...Wilkins THE JOURNAL OF NURSING ADMINISTRATION Nurturing Charge Nurses for Future Leadership Roles Patricia A. Patrician, PhD, RN, FAAN Douglas Oliver, DNP, RN, ACNS-BC, NE-BC Rebecca S. Miltner, PhD, RNC-OB, NEA-BC Charge nurses are untapped leadership resources that can be groomed for future advanced leadership positions in healthcare organizations. The purpose of this study was to understand the development needs for the charge nurse role. This study demonstrates they receive little or no training for assuming positions of leadership and offers suggestions for enhancement of preparation. There is growing evidence of an impending crisis in chief nursing officer (CNO) retention.1 Seventy percent of CNOs report they will change jobs or retire in the future.2 The critical need for succession planning in nursing leadership has been demonstrated, yet two-thirds of CNOs reported that they do not have succession plans in place.3 Proactive planning is clearly needed to prepare the next generation of nursing leaders.4 The 1st step in succession planning is to identify nurses to mentor and develop. Commonly, nurses in management roles are likely candidates for development; however, many organizations do not consider charge nurses candidates for advancement based on the perception of the role as more of a task master than leader.5 Martha Dawson, DNP, RN, FACHE Kathleen A. Ladner, PhD, RN, FACHE and play a mission-essential role in managing patient flow, staffing, patient and family concerns...
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...principle is a major driver for the commitment of nurses and other care providers. Care providers are required to work in collaboration and include patients in the process of care. Nurses form the core of health care delivery in all facilities. The role they play in the coordination of care is essential for the professionalism of care providers. In the process of care delivery, it is important to understand the medical history of the patient to determine the most appropriate interventions to employ. Care providers should employ interventions that are besides guaranteeing positive health outcomes address the needs and interests of the patient. It is important to include family members in the treatment program since they understand the patient and his needs better. This paper employs Root Cause Analysis approach together with the Failure Mode and Effect Analysis to determine the impact of the events that resulted in the death of a patient Mr. B. A. Root cause analysis The principal purpose of the Root Cause Analysis is to conduct an evaluation of the highest level of the problem to identify the actual cause. In the case scenario, the root cause analysis rules out the possibility of inadequate patient assessment as a contributor to the factors that resulted in the death of the patient (Andersen, Fagerhaug & Beltz, 2009). The patient arrived at the facility complaining of severe pain in the hip region and the left leg. The nurse in charge conducted a routine check for vital signs including...
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...principle is a major driver for the commitment of nurses and other care providers. Care providers are required to work in collaboration and include patients in the process of care. Nurses form the core of health care delivery in all facilities. The role they play in the coordination of care is essential for the professionalism of care providers. In the process of care delivery, it is important to understand the medical history of the patient to determine the most appropriate interventions to employ. Care providers should employ interventions that are beside guaranteeing positive health outcomes address the needs and interests of the patient. It is important to include family members in the treatment program since they understand the patient and his needs better. This paper employs Root Cause Analysis approach together with the Failure Mode and Effect Analysis to determine the impact of the events that resulted in the death of a patient Mr. B. A. Root cause analysis The principal purpose of the Root Cause Analysis is to conduct an evaluation of the highest level of the problem to identify the actual cause. In the case scenario, the root cause analysis rules out the possibility of inadequate patient assessment as a contributor to the factors that resulted in the death of the patient (Andersen, Fagerhaug & Beltz, 2009). The patient arrived at the facility complaining of severe pain in the hip region and the left leg. The nurse in charge conducted routine check for vital signs including...
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...the differences between nurses that have an ADN versus BSN degree. Differences include a difference in the curriculum, the abilities emphasized, and the patient outcomes. Another path the nursing student can take is to pursue a Bachelors’ degree. This degree requires 4 years of school including all of the basic classes as well as the nursing courses. The additional courses required above those included in the associate nursing degree are additional nursing management courses, nursing theory and more of an expansion on course work. The student must still take the same board exams in order to get their license. Although taking the same test at the end of schooling for both degrees, there is an additional emphasis on preparing the nurse to take a leadership role with the 4 year degree than with the 2 year degree. The next difference that is the skill level that each the ADN graduate and the BSN graduate possess. The article “Analysis of Differences in Entry-Level RN Practice by Educational Preparation” (JE Smith 2002) examined surveys of new graduates and their experiences in their healthcare setting and how well they think they reacted to it. The article states that differences in the ADN and BSN changed the outcomes only slightly. The teaching activity was 42nd on the ADN list and 41st on the BSN list, and the leadership activity was 43rd on the ADN list and 47th on the BSN list (Smith, 492). In my hospital the BSN’s are the charge nurses, and they are responsible...
