Well, I finished faxing all of my material last night (December 6).
This is the first semester in 20 years that I'm sorry to see come to a close.
Perhaps I should fail the change project, so I can have another shot...
(Okay, biting my tongue...)
I received a ne job offer today based on having a BSN degree. Johnson and Johnson wants me to be one of their presenters for their technology for RNs and P.A.s. They couldn't speak to me about it before because a Bachelors Degree is required. Wow! I'm excited about it.
I wonder what other doors this degree will open? Had I known it was a key to new paying possibilities, I probably would've pushed ahead sooner!
Hoping to start the EMBA program in the spring, but TWU can't approve my application without proof that I've passed this semester and graduated.
I'm nervous about continuing school and nervous not to... I really can't wait to see what my life will evolve into once the EMBA program is completed! I have so many plans and hopes! It's been a long time since I've felt true hope for something different than the routine my life has become.
Luckily, my husband and daughter share the hope for our future. We are all waiting and watching to see where we will be lead over the next few years.
Thank you for this semester.
Good luck with the future You make!
Monday, December 7, 2009
Sunday, November 29, 2009
Peer Review
I was honored to be part of a peer review mentoring session.
S.H. was unable to attend the Peer Review Session, so her friend J.M. sat in for her.
When J.M. came to debrief with S.H. about the meeting, they let me stay. (carefully keeping the names and identities of all parties confidential!)
The bottom line to the discussion was that taking responsibility for your actions is the key!
The Peer Review Board is make of the person's Peers. Human Peers. Humans make mistakes and the recognize that fact.
The Peer Review Board is looking for the cause of why the problem occurred, not just who to blame! If the cause is the nurse's lack of education, opportunities for remediation will be given so the nurse will feel confident that the problem will not occur again. If the Nurse denies all responsibility and blames others for their issues, the board worries that other problems may be covered up, not reported, education will not be attained, and further harm might be done. These nurses that refuse responsibility, have no remorse, and try to push blame onto others have a high chance of being reported to the BNE for closer inspection.
The Peer Review Board is also looking for system causality. If many different departments are doing the same things, some things not as safe as others, the system needs to be changed. Perhaps the nurse thought they were doing what was best, but there are safer ways to provide the care to the patient. The safest care possible needs to be provided to all patients, system wide. The nurse being reviewed will have the opportunity to change their care first, since they have helped to recognize the problem.
S.H. and J.M. have been leading the peer review boards for many years. They had many examples and shared many experiences.
Bottom line...
Take Responsibility for your actions!
(16-6-10)
S.H. was unable to attend the Peer Review Session, so her friend J.M. sat in for her.
When J.M. came to debrief with S.H. about the meeting, they let me stay. (carefully keeping the names and identities of all parties confidential!)
The bottom line to the discussion was that taking responsibility for your actions is the key!
The Peer Review Board is make of the person's Peers. Human Peers. Humans make mistakes and the recognize that fact.
The Peer Review Board is looking for the cause of why the problem occurred, not just who to blame! If the cause is the nurse's lack of education, opportunities for remediation will be given so the nurse will feel confident that the problem will not occur again. If the Nurse denies all responsibility and blames others for their issues, the board worries that other problems may be covered up, not reported, education will not be attained, and further harm might be done. These nurses that refuse responsibility, have no remorse, and try to push blame onto others have a high chance of being reported to the BNE for closer inspection.
The Peer Review Board is also looking for system causality. If many different departments are doing the same things, some things not as safe as others, the system needs to be changed. Perhaps the nurse thought they were doing what was best, but there are safer ways to provide the care to the patient. The safest care possible needs to be provided to all patients, system wide. The nurse being reviewed will have the opportunity to change their care first, since they have helped to recognize the problem.
S.H. and J.M. have been leading the peer review boards for many years. They had many examples and shared many experiences.
Bottom line...
Take Responsibility for your actions!
(16-6-10)
Favorite CEO gone, but not forgotten...
Last Week our favorite CEO, Britt Berrett was escorted out of our facility.
He has accepted a position with our competitor!
At first, I didn't know how to handle it. He is the living example of our culture.
Now he is taking our culture across town! My mentor decided it was a very great compliment to Medical City that our competition would want what we have.
