Clinicals Week 11

For the week of 11/23/09, I spent 7 hours with my preceptor. We attended the leadership meeting for the 6th floor, which is the rehab and transitional care unit. The leadership on this unit were having problems communicating. O.C. discussed the communication barriers with them. He also pointed out that they have different personalities that are contributing to the difficulty communicating. He was great. He stayed calm and neutral and was able to get each of the managers to see the other side of things. It was a very productive meeting and I think that the managers walked away feeling much more optimistic. They also had a newfound desire to try to communicate better with each other. It was a great learning experience for me since I am new to a management position.
My preceptor and I spent the rest of the clinical day discussing experiences during our time together. I got to ask him a lot of questions. This was my last clinical day and I truly feel like my experience was so enlightening. O.C. was a great preceptor and he taught me a lot!

Clinicals Week 10

For the week of November 16th, I spent 8 hours with my preceptor. We attended a lot of meetings. It really showed me how important it is to have time management. We went to three meetings and in between meetings we checked emails, took care of phone calls, and worked on ongoing projects. It was quite a busy day! The first meeting was about implementing computerized provider order entry (CPOE). Of course, this is a difficult process because providers tend to be resistant to these types of changes. But, after a long time of planning Cook Children's should have it fully in place by the end of December. The second meeting was for Patient Care Council. It was a director level meeting that is informational in purpose. Each director gave updates for their departments if they had any. And the last meeting was to plan the charge nurse workshop for the charge nurses on the 4th floor. They discussed the agenda for the workshop and who the speakers would be. They also discussed some case presentations that they would have for the charge nurses, one of them being a simulation of a code for a child that had apnea after receiving a narcotic. This is a great case for this pre and post surgical floor because it is a very real possibility that this could happen on this type of unit.

Clinicals Week 9

I was unable to schedule any clinical time for the week of November 9th, due to conflicting schedules between me and my preceptor. I did, however. have to time to work on the evaluation for my change project. For my project, I implemented a cheat sheet/algorithm for the nurses to follow for a complicated test that they do on their unit. The orders were very hard to follow and the nurses had made multiple errors on multiple occasions. My preceptor and his nurse managers tell me that the tool was very well received by the nurses on the unit. I plan to ask each of the nurses to fill out an evaluation of the tool and to find out if it was helpful for the nurses that were able to use it.

Clinicals Week 8

For the week of November 2nd, I spent a total of 5 hours with my preceptor. I accompanied him to multiple meetings. We went to a Respiratory Therapy Leadership meeting. O.C. is invited to this meeting because he is the director of the Rehab and Transitional Care Units where many patients have trachs. This meeting was pretty mundane, but I did notice that some of the RT's seemed to lead the group more than others, regardless of their titles. My preceptor and I discussed this after the meeting. He confirmed that the ones I had identified as unofficial leaders were exactly that. He called them natural leaders. He explained to me that those are the types of people that he takes care to develop and encourage to advance their careers.
We also attended a meeting with the nurse educator for the 4th floor. They are developing a charge nurse workshop for new and existing charge nurses on the unit. They discussed many topics to be incorporated into the workshop, including managing up, dealing with frustrated families, and dealing with difficult physicians. It was good to see how these types of education are developed. I have been to many of them, but have never been involved in the development.

Mid Semester Evaluation

o 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 met some of the clinical objectives. Two of the main clinical objectives that I have met are Critical thinking and Cultural competence. For critical thinking, I frequently ask O.C. questions. I analyze both sides of a topic (nursing unions) before making a judgement. And I can logically defend my opinions and decisions. For cultural competence, I have discussed culture and race in depth with my preceptor. He is a minority, as are many of his nurse managers. We have discussed the makeup of nursing at Cook Children's and if it is becoming more diverse or not. I feel a lot more culturally competent after these discussions.
I have also met some of my personal objectives. I have identified steps in the conflict process and how to deal with conflict in the workplace. I have witnessed my preceptor navigate his way through conflict on one of his floors. It was very enlightening. I also have applied time management skills in planning clinical experiences. My clinicals have been difficult to accomplish at times. But, I have managed to balance that with my full time job and my home life.

o 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 discussed two of my personal objectives in the previous question. I have identified steps in the conflict process and how to deal with conflict in the workplace. I have witnessed my preceptor navigate his way through conflict on one of his floors. It was very enlightening. I also have applied time management skills in planning clinical experiences. My clinicals have been difficult to accomplish at times. But, I have managed to balance that with my full time job and my home life.

The other two are using leadership principles in making policies for staff and researching types of budgeting and indentifying the type used at my clinical site. I have discussed the budget with my preceptor, but I still need to research what kind of budgeting that he uses. We have yet to discuss making policies for staff. I will try to focus on these in future clinicals.

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

All of these things have fostered my growth as a professional nurse. As I have mentioned before, I am new in a management role in my job. I have been able to take some of the things that I have learned and apply them almost immediately to my professional position. I have especially used critical thinking and conflict management. I have applied the conflict resolution process used by my preceptor in my own job. I have also been making an effort to analyze all situations from all sides and making an informed decision. I have learned a lot!

Clinicals Week 7

The week of October 26th, I spent a total of 4.5 hours with my preceptor. One day we discussed my change project (a quick reference for the nurses to use for a complicated test that they do on this floor). O.C. told me about the feedback that he had gotten so far. It sounded like the nurses liked it. I plan to give them a survey after it has been in use a little bit longer.
We also attended a Quality Improvement Council meeting. This council regulates quality for the whole hospital. They also track quality indicators. At this meeting there were also two pesentations regarding research at Cook Children's. One of the presentations was a research project that a nurse had thought of for her master's program and then actually implemeted it at work. She implemented a line insertion team in the NICU. This team now inserts over 90% of all PICC lines in the NICU. This team also rounds on each of these lines daily and teaches staff about caring for the lines. In the first year, they have decreased infections from central lines by over 80%. She showed a dramatic improvement with graphs. She stated that the hardest part to implementing this project was getting physicians and administration to buy into it. I can believe that! But, it was amazing data nonetheless. I was astounded at the results!  I would assume that this would produce some hospital wide changes and maybe even further reaching than that. She is presenting at quite a few conferences.

