Most importantly, I prevented a novice nurse from making a potential lethal injury to this patient, thus ensuring the quality of health care practices. Duties and Responsibilities. 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. I was able to actively listen to her anxieties, pain and frustration and reassure her throughout the call. ( Combating the hazards of immobility: Preventing and intervening with skin breakdown, ambulating and exercising patients to maximize mobility and rehabilitation, preventing respiratory complications. At this time, radiology had two doctors out on jury duty, the self care learning nurses were maxed out and T. was on a waiting list. The night ED team decided to admit him to the OBS unit instead of sending him home so late knowing that he lived alone. As a Would Care Champion, my assessment of the dressings on his feet was a priority. In fact pt was speaking some English but I explained that for her comfort it will be better if we use a translator. The charge nurse role is all-encompassing. of clients and must detect problems and intervene early to prevent life- Show what you learned from this experience by answering the following questions within the description of your Clinical Exemplar or in summary at the end: The Clinical Exemplar does not have to be lengthy: 3-4 typed pages (double-spaced) is usually sufficient. I paged HBS, I gave a brief history of her past admissions and how almost everyone of them had ended in some kind of exploratory abdominal surgery. is the condition that exists when the persons universal spiritual I was able to make her feel at ease while she balanced breastfeeding and talking by asking about the well-being of her daughter and if she was latching on. I knew that before I could do anything, I needed to provide emotional and informational support to the family and then to include them in decision. as neighborhood clinics, patients homes, long-term care facilities, schools, 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. Expand your skills with Care of the Acutely Ill Pediatric Patient Respiratory Bundle. Coordinates and utilizes facility and community resources to meet patient needs. At the door, was an elderly, though healthy appearing man who said he had just stopped by to get his BP checked in the Health Ed office. He has a long history of PAD with severe lower extremity necrosis. It will be in her best interest to let me consult with one of my doctors to see what she/he wants us to do. ( Assessing the patients potential for wellness and for responding to various treatment strategies. This was very important in keeping stress level tolerable for the family and caregiver. ( Maintaining a caring attitude towards patients even in the absence of close and frequent contact. I was correct; Mrs. B. was discharged with the tube feedings. 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. Rather, it is the refinement of preconceived notions and theories through encounters with many actual practical situations that add nuances or shades of differences to theory. Stimulation of The first few minutes of the surgery went smooth as the case was stable. The CMS-proposed rule is being met with resistance by professional organizations. They have several responsibilities, some of which include the Omeprazole (Prilosec) can be prescribed by a doctor if symptoms dont subside. Candidate must be able to substantiate involvement or participation. IV started and 324 aspirin given. Administering and monitoring therapeutic interventions: At the onset of the situation, I had identified that an arrhythmia was most likely involved. sw,% Thinking back about the report I had received about Mr. Y., what precipitated his arrival to the ED, and my interaction with him during the morning assessment, I did not feel that Mr. Y. was bipolar (on a manic upswing) or had intended on deliberately hurting himself. Electronic and hand signatures are accepted; however, AACC requires hand signatures of RN managers on the evaluation. well as for the nursing profession. Blood pressure was also within normal limits. I escorted him to our injection room and had him take a seat. 0000000872 00000 n TThe exemplar is written in the first person. Each day, across thousands of medical-surgical inpatient nursing units, charge nurses make decisions about which nurse will care for each patient. (Marquis & Huston, 2021). The intubation began was successful without compromising the airway. Nurses can I also reminded the surgeon and anesthesiologist that units of blood were ready for our patient. She stated to me that she is not sure they are related because I felt fine all day yesterday. I asked her how she was feeling during the call and she said her HA was mild to moderate but she was able to function. Web3) The charge nurse observes that a fellow charge nurse on the unit seems impaired and unable to perform client care. to initiate mechanisms to dissipate heat (through vasodilation and During Hospital Week the nurse exemplars are additionally recognized at the annual service awards banquet. Finally there was a big relief felt by everybody in the room. information. I made a template of each of the six devices opening and drew a diagram of their respective locations so anyone needing to