I've worked at the facility that he will be converting into the light... and if anyone can change that hospital, Britt will be the one!
Bye BB! You will be missed!
It will be interesting to see who takes the reigns and where they will lead us!
(18-2=16)
He has accepted a position with our competitor!
At first, I didn't know how to handle it. He is the living example of our culture.
Now he is taking our culture across town! My mentor decided it was a very great compliment to Medical City that our competition would want what we have.
I've worked at the facility that he will be converting into the light... and if anyone can change that hospital, Britt will be the one!
Bye BB! You will be missed!
It will be interesting to see who takes the reigns and where they will lead us!
(18-2=16)
Monday, November 9, 2009
Talented, Enthusiastic, Staff!!
Last week, I had the joy of interviewing my mentor.
It was fun to find we had so many goals and ideals in common.
I've posted the interview, so I won't go into a lot of detail here, but I did want to post my favorite part of the interview.
I asked S.H. all of the required questions, then I added one to personalize the interview.
I asked S.H., "if she could have any One thing, in unlimited amounts, that would make her departments flourish, what would it be?"
I thought her answer would surely be unlimited Funding, but it wasn't.
Without hesitation, she replied, "Talented, Enthusiastic Staff."
Her reasoning was simple. Talented, Enthusiastic Staff members make it fun and enjoyable for the surgeons to operate. When the surgeons feel confident about the staff's abilities and they are comfortable in the environment, they will bring more cases to that facility. More cases means more funding, which means more staff positions and more equipment. It's a circle that all relies on talented, enthusiastic, staff.
If the staff is unhappy and apathetic, surgeons operate elsewhere.
I fully expected more $$$ to be the answer.
See how much I still have to learn????
(26-8=18)
It was fun to find we had so many goals and ideals in common.
I've posted the interview, so I won't go into a lot of detail here, but I did want to post my favorite part of the interview.
I asked S.H. all of the required questions, then I added one to personalize the interview.
I asked S.H., "if she could have any One thing, in unlimited amounts, that would make her departments flourish, what would it be?"
I thought her answer would surely be unlimited Funding, but it wasn't.
Without hesitation, she replied, "Talented, Enthusiastic Staff."
Her reasoning was simple. Talented, Enthusiastic Staff members make it fun and enjoyable for the surgeons to operate. When the surgeons feel confident about the staff's abilities and they are comfortable in the environment, they will bring more cases to that facility. More cases means more funding, which means more staff positions and more equipment. It's a circle that all relies on talented, enthusiastic, staff.
If the staff is unhappy and apathetic, surgeons operate elsewhere.
I fully expected more $$$ to be the answer.
See how much I still have to learn????
(26-8=18)
Tuesday, November 3, 2009
Mid-Semester Self Evaluation
Here's the Scoop:
2 Course Clinical Objectives
A. Interact with Peers via the discussion board to promote classroom knowledge of the BSN prepared nurse with a global perspective.
I have learned so much from my fellow student via the discussion board in each of my online classes. I was biased when I began the online process, thinking that I could read the material, take a few tests and get a grade. I wasn't actually planning on learning anything.
What a wonderful surprise to find myself looking forward to checking the discussion board to see what my peers had to say. I enjoy looking up their references and providing data that I have found to enrich their learning experience.
B. Complete change project, implement it, test it, and evaluate it.
Unfortunately, I have yet to implement my change project. I'm making a Surgical Portfolio to help staff members unfamiliar with their assigned cases. The portfolio contains the preference cards, pictures of room set-up, a brief synopsis of what the case actually is, and specific surgeon pointers. I wanted to do 5 cases from each specialty service line, but it has become enormous. We have several specialties including: General, Vascular, Endovascular, Orthopedics, Plastics, Pediatrics, Cranial-facial, ENT, Gynocology, Transplant, Thoracic, Bariatrics, and Laparoscopic surgery.
I'm going to pair it down and implement a few cases with the option to add more cases if the portfolio is a successful venture.
2 Personal Objectives so far in the course; relate your progress on these objectives to your work in your specific clinical site.
