Standards of proficiency for registered nurses

PROFICIENCY REPORT FROM Ms. O

PRACTICE

Ms. O is a registered nurse on the inpatient psychiatric unit for (35-37) acute / rapid stabilization of (MH/BS), assigned to evening tour of duty, coed patients with diversified backgrounds at different developmental stages. The patient’s clinical presentation typically presents as acute depression, bipolar, schizophrenia, anxiety, substance abuse problems, and PTSD including psychosocial issues. Ms. O functions as charge nurse continue to demonstrate leadership, greater accountability, and knowledge in the delivery and application of her nursing practice, critical thinking, planning, prioritizing, collaboration, and coordination of skills while guiding, and directing (13-15) staffs in the provision of direct quality nursing care with minimal supervision.

Practice: Applies the nursing process to systems or processes at the unit/team/work group level to improve care. Demonstrates leadership by

Involving others in improving care.

Ms. O applied nursing process to the provision of patient care in order to improve care outcome. Ms. O demonstrated using nursing process in the following ways: completes and implements initial assessment, reevaluation with follow-up based on the patients presenting individual clinical presentation, provides education upon assessment of patient/family’s educational needs, and team for a safe discharge plan. She participates to address the overall holistic function and maintenance of the Veteran’s physical, emotional, and social environment toward the goals of achieving physical survival, self-determination, and autonomous community functioning because of (assessment, planning, monitoring, advocacy, and implementation) contributing to the Veterans full potential. Ms. Oke assist to safely discharge approximately (25-30) patients per week and this discharge performance contributes to helping reduce the length of stay (LOS) as indicated from fy 2014, from (12.3-7.56) days per utilization management. During shift reports as Charge nurse, assist staff with focusing on problem areas unique for the patient’s treatment, behavior, or psychosocial well-being. Monitors and implements crisis intervention for those patients having active suicidal, homicidal or aggressive behavior because of diminishing mental and physical conditions. Implementation of one to one observation, medication administration, or rapid response. Provides goal/wrap-up groups and informal health education in the areas of medication compliance, suicide, smoking, and alcohol cessation while inpatient and upon discharge to patient and family members when applicable. She is competent in administering medications like insulin, and PRN effectiveness f/u within (60-120 minutes), monitors adverse reactions and critical syndromes (Extrapyramidal side effects, Tardive dyskinesia, and Neuroleptic malignant syndrome) associated with this class and use of antipsychotic medications for sustained quality clinical care and safety. Provides leadership during response to fire drills, and disaster with the goal of maintaining safety for patients and staff while meeting timeframe activation for response to alarm. Maintain infection control and procedures (PPE, hand washing, etc…) Her manner of practice is sensitive to and respectively for diversity of patients and staff in a non-judgmental way by promoting the medical centers mission, vision, and core values “I CARE” while contributing to the nursing profession with compassion and respect for the dignity, worth, and uniqueness of all individuals without regard to social, political, economic standings, or healthcare problems. Regularly is complimented by mental health patients for her care provided to them while hospitalized. As a result of her practice, sustained quality patient care has been maintained and or improved while applying the ANA code of Ethics, Nursing process, and VHA Nursing policies to guide her professional practice. Reflecting a culture of values: Integrity, Commitment, Advocacy, Respect, and Excellence; “I CARE.”

Ethics: Supports and enhances client self-determination. Serves as a resource for client and staff in addressing ethical issues. For example, serves as a resource for Veterans and staff in addressing ethical issues. Advocates on behalf of the patient in support of self-determination and diversity of all patients, including staff. Continuously maintains patient privacy and HIPPA policy during visitation, phone calls with family, electronic medical records (EMR) use, and with others as a need to know basis, including staff. Routinely ensures MHBS patients are maintaining appropriate distance away from others while in line for medication administration for patient privacy sustainment per VISN directive.

Resource Utilization: Identifies and assesses resource utilization and safety issues, taking appropriate action. She demonstrates her ability to report safety hazards, incident reports, staff injuries, and equipment failure or request for new equipment from her supervisor. Initiates a compatible working relation with other services such as (Biomedical, LIDS, Environmental Services, IRM, Linen/Clothing room, Maintenance, Units, Departments, VA Police, and Dietary) in order to obtain needed resources, supplies, services, and repairs for best possible patient care delivery. She collaborates with AOD and ER for admissions, call pharmacy to clarify medications for patients, notify nurse managers and NOD if any incident or for staff issues. Ms. O collaborate with peers to avoid spilling and to complete workload in a safe and timely manner.

