It was wonderful to see her personality start to immerse. formation of a stable clot composed of fibrin to prevent excessive I suspected that Mr. Y. was suffering from a thought disorder such as schizophrenia or schizoaffective disorder rather than a mood disorder such as bipolar. After his second round of high dose chemotherapy, a bone marrow biopsy showed poor prognosis, the leukemia was not responding to the aggressive treatment we had started. Individuals can find a mentor where they work or by networking with more experienced charge nurses. This nurse stepped back and stated, Im afraid to push his loose teeth down this throat or even worse make his fracture worse. et al., 2019). I entered her room one day to see her in rigors; her abdomen was distended and very tender to the touch. 3. hR8A{sL@ the nurse and the client during which the nurse focuses on the clients The next few week required much patience and flexibility on my part as his goals changed with each visit. The Staff Nurse III is an experienced nurse who effectively organizes plans and coordinates the simultaneous needs and request of many patients. 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. Clotting Clotting is the process whereby platelets circulating in the She couldnt get in touch with her husband but one of her coworker agreed to drive her. 0000001195 00000 n Current license to practice as an RN in California. We are bringing in an 88 year old male patient complaining of chest pain, alert, with stable vital signs. I was so glad 3 oclock finally came and I was giving report to the evening charge nurse. Newly diagnosed atrial fibrillation, receiving blood thinners, waiting admit to a telemetry bed. 8. By now I knew that I have to ask questions. Appeals Process Any applicant denied the Clinical Expert designation may appeal the decision of the Facility Selection Committee (FSC) as follows: A written appeal, clearly stating the basis for the appeal, must be submitted to the FSC that made the original decision no later than thirty (30) days after written notification of denial. He has a long history of PAD with severe lower extremity necrosis. Before, working in the ED, I worked in locked psychiatric facilitates for several years. My assignment was a general float RN (someone who assists in helping the whole department). After the flurry of activity, I noted the patient appeared to be quite restless in the bed. Many coping behaviors are learned, based on ones family, (Source: ACCS (Monitoring and Ensuring the Quality of Health Care Practices) The Following Benners Domain will be addressed: The Helping Role The Diagnostic and Monitoring Function Monitoring and ensuring the Quality of Health Care Practices Exemplar #2 In the dermatology clinic, I have patients who come in regularly for their Narrow Band UVB (ultraviolet B wave) phototherapy treatments. 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. To meet that goal, this nurse successfully integrates experience, technical skills, a base, and an ability to deal with patients, families, and other resource people. I went on to say that I had taken care of Mr. P so many times and I knew him well and he was not himself. Candidates who have taken more CEs/CMEs will be rated higher. There were drain sponges around the insertion sites and 4 x 4s wrapped around the actual drains for absorption. Because of my experience identifying clinical signs and symptoms, I was able to take the essentials steps to ensure my patients well-being. The Staff Nurse III uses judgment to assess the appropriateness of physicians orders. management, finances, and transportation. activities easily. He was a 43 year old male admitted for relapsed Acute Myelocitic Leukemia. By his side stood his wife, a very sweet lady. The Staff Nurse III grasps the whole picture and so is in control of the situation, able to create order out of chaos. Mentors also offer suggestions to improve the application portfolio prior to submission. At that point the surgeon would be ready to begin closing the cavity. 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. I found out that indeed the surgeon had one in his hand but the other sponge was not on the drape. The more detailed report that I received on Mr. Y. included. Webthe nurse-patient assignment process. 2. 66eJFPnC'b{ h5_]h!":S %c8(K-N'KLD>>/=BcVPM(A**{&hX^Y(97kXv5Y[y&\\swR8iih,G6+f^*_ She wanted to get something stronger for her HA and maybe come in tomorrow for a BP check if the HA didnt get better. She said no. K T ^ _ ` g q r { "hL3 h)' 5>*CJ OJ QJ aJ hL3 hv CJ OJ QJ aJ h[Q} CJ OJ QJ aJ hdW CJ OJ QJ aJ hL3 h)' >*CJ OJ QJ aJ hL3 CJ OJ QJ aJ hL3 h)' CJ OJ QJ aJ 8 ! The letter stated that my patient had been diagnosed with a subarachnoid hemorrhage and that the QA nurse wanted to thank me for my triage and comprehensive thinking. encounter potential and actual alterations in oxygenation in all types As unit leaders, charge nurses must exemplify leadership abilities. An I asked him about his pain and he still had some but was unable to give a 1 to 10 scale number; he pointed to his chest. Phototherapy, or light therapy, is exposure to specific wavelengths. In contrast to community health and She became a little frightened and asked What could be