A. Interact with Mentor to promote knowledge from a reality based management perspective.
I have been blessed with the best Mentor! She is a real person, not just a figurehead that has her executive assistant do everything for her. SH is constantly busy and is on more committees than I know about. She has shared many of them with me, but I still don't think I know them all. SH has allowed me to follow her to multiple meetings and educational offerings. We spend time discussing our opinions about the new information we've received and whether it will benefit our department, nursing, the doctors, the hospital, the patients, etc. It's her belief that mentoring and teaching is a way to give back to her chosen profession. I am able to speak with her about difficult situations and she gives me suggestions on the most appropriate ways to manage them.
The funny thing is that I thought by going through online classes, I would miss the human interaction where I would learn from the educator personally. With my chosen mentor, I learn something each time we are together.
B. Create schedule and rigorously adhere to it, so as not to get behind in my last 2 classes.
Being a work-aholic, I find it hard to leave work when they ask me to stay. Once I get home, I'm the mom of a very busy adolescent, so we're probably off on an errand for volleyball, track, student council, or rushing to a game I didn't know about and collecting her friends to go too. Not to mention cooking, cleaning, laundry, and all the other wife stuff that must be done.
My high-acuity class is current. I have a terrific team to work with and we've divided up the duties nicely. I'm behind on this class because I've bitten off more than I can chew and now my photo printer is broken, blah, blah, blah... I'm going to have to turn in a slightly smaller project than I originally envisioned.
This frustrates me, but it's more realistic. I just want to help my peers that struggle with their unfamiliar assignments, but I can't cover all of our cases.
I'm focusing on the most commonly complained about, and the most popular. I figure if I can cover these, whoever gets assigned will have a decent head's up about how to do the case comfortably with the best outcome and the least stress.
Statement and discussion of one way these items have fostered your growth as a professional nurse.
Having these objectives: learning with my peers, learning from my mentor, creating my surgical portfolio, and adherring to a schedule, have helped my time management and organizational skills.
Nurses need to be organized to provide the best care for all of their patients in the short time they are allotted each day. Time management is crucial to survive in this new multitasking way of life that I have embraced.
My peers have opened my thoughts up to those of others. I may not agree, but I can appreciate their point of view and perhaps understand why they feel the way they do.
My mentor has given me invaluable lessons on remaining cool in the face of adversity from different committees filled with less than pleasant members. When I become frustrated by my peers, I consider how she would turn the situation around for a mutually pleasing solution.
Once I get the Portfolio implemented, I will be interested to see if my peers will spend a few minutes to use the suggested practices when they are unfamiliar with their assignement, or if they will disregard the option.
I have learned to say, "No, I can't stay late today," so I can get home and work on my homework! I just need to say it more often. The cases will get done without me. I don't feel expendable, just convenient. I love my job, so it's hard to leave. This class has taught me to appreciate my work with a more global perspective.
2 Course Clinical Objectives
A. Interact with Peers via the discussion board to promote classroom knowledge of the BSN prepared nurse with a global perspective.
I have learned so much from my fellow student via the discussion board in each of my online classes. I was biased when I began the online process, thinking that I could read the material, take a few tests and get a grade. I wasn't actually planning on learning anything.
What a wonderful surprise to find myself looking forward to checking the discussion board to see what my peers had to say. I enjoy looking up their references and providing data that I have found to enrich their learning experience.
B. Complete change project, implement it, test it, and evaluate it.
Unfortunately, I have yet to implement my change project. I'm making a Surgical Portfolio to help staff members unfamiliar with their assigned cases. The portfolio contains the preference cards, pictures of room set-up, a brief synopsis of what the case actually is, and specific surgeon pointers. I wanted to do 5 cases from each specialty service line, but it has become enormous. We have several specialties including: General, Vascular, Endovascular, Orthopedics, Plastics, Pediatrics, Cranial-facial, ENT, Gynocology, Transplant, Thoracic, Bariatrics, and Laparoscopic surgery.
I'm going to pair it down and implement a few cases with the option to add more cases if the portfolio is a successful venture.
2 Personal Objectives so far in the course; relate your progress on these objectives to your work in your specific clinical site.
