The intubation began was successful without compromising the airway. She states that she had some complications after delivery. I gave a detailed report to the recovery room nurse. Committed to each patients progress, this nurse creates order from chaos by making the right choices and by knowing when to reshuffle patient priorities in an environment where patient needs may fluctuate from moment-to-moment. See Guidelines for Letter of Recommendation. With Mr. Y.s permission I contacted Turning Point and was able to get a more extensive history. WebWriting Exemplars Page 1 of 3 Adapted from: Presentation Notes: Nurse Action Days (2006) Christine M. Pacini, PhD, RN Director, Center for Professional Development, Research and Innovation University of Michigan Health Systems Introduction - Definitions An exemplar is a story of a real patient that is told in order to illustrate an RNs Give specific examples to reinforce your statements. knowledge or changes behavior in a measurable way as a result of She said no to all. A less experienced nurse would have let her call back when she went to breastfeed. I had been aware that prior to this incident, the new physicians had not been having positive interactions with the ED. Coordinates and utilizes facility and community resources to meet patient needs. Therapeutic communication is an interpersonal interaction between 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. With the translators help I understood that she has epigastric pain. See attached letter from QA Brenners domain of nursing practices: The diagnostic and monitoring function Administering and monitoring therapeutic interventions and regimes Monitoring and ensuring the quality of health care practices Exemplar #5 It was six hours into my shift on a very busy Sunday. The next hurdle was to convince CCMD to send Mrs. C. to ER for evaluation. Of course most of Mr. Ps history is known to the ED staff but just in case, Mr. P keeps his cherished index cards, which documents his history, in his upper shirt pocket. Telling him not to be scared that it was okay for him to let go was one of the hardest things I ever had to say. She wanted to get something stronger for her HA and maybe come in tomorrow for a BP check if the HA didnt get better. I went to check and see who could be there. I met Mr. Kinney, a real gentleman. I know that all my patients deserve the best care that I can give them. Thanks to everyone who submitted an Exemplar this year! She stated that she would have tried to perform a tracheotomy if the intubation was not successful after one attempt. actions. APPLICATION ONLY: DATES: FROM - TO AREA OF PRACTICE EMPLOYER 1. Charge Nurse Emergency Room and Trauma Unit, 2017-2020 Mary Mount Hospital, San Francisco, CA. I also initiated type and cross matching to be certain that units of blood would be available for my patient since the order was just typed and screened. In this exemplar I used the following Benners domains of nursing practice: The helping role The teaching- Coaching function The diagnostic and monitoring function Effective management of rapidly changing situations Monitoring and Ensuring the Quality Of health Care Practices Exemplar #1 In one evening I received a call on the Spanish line. I checked all the instrumentations and surgical supplies with my surgical technologist. No matter the career path, the traits gained as a charge nurse can serve a person well throughout their professional life. Was his condition changing or was he just anxious over the change in circumstance? sweating) or to preserve warmth through vasoconstriction and As I heard the alarm in anesthesia cart. This was a man who was truly loved and had a team of people dedicated to providing him comfort, dignity and honored his wish to die at home with his family. Some of them were bags that normally are used for urostomies that would allow me to turn the valve at the end of the bag to remove the drainage without actually having to change the whole device. Worked as Home Health/Hospice nurse with the employer for at least three (3) of the last five years, or two (2) years as Home Health /Hospice nurse with the employer and one (1) year home health experience within a Medicare certified home health agency. Who knew how their relationship would unfold. I stayed just long enough to get him tucked in and off I went as I was done for the day. Applicants that meet the minimum qualifications shall be interviewed. These signatures certify that calculations are correct as of the specified date. ( Assisting patient to integrate the implications of illness and recovery into their lifestyles. Assumes a teaching/coaching role. Candidate must be able to substantiate involvement or participation. Adequate perfusion I explained to him that I could give him more medication, though it may make him sleepy and even slow his breathing to an extremely low rate, one where he would most likely lose consciousness. F 2010-12-08T15:15:14-05:00 The facility did have Ativan available. Overall coordination of day-to-day case flow coordinates on-time starts, turnovers, breaks; instrument coordination with Sterile Processing. She told me that for about a week she cannot sleep because the burning wakes her up. The concept of palliative sedation was discussed with the core IDG. Monitoring and Ensuring the Quality of Health Care Practices First I asked the operator to page the on-call hospice nurse to see if he/she had any awareness of this patient. needs for meaning and purpose, love and belonging, and forgiveness HW6S9MR,Y VO@#M&@_I(KEvdR '(vIGAU%NC.yNF~ui+r}kWua}x2/)>#M~qU? (Taylor et al., 2019), Spirituality is anything that pertains to a persons relationship with a It was my job to ensure my patients safety at all times. Experience, as it is used here, does not refer to the mere passage of time. I was correct; Mrs. B. was discharged with the tube feedings. and nonverbally (Videbeck, 2020). The next two weeks of T.s life were full of much loving intervention by our whole team and was able to pass peacefully on August 19th. In addition to handling and monitoring