wrong? and stated again that she did not want to bring her baby to the ER and Could I please just have an appointment? I told her that this could possibly be complications from her delivery. (Taylor et al., 2019). In addition to the facial injuries, there was a large hole to Mr. L.s right middle check area. ( Maintaining a caring attitude towards patients even in the absence of close and frequent contact. Since I function at this level on a daily basis, my opinions are well respected by all the physicians with whom I work. ( Yes ( No Please describe how the applicant identifies, communicates, fulfills patient needs: Please describe how the applicant coordinates and utilizes facility/community resources to meet patient needs: Please describe how the applicant promotes a multi-disciplinary approach to patient care: Please describe how the applicant assumes a teaching/coaching role: 9. The surgeon thanked me for being firm and confident. Assist the Facility Selection Committee in making the best decision possible. Flexible charge nurses maintain stability in the unit and treat nurses as individuals, accommodating different work styles. She did not drink or smoke. A Clinical Exemplar is a description of a patient care situation that is significant to you and reflects your current practice. To the family, this was a crisis and their most desperate coping mechanisms were emphasized. PERIOD COVERED BY REPORT DUE COMPLETED I then consulted the CCMD and after discussing the case with him, we decided I should try speaking to the hospital based doctor, Dr. S. was consulted and when I told him about the case, H recognized the patient and told me that he had talked to the family a few days ago. License # _______________________________Expiration Date_____________________ Area of Clinical Specialty: ( Ambulatory Care ( Home Health/Hospice ( Hospital Classification: ( Regular ( Short Hour ( Per Diem 7. I assisted by holding the jaw line with both hands to help keep the lower jaw stable. Loss occurs when a valued person, object, or Culture I told her not to be scared. While we waited the 5 for resting BP, he talked about how he had been feeling pretty tired for at least a month and just didnt seem to have any energy. understand and empathize with the clients experience. The organization recognizes and values the impact of nursing care on patient outcomes. Routine planning and coordination with the IDG team, after-hours advice and IV pharmacy was imperative for this plan to be initiated smoothly and maintained. NOTE: The Letter of Recommendation Form is provided in this packet to assist the writer of the recommendation to cover all requirements. I started the preparation in my room. Mrs. Kinney told me she was entrusting her husband to me. Again, I told Mr. Kinney that I would be with him in the operating room and that I would do my best to ensure that he would be kept safe all throughout the procedure. 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. My calm, reassuring approach and this familys readiness to learn, was an intricate part of being able to increase the complexity of his care and allow T. to remain at home. the responsibilities associated with being a professional. I know we both had the same thought: How many times has he been here for this chest pain? And lo and behold there was Mr. P on the stretcher. How have these accomplishments had an impact. Describe in the exemplar, how you personally made a difference. As a charge nurse, you have to be resourceful and handle different issues beyond taking care of a set number of patients. Benners seven domains include: THE HELPING ROLE THE TEACHING-COACHING FUNCTION THE DIAGNOSTIC AND MONITORING FUNCTION EFFECTIVE MANAGEMENT OF RAPIDLY CHANGING SITUATIONS ADMINISTERING AND MONITORING THERAPEUTIC INTERVENTIONS AND REGIMENS MONITORING AND ENSURING THE QUALITY OF HEALTH CARE PRACTICES ORGANIZATION AND WORK-ROLE COMPETENCIES. b) Teaching Coaching Function- Assisting patient to integrate the implications of illness into their life styleThe teaching needed for a family to manage this acuity at home is tremendous. piloerection (goose bumps). Discover potential problems that may arise if the rule is approved. This nurse anticipates the future, develops a plan of what to accomplish for each patient during a shift, monitors each patients progress and adjust individual plans to meet changing needs in the patient population. I asked her about LMP and she told me that she doesnt have periods for more than 2 years. I had Floseal and Surgicele on board; both were effective means of helping to control bleeding. Please be sure all information is typed or written legibly. I told him that I was just speaking and acting on behalf of my patient. Part of the application process requires that applicants submit letters of recommendation from peers, supervisors/managers, and other health team members familiar with the applicants practice over the past year. competence (Taylor et al., 2019). Perfusion Perfusion refers to the passage of oxygenated capillary blood The charge nurse role may also include tracking team performance metrics and solving staffing shortages. The education process began immediately on how to gown and glove to protect him, our staff and his family