Journal 2

Journal 2
This week my preceptor asked me to follow the house nursing supervisor for a couple of hours because she was going to be in a board meeting. I attended their usual morning bed management meeting. This meeting comprises all the directors and assistant directors of the nursing staff, plant operation, environmental services, chaplain, and manager of social services, associate administrator and House nursing supervisor. At this particular meeting the CEO was present. This meeting is always chaired by the house nursing supervisor. They discuss staffing, number of patients on each floor, number of inpatients and out patients going for surgery, discharges and possible discharges, transfers, and other issues. This is a short and brief meeting where the nursing supervisor collaborates with the other managers to keep the hospital operating effectively. Staffing always remains the most pivotal to daily unit operations, patient safety and also patient/family care satisfaction.
I learnt a lot from my preceptor this week. As usually she goes through her mails, plans her activities and goal for the day. My preceptor guides the staff under her through series of routines, procedures and predefined practice guidelines. She talked about the new staff polices that she was redrafting and was working on it last night. She reviewed the occurrence reports which she explained to me are done on monthly bases. She reviews the reports, identifies the problems and after that meets with the various directors and finds ways to improve clinical issues. After reviewing the occurrence report she sets up a meeting with the medical staff involved on one on one bases. She makes the identity of the person who wrote the occurrence report anonymous in order to protect the person. After that we went for our usual walk around the hospital. She had a list of some staff members who were celebrating their anniversary birthday. We stopped by and congratulated them. We went to surgery, holding room, ER to make sure they were ready for JACHO visit. We also visited some floors and interviewed some patient at random to enquire about their care at the hospital. She told me that when she enters the room she looks at the board, ceiling and everything in the room to make sure that everything is in order. After the rounds she reported any problems she found to the director on the floor.
We went back to the office and had a peer review meeting with the director of medical surgical floor. We reviewed the charts of some new medical staff. My preceptor went through one of the charts with us. I had the opportunity to review some charts myself. We reviewed the charts to see that H&P, immediate post-op notes, dictated notes, and unexpected abbreviation were on the charts. We also checked orders to make sure they had date and time on the charts. It was also a learning experience for me as a nurse to make sure that my orders and notes are up to date. My preceptor also briefed me a little bit about budgeting. She explained to me that budgets are in buckets and cannot use one for another. She stated it took her time to learn that budgeted money must be spent before it is taken away. She told me that her biggest challenge is cutting down budget during this economic crisis. She feels she has done very well with budget by cutting down on marketing, travelling, etc without negatively impacting bedside supplies.
I learned a lot every from her each day and it has been a learning experience for me. The role of the CNO is complex and demanding. Her position is the most essential to drive the success of the hospital.

Journal 1

I was with my preceptor yesterday. I have been a bedside nurse for almost 4 years and had not had the exposure to the administrative side. It was a challenging experience and also an opportunity to learn new skills. My preceptor in the morning delineates the objectives and goals for the day. She reads all her email, assesses and evaluates activities on assigned area. After that, we made rounds to the emergency room, surgery, nursing supervisor’s office and to some of the floors to check about their staffing and how they are doing. During the walker she greets any staff member she comes in contact with and asks how they are doing. My preceptor, when she runs into visitors, enquire if she can help them.
After that we went round to co-workers on the administrative side. She motivates and communicates with the people responsible for various activities in a team setting. Our first stop was with the Nursing Supervisor’s Quality Manager who is in charge of infection control. They discussed risk of infection, action plan, exposure risk and how to involve the opinion of other expects such as the MD in charge of infection control. We visited with the risk manager officer who deals with medical staff peer review, patient grievances and other issues. She showed her all the files that needed immediate attention.
I also sat in another meeting with my preceptor and the Executive Administrative Director. She stated “I am the CNO’s brain”. They addressed the medical staff peer review. The theme of the meeting was quality peer review peer committee. Minutes were read, charts reviewed, issues were addressed, letter were sent and calls were made. There was another informal meeting with the Director of education about internship, educational budget and on leadership challenge implementation.
The Chief Executive Officer plays an important role; she is a very busy woman who leads nursing services on a journey of excellences. She provides positive reinforcement, makes sound decisions and divides daily activities.

Met my Preceptor

I met officially with my preceptor on tuesday, September the 9th and I followed her to a staff meeting , which include all the clinical and environmental managers. This meeting is done every morning. They discuss staffing, admissions, patient transfers and any other clinical issuses. This meeting is organize by the morning Nursing Supervisor who coordinate with the managers to make sure that everything is okay and also maintain balance . This meeting was very short and breif. I learn that this is done to maintain balance and to increase the level of workplace satisfaction.