A. Interact with Mentor to promote knowledge from a reality based management perspective.
I have been blessed with the best Mentor! She is a real person, not just a figurehead that has her executive assistant do everything for her. SH is constantly busy and is on more committees than I know about. She has shared many of them with me, but I still don't think I know them all. SH has allowed me to follow her to multiple meetings and educational offerings. We spend time discussing our opinions about the new information we've received and whether it will benefit our department, nursing, the doctors, the hospital, the patients, etc. It's her belief that mentoring and teaching is a way to give back to her chosen profession. I am able to speak with her about difficult situations and she gives me suggestions on the most appropriate ways to manage them.
The funny thing is that I thought by going through online classes, I would miss the human interaction where I would learn from the educator personally. With my chosen mentor, I learn something each time we are together.
B. Create schedule and rigorously adhere to it, so as not to get behind in my last 2 classes.
Being a work-aholic, I find it hard to leave work when they ask me to stay. Once I get home, I'm the mom of a very busy adolescent, so we're probably off on an errand for volleyball, track, student council, or rushing to a game I didn't know about and collecting her friends to go too. Not to mention cooking, cleaning, laundry, and all the other wife stuff that must be done.
My high-acuity class is current. I have a terrific team to work with and we've divided up the duties nicely. I'm behind on this class because I've bitten off more than I can chew and now my photo printer is broken, blah, blah, blah... I'm going to have to turn in a slightly smaller project than I originally envisioned.
This frustrates me, but it's more realistic. I just want to help my peers that struggle with their unfamiliar assignments, but I can't cover all of our cases.
I'm focusing on the most commonly complained about, and the most popular. I figure if I can cover these, whoever gets assigned will have a decent head's up about how to do the case comfortably with the best outcome and the least stress.
Statement and discussion of one way these items have fostered your growth as a professional nurse.
Having these objectives: learning with my peers, learning from my mentor, creating my surgical portfolio, and adherring to a schedule, have helped my time management and organizational skills.
Nurses need to be organized to provide the best care for all of their patients in the short time they are allotted each day. Time management is crucial to survive in this new multitasking way of life that I have embraced.
My peers have opened my thoughts up to those of others. I may not agree, but I can appreciate their point of view and perhaps understand why they feel the way they do.
My mentor has given me invaluable lessons on remaining cool in the face of adversity from different committees filled with less than pleasant members. When I become frustrated by my peers, I consider how she would turn the situation around for a mutually pleasing solution.
Once I get the Portfolio implemented, I will be interested to see if my peers will spend a few minutes to use the suggested practices when they are unfamiliar with their assignement, or if they will disregard the option.
I have learned to say, "No, I can't stay late today," so I can get home and work on my homework! I just need to say it more often. The cases will get done without me. I don't feel expendable, just convenient. I love my job, so it's hard to leave. This class has taught me to appreciate my work with a more global perspective.
Saturday, October 17, 2009
Change Project Underway... Surgical Portfolio Coming Soon!
We have had the joy of inventory this week. Since I stepped down from my supervisor role, I found counting supplies quite enjoyable! We organized as we went, so the rooms are easier to navigate and the supplies are tidy. We'll see how long that lasts...
Unfortunately, I was unable to follow SH this week. My after work schedule was packed with kid stuff.
Luckily, I have another project to keep me busy. I'm working on my Surgical Portfolio Change Project. I have collected preference cards from each service line for the cases performed most often. I'm working on a brief synopsis for each and trying to collect pictures of the table set-up and the room organization for each. Once I have all of the raw materials, I will put the pieces together to form a portfolio for use by staff members that are unfamiliar with these assigned cases. I look forward to hearing their feedback, so I can further modify the book so the cases will be easier to understand, perform, and set-up. My hope, is for the staff and physicians to feel more comfortable with the care of our patients.
Unfortunately, I was unable to follow SH this week. My after work schedule was packed with kid stuff.
Luckily, I have another project to keep me busy. I'm working on my Surgical Portfolio Change Project. I have collected preference cards from each service line for the cases performed most often. I'm working on a brief synopsis for each and trying to collect pictures of the table set-up and the room organization for each. Once I have all of the raw materials, I will put the pieces together to form a portfolio for use by staff members that are unfamiliar with these assigned cases. I look forward to hearing their feedback, so I can further modify the book so the cases will be easier to understand, perform, and set-up. My hope, is for the staff and physicians to feel more comfortable with the care of our patients.