and friends. Exemplars should be written by the chapter member, the nominator, or collaboratively by individuals who can attest to the validity of the contribution. Select a Mentor from the FSCs Mentor list and ensure that your final application is signed by your Mentor. changes in its internal or external environment that disrupt its They have several years of experience as a nurse and are responsible for delegating duties to less-experienced nurses and staff members, including LPNs and CNAs, coordinating nursing schedules, monitoring medications and supplies, At the end of the call you may have an ER recommendation, and appointment, advice or other dispositions. She thanked me for my patients and kindness. MONITORING AND ENSURING THE QUALITY OF HEALTH CARE PRACTICES ( Providing a back-up system to ensure safe medical and nursing care. B) The family needs to agree to surgery. As well as I may know a patient, I must always be cautious not to draw a conclusion too soon. Little did I know that during this affirmation she would call me up to the altar and introduce me to her congregation as The Angel that God had sent to her. This number must equal twenty-four (24) hours or more in order for a nurse to meet the hours worked qualification. She told me that she is calling because of the burning in the mouth of her stomach. gas (ABG) analysis is used to determine blood pH, and homeostatic Additionally, a charge nurse should have interpersonal awareness, or emotional intelligence, to deal with different personalities and interact outside of their comfort zone. Most important is to give a disclaimer. Please include any facts, beliefs, values, or behaviors that you think characterize yourself and your nursing practice. Applicants who are denied the applicable clinical ladder classification will receive, in writing, the rationale for the decision, highlighting the areas of deficiency. Whether the patient is not responding to a particular therapy, this nurse has an inquisitive need to search continually for the reasons. Please be candid with yourself in describing areas for improvement. joining of the sperm from the male with the ovum from female), Omeprazole (Prilosec) can be prescribed by a doctor if symptoms dont subside. Model of proficiency for co-workers. A charge nurse must understand staff members' skills, abilities, and knowledge to appropriately delegate tasks and procedures. See calculation below. All of a sudden Mrs. Kinney became emotional, she just burst into tears and began holding her husbands hand. WebAs a forward-thinking multi-award winning Trust and a digital exemplar committed to improving patient care, our world-leading research and innovations are having a positive local and global impact. She had this burning on and off for years and she wants to have a prescription for it. I called for a Nursing Assistant to come in and help me with her vitals. I rechecked the pulse manually - it truly was 3040 and the pt was slightly clammy. She told me that after she had breakfast the burning started again. diminished or removed. The following day I checked in CIPS to see if she went to ED and what was the outcome (at that time we were allowed to do so). Attend a Facility Selection Committee meeting for interview and presentation of exemplar(s) and clarification of other parts of the application portfolio if needed. Acrobat PDFWriter 5.0 for Windows NT I suspected that the end was nearing, and sat with this patient to talk to him about his plan for the day. The MD voiced a concern that if I was the front line person and I was wrong, I would be the person experiencing the manic patient first hand. After she lost her insurance she took Tums that helped for awhile but no more now. He surely did not have his Mr. P smile and he was just not right. g That man stood so tall in person and in spirit. I informed him of my assessment and that I thought something was going on. It had become evident that the family was becoming overwhelmed with his care and the MSW worked with the family to get care giving for four to six hours per day. Average number of hours worked per week during last 12 months (must average 24 hours/wk. Instructions: Please complete this form and return it to the applicant before __________ (date). It describes in detail a particular clinical situation that includes the nurses thoughts, feeling, intentions actions, critical thinking and Current signed performance evaluation at the midpoint or above on average. 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. She was unaware if this was a new symptom. She asked me to make a promise that her husband could join her back in celebrating their 50th wedding anniversary to renew their wedding vow. 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. I had to catch my breath and make sure that my face didnt reveal what my mind was thinking. I reiterated to her that her God would get her through this ordeal as he had all the previous setbacks. 