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...nursing programs are intended to be two years in length based to prepare practical bedside nurses for secondary care settings, such as community hospitals and long-term care facilities. The Associate degree nurse is prepared .to function at the intermediate level, not in leadership and management position. The professional behaviors, communication, assessment, clinical decision making, caring interventions, teaching and learning, collaboration, and managing care are the eight center competencies of ADN. By using clinical and thinking skills ADN graduate is responsible for caring for others while keeping the values of nursing profession for better outcomes. The inclusion of public health nursing as a part of curriculum is main difference between nursing in baccalaureate and diploma programs. BSN Program The Baccalaureate graduates are prepared in order think reasonably, evaluate critically, and communicate effectively with clients and other health care professionals. Baccalaureate programs are four academic years in length, and the nursing major is typically concentrated at the upper division level. There are vital components to prepare the baccalaureate graduate as generalist to practice nursing in beginning leadership position in a variety of settings. These components are liberal education, quality and patient safety, evidence-based practice, The following competencies are the nurse who prepared for BSN -.Direct care to the patient by using nursing process with applicable...
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...Quality Leadership Task 2 A. Root Cause Analysis The Root Cause Analysis is a technique used to determine what happened, why it happened and determine things to do to prevent a reoccurrence. * At 3:30pm a patient arrived to the Emergency Department with a dislocated hip and was experiencing elevated respiration rate of 32 and a significant pain score of 10/10 * At the patients time of arrival there was 1 RN, 1 LPN, 1 Secretary, 1 Emergency room physician, and an in house respiratory therapist on staff at the time of the patient’s arrival and there were two other patients being cared for. * The physician decides to do a reduction of the patients left hip and need to have the patient at an appropriate sedation level * At 4:05pm the nurse administered Diazepam 5mg IV per the physicians order. * At 4:15pm the nurse gave Hydromorphone 2mg IV per the physicians order. * At 4:20pm the patient is still not sedated enough and the nurse gives an additional Diazepam 5mg IV and Hydromorphone 2mg IV. * At 4:25 Proper sedation is achieved and the physician performs a reduction of his left hip. * At 4:30pm the procedure was complete and the nurses are alerted to another patient in route to the ER in acute repertory distress and the nurse places the patient on an automatic blood pressure machine to monitor B/P and pulse oximetry. * At 4:35pm the patient had a B/P reading of 110/62 and O2 stat of 92% * The nurse and LPN receive the ER transport patient...
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...Riverbend City Debrief and team project update, that is, cohesion, inclusion and identity after a trail derailment that resulted in a catastrophe. 17u4d1 - Riverbend City Debrief Nurses with difficulty integrating into the team Actually, there two nurses who have a problem integrating into the team. The first is Brandi Button, the respiratory therapist. In the first case, she cannot accommodate the opinion of other team members. For instance, when Pat talks about Maud’s blood gases and the need to call a doctor, she flashes away that idea. In addition, Brandi tries to setup new protocols which have not been put in place by administration. The other nurse who has difficulties working in the team is Alan Warnock, RN - Intensive Care Unit, RCMC. The nurse appears bossy and commanding. Alan goes right ahead to give Lupe, the housekeeper, orders. This is against the protocols since Alan is not Lupe’s supervisor. In addition, Alan goes ahead offending the housekeeper since she is of Mexican-American origin. This is not right. Communication strategies being used by charge nurse to build the team The charge nurse is using ‘be informed’ as the major communication strategy. The charge nurse pairs the nurses floating from other units to the ones operating in PICU. This is ensuring that the nurses get any kind of informational help they might require in the process. Such a communication strategy is effective in creating a cohesive team (Wise, 2007). Supporting behavior change ...
