Doing the case open made it easier for the surgeon to control bleeding which lead to stabilizing the patients condition. 1984 0 obj <>stream I met the needs of the patient, the family, the charge nurse and Kaiser. My newer, more inexperienced colleagues could not quite understand my reaction, as they were still trying to establish their boundaries. It was the first time I ever saw Mr. R. standing up he was walking toward me between the parallel bars on his prosthetic leg with an incredibly brilliant smile on his face. It also provides an opportunity for you to identify publications, presentations of papers, honors received, and professional associations of which you are a member. finally, the larger organization. She had been discharged from 4W and after returning home for a brief period of time, returned with major abdominal pain. WebRNss ppracttice. Because I showed interest in her symptoms and patience to listen to her story, Mrs. C. seemed more willing to talk. They were upset and afraid that their mother would not get the pain medicine she may need and asked if one of the family members could spend the night in the patients room to observe and assist her. It was my day off and I got a call informing me of his eminent demise. The Nurse of the Year will be revealed on May 13, 2015 in the Deaconess Legacy Conference Room at Later the patient went to CT, returned and was transferred to a trauma center. 3. He had been at a meeting in the building. The Staff Nurse III uses judgment to assess the appropriateness of physicians orders. He told me, I feel like I cant catch my breath, and Im hurting more than yesterday. In our Purple Book the home treatment advice presents a list of food that should be avoided (we all know that Mexican food is mostly spicy) and explains in detail about meal timing and positioning when sleeping to avoid acid reflux. H H / H I I - P o s e s s e s a P H N c e r t i f i c a t e o r s e r v e s a s a H H / H c a s e m a n a g e r H H / H I I w o r k s i n H o m e H e a l t h a t l e a s t 3 y e a r s w i t h t h e e m p l o y e r H H / H I I w o r k s i n Home Health at least 2 years with the employer and 1 year HH experience within a Medicare certified home health agency Work in the area of clinical specialty for the employer an average of 24 hrs/week over the last year. This time, I got a BP that was indeed elevated but the pulse was 30. I explained to her that being sleep deprived and overwhelmed are normal postpartum situations especially for a new mother, but being woken up with a severe HA is not. Her history included Parkinsons disease, CKD, COPD, and HTN and elevated K. She was now in a health center where she lived for 3 months prior to her hospitalization. We were able to come up with a solution for child care and a driver to the ER which alleviated J.s anxiety, ensuring her to seek treatment now. 659 5. Fevers began and she was readmitted, requesting 4E. After receiving report I was able to visual see Mr. Y. from the nurses station. Nursing exemplar.pdf. Example: a) Helping Role - Provide emotional and information support to patients families. What was the situation and how did you intervene? Normal expressions of grief may be physical The Staff Nurse III draws upon the patient, family and significant other as resources. The Facility Selection Committee is comprised of: Nurse Executive, Director of Nursing Practice (DONP) or designee 2 RN managers (appointed by the Nurse Executive/DONP or designee) 1 Staff Nurse III (minimum) 1 Staff Nurse actively involved in a professional committee 2 Staff Nurse IVs or HH II or III Alternates: a substitute in the same category to be used as needed. A Public Health Nurse (PHN) certification, or serve as a HH/H case manager. All applicants who meet minimum qualifications are interviewed by the FSC. These Unit/Shift _________________/___________ Facility__________________________________ Phone: WORK___________________ HOME___________________ OTHER______________ R.N. The upper and lower jaw was loose and appeared to be floating. I gather all my data and in my SBAR presentation I described her symptoms and I emphasized that women at her age and menopausal, can have atypical chest pain. The Role of Mentors As an applicant for Staff III/IV, HH/H III, you must select a mentor to assist you in the application process. Able to provide leadership in a crisis, the Staff Nurse III transforms chaos into a manageable situation that has a greater likelihood of positive outcomes. I reassured her that she would be in very capable hands and nothing was going to be done without an explanation and her consent. Two letters of reference are needed from a Clinical Nurse with at least two years experience at BID Needham or an advanced practice nurse (NP or CNS). Removing all of the sterile gauze revealing her peri-skin already red and angry, just short of excoriation, I assessed immediately that the plan of care for her dressings would require more than simple sterile gauze. (It is the RN's responsibility to notify the FSC if their hours fall below 24 hours.) Appeals Process Any applicant denied the Clinical Expert designation may appeal the decision of the Facility Selection Committee (FSC) as follows: A written appeal, clearly stating the basis for the appeal, must be submitted to the FSC that made the original decision no later than thirty (30) days