Sunday, October 11, 2009
Busy Busy Week!
Wow! We had a huge week at work and SH had so much for us to do after 3 PM.
Peer Review is moving along. It was amazing to hear about things many of us would consider minor that can really make a big impact when you don't take care of them. One Nurse will be reported to the Board for changing her documetation for only one patient because she didn't come and talk to the review board personally and take responsibility for her mistake. Since she refuses to discuss the small problem, the review committee feels she could falsify other documents to cover other mistakes instead of learning and moving on!
Why did she change her documentation? Because she misread a feeding order and fed a patient q3 instead of q4 hours.
Oh, the Horror! Geez! A simple phone call to the doctor, explaining the error, and all could've been well after a short butt-chewing. Ummm, the next feeding could've been skipped to satisfy a tight fluid restriction, or whatever was needed, but to be disciplined and possibly lose your license over something so small?
The real issue is her need to Cover it up! to not respond to any of the inquiries on the local level! to not take responsibility for her actions! Because of these bigger issues, she is Dangerous!
We also discussed the composition of the local peer review board. It is made up of experienced, veteran nurses from many different areas and floors of the hospital. Each unit uses different technology and has slightly different floor specific policies. Members of different units may not have the full picture without the discussion by the nurses familiar with these policies. They all rely on each other to decide which peers are within the appropriate scope of their practice and which ones are out of line. It is terrific that a group reviews these issues, instead of one individual. If the nurse under review handles it with the review board, it usually doesn't go any further. The nurse is given suggestions, information, and tips on how to handle the situation in the future to make her actions fit the situation properly, and how to make her documentation clear so there isn't any question that she did the right thing, etc. If the nurse is deemed dangerous, the board is consulted.
We discussed H.C.A.P.S. in detail comparing our hospital with our main competitors on the national level based on the new standards. We are highly rated for a facility our size, but there are always areas that we can improve. I wish we could narrow our competition to hospitals our size that handle the multitude of complicated cases we handle. Our rating would be on top, I'm sure! Unfortunately, we are compared to outpatient facilities, ambulatory surgical centers, problem-focused clinics and smaller hospitals that don't have our acuity. It must be easier to score high when you only handle one type of client that isn't deathly ill to begin with! It would be easy to standardize care, navigate through the facility, and keep your patients and doctors happy.
SH also invited me to attend the N.T.O.N.E. meeting. This is the North Texas Organization for Nurse Executives meeting. It was held at Medical City on Thursday. We had 2 powerful Nurse Speakers. They delivered the 2 most front-line nursing focused seminars I can remember hearing. I was expecting to hear executive nurses telling other executive nurses how to be executive nurses. I was thrilled to hear these presenters focused on the front line nurses on the floor.
The first focused on actual care givers at the bedside and how the executives are losing touch with them. Data in this area is hard to find because there is no standard collection tool that everyone uses. There is a lot of raw data that needs to be interpreted, but since it isn't standardized, the interpretation can be questioned. Bottom line was, the bedside nurses don't feel in touch with the system. They feel like they are doing all of the work, more and more mandates are being handed down by the upper echelon, and they are spending all of their time charting and very little time actually providing patient care. She encouraged everyone present keep the front-line nurses involved in the system changes so they will feel empowered by the changes, use the changes, and feel supported, instead of feeling more pressure to perform more "meaningless" tasks.
The second focused on Medication Administration and how interruptions caused mistakes. Several hospitals have implemented a "medication interruption free zone" and use vests or sashes while preparing/delivering medications. Medication errors have been reduced by 80% in several facilities because everyone works to not interrupt the nurses wearing their sashes. They only wear them for med. administration, but the difference is great! New technology doesn't have to be expensive, a simple SASH worn during medication administration can be extremely cost effective when compared to the cost of an ERROR!
I was so interested to see and hear these presentations. Our Leadership team is trying so hard to keep our best interests in mind while they implement new mandates set down by JCAHO and the BNE, but as one of the front-line nurses, it's easy to think they are clueless to our needs.
