Reflective Clinical Objectives

Reflective Clinical Journal

Clinical Objectives

1. Examine the various roles and responsibilities of a nurse leader and manager.

            My clinical rotation took place at Utah Valley Medical Center in the Cardiac Cath Lab where I was able to see the many roles and responsibilities that a manager has to accomplish. For instance, he had a daily schedule: every hour was reserved for certain activities in the unit; he even had appointments to fulfill within the community, such as going to elementary schools and giving talks and presentations with different universities. Some hours in the week he dedicate to do budgets, balancing cost, staffing and attending different management meetings with his unit and the hospital, as well as going to Salt Lake City to attend and participate in regional meetings.

2. Manage time in order to effectively complete the clinical hours and expectations.

            I was able to finish my 60 hours on time, even though I had to cut hours off of work and family matters. Nevertheless, I enjoyed every single hour at the clinical site. I learned valuable information that will stay with me forever.

3. Demonstrate responsible and professional communication in verbal, nonverbal and written interactions.

            I communicated verbally with the manager most of the time and used positive expressions; I always smiled and was thankful for all their help in my learning experience. In writing, I presented the outline of my project, which he approved, and gave some advice on how to apply it in the unit.

4. Organize and complete a project that utilizes the concepts of nursing management to solve a clinical problem.

            This was my favorite part of the clinical experience, because it gave me the opportunity to elaborate on a project that was going to benefit not only the cath lab unit, but also the Cardiac ICU and Telemetry unit, since they work together. My project was to identify any deficits in the communication between the cath lab and the other two units by administering a quiz of ten questions, identifying the problems and motivating the clarification of services in order to close these problematic gaps.

5. Delegate appropriate tasks or activities to others and self evaluate delegation style.

            During my rotation, I was able to work with the secretaries of the unit, health team and other charge nurses in the ICU and Telemetry unit, and delegate the distribution of the quizzes and time guidelines. This health team was very supportive and willing to contribute with the project.

6. Examine and evaluate records related to care monitoring, error prevention, incident reporting and quality improvement.

            Every Monday, all the managers of the Cardiac ICU, Cath lab and Telemetry meet with the main manager and discuss quality improvement and even see statistics from other hospital (called benchmarking) in order to see where they stand against other organizations. UVRMC always has the highest percentage in most areas.

Clinical Goals

1. Improving the quality of patient care by applying leadership skills.

            I had the opportunity to be in the cardiac catherization of some of the patients who came to the unit. I decided to release the tension of the patient by establishing a therapeutic communication.

2. Willing to learn a leadership role that enables me to better the quality of patient care.

            Knowing that this was going to be my last rotation in a clinical setting, I decided to learn and assimilate all I could during those sixty hours I had. I placed extra attention on the manager's activities, and he was very supportive and willing to provide as much information as I needed.

3. Develop leadership skills through education and collaborating in research projects.

            I accomplished this goal by elaborating on a project that was going to benefit the unit in resolving some educational gaps the units were encountering at this time.

4.  Create a positive relationship within the organization.

            During the work on my project, I learned that by showing respect to each member on the health team, we are able to accomplish great things through cooperation and mutual involvement.

5. Development of trust to establish and honest communication with the health team.

            I was only able to build my senior project in the unit I was assigned to because our communication established trust through the sharing of information and a mutual willingness to listen to some of the units' problems

Objectives 11 and 12

Objective # 11

A)    Elements of quality care when receiving health care services:

1.      Medical treatments received on time and accurately.

2.      Updated heath status and treatment plan.

3.      Privacy; for example, knocking on a door before entering patients' rooms.

4.      Respect and courtesy regardless of patient status.

5.      Prompt pain control.

6.      Effective rehabilitation processes.

7.      Education during hospitalization and upon discharge.

8.      Good nutrition and a variety of meals.

9.      Able to discuss care with the health team.

B)     Elements of quality care as a nurse professional:

1.      Plan of care: Provide the patient with the highest quality of medical treatment and the best care in all aspects: physiologically, mentally, socially and holistically. All treatments performed on the patient are supported by evidence-based practice.

2.      Accountability: All nurses are responsible to the patient, family, the health care team and the organization where he or she works.

3.      Communication: A healthy communication between the patient and the nurse is the base for effective communication among the entire health care team.

4.      Education: The critical thinking abilities of the nurse are imperative for the good rehabilitation processes of the patient. Also, the nurse should be engaged in teaching the patients at all times.

5.      Leadership roles in patient care: Nurses use management and leadership skills to secure high quality care to the patient.

Actually both elements share some similarity because the expectation of the patient is to receive an excellent care while he or she is hospitalized. And the elements of the professional nurse in the quality care are base in all the needs of the patient.