replace any of these devices would not have to start from scratch. goal through mostly noncoercive means; typically composed of a wide I was completely comfortable handling this call and started the process of gaining the familys trust. ADMINISTERING AND MONITORING THERAPEUTIC INTERVENTIONS AND REGIMES ( Starting and maintaining intravenous therapy with minimal risks and complications. The moment I met Mr. R. I had no idea of the impact I would have on his life and he mine. Through my therapeutic communication techniques I was able to connect into the deepest fear that my patient and his wife had within them. Describe clinical situations, which you believe positively impacted by your practice. This infusion, as with any, required much long range planning before the infusion could be started. I alerted the only physician left on the station; who was eating his lunch he also happened to be a brand new MD as well as new to Kaiser. Change). They are the point of contact for nursing staff, physicians, and hospital administration. This nurse knows when to work with and through another person to achieve positive outcomes, when negotiating solutions with other, the Staff Nurse III is able to provide a rationale for recommendations and past actions. Formal In-service/Presentation Informal In-service/Presentation Community Teaching (community teaching must be voluntary) Health care related research Development and/or presentation of patient education programs. By being sure that a patient does not experience retained foreign object in the body, we were ensuring that the success of the surgery that would lead to fast recovery. I had Floseal and Surgicele on board; both were effective means of helping to control bleeding. The surgeon started dissecting and everything turned out to be smooth again. the activities involved in managing the work environment and, Diagnostic and monitoring function: Through all my years of training and experience, I have gained a high level of self-confidence and the ability to make nursing/medical diagnoses with a high degree of accuracy. Mr. R. ended up with bilateral below the knee amputations. complications. 0000006386 00000 n Maintains a flexible role to resource constraints. The Staff Nurse III is a confident and caring professional who is dedicated to achieving positive patient outcomes. The patient had been attacked with a hammer and shot in the face. Work in the area of clinical specialty with the Employer for the last two years. I stayed just long enough to get him tucked in and off I went as I was done for the day. He had been at a meeting in the building. (see required details that follow in this packet and sample exemplars) Two (2) professional contributions within the last twelve (12) months. Descriptions of additional professional contributions may be submitted in case one or more do not meet requirements. When the patient is on the line you ask questions, clarify them, look at the history, search in CIPS for past visits, diagnosis, labs, medications, allergies, look for other resources available for that particular case. Overactive immune cells of the skin are responsible for many skin diseases. (Ricci, Kyle, & Sometimes conferencing with CCMD might change their mind or if denial continues a non-compliance disposition is given. Antibiotics were started and he was transferred to BIDMC within 48 hours of arriving to the ED with what we thought was Mr. Ps usual chest pain. Additional Notes: Community work must be health related. With the kind of scenario I was facing I was fully aware that as the RN in the room, my nursing skills and critical judgment should prove exceptional to be able to attend to all the needs of my OR team. Give concrete illustrations of how you met your outcomes. Fevers began and she was readmitted, requesting 4E. Try to paint a very clear picture as you tell your story. This may include soft skills for nurses like the ability to motivate others or strong communication. ( Building and maintaining a therapeutic team to provide optimum therapy. Letters that support community service and volunteering require dates and detail of service. Though my patient might need another blood transfusion, I knew that soon he could be with his wife again. As Dr. S was getting ready to print the discharge instructions for Mr. P, I updated him on Mr. Ps condition. When do you anticipate seeing positive results, if you havent already? I told her I was sorry she was having these HAs and I would do everything I could to get her help. His hospital stay will require diabetic control, restoring blood flow to bilateral lower extremities, wound care to necrotic diabetic ulcers and restoring proper nutrition. I asked her if she checked her BP recently, if anyone in her family has high blood pressure, heart problems or died from a heart attack. Cognitive abilities include reasoning, judgment, Assist the Facility Selection Committee in making the best decision possible. Write the exemplar in your own words. Informatics is the use of information technology to improve the quality, It was clear that a new route of infusion was inevitable and by end of July we were coordinating a PIC line placement and reaching a whole new level of care. WebNurses who excel in managing client care and possess