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...Caring in nursing Name Professor Institution Course Date Introduction Concept analysis can be referred to as the activity where different concepts, their characteristics as well as their relations with other concepts are brought out clearly and evidently (Fawcett& Desanto, 2012). The creation of a distinct conceptual clarity about the different concepts proves to be of great importance to all the forms as well as the kinds of research. The general outlined guidelines of research as well as the philosophical literature are often in the mentioning of research analysis or on the hand also mention the concept of the research. Different disciplines have formulated different methods or rather devised different methods of concept analysis. These different methods are meant for the development as well as the clarification of their own concepts in their different fields. The methods may at one time share a scholarly view of the problems of concept as well as the methodology, however, since they are discipline specific, they too may also be in need of various modifications before they could be of use and applicable to the different fields in which they are meant to be used. In nursing science, the art of concept analysis is at a greater height seen as an integral part of the development of a theory and a discipline of the science of nursing. This paper evaluate the nursing concept of care in nursing. Caring in nursing Caring in nursing is the active support as well...
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...A1. Sentinel Event On the evening of September 14, 2011 a sentinel event occurred at Nightingale Hospital. According to Joint Commission, a sentinel event is characterized as an unexpected occurrence involving death or serious injury mother proceeded physical), or the risk thereof (http:www.jointcommission.org). A three year old child was accompanied by her mother for an outpatient procedure scheduled for September 1, 20111. The mother proceeded to register the child for the procedure and was provided details regarding anticipated length of surgical time and physical assessment. The pre-operative nurse was informed by the mother of the child that she needed to run an errand but left contact info(i.e. cellphone number) with the child’s nurse in the event the surgical procedure was to end sooner than expected. Unfortunately, the pre-operative nurse did not chart this pertinent information in the patients chart, it was documented on a sticky note attached to the chart. Post-surgery, the child was taken to the recovery area with care assumed by a recovery team without sight of mother. The father of the child presented to the recovery room and began hugging the child and was able to verify child’s name, date of birth, and was listed on face sheet in chart as father of the child with proper identification. Discharge instructions were provided to the father and the child was released in the fathers’ care. Approximately two and a half hours later, the mother arrived to the unit to...
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...A. The sentinel event was related to respiratory arrest secondary to conscious sedation procedure. There were several factors that played a role which included high patient census, poor staffing, alarms dismissed by staff members, patient was left unmonitored, and no supplemental oxygen initated prior to the procedure. When the patient was pulseless no CPR was initiated until the code team arrived and critical interventions were delayed by the emergency room staff. The patients medication reconciliation or history weren’t reviewed by the emergency room physician. Tripple doses of intravenous valium and dilaudid were given without a lapse in time. The patient was elderly and on chronic oral opioid medications. “Normally these types of medications are administered with low doses and titrated per patient’s sedation level. Patient, monitoring or sedation level weren’t assessed between doses. This event is known as a sentinel event. In any situation that causes injury, or death a root cause analysis must be completed and reported to the Joint Commission. B. To implement a change in the conscious sedation procedure a team or committee needs to be established. All staff in the emergency room can become active participants by joining a committee or subcommittee. These main categories may include patient characteristics, task factors, individual staff members, team factors, work environment, and organizational management (IHI, 2014)...
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...Competency Differences Between ADN and BSN Nurses Rashpal Mangat Grand Canyon University: NRS 430V Jayme Goodner September 18, 2013 Competency Differences Between ADN and BSN Nurses The difference in competencies between nurses trained at the associate-degree (ADN) level versus the baccalaureate-degree level in nursing (BSN) is miniscule. The BSN program incorporates most of the curriculum taught in the ADN program, excluding the leadership/ management, public health and critical thinking aspects. In 1951, Mildred Montag introduced a 2-year degree program (ADN), which trained the nurses for “intermediate functions requiring skill and some judgment” (Schank & Stollenwerk, 1988). In Montag’s curriculum, the role of nurse was focused on clinical skills and mostly task oriented. Due to the advanced education, a BSN graduate varies from a ADN graduate, in that they are well equipped to have a broader scope of practice, better comprehension of the culture, economic and public health issues that impact the patients. According to the American Association of College of Nursing (2012), nurses prepared at the BSN level, tend to have lower mortality rates, scarcer medication errors, and encouraging outcomes (Fact Sheet, 2012). In this paper, nursing judgment on patient care situations will be the differentiated between ADN and BSN competencies, which regard to the three major factors only required within BSN education: leadership/management, critical thinking and public health...