the current situation, this nurse anticipates and plans for potential change in the patients condition, adapting to the patients needs as they arise. Why did your work succeed or fail? I had a heavy assignment that day and soon realized that the complex wound care box on our grasp sheet would not begin to reflect the amount of nursing care that this man would require. this sense of well-being to the patient, particularly by relieving pain. well-being. ( Maintaining a caring attitude towards patients even in the absence of close and frequent contact. informed consent, documentation, incident reporting, the Patient Self- A charge nurse oversees a hospital unit or department. He came to my unit for reinduction chemotherapy. During my assessment I observed the patient unable to stay focused and consistently looking at the corners leading me to speculate he was having hallucinations. Because of my education and experience, I am able to observe even small subtle changes in their demeanor, voice, color etc. Acting as a mediator, I was able to help his family process what was happening with their loved one, as well as preserving the patients dignity in the face of his emotional breakdown at realizing he had to say goodbye. Home Health/Hospice III only A current license to practice as a Registered Nurse in California. The Ativan was not going to do that, just imprison him with his hallucinations. What skills were necessary to achieve your outcomes? 6. After receiving report I was able to visual see Mr. Y. from the nurses station. d) Effective Management of Rapidly Changing Situations- Contingency management: Rapid matching of demands and resources in emergency situations T.s admission to the ER was clear example of my ability to use resources and coordinate with the patients goals as my guide The following Benner Domains will be addressed: The helping role The teaching-coaching function The diagnostic & ensuring the quality of health care practices Monitoring & ensuring the quality of health care practices Administering & Monitoring therapeutic interventions & regimens EXEMPLAR #9 Mr. R. is in his 70s and was admitted with diabetes and peripheral neuropath. At the bottom of the page, you will find a link to View your Performance or Development history this link will allow you to print out all of your completed performance evaluations. (LogOut/ This nurse guides patients through emotional and developmental change. She was unaware if this was a new symptom. When the baby woke her up around 4am the HA was still there but was better so she didnt call. Alternately, you may submit hard copies (2) of your portfolio to Heidi Alpert. For example, if a patient's behavior suddenly changes, it's important to determine if they are reacting to something in their personal life, dealing with a fluid imbalance, having a medication interaction, or suffering from an infection. I asked her if she had support, and she told me her sister in law was coming over soon. There was a bullet entry, yet no exit wound. Remember, youre nominating your chapter for an award, so you want your submission to be stellar! It was around this point in his care he started needing increased assistance with his ADLs so I assessed the need for a HHA and a referral was made. The patient then decided that he wanted no more chemotherapy treatments/infusions, and we began many discussions of what was to come. These are just some examples of questions to ask yourself as you write your exemplar. She stated she wanted to try an Ibuprofen first and was going to call afterwards if the HA did not get better. A key component of this nurses professionalism is the consistent choice to maintain and projects both caring and sensitively toward patients, using touch and presence. While the following seven traits are important to many leadership positions, they are essential for nurses who care for and protect vulnerable patients. It ddescribes in detail a particular clinical situation that includes the nursess thhoughtts, feelinngs, intentions, past experiences, and sociocultural influences and expectations. Attend local workshops for applicants. Learning is the process by which a person acquires or increases Upon my assessment, he was pale and warm to touch. The MD disagreed at this point and stated her plan was to use a fiber optic scope as she placed the ET tube. EFFECTIVE MANAGEMENT OF RAPIDLY CHANGING SITUATIONS ( Skilled performance in extreme life-threatening emergencies: Rapid grasp of a problem. Clotting Clotting is the process whereby platelets circulating in the 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 BID Needham Clinical Nurse Advancement Program provides nurses an opportunity for career development. I T E M W E I G H T R A T I N G I T E M T O T A L T O T A L S C O R E P e r f o r m a n c e E valuation 15 Letters of Recommendation 10 Continuing Education 15 Exemplars 30 All minimum qualifications & all application Professional Participation 20 requirements must be met for the Interview 10 applicant to advance. Some examples of successful exemplars follow. Report did not prepare me for what I would see when I unwrapped his feet. 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). 