orientation process and how the CNO has requested only 10 employees be under orientation at one time for the entire hospital. This will be difficult to rationalize to staff given the rise in patient census. Week 7 (3/4/15; 3/5/15)100/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; attended two heart failure round table meetings with a JCAHO representative and heart failure team members, unit directors and CNO; attended employment law and corrective action seminar; attended the final management system series at St. Vincent's Medical Center Riverside related to challenging aspects of HRObjectives: 2, 6This week our hospital was up for renewal on JCAHO's heart failure accreditation, and I was able to observe the interactions between the JCAHO representative and heart failure team members. Our team was well prepared and ready to review tracers and discuss how we care for heart failure patients from beginning to end. During the employment law and corrective action seminar, I learned how to identify mechanisms required to resolve problems in order to improve care, as well as who to contact when an issue arises. We reviewed and discussed laws pertaining to discrimination, EEOC, federal acts and common law tort theories. We also discussed the corrective action process. As a student I felt this seminar was very informative and I was able to take away a lot of information that will help me better my own practice. In the management series, we reviewed some of the same information in the previous seminar, but touched more on FMLA, LOA and worker's compensation, wage and hour laws, and risk management. From these opportunities, I feel I have better developed my leadership behavioral competencies and the skills necessary to be successful in healthcare.Week 8 (3/18/15;3/20/15)116/135Attended daily huddle meetings and bed board meetings with nursing supervisor, directors and managers; attended the MOR meeting; attended leadership meeting involving all St. Vincent's campus; attended end of life seminar; attended ethics at work seminarObjectives: 3, 7, 9At the MOR meeting, it appeared that things are going in the right direction for the med/surg units, and productivity is improving. My director is still mentoring the new 3rd floor manager and we had several meetings with her to see how she is adjusting to her new role. The leadership meeting with all campus via teleconference was again interesting. It was neat to see what other campus are doing to engage associates and improve quality, the patient experience and associate engagement at each campus. In the upcoming months the organization will be transitioning the 5th floor into an inpatient hospice unit. The educational seminar provided a hospice overview, and identified hospice-appropriate illnesses that would justify admission. The ethics seminar helped me to better understand the practice of ethics at work from a leadership standpoint. I was able to think through ethical dilemmas, and better understand the framework for decision making. Week 9 (3/26/2015)123/135Attended the Joint Commission (TJC) kick off meeting for total knee and total hip replacements; sat in on chart reviews of current and closed charts on patient's with total hip or total knee replacements; attended the closing remarks meeting that discussed findings from the review process with the TJC's nurse reviewer, directors, managers, education and QI staff.Objectives: 1, 2, 4In the initial kick off meeting, I had the opportunity to hear the lead orthopedic surgeon discuss advancements and various trials the program has participated in. One area that the program struggles with is pain management and the re-evaluation post medication. I was able to sit in on several chart reviews with nurses and managers on the ortho unit, with the nurse reviewer from TJC. Fortunately the reviewer put everyone at ease and was able to multi task and appropriately review two charts at once with four nurses and even managed to include me in the process. Evaluating current and closed charts allowed me the opportunity to assess the overall nursing process of specialty patient care. After lunch we had a round table discussion with the reviewer where she gave feedback on various programs within the joint replacement program. We also looked at changing metrics for outcome evaluation in the future. She also reinforced the importance of specialty certification for staff which is something I myself have been working towards. Hearing it from the reviewer reinforced the importance of attaining it. Week 10 (4/1/15; 4/2/15)135/135Attended career development seminar; attended daily huddle meeting and bed board meeting with nursing supervisor, directors and managers; attended the glycemic control meeting; attended the hospital directors meeting; attended the nursing leadership meeting with hospital directors, managers and CNOObjectives: 1, 5The career development seminar was not much more than an overview of the career development ladder our organization has to offer. This is the most comparable thing I have found to a succession plan that the company offers. The program allows nursing associates to reach different levels of the plan with the reward of a $1/hr raise upon completion. The motivation for nurses to participate has been lacking in the organization due to burnout and low morale. The glycemic control meeting again consisted of pharmacists, nurses and dieticians. The issue discussed this week was timing of meal trays and administration of insulin to patients. Because med administration times are consistent through the 3 campus's on the EMAR, and tray delivery times are different, the medication is profiled as a PRN and often getting missed, resulting in poor glycemic control. Until all hospitals can come to a consensus on med administration times, this will continue to be an issue. The directors meeting was an informal meeting where