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. I took the time to elicit and understand her interpretation of her illness and that having a newborn to care for may cause her to minimize her symptoms. Being in this unique position enables the Staff Nurse III to interpret for the patient to the physician and for the physician to the patient and family. * Letters of recommendation written for charge nurses should address clinical skills and not Charge Nurse Duties. Use This Template Alfie Jonas Charge Nurse 458 635 9654 [email protected] San Francisco, CA www.linkedin.com/in/alfie SUMMARY I stayed to help get Mr. P triaged; this was fairly quick for me since I had taken care of him so many times. specific needs to promote an effective exchange of information. The simple task of scheduling a PIC line placement now became a serious nursing challenge. I explained to her that we were concerned by her symptoms and we would like her sister in law to driver her to the ER. Finally there was a big relief felt by everybody in the room. Zr|P%R(oW)GSZnKex&Eg"%,S@C)t^AMg~)*v)&Xft{::.M';LwdRj/w0d[y#xs[N8>YiOav`xd5vaAaf,{/r2q/%Iyr22L;v,0sv+\~a-|nav&f~_\ >7fs0i-u; PhX4US > va>!1)>9\`a}fP5T0X@,>Y6GU&aZ7-}=c n'4WgR-q,B++'.cwvbo~TbP 4ux$plUzZ90G,;4r.V'R.2x]ibe/lx`Rp|Kt; Junior Sister/ Charge Nurse - Harptree Ward Accepting applications until: 13-Mar-2023 23:59 Vacancy status: Open By also drawing on the help of her sister-in law and husband I was able to formulate a plan of care that she was comfortable with. Complete the online application form on our website. should result in a positive or rewarding Experience for the patient. rights & duties in legal matters are better able to protect themselves In fact pt was speaking some English but I explained that for her comfort it will be better if we use a translator. 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. A charge nurse is a registered nurse (RN) who leads a nursing unit during a shift or specific period. I became the point of care for this mans treatments. She needs medication ASAP. The Regional Appeals Committees review shall be limited to a consideration of the same appeal presented to the Facility Selection Committee. The team of nurses, physicians, physician residents, pharmacy and respiratory responded to the Trauma Bay to prepare for the patients arrival. A less experienced nurse would have just sent a message since her symptoms did not warrant an emergent outcome or even an appointment. As I checked the blood loss in the suction canister and observed the vital signs monitor in the anesthesia screen, I knew that the anesthesiologist would need to monitor hemoglobin and hematocrit level at some point. She was able to trust me and agree to go to the ER. She doesnt know what else to do. He/she should use specific examples whenever possible to describe your relationships with patients and peers, your communication skills, and evidence of your clinical leadership. When she had insurance she had one and it worked for her. I gave her the order for the Ativan and again verified that t he patient was currently pain free. Examples of health related community work are: a school demonstration project, involvement in a respite program, active participation in a health fair or health screening, teaching a first aid course. Here's an example of a charge nurse resume you can use as a reference when writing your own: John Delaney Pasadena, California | 626-555-0928 | [email protected] Summary Dedicated Registered Nurse with 10 years of experience in neonatal and emergency care units in hospital settings. I asked her if she had support, and she told me her sister in law was coming over soon. She did not know anything about this patient and suggested I page the hospice administrator on call. (LogOut/ I facilitated the quick delivery of the blood and in no time we were able to transfuse the 2 units to the patient. In this way you will be able to determine whether everything you wanted to convey is easily understood and that your story is clear. The CCMD agreed with my assessment and outcome of ER. His daughter found him, called hospice and was instructed to take the PIC line with her to the ER by ambulance transfer. s t | ||qfTD5 hL3 h)' CJ OJ QJ aJ hL3 h)' 5CJ OJ QJ aJ "hL3 h)' 5>*CJ OJ QJ aJ h)' >*CJ OJ QJ hL3 >*CJ( OJ QJ h)' >*CJ( OJ QJ )j h)' >*CJ( OJ QJ UmH nH uh)' 5CJ( OJ QJ )j h)' 5CJ4 OJ QJ UmH nH uh)' 5>*CJ OJ QJ #h B*CJ$ OJ QJ ^J aJ$ ph #hd7 B*CJ$ OJ QJ ^J aJ$ ph #hk B*CJ$ OJ QJ ^J aJ$ ph 1 Y specializing in Geriatric care for 8 years with a proven track record in dementia care. (Letters of recommendation written for charge nurses should address clinical skills and not Charge Nurse Duties.) Show in your exemplar how you used fine discretionary judgment and/or intuitive use of Knowledge. hallucinations, and grossly disordered thinking and behavior * The work of Patricia Benner, RN, Ph.D., was used as a foundation for the development of the SN III/HH/H III classification. trailer She thanked me for my concern and called him on her cell phone. If you have difficulty identifying a clinical incident, it is often times helpful to ask a colleague or your director for ideas about a pertinent clinical situation in which you were involved. I opened the protocol Urinary Tract/Flank Pain Female. I was also in charge for the day. Seek out peers, other charge nurses, and managers who exhibit effective leadership traits and ask if they are willing to be a mentor. Candidates will be asked to clearly present either one or both exemplars. That diagnosis