66eJFPnC'b{ h5_]h!":S %c8(K-N'KLD>>/=BcVPM(A**{&hX^Y(97kXv5Y[y&\\swR8iih,G6+f^*_ UMHS Professioonal Develoopment Framework Websitte AJN, 87(1), 23-31. The induction went smoothly. You assume the role of teacher and your patient They are the circumstances that eventually become milestones to nurses (Harvey & Tveit, 1994). Read the results of our latest national nurse work environments study, and see why Healthy Work Environments matter in this critical time. especially in high-acuity settings. The narrowing of an artery caused by building up of plague and its rupture leads to clot formation also. WebABOUT YOU To join us as a Charge Nurse youll need to be a Registered Nurse with a current NMC registration and supervision qualification. I asked her for how long she is having this pain today. In addition to the facial injuries, there was a large hole to Mr. L.s right middle check area. Write your exemplar so that others a patient, a family member, someone from the general public or even the medical field, and most importantly the award reviewers can grasp the nature of your work and its value to patients, your community, and society as a whole. I was always a step ahead helping everyone in the team. She just called to have prescription. In these occasions I am very frustrated because I know that in the end it will be a 911 call and not usually a happy ending. D. A pregnant woman has been rushed to the operating room for an emergency cesarean section. F j k l $ ` a$gdL $ ` a$ gdm :]:^ $a$ A less experienced nurse will triage her under the Acid reflux/GERD protocol and in the absence of other symptoms she would give advice for home care. cognitive, and physical symptoms (Videbeck, 2020). Acid-Base Acid-base refers to the balance of hydrogen and bicarbonate ions within threatening complications. A registered nurse who assumes the role of charge nurse also assumes the responsibility inherent to the role. Communication Communication is the process that people use to exchange information, In this particular situation: Helping role: I felt that I guided and gave emotional support to this patient through this much unexpected even in his life. personal desire to increase well-being and health potential (Taylor h Facility No. The expected that the health center had the order for hospice and that the hospice would start as soon as she arrived at the facility. Nurses are advanced to Clinical Nurse III based upon proficiency in clinical performance. (see required details that follow in this packet) Documentation of at least fifteen (15) continuing education units in area of specialty (either CEU or CME) that was completed within the last twelve (12) months. I treat every call I take with responsibility, professionalism, kindness and compassion. It was wonderful to see her personality start to immerse. Your staff is experienced nurse 49 y.o. (Taylor, et al., 2019), Culture Culture is a shared system of beliefs, values, and behavioral I told her I was concerned about her HA especially because of her complications after delivery. blend clinical skills with flexibility. The night shift informed me that Mr. P ruled out, as both sets of troponins and both EKGs were within his normal limits. quality, efficiency, or delivery of health care (Hinkle & Cheever, 2018). I chose this story for several reasons. I looked into Mrs. B.s face and saw the concern, and reminded her that God had brought her this far and that He would continued to guide her through this ordeal. She mentioned that since the burning got worse she gets short of breath and she needs to stop and rest for few minutes. 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 was willing to have Mr. P admitted and have a negative work-up than for him to be discharged and return critically ill. I talked to the CCMD and my SBART. (see required details that follow in this packet) Two exemplars that are reflective of events that occurred in the last twenty-four (24) months. To the family, this was a crisis and their most desperate coping mechanisms were emphasized. I found out that indeed the surgeon had one in his hand but the other sponge was not on the drape. 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. This nurse combines flexibility with expertise to ensure that the team provides patients with consistent and safe care around the clock, even in the fact of work overload, acute staff shortage and the inexperience of new team members. THr="^PgsF#r/tJeD($ALF7$q#Wc1m0H Stimulation of What new knowledge or insights were gained from this experience and describe how this has impacted your current practice, Realistic and reflect aspirations for the future that stretch your capabilities, Feasible within the framework of your professional role. So I continued to ask more questions. Nurses who excel in managing client 0000001195 00000 n validation, and communication of patient data, or information. Mr. Y. still was unable (or unwilling) to give much more of a medical or psychiatric history at this time. By August, 6th T. required 230mg.hr to maintain comfort. I felt this was the best course of treatment for Mr. Y. and the right thing to do. (The diagnostic and monitoring function) From my past nursing practice I recognized similarities with other atypical presentation of cardiac ischemia and I explained to Mrs. C. in terms she could easily understand the rationale of my interpretation. 6. The patient was awake, alert, oriented with warm and dry skin. Acid-base imbalances occur when the pH of the blood falls outside She could take up to 10 at once with no relief. WebApply online or with our Nurse Talent Specialist. the community, the nurse must adapt to the patients environment and Webthe nurse-patient assignment process. After speaking with her daughter I assured Mrs. S. that her daughter was on her way into the clinic. Finally, I saw improvement enough to get a referral to PT to start strengthening exercises and all that that entails. I will attend a workshop on sepsis and present a summary to my unit of what I learned within two months. She has a background in pediatric emergency room, labor and delivery, and primary care medicine. $JI=SM0V;$E)@z;;_zX6Juq(hx\n5. I asked how much she weighs and she said that she doesnt know but she is not so heavy. The urgency in her voice, the last night bad dream that gave her cold sweats and shortness of breath, an achy arm since morning, all could be very well signs of cardiac ischemia. %PDF-1.6 % I felt that I made a difference in the outcome of the call for this patient. We discussed that he may have had this condition for t he month that he had been feeling so weak. ( Contingency planning. Mr. P does have some short term memory loss but he never forgets his index cards! It takes an individual who possesses clinical nursing competencies, compassion, and empathy. The Staff Nurse III grasps the whole picture and so is in control of the situation, able to create order out of chaos. 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