PROFICIENCY REPORT

PROFICIENCY REPORT FROM MS. Y

PRACTICE

Practice: Ms. Y is a Bachelor’s prepared registered nurse with….acute care nursing experience who utilizes the nursing process and evidenced based practice to care for patients

Demonstrates proficiency using the nursing process in providing care for clients with complex nursing care needs. Guides and directs others who provide care.

• Functions in the capacity of charge nurse on the night shift. As charge nurse duty ensures the smooth running of operations on the unit. Also delegates patients assignments by assigning patients to oncoming tours; coordinates new admissions by assigning rooms to new admissions and ensuring that orders are carried out; ensures team work on the shift, and addresses others issues arising in the course of the night.

Ethics: Identifies ethical issues in practice and takes appropriate action.

Takes appropriate action in identifying and serves as a resource for clients and staff in addressing ethical issues.

. On June 2016, I had a patient who was in pain due to orthopedic surgical procedure. During initial assessment, patient rated pain 10/10 and did not have any pain medication ordered. I called the on-call surgeon who directed me to call the attending surgeon. Every attempt to reach the attending surgeon failed. After several attempts, I called the on-call surgeon back and eventually got orders for pain medication. The patient threatened to leave and even attempted to get out of bed. I was able to calm him down and eventually obtained order for his pain medication. The patient was kept comfortable throughout the shift. The attending surgeon called in the morning and commended the nurse stating that he appreciates all the efforts made to ensure his patient was comfortable during the night.

Resource Utilization: Delegates care in a safe, efficient, and cost-effective manner. Assists clients in identifying and securing appropriate services.

• A patient who was discharged called the unit in June 2016, saying that the husband lost his driver’s license when they came for appointment and needed help finding it. I asked this patient the locations they had been while in the hospital. I called some places, and eventually, I called the pharmacy and found out the patient left the drivers license at the pharmacy. I got back to the patient and told them we found it, they were happy and relieved.

PROFESSIONAL DEVELOPMENT

Education/Career Development: Implements an ongoing educational plan to support own professional development.

• Currently, undertaking masters in Family Nurse Practitioner.

With the growing demands for clinicians in VHA and the ongoing proposal to recognize APRNS as full practice providers within VHA facilities, obtaining this degree would benefit the hospital in that it would provide more affordable care that is safe and of high quality to the men and women who have served; and also help alleviate provider shortages and ensuring access to services in high demand.

• June 2011, I attended a course titled “Diabetes Medications – Initiating, Advancing and Stopping for the Advanced Practice Nurse” on myVEHU. The course addressed common oral diabetic medications and insulins; and the safety issues associated with them, with an emphasis on patient safety. I have been able to incorporate knowledge gained into caring for diabetics on the unit and providing education on lifestyle management to keep their diabetes under control. For example, I had a patient who was on insulin and has been hypoglycemic in mornings for the past two days. After reviewing the chart, I placed a call to the MD prior to end of my shift and the patient’s AM insulin dosage was adjusted. The patient’s AM blood glucose was controlled in a timely manner as a result of this and this also led to a reduction in cost of hospitalization.

Performance: Conducts self-assessment of performance and identifies own learning needs. Assesses performance of others.

• Continually assesses my own practice and makes adjustment in practice as needed based on Evidenced-Based practice. Open to correction and constructive criticism.

• For example, I when I came here newly, I heard a patient complaining that she was given an intramuscular injection and that the nurse did not mark the site properly. I brought this to the attention of the clinical nurse leader. As a result, education was provided to all staff on the proper sites for intramuscular injections. This has enhanced knowledge about the area of concern, lead to client satisfaction, and also prevent complications that could arise from wrongful injection.

COLLABORATION

Collaboration: Refers to, consults with, and makes provision for continuity of care with other health care providers.

• In May 2016, on the night shift, I had a patient who developed nausea and vomiting, having greenish emesis. A call was made to the physician who came in during the night. The patient was taken to the OR the next day for surgery. The physician was impressed and wrote to the Director of Nursing about the episode. I received a commendation letter as a result of this action. This has improved the image of the unit and also promoted patient safety as the patient was saved from what could have been a sentinel event. I also educated staff on the use of SBAR to communicate with physicians.

Collegiality: Provides feedback regarding the practice of others to improve client care.

SCIENTIFIC INQUIRY

Quality of Care: Participates in established quality improvement studies and/or activities.

• Represents my unit at the Women Veterans Health Committee. Even though I worked the night shift, stayed to work as a volunteer at the VA Goes Red for Women event on Friday, Dec 5th, 2016. At the event, we served about 100 participants. I provided education to female veterans about the importance of being heart healthy. The outcome includes improved veteran’s health, health promotion and disease prevention; reduced cost of hospitalization related to cardiovascular disease.

Research: Uses a body of research to validate and/or change own professional practice.

• I use the SBAR in communicating with the providers when needing clarifications with patient orders or any issues arising in the course of my tour. On May 2016, I provided education to colleagues on the use of SBAR in calling physicians and delivering clear messages to promote quality of care and patient safety. Evidenced-based practice shows that use of SBAR enhances provider/nurses communication in that it aids in providing accurate and concise information about a patients care, treatments, current condition, and recent or anticipated changes. Incorporating this into patient care has proved to be an effective technique that can be used to clarify and streamline information exchanges between doctors and nurses, thereby reducing the chance of patient harm due to disorganized and unclear communication.

GOALS:

Short Term Goal

Complete my master’s program in FNP in 2017.

Long-Term Goal

Certification in mental health nursing

Doctorate degree in Family Nurse Practitioner