Objective # 11

Managerial Methods of Terminating an Employee

            To terminate an employee is a very difficult situation, but at times necessary, due to the inability of an employee to perform well. The first thing to do is to call the employee to the office in a private manner and treat him or her with respect, because they have rights as human beings. It is a good idea to explain to have a neutral witness, preferably someone from human resources, in order to record the meeting's proceedings. During the meeting, one should be sensitive to the employee's feelings by avoiding humiliating or other negative remarks. Then explain to the person the reasons for the decision to terminate. Try to end with a positive remark, like wishing to the employee luck on their future.

Leadership Objectives

Roxana Zavala

Objective 5

Patient Care Models

             In the organization where I have worked since 2008, we use the functional method. We have a Charge Nurse, who, on the weekdays, is the Director of Nurses (DON). On the weekends, the nurse in charge of the shift becomes the Charge Nurse for that shift. Our facility is meant for short-term stays: no more than 90 days. There are only 16 bed available. Patients are admitted in order to obtain an optimal rehabilitation and later be able to be discharged home or be transferred to a long term facility. In some cases, patients are sent to hospice agencies for the end-of-life process. The Charge Nurses assess, plan, implement, coordinate, monitor, and evaluate patient health care plans. The RN on duty monitors medications, assesses, plans, implements care and evaluates care outcomes. The RN is also in charge of performing all the wound care and treatments. We also have three certified nurses assistance (CNA) when the establishment is full and two CNA when the census goes down to ten patients. CNA provide functional roles like toileting, bathing, bed-making and fulfill clerical and housekeeping roles as well. I noticed that this method is very common in the state of Utah, and works very well in my work place, because it allows us to focus on our duties. Of course, all the employees work as a team in all aspects of patient care. Our CNAs never get burnt out, because we motivate them with gift cards, thank you cards and words of encouragement and appreciation.

 Different Types of Power

1. Reward power: When the person is able to grant favors or reward others. This type of power among leadership brings optimal results in loyalty.
2. Coercive power: My least favorite kind of power, because it uses fear of punishments like transfers, layoffs or dismissal if goals are not met.
3. Evert power: Obtained through knowledge and experience. This kind of power is limited to a specialized area.
4. Referent power: Power that managers or leaders have because they possess charisma and others see them as model leaders.

Objective #6

Attitude toward change

            In my life I have been through a lot of changes and I don’t regret any because each has served an opportunity for me to be challenged and adapt myself to new situations and circumstances. But it is also true that the older one gets, the more resilient one is to accept change. I am always open to new opportunities that can help me to grow in all aspects of my life. For example, my family is getting ready to face a big change: I live with my mother and nice and am also the main provider for my family. I had decided that we should move to California or Arizona, but my family disagrees with this big change. My mom has gotten used to living here and my little niece likes her friends and teacher. I explained each of them all the benefits of the change and after two long months of talk they are still undecided. I will give them time to process the change. In April we are going to Arizona for a week and staying at my niece's house, and in May we are going to California for two weeks and staying in my brother's house. After this, we will make the final decision. If they accept the change, I will be very supportive in their emotional needs and hopefully all of us can be happy.

Objective #8

Career Development Plan

            For my future in the nursing profession, I want to make a reality out of my career development plan. I’m glad I was exposed to this chapter; it helped me a lot to broaden my view on the development of an effective career plan. I will use these steps I found in the book as an outline. ( Marquis.B&Huston, C.,2009)

1. I will assess my interest, skills, strengths and values by deciding what I am going to do for the rest of my nursing career, in order to grow personally and be able to help my family.
2. Determination of Goals: at the moment my goal is to move to a bigger state, where I can pursuit my PhD in education. For three years I have been teaching the CAN; now I want to teach the nursing students.
3. Assess the Organization for Opportunities: in my mind, there are two universities were I want to go: AZU in Arizona or UCLA in California. I going to apply to both of them and do whatever it takes to get there.
4. Develop Strategies: My strategies are applying to those schools and be able to meet their requirements for the institutions.
5. Implement Plans: once I am accepted to one of these schools, I will prepare my family for the final move.
6. Evaluate plans: I will evaluate what state offers more security and is the most cost effective in order to make the final decision.
7. Reassess and Make New Plans as Necessary, at Least Biannually: in the worst case scenario, if I don’t get accepted to any of those schools I will self-assess my other interests.

Objective #9

Motivation

            “How we feel about and enjoy our work is crucial to how we perceive the quality of our lives.” —Jo Manion

            For me, motivation is an inner force that inspires all people to do great things, to make the impossible possible. Motivation is necessary in order to accomplish a task. Motivation, for me, is positive energy that is between your mind and your soul; it is a deep and powerful source that all humans have in order to succeed in this life.