I witnessed in person the focus of our executives. I heard their questions and discussions and I know they are not clueless, they are simply trying to compromise so many issues into working solutions that the bedside nurses can't realize all of the effort that has gone into each new decision.
Peer Review is moving along. It was amazing to hear about things many of us would consider minor that can really make a big impact when you don't take care of them. One Nurse will be reported to the Board for changing her documetation for only one patient because she didn't come and talk to the review board personally and take responsibility for her mistake. Since she refuses to discuss the small problem, the review committee feels she could falsify other documents to cover other mistakes instead of learning and moving on!
Why did she change her documentation? Because she misread a feeding order and fed a patient q3 instead of q4 hours.
Oh, the Horror! Geez! A simple phone call to the doctor, explaining the error, and all could've been well after a short butt-chewing. Ummm, the next feeding could've been skipped to satisfy a tight fluid restriction, or whatever was needed, but to be disciplined and possibly lose your license over something so small?
The real issue is her need to Cover it up! to not respond to any of the inquiries on the local level! to not take responsibility for her actions! Because of these bigger issues, she is Dangerous!
We also discussed the composition of the local peer review board. It is made up of experienced, veteran nurses from many different areas and floors of the hospital. Each unit uses different technology and has slightly different floor specific policies. Members of different units may not have the full picture without the discussion by the nurses familiar with these policies. They all rely on each other to decide which peers are within the appropriate scope of their practice and which ones are out of line. It is terrific that a group reviews these issues, instead of one individual. If the nurse under review handles it with the review board, it usually doesn't go any further. The nurse is given suggestions, information, and tips on how to handle the situation in the future to make her actions fit the situation properly, and how to make her documentation clear so there isn't any question that she did the right thing, etc. If the nurse is deemed dangerous, the board is consulted.
We discussed H.C.A.P.S. in detail comparing our hospital with our main competitors on the national level based on the new standards. We are highly rated for a facility our size, but there are always areas that we can improve. I wish we could narrow our competition to hospitals our size that handle the multitude of complicated cases we handle. Our rating would be on top, I'm sure! Unfortunately, we are compared to outpatient facilities, ambulatory surgical centers, problem-focused clinics and smaller hospitals that don't have our acuity. It must be easier to score high when you only handle one type of client that isn't deathly ill to begin with! It would be easy to standardize care, navigate through the facility, and keep your patients and doctors happy.
SH also invited me to attend the N.T.O.N.E. meeting. This is the North Texas Organization for Nurse Executives meeting. It was held at Medical City on Thursday. We had 2 powerful Nurse Speakers. They delivered the 2 most front-line nursing focused seminars I can remember hearing. I was expecting to hear executive nurses telling other executive nurses how to be executive nurses. I was thrilled to hear these presenters focused on the front line nurses on the floor.
The first focused on actual care givers at the bedside and how the executives are losing touch with them. Data in this area is hard to find because there is no standard collection tool that everyone uses. There is a lot of raw data that needs to be interpreted, but since it isn't standardized, the interpretation can be questioned. Bottom line was, the bedside nurses don't feel in touch with the system. They feel like they are doing all of the work, more and more mandates are being handed down by the upper echelon, and they are spending all of their time charting and very little time actually providing patient care. She encouraged everyone present keep the front-line nurses involved in the system changes so they will feel empowered by the changes, use the changes, and feel supported, instead of feeling more pressure to perform more "meaningless" tasks.
The second focused on Medication Administration and how interruptions caused mistakes. Several hospitals have implemented a "medication interruption free zone" and use vests or sashes while preparing/delivering medications. Medication errors have been reduced by 80% in several facilities because everyone works to not interrupt the nurses wearing their sashes. They only wear them for med. administration, but the difference is great! New technology doesn't have to be expensive, a simple SASH worn during medication administration can be extremely cost effective when compared to the cost of an ERROR!
I was so interested to see and hear these presentations. Our Leadership team is trying so hard to keep our best interests in mind while they implement new mandates set down by JCAHO and the BNE, but as one of the front-line nurses, it's easy to think they are clueless to our needs.
I witnessed in person the focus of our executives. I heard their questions and discussions and I know they are not clueless, they are simply trying to compromise so many issues into working solutions that the bedside nurses can't realize all of the effort that has gone into each new decision.
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