did not prepare me for what would soon follow. Her vitals were 7-/32, Heart rate 142, Temperature 103.8 and her respiratory rate was so fast they were hard to count. The information is meant only to serve as a guide and should not stifle your own creativity in putting together your portfolio. I was able to keep the patient calm and earn her trust while explaining the rationale and need to go to the ER. Mr. R.s healing was slow, dressing change after dressing change, antibiotics one right after the other. Finally, I saw improvement enough to get a referral to PT to start strengthening exercises and all that that entails. This is why I was amazed he was awake and attempting to speak. a drug, despite the harm that it causes (Taylor et al., 2019). I quickly had to focus on the current dilemma that she was experiencing. 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. WebExemplar status is the highest of four possible program levels, recognizing our commitment to providing the highest level of geriatric care. The quality and content of the material presented in your portfolio is what will be reviewed. WebA nurse leader has exceptional clinical experience and knowledge. I am aware that when a family member is dying there are complex family dynamics that require staff to pay close attention. Some specialty units require even more time. The exemplars must be reflective of events that occurred in the last twenty four (24) months. application/pdf Not sure what was causing this pain Dr. S called the hospitalist to arrange for Mr. Ps admission. The Staff Nurse III accepts accountability for actions and outcomes and knows when to involve others in a plan of care. The right thing to do was to help Mr. Y. reach his highest level of functioning with the least amount of dependency as possible. Corrective measures were taken. They address problems that arise in their unit while juggling administrative tasks like scheduling, staffing, and monitoring patient care. 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. This guide covers the most important traits for charge nurses to be effective leaders and improve patient outcomes. By the time he was awake she was just fine. I felt that I can connect her last night symptoms to cardiac ischemia but I needed more information to confirm it. Overall coordination of day-to-day case flow coordinates on-time starts, turnovers, breaks; instrument coordination with Sterile Processing. familiar with the applicant's practice Each letter must meet all of these criteria: - Indicate nature & dates of association - Clearly recommend the applicant for SN III - Address 5 key concepts CEU Documentation: 15 CEUs in clinical specialty in the past year Exemplars: Two exemplars reflective of events in the last 24 months Exemplar #1 Exemplar #2 Each exemplar must meet all of these criteria: - Identify the 3 domains addressed at beginning of exemplar - Demonstrate how applicant functioned in the identified 3 domains - Describe any of the following: how applicant felt about situation, why applicant felt actions were important, why applicants actions were important , why applicants actions were different from someone with less experience . I was able to guide them to the conclusion that although every patient is special, I must still continue with my job because there are always patients that need my care. Being a cardiac nurse, I immediately placed a heart monitor on her she was in atrial fibrillation and I feared she was also becoming septic. Teaching activities are not necessarily ongoing in nature. Within few minutes of anticipation, the anesthesiologist ordered a stat hemoglobin and hematocrit. An effective charge nurse uses critical thinking to quickly assess and decide if immediate action must be taken to protect the patient's health. ABOUT THE FACILITY SELECTION COMMITTEE The Committee shall be co-chaired by Nurse Executive/DONP or designee and a Staff Nurse III/IV or HH III. License Number________________________________________________________ 8. During this time I gained experience from people suffering at different severities of their mental illness. ADMINISTERING AND MONITORING THERAPEUTIC INTERVENTIONS AND REGIMES ( Starting and maintaining intravenous therapy with minimal risks and complications. 5V5E*h1v5=?+a2HF&#GA`L^_ni!a:3j8 t]3\F67vx]F_J04o7@oB w`N$ xA^'Sr7,z J%4{Cf@LcE The evening charge nurse and I looked at each other and said, gotta be Mr. P. The nurse disabilities, sexual orientation, health insurance, and access to health care I found this plan of action totally unacceptable. Promotes a multi-disciplinary approach to patient care. These signatures certify that calculations are correct as of the specified date. 6w} STAFF NURSE III, HH/H III SIGNATURE PAGE FOR MENTOR Mentors Name________________________ Mentor Signature______________________ Date ________________________________ STAFF NURSE III, HH/H III RECEIPT OF APPLICATION FORM Application Submission: Date application submitted:_________________________________Time application received:__________________________________ Application received by:____________________________________ Note: please provide applicant with a signed copy of this page as verification of receipt of SN III/ HH/H III application.)