            I remember when I worked at the University of Utah Hospital. Each week my manager gave me a gift card that was worth five dollars to reward me for my hard work at my shift. I collected more than 50 gift cards. For me, this reward was a big motivator to keep working in the unit. I totally appreciated that my manager recognized my dedication to my patients and my hard work. As a matter of fact, I have kept some of these cards as physical reminders of those great times. I have received other awards from my managers, but those U of U gift cards gave me a sense of accomplishment as a nurse, especially because at the time I was a brand new nurse. I am still working in this profession; this year is going to be my seventh year as a nurse, thanks to those cards that my dear manager gave me.

Objective #10

Managing Conflict

            I remember a time when I was a new RN and was overwhelmed information I needed to process and master. I had a conflict with an experienced RN; she had noticed my lack of skills and was not tolerant whatsoever of my situation. Every time we had to work together, she started to make negative comments about my performance as a nurse. It got to the point that I could not tolerate her anymore, so I decided to stand up for myself by working harder, reading my protocols, attending all the nursing seminars, subscribing to nursing magazines and going to an online university to get updated information. After a few months, we were in the lunch room together and she made a positive comment about my performance. She said I was very persistent in my attempts to succeed as a nurse, and that she had underestimated my nursing capabilities. I also remember talking to my manager about this situation in one of the meetings. She encouraged the old nurses to be more supportive to the new nurses by coaching, doing mentoring, and avoiding destructive comment aimed at the new employees. This manager stood by my side in those difficult moments. Her actions showed me that she was clearly validating my efforts to succeed as a nurse.

            The way my manager handled this situation is how I want to handle a case when new nurses have to deal with intolerant coworkers. The first thing I will do is talk to the intolerant nurse and remind her of when she was new in the profession and what motivated her to stay in the nursing field. Secondly, I would encouraged her to be a mentor to the new nurses, since she is considered one of the best experienced and skillful nurses in the unit. I would remind the experienced nurse of the importance and value in managing diversity in the health arena.

An afternoon with Adam Patch.

First of all I want to thanks my professor for making us going to these wonderful presentation. Since these event happens, I have decided  to be happier and share my love to all humankind. Adam's speech have inspire me to really focus in the most important thing in life, that is to enjoy every single minute that we live on earth. By helping others ,we can forget our problems, like depression. He said that service is the best medicine for these illness.  He taught us that ,by serving and loving others we can able to heal from our sadness and loneliness that is reason why so many people end their lives. I don't  want retribution for my service, I will do it  because I really care about my fellow being. I can't wait to go someday were people really need me, But for now I will love and help to those who surrounded me.

Power gap in females nurses.

More than ever is the need for good nurse managers. Sometime the power gap is in the way. But studying this chapter in my book I learning how to overcome these problem and start enhancing the power we need to become the best manager. First of all we must irradiate positive energy; we can develop this energy by taking care of ourselves, like engaging in physical fitness so we can be empower with energy and stamina to confront stressful  times  at work. Also having a good relations with our families will gives support and happiness.
Presenting ourselves as a professionals well groomed, erect posture and with good communications skills are important to succeed.
Working hard at all times, specially working with the team and be and example is a must to succeed as a manager.
Have good relationship with all the manager and shared strong values. Learn the culture of the organization, prioritize your goals for the organizations. Increase your skills to the master level will give you more power. Look to other managers for advice and counseling. Broadened your vision towards the community. Be flexible to others. For management sense of humor is a plus to have and one of the more important attributes empower to others by sharing knowledge and supporting each other. I going to work in developing these skills at my current nursing job so I can become an excellent nurse for the benefit of my patients and the community in general.

Operational and Strategic Planning

We are in a changing world, were organizations forms of management are changing too. The management theorist have learn more about human behavior. Many organizations are creating an environment less rigid to their employees. At the moment I doing my rotation at the Cath Lab, the manager and employees are enjoying to work together, outside of their working days they are engage in social activities like hunting and dinning. And all of the employees are invited nobody is left behind. The working atmosphere is less tense and they work as a team. What a example of a unit. All the employees are engaged into benefit the unit. The manager is an example of fairness and discipline. I think people work better in a place were is less bureaucracy and were the employees are empower; and in consequence the patients are the ones who will benefit.

Ethics during the end of life in the hospital.

In the hospital settings we nurses encounter patients near the end of life. In the medical records the advanced directive is available, but does not transfer from unit to unit or hospital to another facility; in consequence  postponing the death of the patient. End of life documents should be a team work between nurses and doctors and of course computerize tools.
We nurses have the ethical duty to communicate with the patient, family and physicians about these issues and resolve any conflict between the patient and relatives. The health team should respect the person's values and wishes at the end of life by maintaining comfort and dignity.