PROFESSIONAL DEVELOPMENT

Development Education/Career: Acquires knowledge and skills to maintain expertise in area of practice. Participates in educational activities to improve clinical knowledge and enhance role performance. She completed her BSN in 2018. She continuously accountable for meeting the qualification standards and functional statements of assigned grade and Basic Life Support (BLS) certification, has maintained all annual education requirements for medical center and Nursing employees. Ms. Oke guide and assist newly hired Registered Nurse (RN), Licensed Practical Nurses (LPN) having no previous knowledge or employment experience within VHA system.

Performance: Evaluates practice of self and others using professional standards, relevant statutes, and regulations. Takes action to improve performance. Ms. Oke assess and maintain the educational need for her position. She is up to-date with the TMS educational requirements and competencies needed to perform her duties. Her nursing license is current for the practice. Ms. Oke work ethics is an exemplary, stay away from excessive call- out. She advice and recommended staff to avoid excessive call-outs. She participates in the training of new staff education and understanding of 2-North unit standard. Ms. Oke oriented staff that comes from other units to work in 2 – North and actively involved in evaluating unit practices against the standards set by JACHO OSHA. She conducts teaching group of patient’s on Diabetes. She plays a huge role in calculating and graphing how well 2-North unit follow-up in PRN effectiveness when compared to benchmark and the rest of the Hampton VAMC and consistently performs draw note for continuity of care, communication, and assess for high risk for falls patients, documents in CWAD.

COLLABORATION

Collaboration: Uses group process to identify, analyze, and resolve care problems. Ms. Oke routinely communicates anticipated discharges and transfers of patients with Emergency Psychiatric Nurse attempting to admit MH/BS patients to the units, whom have been waiting in ED under virtual bed status. This lead to Ms. Oke partnering with unit Environmental staff to develop a back-up plan for improved communication, bed allocation, and cleaning called “To be cleaned,” (TBC) when electronic bed board system is inoperable or as a second layer to ensure timeliness of room preparation and assignment to maintain seamless ACCESS TO CARE. She delegates tasks appropriately and per level for NA’s, LPN’s and as well as RN’s. Example RN’s performs the first hour rounds to ensure no patient is on the floor or having behavior or medical issues. As charge nurse on night tour, Ms. Oke performs research to complete what we call the AM Worksheet. The AM worksheet has in it names of resident patients who are scheduled for bloodwork to be drawn, who have urine to be collected, who have withdrawal scale assessment.

Collegiality: Educates colleagues and/or students and serves as a preceptor and/or mentor. Ms. Oke routinely, provides role modeling, educational learning and guidance to nursing students when performing clinical rotation on the (MH/BS) unit regarding specific practices unique to Mental Health Nursing, such as use of coping skills, designation of a temporary detainment order (TDO) vs. involuntary committed (IC), application of restraints, signs and symptoms of Alcohol withdrawals with use of Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale, for score aggregation and management with benzodiazepines. Consistently, informally in-services medication nurses of proper protocol and procedures when verifying insulin to uphold infection control standards and application safety.

SCIENTIFIC INQUIRY

Quality of Care: Initiates/participates in quality improvement activities that result in approved outcomes. Quality of Care:

Ms. Oke uses knowledge to validate or change work group practices as appropriate, such as VHA National Pain Management Strategy and TJC standards; assessing for pain with vital signs as the fifth assessment and completion of the comprehensive pain assessments for monitoring and improvement in outcomes of pain treatment in the VHA system.

Research: Uses a body of research to validate and/or change work group practice. Ms. Oke given the escalating concerns in healthcare regarding accountability and responsibility for providing high-quality patient care and safety, removal of the behavior is crucial. Interventional educational awareness and effective zero-tolerance policies to deflect the disruptive events. The technique uses pre-written responses to the most common distruptive behaviors, while ultimately improving staff relations and who have blood sugar assessment, who have stool collection for occult test, who are on blood pressure medications for vital assessments, and who have special procedures such as NPO, I & O.

Ms. Oke demonstrates her ability to report safety hazards, incident reports, staff injuries, and equipment failure or request for new equipment from her supervisor. Initiates a compatible working relation with other services such as (Biomedical, LIDS, Environmental Services, IRM, Linen/Clothing room, Maintenance, Units, Departments, VA Police, and Dietary) to obtain needed resources, supplies, services, and repairs for best possible patient care delivery. She collaborates with AOD and ER for admissions, call pharmacy to clarify medications for patients, notify nurse managers and NOD if any incident or for staff issues. Ms. Oke collaborate with peers to avoid spilling and to complete workload in a safe and timely manner.

Goals

Ms. Oke achieve her BSN in October 2018. She is in school for her master program in Nurse Practitioner at Walden University. She plans to get certify in Mental Health Board certification soon. Ms. Oke obtain mandated CEU requirements for Registered Nurse for Virginia renewal.