Each nurse on CIU can have a patient load of up to 4 patients during the shift. However, there is one situation where the nurse could potentially have a patient load of only two patients and that is if one of the patients is receiving a certain IV drip that requires closer patient monitoring. I have not had this situation happen yet, therefore, when I do start the shift I am either at my load of 4 patients or have 3 patients. If I am not full, shortly after the shift starts I usually get my 4th patient. I believe that having 4 patients allows me to spend enough time with my patients and get all of my cares completed in a timely manner. I think if I had any more than 4 patients, I wouldn’t get the chance to get to know my patients like I do and I think this would impede on the quality of care given.
1.Describe how these patient assignments were made. (2 points)
The charge nurse assigns each person to a pod and then from there the nurses usually have the choice of which 4 patients they take. If a nurse has been on the pod before and some of those patients are still hospitalized, they will typically choose to keep those patients and then the other nurse would get the newer patients. The nurses often do this because they already know all about these patients, especially if they were just on the floor the day before. Also, when they complete their initial start of the shift assessment on patients that they have already had, they can recognize changes in these patients easier because they can compare findings to what they know from previous assessment findings. However, if a nurse has had a patient in the past it is not definitive that they will receive this patient again. The nurses also consider different factors such as, contact precautions, confused patients, and high fall risk patients. Therefore, patient assignments are based on a variety of factors to ensure that all patients will receive safe and timely care.
2.Discuss how you prioritized your patient cares and include a rational. What patients did you see first, second, etc. (2 points)
The last two shifts that I have worked, I wouldn’t consider one patient to be in a much worse condition than another. Therefore, up to this point I haven’t felt the need to get to one patients room over another patient first. Each shift after I receive report, I check the patient’s laboratory findings and previous vital signs, and then begin gathering their medications out of the Omnicell. When I have all of the medications in my computer on wheels, I start to go in order from my first patient’s room and then down the line, for example, 601 to 603 then 605 and 606. Regional has a new policy of bedside reporting, this means that during report, the previous nurse, my preceptor, and I all go into the patient room and introduce ourselves and go over a few things in the room. By doing this, we can be sure that the patient is stable at the beginning of the shift and then we can leave the room and take time getting ready for medication pass and assessments. When I go into the room, I complete my physical assessment and then my medications.
I do this for all four patients and then complete my charting for 8 pm and sometimes by this time it is close 10 pm, so I can begin charting for that also. If patients request pain medications, I will get them their medications throughout the night as well. At midnight and 4 am, I complete vital signs for all of my patients and often obtain bed weights during 4am vitals to minimize the amount of times having to wake the patient. Around 6 am I start passing medications again. If a patient were to complain of pain or needed something, such as a dressing change, right at the start of the shift, I would see this patient first and complete my assessment and the rest of the medications for this patient right then and there. I find that combining multiple tasks when going into rooms has saved me a lot of time throughout the shift.
3.What methods did you use to make your prioritization decisions? (1 point)
I generally look at my lab results and recent vital signs immediately following report. This information is usually relayed to me during report, but I still think it is important to go through these findings myself. I also look at upcoming medications and prioritize based on those three results. However, if a patient is in pain, I get all of that patient’s medications ready and go to their room first and complete all of my initial cares right then.
4.What changes did you have to make with patient cares during the shift? (2 points)
This past clinical I started off the shift with 3 patients. As I was in my first patient’s room, we noticed in Teletracking that we were getting a patient from the RAU. Therefore, I finished passing medications for my first patient and completed an assessment and then begin looking up some information for my new patient. We then made sure the other 3 patients were still doing okay and went down to get report on the new patient. Once we got the new patient on the floor, we finished going through assessments and medications. This was the one time I remember having to change patient cares throughout the shift, but I honestly think in nursing we are constantly adapting to and prioritizing tasks. Therefore, I am positive that there were other times throughout the shift that I had to adjust patient cares, but since it is a constant cycle I have a hard time pinpointing exact moments.
5.Describe the title and role of someone you observed in the role of a leader today then answer at least 3 of the following questions: (6 points)
•Discuss the core leadership competencies and skills needed for this role
According to Giddens (2013), leadership is not solely for those in management positions, such as managers and directors, it can also be those who take the role of leadership informally, such as staff nurses (p. 375). Throughout my experiences I have been able to observe the role of both formal leaders and informal leaders. The formal leader in my clinical experiences has been the charge nurse. The charge nurse is very flexible and handles stress well. She is always there to answer questions and give a hand if needed. I have also observed informal leaders throughout clinical and one was a staff nurse with a lot of expertise.
This nurse was always checking in with the members of the team and asking “are you good” or “do you need me to help you with anything”. This staff nurse would always take time to explain interesting pieces of knowledge to me throughout the shift. From observing the leaders that I have observed this far, I believe that the core competencies for leadership are communication skills, critical thinking, a willingness to help others, and a positive attitude. Other competencies are leading the vision of the hospital, interpersonal skills, introducing change, and health care knowledge (Giddens, 2013, p. 380).
•Do you view this leader as a transformational or transactional leader and why?
I think the leaders that I have encountered so far have all been transformational leaders. This type of leader inspires members of the team, encourages critical thinking, and acknowledges the work that the team does (Giddens, 2013, p. 379). The charge nurse is often seeking opportunities for me to be able to complete skills on the floor that may not arise with the patients that I am caring for that shift. I think that the charge nurse and my preceptor are both very good at encouraging me to utilize critical thinking.
They ask me questions to make me think about why something is done or what might cause something to happen in certain situations and if I am unsure of an answer they will explain it in detail for me so that I have a better grasp on certain topics. For example, the other night my preceptor asked me how I could point out that my patient was ventricular paced. I was unsure and so he began to explain where the spike occurs on the rhythm when a patient is either atrial paced or ventricular paced. I feel that that this is an example of transformational leadership because my preceptor is always testing my knowledge and makes sure to make every moment an opportunity for growth and learning.
•What type of power does this leader use to get things done? Is this an effective way to achieve the desired outcome? Why?
I believe my preceptor uses informational power. According to Giddens (2013), informational leaders impact their followers by providing information in a clear and concise way (p. 378). Rather than feeling intimidated or nervous for clinicals, I go into each shift confident because I know that when I leave, I will leave with way more knowledge than I came with. Informational leadership is best when the information is given indirectly, such as through clues or recommendations (Giddens, 2013, p. 378). I feel that my preceptor never gives me answers right away, first he will question my base knowledge and then if it is wrong or does not fulfill what he was asking, he will begin to explain things. I think I get more out of this because it makes me think about what I already know and try and use that knowledge to understand new ideas.
•What challenges does this leader experience in managing his or her time?
One of the challenges that I have noticed with this leader (the charge nurse) is that she has developed a very close relationship with all of the members of her team. I think the relationships she has with her staff is great because she is able to provide them with recommendations and feedback for improving care without staff becoming offended or upset. With that being said, the reason I think this is a challenge is because she often spends a lot of time sitting at the pod talking to members of the team about subjects unrelated to patient care. This may impact managing her time since she may be putting tasks off while she is chatting with the team members. I feel that having a good relationship with the members of the team is paramount in a leadership role to ensure that the followers will respect the leader and follow the vision of the facility, but I think it can also be negative for time management if the leader and follower spend a lot of their time discussing things outside of patient care.
