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.