after written notification of denial. I asked my patient about any concerns that he might want to clarify with me. She agreed. (Taylor et al., 2019), Functional Ability Functional ability is a persons ability to perform activities of daily Committee work may be hospital or professionally based GRASP PPC Performance Improvement Policy and Procedure Other The applicant may document the role of the committee (charter), meeting frequency, and your contribution by completing the optional form on committee participation documentation included in this packet. ( Gaining social support from other nurses. in which they simultaneously send and receive messages both verbally the body, including organs and body systems, osmosis, diffusion, I hooked him up to the cardiac monitor which showed an apparent 2nd or 3rd degree heart block. Facility No. Alternately, you may submit hard copies (2) of your portfolio to Heidi Alpert. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Welcome to Tracys ProfessionalPortfolio. Health Promotion Health promotion is the behavior of an individual motivated by a The decision of the Regional Appeals Committee is final and binding, and shall not be subject to the provisions of Article XXXVIII of the Collective Bargaining Agreement. I asked a second RN to look in the trash bag and she was unable to find it as well. You are eligible for advancement following a minimum of two years nursing practice experience, one year of which must be on your current unit at BID Needham. The charge nurse role can lead to advanced nursing positions or other opportunities to improve an individual's management abilities. She just wanted a message and something stronger for her pain but I intuitively knew something more was going on her and I felt she needed more urgent care. The charge nurse role requires diligence, patience, and skill. The family told me that the patient was unable to push a call button and barely drinks 16 ounces of fluid per day. She attributed it to lack of sleep and new mother anxiety, but wanted reassurance. decisions, solving problems, interpreting the environment, and She was coming in for ultra violet treatment twice per week for her psoriasis. ( Getting appropriate and timely responses from physician. We had developed a very special relationship, one built on mutual respect and trust during the course of these treatments. manager (Taylor et al., 2019). (Hinkle & Cheever, 2018). He was able to come home right away and told me she would be at the ER within 1 hour. As a leader, the charge nurse must demonstrate humility as they collaborate with healthcare teams. Coping is any behavior that is used to decrease stress and She became a little frightened and asked What could be wrong? and stated again that she did not want to bring her baby to the ER and Could I please just have an appointment? I told her that this could possibly be complications from her delivery. Cognitive abilities include reasoning, judgment, Please submit a letter of recommendation from each of the following parties who are familiar with your practice over the last year. I came back to her and thanked her for the patience. My inquisitiveness and intuition using the nursing process brought me to an emergent outcome that was not in the protocol. WebA nurse leader has exceptional clinical experience and knowledge. The Staff Nurse III raises the level of practice by effectively using whatever resources exist and by functioning as a dependable expert readily available to other team members. I will develop an information sheet for caring for patients with chest tubes within three months. He did seem more relaxed, but I was becoming uneasy as he still was clammy. This was one such patient. Nurses can It wasnt long after entering the room that I noticed that this patients GLASGOWCOMA scale had deteriorated from 13 to 7 (a GLASGOW score less than 8 may indicate severe brain injury). Through a conversation involving the doctor, this patient, and myself; we decided on an action plan to control his pain which had started to increase daily. WebWhat is an exemplar? These qualities can strengthen positive relationships throughout the unit. He has a long history of PAD with severe lower extremity necrosis. These cognitive Cross). There were drain sponges around the insertion sites and 4 x 4s wrapped around the actual drains for absorption. The Facility Selection Committee shall review the appeal and either accept the application or deny the appeal, providing a written explanation of the reasons for the written denial. Write the exemplar in your own words. A charge nurse oversees all of the nurses in the hospital unit and is responsible for other administrative duties. I took my assessment and experience and make a case to the physician to discontinue the Ativan and allow me to give a psychotropic such as Haldol. Expand your skills with Care of the Acutely Ill Pediatric Patient Respiratory Bundle. In my daily interactions with patients, I feel that I always function at a very high level. At that point the surgeon would be ready to begin closing the cavity. As I pushed the gurney towards the OR, I felt the anxiety that my patient and his wife shared. this sense of well-being to the patient, particularly by relieving pain. D I reassured her that it was common for new moms to feel this way. I offered to call a family member