Clinical Summation

Clinical Objectives:
I have met the Professional Accountability goal. I am present and accounted for during all clinical time previously scheduled other than one afternoon that my preceptor had to leave an hour early. I personally feel that I should have made a better clinical schedule such as longer periods of time instead of so many short spurts of time.
I use Theoretical Knowledge consistently when communicating and assisting with the staffing matrix and supply requisitions. This facility has just completed its first 90 days of operation and has not yet established a working budget for all areas including the patient care units.
Personal Objectives:
I am currently assisting with the development of a consistent manual supply ordering system that can easily be used until they go partially automated in August. Using a spreadsheet, I am formulating a list of frequently ordered supplies and corresponding order numbers that can be used as a pre-printed requisition.
I am getting a very close look at executive nursing administration and discovering that its a lot of work and much stress at the same time. This has offered me an opportunity to really think about it. Is this really something that I would want for myself? Many of these Directors arrive before eight but a few of them often stay until well after rush hour traffic. It appears to me that the ones who put in these kind of hours are usually nursing departments.
I still have not had an opportunity to look into formulating unit budgets and it does not look like I will get this opportunity because they are not planning to implement unit budget guidelines until 6 months to a year into full operations.
I was hopeful that I would get to observe a board meeting or two to see how the major decisions are made but, these meetings are held strictly confidential and unable to have observers.
Course Objectives:
Professional Accountability: I have been very faithful to my proposed clinical schedule. I am sure to be on time and offer assistance to my preceptor for any of her needs.
Critical thinking: I have been very forthcoming on my clinical needs and expectations with my preceptor and she has included me on everything she possibly could. She answers any questions or finds the answer if she doesn't know it. I have applied my critical thinking skills whenever applicable with TDH survey, chart auditing, formulation of supply ordering system and Matrix development.
Communication: Demonstrates effective verbal and written skills in communicating with individuals, groups, and health care providers. Participated in departmental meetings and helped develop action plans regarding process improvement with the Quality assurance director and case manager.
Client advocacy: Advocated for clients during a pain management meeting on appropriate time frames of pain medication delivery. We will do a quick study on the length of time between patient calls for pain medication and actually delivery to improve patient satisfaction. Spoke to staff members about appropriate Pain Management for the post-operative patient and how to effectively advocate for the patient.

Leadership skills: I have shown leadership skills by offering to contribute to my learning facility by taking on projects such as supply order systems and pain management control. I have also been assisting with the scheduling matrix.
Cultural competence: I have a wide base of knowledge regarding different cultures and ethnicities. I involve myself in an ongoing learning process in this area.
Theoretical knowledge: I actively participated in the Texas Department of Health initial survey of the facility which lasted 3 full days. I have been included in multiple department meetings and Texas Department of Health and Joint Commission preparation meetings. I offer my input regularly on my experiences.
This clinical experience has given me a more objective look at upper management in the nursing world. It is not an easy job. You don't have a buffer between yourself and the CEO or CNO. You take much more responsibility and accountability onto your shoulders with upper management nursing. I have always thought that I have very good leadership qualities. I feel that I could be an effective leader in many situations or positions. Now, I am starting to think that I wouldn't ever want to be that far from the bedside. I like the patient care aspect and using those bedside skills everyday is something I enjoy doing and I am proud to be good at it. It's good to have seen how very different it gets the further you climb the clinical ladder.

Last Clinical Days!!!

I finished up my clinical time this week (thank the lord)! The short days were tedious but I learned some things about Administrator functions that I wasn't familiar with before. My preceptor actuall has to be on-call approximately 10 days out of each month. Something she is hoping to be rid of in the future when they establish a routine house supervisor position control. In the meantime, the facility did well for the Texas Department of Health survey. A few recommendations were given but, nothing major. That was interesting to see an initial survey take place. I have been involved in Joint Commision surveys but, never an initial. This was probably the most interesting thing that happened during my clinical experience. I spent 4.5 hours with my preceptor on Monday and again on Wednesday. The extra half hour each day was to make up for a day that was cut an hour short previosly noted.

Texas Department of Health Survey

Wednesday, July 22nd, I arrived to my scheduled clinical to find that TDH had arrived unannounced for their initial survey. This stirred up some excitement in this facility. It was the initial state survey which lasts 3 full days. I was all over the place from helping clear and straiten up the inpatient unit to helping locate policies and procedures in the hard copy manuals. The faciltiy I am completing my clinical time in is not fully automated yet. This means that everything is done on paper or, "downtime," forms. We did a million chart audits to make sure everything was in its place. My preceptor was on the cell phone constantly to troubleshoot everything from ER to OR. It was interesting watching her use her communication skills to make things happen. I stayed for 4 hours Wednesday and Friday as anticipated but, also added in 4 hours on Thursday to be of assistance and learn more out of the TDH survey process. This made up for Monday that my preceptor needed to pass on to take her son to the Freshman orientation at UNT. This made a total of 12 hours for the week.
The grand total as of now is 51 hours, leaving me only a little over two more clinical days this week.

Mid-Semester Evaluation

My Mid-Semester Self Evaluation has reasonable objectives met.

• 2 Course Clinical Objectives and 2 Personal Objectives so far in the course;

Clinical Objectives:

I have met the Professional Accountability goal thus far. I am present and accounted for during all clinical time previously scheduled other than one afternoon that my preceptor had to leave an hour early. I personally feel that I should have made a better clinical schedule such as longer periods of time instead of so many short spurts of time.

