Melodie Phillips

NRS-430V Professional Dynamics

October 18, 2015

Craig Smith

EDUCATIONAL PREPARATION

The difference in the competencies between the Associate Degree Nursing and the Baccalaureate Degree Nursing level is that the Baccalaureate degree program encompasses all of the course work taught in the Associates Degree Nursing program, plus a more in-depth treatment of the Physical and Social Sciences, nursing research public and community health nursing management, and the humanities. The additional coursework enhances the students professional development, and prepares the new nurse for a broader scope of practice and provides the nurse with better understanding of the Cultural, Political, Economic, and Social issues that affect patients and influence health care delivery 1. A nurse earns a baccalaureate degree is more qualified and prepared to work in all of the health care settings; Critical Care, Outpatient Services, Mental Health Services and Public Health Services. The baccalaureate degree nurse is also prepared to work in private homes, Outpatient Centers and Neighborhood clinics where demand is fast expanding. The Baccalaureate Degree nurse curriculums include clinical, scientific decision making skills, humanistic skills, including preparation in Community health, patient educations, nursing management and leadership. BSN nurses not only provide more complex aspects of daily care and patient education, but also design and coordinate planning of nursing care for the entire length of stay. 2. A patient care situation I’m going to reference is true and happened to me on the floor. A patient was admitted for abdominal pain. The patient had numerous EGD’s and Colonoscopies, all which came back negative. The patient was well known throughout the hospital as a frequent flyer. I didn’t treat him that way. I treated him like he was my patient who was in pain, and needed my help. As the patients stay continued on through out the weekend, he was transferred to numerous doctors. By Monday, he had his fourth doctor. This doctor had a preconceived notion that the patient was only there for pain medication and labeled the patient a “Drug Seeker.” I was attempting to be the patient’s advocate, this doctor refused to listen me. He went through the chart, looked up history, and never saw the patient. He decided to cancel his intravenous pain medication. When the patient asked for his next dose, he found out from me that his medication was cancelled. I asked him if the doctor had seen him, he stated “no.” He was very upset, and rightfully so. All he wanted to do was talk to the doctor about why his medication was cancelled. That was his right. I attempted numerous times to get the doctor to speak with the patient just once, to no avail. As the day went on, I kept trying to get them to talk, all the while trying to keep the patient calm and relaxed. His pain was out of control, and the doctor wouldn’t budge. The patient kept asking over and over for a “face to face conversation” with the doctor. The last time I asked the doctor to speak with him, he yelled and stated “I don’t have time for this type of patient. All he wants is his pain medication. I will not see him” I asked him for discharge orders, so that the patient could go home and take his pain medication there. The doctor refused to sign discharge orders, medication, and seeing the patient, just once. I had to speak with the chief of staff regarding his behavior, and all I got in response was “let him leave AMA.” The patient didn’t want to leave AMA because he wanted to be seen and heard. I attempted to call the doctor one last time, and was told that he no longer is accepting calls after 5pm. I had to call the on call physician. I explained the situation to him, and he didn’t want to discharge the patient home (because he wasn’t familiar with the case), so he re ordered his pain medication. The next day I had to go up the chain of command to get the situation resolved. I got my manager involved, who has a Bachelors degree. She got through to all involved, making everyone happy in the process. She even got the doctor to go and see the patient, and the patient was very happy with the results. The patient was discharged, and everything worked out. As the advocate with only an associates degree, I can see how my decision making skills weren’t as refined as my manager. I was amazed at how effortlessly she worked to get the situation under control. She was so professional, that it didn’t even seem like she worked all that hard to get the results that she wanted. I want to be able to have results like that. My outcome was only writing up an incident report, and “tattling” to whomever would listen.

1. American Association of College Nursing Fact Sheet: The impact of Education on nursing practice. 2. American Association of College Nursing (1995): A model for Differentiated Nursing practice pp. 26-29. Washington, DC; Author