Journal 5

This week my clinical experience was a different learning experience. My preceptor was putting together data for the Divisional meeting organized once a year on strategic budget planning. She explained that she has to master different data such as surgery turn over, nursing turn over, and falls in strategic budget planning as well as defending the budget in from of the board of trustees. She was trying to round up with the Nursing Directors who have not submitted their report. My preceptor advocates for nursing. The Director of med-surgical submitted staffing proposal and explained why it is important to reduce ratios with fall data, patient satisfaction, capital dollar request, budget on the needs of the floor and historical data on what was spent last year. I realized that it is not an easy task to reduce ratios because I used to think it was so easy for the manager to do that. We nurses always say that management does not care; why can’t they cut the patient-nurse ratio? It really involves lots of facts and data.
We attended the morning staff meeting and discussed some issues on misunderstanding with transfers of staffing to other floors, discussed present census, discharges, transfers, assigned transfers, available beds and other clinical issues. After that we made our usual rounds, stopped at women services, ICU, Endoscopy and then at the director of operations to see how they were doing. During the rounds my preceptor greeted any person she came across and also helped visitors to find their way. We also attended a confidential meeting and she explained to me the importance of confidentiality of that meeting.
After that, we went through the SPAE program. SPAE is an acronym for serious preventable adverse event. The SPAE includes UTI, pressure ulcers, DVT, and falls which could be prevented during the hospital stay. She instructed me on how to fill an incident report. She also had a meeting with the risk manager over the phone. The risk manager is new to the position, so my preceptor went over some of her roles with her. The preceptor needed the risk manager to consider staffing to analyze and prepare data on falls. My preceptor and the risk manager discussed programs to help reduce falls, and they also talked a little bit about peer review.
I also attended a meeting with my preceptor, VP of human resources, Director of education with one of the trainers for this LPI (Leadership Practice Inventory) Training .The trainer explained the importance of the workshop. The trainer talked about five practices of exemplary leadership; Model the Way, Inspire, Enable others To Act, Encourage the Heart, A Share Vision, and Challenge the Process. He further explained that the sections will engage the leaders to think on higher levels and also challenge workers who are not happy to work to work better. It will help them make decisions for themselves by asking yourself, how you see yourself at work, are you On purpose, Prison or a passenger. He identifies training development for trainers that will help them develop job skills. management performance and leadership job skills performance. The trainer again suggested adding an additional training matrix which is moving people to purpose. He gave them books to read and offered me one. VP of human recourses added that good effective management comes from good leadership and developing your leadership skills makes a difference in an organization. They all applauded the strategy and discussed the implementation of the workshop.
This was a challenging week and learning experience that increased my skills and knowledge in nursing. I am so grateful to have her as my preceptor.

Journal 4

This week was another learning experience with my Preceptor. She is a very busy lady and always multitasking with her Job. I even asked her this question, “How do you do it?” She smiled and said “I have the brains “.She loves what she is doing and very knowledgeable and abreast with time. My preceptor guides the staff under her through series of routines, procedures and pre- defined practice guide lines. She talked about the new staff policies that she is redrafting the previous night.
As usual she has her goals on a calendar and tries hard to meet her goals; she makes room for other side issues and distractions. We did a lot of walking in the morning. We went to the morning staff meetings and walked around a few floors and surgical floor to see how they were doing. We stopped at Marketing and Physician Relations coordinator and had a discussion on their MAGNET JOURNEY on when to implement it. It was a brief meeting. She had the monthly meetings with the nursing staff Directors on one to one basis.
I attended the meeting with the medical surgical Director of Nursing. They discussed their weakness/strength, Budget, staffing, Nursing, patient safety and patient satisfaction. They have started a new program in the hospital known as Rounding with Purpose. As part of their commitments they want to provide superior care and service to their patients, families and visitors. This Rounding with Purpose is monitoring patient’s well-being and caring for their personal needs on an active hourly basis. The medical surgical Director was asked about how staff is complying with the Rounding with Purpose program. She said her staff is doing very well with minor exceptions and she had addressed the issues with the involved staff. My preceptor and I went through the annual budget report; I made some suggestions that may help to offer a better explanation when the Divisional heads meet with the Board of Trustees.

Journal 3

This week my preceptor asked me to follow the house nursing supervisor because she was going for a meeting. This was another learning experience. We first went to the usual bed management meeting which is always chaired by the house supervisor. It is an informal meeting done every morning. I also learned how the house nursing supervisor reports death which is a State of Texas regulatory process. In addition all deaths also have to be reported to life Gift in Houston. I also observed the Supervisor report death to the Justice of Peace of the Tarrant County Death Office. The house supervisor plans her goals for the day and deals with issues and situations as the day goes by. She told me that each day is different. She is the one who coordinates with central scheduling associate on all patients who come in the hospital. They coordinate with the Doctors in getting admissions for their direct admit patients. She collaborates with the directors of the various floors, ER, Cath. Lab, Surgery, patient transfers and staffing. She coordinates with healthcare interventions and communications for those individuals whose self-care needs are significant.
We went round the floors, ER, Cath. lab and surgery to make sure that patient transfers were done and also checked on the supervisors in each department to see how they were doing. The hospital has a central board on the intranet where they post all in house transfers. The nursing supervisor is also in charge of in house transfer of care of patients to other facilities. I witnessed a transfer of a baby to another care. We went through the procedure together. The dispatch team that handled the baby transfer is known as the teddy bear team. The teddy bear team comprises a nurse and two EMS staff. In this situation, it is the duty of the charge nurse to make sure that there is a physician to take care of the baby at the other end. The hospitals have protocol and care guidelines with other hospitals to handle all patient transfers.
The house nursing supervisor collaborates with the staff to expand decision making, problem solving skills and goal-setting. She is a teacher, coach, and facilitator. She has mutual trust for her staff, respects their ideas and takes their feelings and emotions into consideration.