I use Theoretical Knowledge consistently when communicating and assisting with the staffing matrix and supply requisitions. This facility has just completed its first 90 days of operation and has not yet established a working budget for all areas including the patient care units.

• Statement of your personal objectives and discuss how you have or have not accomplished them, supporting them with reasons and/or examples;

Personal Objectives:

I am currently assisting with the development of a consistent manual supply ordering system that can easily be used until they go partially automated in August. Using a spreadsheet, I am formulating a list of frequently ordered supplies and corresponding order numbers that can be used as a pre-printed requisition.

I am getting a very close look at executive nursing administration and discovering that its a lot of work and much stress at the same time. This has offered me an opportunity to really think about it. Is this really something that I would want for myself? Many of these Directors arrive before eight but a few of them often stay until well after rush hour traffic. It appears to me that the ones who put in these kind of hours are usually nursing departments.

I still have not had an opportunity to look into formulating unit budgets and it does not look like I will get this opportunity because they are not planning to implement unit budget guidelines until 6 months to a year into full operations.

I was hopeful that I would get to observe a board meeting or two to see how the major decisions are made but, these meetings are held strictly confidential and unable to have observers.

• Course Objectives and relate them to your work in your specific clinical site, by providing examples;

Professional Accountability: I have been very faithful to my proposed clinical schedule. I am sure to be on time and offer assistance to my preceptor for any of her needs.

Critical thinking: I have been very forthcoming on my clinical needs and expectations with my preceptor and she has included me on verything she possibly could. She answers any questions or finds the answer if she doesn't know it.Communication: Demonstrates effective verbal and written skills in communicating with individuals, groups, and health care providers.

Client advocacy: Advocated for clients during a pain mangement meeting on appropriate time frames of pain medication delivery. We will do a quick study on the length of time between patient calls for pain medication and actually delivery to improve patient satisfaction.

Leadership skills: I have shown leadership skills by offering to contribute to my learning facility by taking on projects such as supply order systems and pain management control. I have also been assisting with the scheduling matrix.

Cultural competence: I have a wide base of knowledge regarding different cultures and ethnicities. I involve myself in an ongoing learning process in this area.

Theoretical knowledge: I have not sat in on board meetings or any as such but, I have been included in multiple department meetings and TDH, AOA, and JCAHO preparation meetings. I offer my input regularly on my experiences.

Statement and discussion of 1 way in which these items discussed above have enabled or fostered your growth as a professional nurse.

This clinical experience has given me a more objective look at upper management in the nursing world. It is not an easy job. You don't have a buffer between yourself and the CEO or CNO. You take much more responsibility and accountability onto your shoulders with upper management nursing. I have always thought that I have very good leadership qualities. I feel that I could be an effective leader in many situations or positions. Now, I am starting to think that I wouldn't ever want to be that far from the bedside. I like the patient care aspect and using those bedside skills everyday is something I enjoy doing and I am proud to be good at it. It's good to have seen how very different it gets the further you climb the clinical ladder.

12 clinical hours this week from Monday, Wednesday and Friday for 4 hours each day. The grand total now is 39 hours.

Returning from the Holiday

I returned from my long weekend in Branson to play catch up on everything else. Spent clinical time with my preceptor on Wednesday, July the 8th for 4 hours and again on Friday the 10th for 3 hours. Wednesday was frustrating because my preceptor had a private meeting with her administrator. I spent time with the supervisor on the inpatient unit looking at staffing matrixes and supply inventory. Friday was better. We talked about future development of the second phase of the facility and the staffing recruitment methods for the 48 bed unit involved. Friday was cut an hour short. My preceptor had to leave at 5 pm for an appointment. I need to arrange longer days to get more accomplished in a day.

Forever and a year...

The four hour clinical sessions are going to have to go! I cannot do it this way all semester. I'm going to have to submit a change in my clinical schedule after I work it out with my preceptor. I was with my preceptor Monday, Wednesday, and Friday of this past week for approximately 4 hours each day. I did participate in a director's meeting for TDH and JCAHO preparation. The facility will be surveyed by AOA within the next 90 days as well as TDH within the next 30 days. JCAHO could be anytime. The facilty is new and this is their initial survey with all of these accreditation entities so they are very excited and confident. It is a well managed facility.

Clinical Times

So...we all probably started clinicals this week. My clinical schedule is going to take forever! Due to my work schedule, I could only work in 4 hour clinicals, 3 times per week. It is a lot to keep up with. I started on Wednesday, the 17th and did a few more hours on Friday, the 19th. Keeping a log of experiences would have been much better if I could have done five 12 hour shifts. Even one per week would have been great. It's also a fairly slow portion of the day when I meet with my preceptor. Many of the organizational meetings and troubleshooting happens during the first portion of the day. The good part about that is that my preceptor and I can focus on what we are trying to accomplish. Still, it's all very time consuming.

Starting Again...

Here we go again. That break went very fast! Is everyone ready to jump back in again? My schedule has calmed a bit. The girls softball season has ended which relieves some stress. My sister is doing fairly well at her nursing facility now. I still have the same aggravations with long term care facilities and the negligence that I find on occasion. My mother moved out of our home which caused stress and relieved stress at the same time. The kids are occupying themselves. Now, getting on with this course, I think I understand the clinical portion. We should have a head start on our paper since the topic was started last semester. That's a bonus!!!