the directors met to compare calendars and verify upcoming meeting times. Finally, at the nursing leadership meeting, all managers and leaders from hospital departments met to speak about the various unit's accomplishments. In the med/surg units (my preceptor's unit), as part of the clinical ladder, they have enrolled 10 nurses in the program, and have also registered those nurses to also take the med/surg certification exam. Being able to participate in hospital-wide engagement meetings and attend advisory meetings has shown me how this organization strives to foster a participative work environment. Provide a brief strategic assessment of the outcomes achieved related to each of the identified personal objectives noted above and your plan to integrate the learning into your academic development and professional practice:Objective 1: Attendance at the hospital directors meeting, nursing leadership meetings, Southside Decon. team meeting, and the Joint Commission (TJC) meetings for total joint replacement and congestive heart failure programs, provided me the experiences needed for further development of leadership strategies to improve patient care. The experience and knowledge gained by attending these meetings provided me with appreciation for what happens behind closed doors. Being able to understand what happens outside of direct patient care, has shown me how to better appreciate and understand the role of the nurse leader, and how to ensure the structure of the nursing services provided within the organization. Objective 2: Communication and participation alongside my preceptor in daily staffing meetings, participation in the management system series, review of the new time and attendance policy, attendance at several meetings for implementation of new Alaris IV pumps, and participation in the JCAHO heart failure and total joint replacement accreditation reviews, provided me experiences essential to leadership. Reviewing and learning the techniques and strategies my preceptor used to participate in policy and decision making while advocating for staff, taught me the importance of communication.Objective 3: Attending the monthly operating revenue meeting, the management system series on finances and budget reports, and sitting in on a webinar/teleconference for the executive appeals decision team, allowed me the opportunity to review the roles and responsibilities associated with operating income budgets. Reviewing supply and staffing expenses, as well as the finance tools available to the nurse leader, taught me the importance of managing finances related to revenue that will be essential in my later professional role as a nurse leader.Objective 4: Through leadership meetings involving all St. Vincent's campus', hospital directors meeting, and TJC accreditation meetings, we reviewed patient safety data in order to assess the nursing processing. Through these meetings I have learned that ongoing assessments and meetings with leadership provides the management team the framework needed to direct patient care services. Through this I have learned the value of communication and open discussion of our organization's growth and development pertaining to outcome measurements. Objective 5: Attendance at several CNO advisory meetings provided me the opportunity to see how leaders obtain feedback from their leader. Attending these meetings has shown me how this organization strives to foster a participative work environment. Learning how to implement practices that enhance professional development for myself and others like the clinical ladder program, provides the encouragement staff need to grow and is something I plan to complete myself.Objective 6: I was able to evaluate policies and review the social forces that impact patient care delivery, by participating in root cause analysis (RCA) for wound programs and gastric tube medication administration. Alongside nurse educators and my preceptor, we used RCA to evaluate c-diff occurrences and also discussed the issue of wound care charting. Being able to identify the components to assure quality and to improve patient care, is essential to the role of clinical nursing leadership. Reviewing best practice techniques is something I strive for and will continue to do so in my future professional practice. Objective 7:Participation in the ethics at work seminar helped me to better understand the practice of ethics at work from a leadership standpoint. I learned the value of thinking through ethical dilemmas, and obtained a better understanding for the framework needed to aid in decision making in future practices and dilemmas. Objective 8: Utilization of evidence based practice for policy and procedure, was executed though implementation of the basin-less bath program led by my preceptor, and a review of the time and attendance policy. Understanding and forming an appreciation for research in current practice and policy development, allowed me to fully comprehend what goes in to creating a new practice. These efforts are something that I will be able to bring to my academic development thorough this program. Objective 9: Analysis of facility practices though participation in the MAPS program, taught me how the Affordable Care Act has affected acute care hospitals. The program helped to educate staff and myself on the cultural changes ahead, especially to more vulnerable populations. Ensuring that practices are effective in promoting equality can be difficult. Continuing to educate nursing staff on cultural issues and vulnerable populations, will ensure that both staff and myself are prepared to care for and manage a variety of patients. I certify that I have completed the individualized objectives and clinical lab hours noted above under the supervision of: Gina McGinnStudent Signature: Date: 4/24/2015 ................
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