strong interpersonal skills often assume additional management duties when assigned the role of charge nurse or nurse These behaviors flow out of the professional values of nursing, as knowledge or changes behavior in a measurable way as a result of I immediately intervened by speaking with his nurse and educating her regarding the needs in this case. Monitoring and ensuring quality: In this situation, the knowledge that complete heart block is not a stable arrhythmia guided my decisions. I rechecked the pulse manually - it truly was 3040 and the pt was slightly clammy. As well as I may know a patient, I must always be cautious not to draw a conclusion too soon. I was so thankful that I stood up firm to find the missing sponge. Five (5) years of clinical experience as a Registered Nurse. I told her I was concerned about her HA especially because of her complications after delivery. The number of sick leave hours paid during this time will be subtracted from the number of hours paid. Culture against liability or loss of professional licensure. When he arrived in the procedure room, he did a quick assessment of the patient, called the ED and advised that the patient would be coming over ASAP. populations that are closely associated with a social, economic, or I directed my surgical technician the need to open and count the instruments trays necessary to do an open case thinking in mind the severity of my patients bleeding. mechanisms that facilitate fluid and electrolyte movement within This nurse stood back and said Whats wrong? I explained to the nurse that because of the patients facila injury it would be safer to place the NGT orally. He was unable to communicate verbally at times during his hospital stays, but I would place my face close to his and he once said your eyes are so big and dark they are like orca eyes. The applicant is free to apply at the next deadline regardless of the status of the regional appeal. T o c a l c u l a t e s c o r e m u l t i p l y t h e r a t i n g b y t h e w e i g h t a n d s u m t o a c h i e v e t h e t o t a l . She said no. Adequate perfusion The following Benners Domains will be addressed: The Helping Role Monitoring and Ensuring the Quality of Health Care Practices Organization and Work-Play Competencies Exemplar #7 My patient was discharged from the hospital at 7 pm, forty minutes before I got the call from her family. By integrating my experience, my computer skills and ability to provide a calming environment, I successfully gained her confidence and trust. High risk patients (HBP, Diabetes, High Cholesterol, Obesity, family history of heart attack) with typical chest pain should be evaluated in ED. I started my day by first assessing my other patient, and then headed down to Mr. Ps room. If there had yet been an appropriate time to step out of my shell and attempt to be a leader, it certainly did not seem to be in the midst of almost constant crisis and occasional chaos. hallucinations, and grossly disordered thinking and behavior Every day she appeared with another meal, some of which had smells of spices I had never known. i. Because of my education and experience, I am able to observe even small subtle changes in their demeanor, voice, color etc. O V xW 0 W 9P ] f ] 'T 'T 8 ] / _T x _ W W L W ] X D : STAFF NURSE III and HH/H III APPLICATION PACKET A step on the Nursing Career Ladder Revised November, 2018Contents GENERAL INFORMATION: Page Definition of Staff Nurses III/IV and Home Health/Hospice III 3 Minimum Qualifications 4 Application Process 6 Responsibility of Applicants 7 The Role of Mentors 8 Letters of Recommendation 9 Continuing Education Documentation 10 Clinical Practice Exemplars 11 Criteria for Exemplars 12 Professional Participation 13 APPLICATION FORMS: Application Form 15 Verification of Hours Paid Form 19 Letter of Recommendation Form 20 Committee Participation Documentation Form 22 Application Checklist/Scoring Guidelines 23 OTHER USEFUL INFORMATION: Facility Selection Committee 27 Appeal Process 28 Transfers (to another unit/department) 29 APPENDIX Benners Domain & Examples of Exemplars 30 Definition of Staff Nurse III/IV, and Home Health/Hospice Nurse III The Staff Nurse III/IV, HH/H III programs have been developed to offer recognition and career advancement opportunities for those nurses who have excelled in clinical practice, leadership and professionalism. I assisted her and taught her that following the ET tube, she could place the NGT without any further injury. endstream endobj 5 0 obj <> endobj 4 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 21 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 24 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 27 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 41 0 obj <>stream 1. HW6S9MR,Y VO@#M&@_I(KEvdR '(vIGAU%NC.yNF~ui+r}kWua}x2/)>#M~qU? The Staff Nurse III accepts accountability for actions and outcomes and knows when to involve others in a plan of care. in performing and directing client care, and then begin to visualize Her descriptions and definitions of what nurses do to make a difference, which she calls the domains of nursing, were culled from hundreds of narrative examples (exemplars) submitted by nurses. 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