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...acute care hospital setting. These are surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections (Nassof, 2009). Urinary tract infections comprise the highest percentage (Paterson, 2012). These infections usually are spread by the contaminated hands of healthcare providers or the patient’s family members. They are also caused by contaminated surfaces or hospital equipment that has not been properly cleaned (Nassof, 2009). The rate of exposure to infectious materials could be reduced if healthcare providers adhered to certain standard precautions such as hand hygiene. The proposal for this nursing research utilization project is to educate nurses on the importance of hand hygiene using evidence base protocol and how they can implement it in order to prevent nosocomial infections. Most if not all healthcare providers sometime in their career fail to wash their hands. Regardless of staff views on hand washing, research evidence-based studies confirm that hand washing is the most important way healthcare providers can prevent the spread of infection...
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...are several differences regarding competencies between nurses that have been educationally prepared at the associate degree level versus nurses that have been prepared at the baccalaureate degree level including a difference in learning leadership skills, a difference in teaching how a nurse utilizes critical thinking, and also, determines how autonomous a nurse will be while practicing. While these differences show certain distinctions in each level of education, there are other things that factor in, such as each individual nurses experience in the field and any previous experience in leadership roles. There are many other differences that distinguish each degree level also. Leadership skills are one of the variations in education that determine whether a nurse is studying in an associate’s program or a bachelor’s program. A bachelor’s program prepares a student for “beginning leadership positions in a variety of settings” (Creasia, J., & Friberg, E., 2011). An associate’s degree program may cover the basics of leadership skills, but a bachelor’s program will teach and prepare the student to begin an entry level leadership position as soon as they become a registered nurse. One example of a situation in which a nurse with a bachelor’s degree might differ when in a patient care situation is that, because of the additional leadership training, they may be able to advance to a charge nurse position quicker than a nurse who has an associate’s degree education. This is a huge...
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...RAFT –Task 2 Root Cause Analysis A-1. Sentinel Event A sentinel event is an event that happens expectantly in a healthcare facility that could result possible death, physical or mental injury to patients unrelated to natural causes of the patients illness as defined by Joint Commission (www.joint commission.org). On the afternoon of Thursday, September 14, at approximately 12:30 p.m. a ‘Code Pink’ (child abduction alert) was called when a minor child/patient, Tina, was discharged to the care of her father without the knowledge of her mother with whom she was admitted with. Tina was registered into the hospital system by Katie Jessup, hospital registrar, who entered all proper demographics and all proper insurance information into the system. The mother was given a time given an estimated time of discharge to be one hour and 45 minutes by the Pre-op Nurse, Greta Doppke. The mother informed Nurse Dopke that she had to leave the hospital to run an errand and specifically gave her cell phone and instructions to call if Tina were to be released earlier than the time specified. Tina’s mother’s errands ran over 2 1/2 hours, which is 45 minutes later than estimated time and the young patient grew restless. Crying for her mother the discharged nurse, Kim Johnson got word from security officer Tim Blackely that Tina’s father had arrived and was in in the main reception area. Nurse Johnson, upon recognition from the child, allowed the father to visit his daughter. Thirty minutes had gone...
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...child abduction. After arriving at the hospital that morning, Tina’s mother checked Tina in with the registrar. The registrar collected Tina’s demographics and insurance information and entered it into the medical records. She made copies of ID’s and insurance cards and had Tina’s mother sign all necessary paperwork for Tina’s surgery. The registrar did not ask for any information regarding the custody of Tina because it was not a part of her job duties. Once admitted, the Pre-op nurse greeted Tina and her mother. The Pre-op nurse had Tina’s mother sign all consent forms for the surgery. She then helped Tina get gowned up and began the pre-op assessment on Tina, started her IV and administered her pre-op medications. According to the Pre-op nurse, Tina’s mother did inform her that she’d be doing something with her son during Tina’s surgery. Tina’s mother gave the Pre-op nurse her name and number, which the Pre-op nurse wrote down in her notepad, so she could be called when the surgery was done. The OR Nurse had very strong feelings on the lack of communication between departments. She said that she has witnessed many issues and seen many problems arise due to a lack of communication and understanding across departments. She strongly believes that working more closely with security would eliminate some of this issues in the future. Following being prepped, Tina went in for surgery. The surgeon said she did an excellent job. He was upset about the situation with Tina and expressed...
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