Clinicals Week 6

For the week of 10/19/09, I spent a total of 3 hours with my preceptor. One of the main things that we did was to attend a Discharge Planning Task Force meeting. On the Rehab Care Unit, they have been having problems with getting the patients discharged in an organized manner. They want to make sure that all loose ends are taken care of before the day of discharge so that families only have to worry about going home on discharge day. This involves physicians writing the appropriate orders in a timely manner, nursing, rehab, and respiratory therapy making sure that all of the education and rooming in has been appropriately done and documented, and case management arranging for all of the home care and equipment. So, many disciplines were present at this meeting. They decided to start having discharge conferences including family, once they have a tentative DC date. They also decided to update the kardex to show all completed education and roomings in. Lastly, they decided that they needed to have written criteria to determine a successful rooming in.
It was great to see all of these people working together and how much could be accomplished when getting everyone in a room together.

Clinicals Week 5

This week I spent 5 hours with my preceptor. I attended many meetings with O.C. I attended a leadership meeting for the rehab and transitional care units that he directs (RCU & TCU). The patients on these units are often in the hospital for a very long time while patients go through rehab and families learn to care for them. In this meeting, it came to light that the managers for these units are having a hard time getting patients discharged in an organized manner. The charge nurses are often having to chase down doctors and nurse practitioners for orders and have a really hard time scheduling rooming in and discharge conference. Also, the case managers were having trouble getting the info that they need to get the days paid for by insurance. This was very interesting. O.C. used a formula that he learned in grad school for identifying and beginning to solve the problem. He went over this method with me after the meeting. I think this helped me with my goal of learning to deal with conflict in the workplace.

On a side note, these last couple of weeks have been so hard for me. My kids have been sick and work has been crazy. I can't seem to keep up. I am just trying to tackle small chunks at a time. If anyone else is having any of these same obstacles, please know you are not alone! We can do this together!

Clinicals Week 4

This past week I spent 6 hours with my preceptor. We did many things, but one meeting stood out as very interesting to me. We went to a nursing executive professional organization meeting. They had a speaker that was a high level nurse exec for one of the local hospitals. She gave a presentation about unions in nursing. This was a very interesting topic to me because growing up in Texas, I don't feel like I know a lot about unions. She explained how many people think that Texas is very vulnerable to union movements right now. She also explained a lot of the tactics that unions and hospitals use when a union tries to come into the organization. I found it all interesting, but I think that her presentation seemed pretty right wing biased. I am more liberal in my views, so I would love to get some other people's views on unions in nursing. From her point of view, it did not sound like a good thing at all. But, I don't like to just believe anything I hear. I need more info before deciding what I think.

Clinicals Week 3

This week I spent a total of 8 hours with my preceptor. It seemed that this week brought about a lot of crisis management. The hospital is extremely busy, especially the ED, due to the flu. This burden is therefore dispersed throughout the medical center. This placed extra pressure on the floors that my preceptor directs. They needed to be able to care for extra patients and make sure that patients were being discharged when possible to keep patients moving through the ED. It also posed a problem because the occupational health department director is being very active in preventing flu outbreak among employees. Occupational health is screening employees and asking them to stay home when they meet certain criteria. This makes staffing difficult for this very busy patient load. O.C., my preceptor, stayed very calm in all situations. He was very good at evaluating the situation at hand and making appropriate decisions to ensure patient and staff safety. I was very impressed by his strategic decision making and his ability to also consider future outcomes.

Clincals Week 2

I did my second week of clinicals with O.C. this week. Just a reminder, he is the director of a surgical floor and a rehab floor at Cook Children's. I spent a total of 8 hours on Monday 9/21 and Wednesday 9/23. We spent one day looking at the budget and discussing how the departments were each doing financially. We also discussed how he deals with staff, nurse managers, physicians, and other administrators. I found all of this information very useful. Just this year, I took a promotion to Clinical Coordinator in the Endocrinology Clinic at Cook Children's. This position functions a lot like a nurse manager in the clinic setting. I have never been in a management position before, so I am very green when it comes to knowing how to manage people at times. I hope that I can take a lot of great lessons away from this clinical experience.
I also was able to sit in on a meeting with the nurse managers from the surgical floor. They discussed quality projects, unit initiatives and also some of the unit problems. I think from this meeting, I have identified an idea for my Change Paper. So far, this has been a very good experience.

Clinicals Week 1

I found a great preceptor. O.C. is the director of a surgical floor and a rehab floor at Cook Children's hospital. He is a BSN nurse and he also has his MBA. I spent my first clinical day with him on 9/14/09. I spent 3 hours during the day and 2.5 hours in the evening, for a total of 5.5 hours. We went to a hospital wide directors' meeting that was for informational purposes. O.C. ran this meeting and directors from all different departments shared information that would be useful hospital wide. This included IS, ED, and Occupational Health, to name just a few. The meeting was very informative. We then went to a pain meeting, where they discussed pain protocols used at Cook Children's. Many changes were decided upon at this meeting. That evening, I joined in at the Family Advisory Council meeting. This meeting was so great. It involved parents and employees of Cook Children's. They created this council so that parents could get involved in making Cook Children's a better place for patients and families and to take suggestions on making their approach more family centered.
O.C. had a very busy day and I loved it. I feel like I am seeing a completely different side of nursing!