Clinicals 1/28/10 - 1/29/10 1800 - 0700

WHAT: I learned a little about the budget and staffing. I do not know if I can really explain it, but I will give it a try. The staffing budget has actual dollars involved, but that is not really what is looked at. What they look at is the census. The manager is allowed to have a certain number of employees per patient, but she does not have to worry about what wage each nurse makes. If all of her top payed nurse are scheduled and the census justifies the need for the number of nurses on it is okay. Employees are allowed to be scheduled an extra shift if they want but if the census is not high enough they are the ones who will be called off first then part time employees next.

The rest of the time I worked on my project. I got all my signs made and put up around the units and made my poster. Now all I have left to do is the teaching. I hope that counts for clinical hours so I can be done following Deb like a lost puppy. Just kidding she has been good.

SO WHAT: The clinical objective I meet was budgeting. I was also able to meet one of my goals. the goal was to learn what the budget is and how it affects staffing.

NOW WHAT: I feel better now about staffing and the budget because I understand that the census plays a bigger part in the decision making than just the money. Of course there could always be more money allowed per patient to keep the patient nures ratio down. That would probably be to much to ask for.

Clinical 1-27 -10 - 1-28-10 1800-0700

WHAT: Deb and I discussed a project I could do. The project we came up with was to research urinary catherter aquired urinary track infections and how to prevent them, then teach my findings at the skills labs in February. Medicade's new law that they will no longer pay for hospital aquired UTI's is what inspired this project.

NOW WHAT: I obtained a copy of a prevention reminded on catheter care and made copies and hung them on the doors of the break rooms and bathrooms for all staff to see. I worked on my teaching posted. I will do more research and continue preparing for the class.

SO WHAT: The goal I meet was to have a project. This project is important because reseach shows that a hospital aquired UTI increases a patients hospital stay as well as increased risks for furthur complications and even death.

Chapters 1-3 thoughts

I have learned about the three main management styles, authoritarian, democratic, and laissez-faire, but I had no idea there were so many different management theories. I was relieved in class when our instructor Dena said she was mostly concerned with the three main styles because I know I would never be able to remember all of the theories.

I see myself as more democratic to laissez-faire because I always like to get other peoples opinion and have my idea confirmed as a good one. But I do not like confrontations so I find myself saying whatever a lot to unless it is something I really feel will would be a big mistake if not done my way. I call it choosing your battles wisely.

Clinical 1/24/10 - 1/25/10 1800 - 0700

WHAT: A rapid response was called. A patients o2 sats were droping and he was having a difficult time breathing. The nurse was concerned about him. The respiratory team, Deb the house supervisor, the clinical supervisor for the floor came. It was good to watch how they all work together asking questions to the patient, nurse and the family about how the patient had been when he began having trouble ets. Respiratory quickly drew blood gas levels. a non-rebreather mask at 10L o2 was placed on the patient. Chest x-rays were done. All of this was done quickly and smoothly and the patient reported feeling better with just the O2.

SO WHAT: The clinical objective I learned was analyzing and managing resources. The patients status was analyized using his family, the RN, clinical supervisor, house supervisor, and respiratory therapist as resources.

NOW WHAT: I learned what a great resource rapid response is any time you are concerned about your patient. And that we should probably use it more often.

Clinical 1-21-10 - 1-22-10 1800-0700

WHAT: When I arrived at clinical Deb had been frantically working on staffing. She had gotten there and there was a note from the executive secretary asking her to do all of the staffing for the whole hospital for the 1800 shift. She was just finishing when I arrived.
After all of the placing people on call at the beginning of the shift nurses had to be called in. A doctor called to have his pediatric patient admitted. The problem is that we did not have any pediatric patients so the unit had been closed. Deb had to call in two nurses because our policy is that one nurse cannot be on peds alone.

And of course the usual stuff: rounds, blood draws, problem solving, and helping out where needed.

SO WHAT: One of my clinical objectives was to learn how the staffing is decided for the morning shifts because that is Debs job, but since she had been doing for the night and it is the same she went over what she had done with me so I could complete my goal. The patient census is the deciding factor for how many nurses will be needed. Who gets put on call is determined by part time or full time status, with part time being called off first.

NOW WHAT: Staffing is a big job and can take a long time. I know Deb starts early in the night getting the census so she can figure staffing for the morning because she gets interupted a lot. I will not complain any more.

clinicals on 1/19/10 - 1/20/10 1800 to 0700

WHAT: Deb taught me about interqual reports. Interqual reports are done on all new admits as soon as possible. The interqual report is then given to a case manager who uses the report to determine if all criteria has been meet for the patients admit. If the criteria is not meet the insurance and medicaid will not pay for the patients hospital stay. The report has to include the admit diagnosis, vital signs on admit, if patient is a medicade patient, and of course the patients name ets.

Some other cool stuff she did was fix the elevator. When they said nurses do everything they were not kidding.

She also had to make sure that respiratory and other staff was available for twins being born with possible low apgare scores.

She was called by a med/surg nure to look at a picc line. The patient said that it was hurting and and she could feel the line. I have never been able to feel a line, but this one you could feel, it was very superficial. The line had just been put in that day it was drawing and flushing fine. Deb said it would be okay and had the nurse put a warm pack on it and given something for the pain.

Deb was called to help with lab draws. She is really good at the hard sticks, I have called her to help me on occations. If the patient had not already been pocked so many times I would have tried, but I have compassion on patients and know that Deb usually gets it her first time.

SO WHAT: One of the clinical objectives meet was organizing. Deb made sure that everthing and everone was organized and ready for the birth of twins. I was also able to complete one of my objectives which was to learn about the interqual worksheets.

NOW WHAT: Organizing is not just making sure you can find things when you need them it is making sure everone and everything is in place in the event they are needed. I have now made a sticker for the back of my badge that has the phone numbers of who I might need for example: lab, clinical supervior, house supervisor, pharmacy, respiratory therapy, and rapid responce. This way I can call them without having to go back to the nurses station to look up numbers not yet memorized. I feel more prepared and organized now.

clinical

Clinical on 1/13/10 to 1/14/10 1800 to 0700

WHAT: I met with our night house supervisor and ask her if she would be willing to let me follow her for 90 hours. She agreeded and asked if I wanted to start right then. I let my family know I would not be home untill the morning and started my clinical hours. I am glad my instructor approved my plan or I would have just wasted 13 hours. I guess it was not wasted I did get a feel for what she does.

We did a lot of running around getting material and supplies for the different units. I even got to go buy diapers for our pediatric unit because we were compleatly out in the whole hospital.

We made rounds and checked on all of the units to see if they needed anything.

It was a pretty calm night. I hope next time we have some admits so I can accomplish one of my goals.

SO WHAT: Well since I am editing my post I thought this might be a good place to put that I was able to accomplish my goal of learning how bed assignments are made for admits. Fist the patients diagnosis and aquity level is evaluated. Then staffing is considered. For example if a patient has a stable medical diagnosis that did not require the ICU the medical unit under the med/surg umbrella would be considered. It the medical unit was full or there was not enought nurses to cover the additional admit another unit may be considered. If the diagnosis is not contagious and the staff and room is avaiable the patient may be admitted to the orthopedic unit. If the patient must be on the medical unit a nurse will be called in even if it is just for one patient.

NOW WHAT: Sometimes I have complained about getting a medical admit when I was working on the orthopedic unit. Now I have a better understand of when and why they do it I do not complain. After all we can not turn a patient away just because our 12 medical beds are full.

Nursing Leadership

I have no idea how to blog. My nursing instructor is making me do this. I hope this is what I do.