of a friend for her, and she requested that I call her daughter. I asked her if she had been drinking fluids and eating, she said she was drinking a lot and urinating normally and she just had eaten a sandwich prior to calling. Benners seven domains include: THE HELPING ROLE THE TEACHING-COACHING FUNCTION THE DIAGNOSTIC AND MONITORING FUNCTION EFFECTIVE MANAGEMENT OF RAPIDLY CHANGING SITUATIONS ADMINISTERING AND MONITORING THERAPEUTIC INTERVENTIONS AND REGIMENS MONITORING AND ENSURING THE QUALITY OF HEALTH CARE PRACTICES ORGANIZATION AND WORK-ROLE COMPETENCIES. She said no to all. After assessing the patient and not really coming to a clear outcome I felt uncomfortable with giving her an appointment or a message. et al., 2019). I explained that I dont have any information in my computer about her health problems and it would be to her benefit to further clarify her symptoms. needs for meaning and purpose, love and belonging, and forgiveness A charge nurse oversees a hospital unit or department. Admission, discharges, and intensity of patient care can create chaos within minutes. I escorted him to our injection room and had him take a seat. WebThe median annual salary of a charge nurse is $68,911, according to PayScale. The committee will choose replacement members from the nominees by consensus. His hospital stay will require diabetic control, restoring blood flow to bilateral lower extremities, wound care to necrotic diabetic ulcers and restoring proper nutrition. Describe clinical situations, which you believe positively impacted by your practice. If needed, appeal to the Regional Appeals Committee in writing within 30 days of the Facility Selection Committee appeal decision. I agreed with her that it was probably not a good idea. The nurse informed me the IV push was every thirty minutes and did not feel comfortable requesting more. Benner believes in the situation-based, interpretive approach to identifying and describing knowledge, which is imbedded in everyday clinical practice. What were your goals and did you achieve them? Acid-Base Acid-base refers to the balance of hydrogen and bicarbonate ions within I should be able to see beyond the immediate needs of my patient in the OR by being his advocate at the time he couldnt care for himself. Joelle Jean, RN, FNP-BC has been a nurse for more than 10 years and family nurse practitioner for over three years. The charge nurse must adapt to new circumstances and navigate or overcome obstacles; they must make the right call without relying on others. I checked all the instrumentations and surgical supplies with my surgical technologist. The team of nurses, physicians, physician residents, pharmacy and respiratory responded to the Trauma Bay to prepare for the patients arrival. She told me that for about a week she cannot sleep because the burning wakes her up. Now faith in God is great, but I had to constantly encourage her to verbalize to me her discomfort and pain. Each day, across thousands of medical-surgical inpatient nursing units, charge nurses make decisions about which nurse will care for each patient. (Videbeck, 2020). Caring for Mr. R. became tricky at times because he had six children from a previous marriage. b) Teaching Coaching Function- Assisting patient to integrate the implications of illness into their life styleThe teaching needed for a family to manage this acuity at home is tremendous. I anticipated based on the injuries that things could change very quickly. endstream endobj 13 0 obj<> endobj 14 0 obj<> endobj 15 0 obj<>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 16 0 obj<> endobj 17 0 obj<> endobj 18 0 obj<> endobj 19 0 obj<> endobj 20 0 obj<> endobj 21 0 obj<> endobj 22 0 obj<> endobj 23 0 obj<> endobj 24 0 obj<>stream to minimize the effects of injury or infection, remove the damaged tissue, Administering and monitoring therapeutic interventions: At the onset of the situation, I had identified that an arrhythmia was most likely involved. It was my job to ensure my patients safety at all times. Lying on his back in our hospital bed he remained soft spoken and only spoke when he had something to say, there was no idle chatter with this patient. Informatics is the use of information technology to improve the quality, Laws and legislation define the scope of acceptable They may be significant one-time events. I took the time to wait for her while she breastfed her daughter and called her husband for child care. Nursing Philosophy and Concept Curriculum Map, 2/16/2016). The Staff Nurse III, then, draws not only upon past experiences but also upon inquisitiveness, intuition and an organized use of the nursing process to anticipate problems and intervene before the patients condition deteriorates. Criteria for Exemplars To assist you in writing exemplars, the following information pertinent to evaluation of exemplars is offered: Two written exemplars must be submitted for review. I rechecked his vital signs and all appeared to be stable. Little did I know that during this affirmation she would call me up to the altar and introduce me to her congregation as The Angel that God had sent to her. Name_______________________________________ 2. By also drawing on the help of her sister-in law and husband I was able to formulate a plan of care that she was comfortable with. 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