N420Report Burke 19 - Shadowing Experience with Peer Review references PDF

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Shadowing Experience with Peer Review references...

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Practicum Experience Report NURS20 – Fall 2019 Lori D. Burke R.N., Department of Nursing, Lock Haven University-Clearfield Campus Bachelor of Science in Nursing Program

N420Report_Burke19

Introduction Emily Snider is the Unit Director of the Labor and Delivery, the largest division of the WomanCare Birth Center at the UPMC Magee Women’s Hospital in Pittsburgh, PA. Nearly 10,000 babies are born at Magee each year, accounting for 45 percent of all births in Allegheny County. Emily has supervision over 34 direct reports within two of the 5 divisions encompassed under the umbrella of the WomanCare Birth Center. Nurse Leader Background A 2010 Graduate of Otterbein University with a Bachelor of Science in Nursing, Emily is currently pursuing a Master of Science in Nursing Education and Leadership at Carlow University. With an anticipated graduation date of December 2020, Emily’s excellence in academic achievement was recently recognized by the UPMC Magee-Womens Hospital Research Intuition and Foundation in the means of a full tuition scholarship. Healthcare agency background Beginning her nursing career in a Community Hospital right out of college, Emily spent two years on a Med-Surg floor gaining “confidence in herself as a nurse” before applying and taking a position in Neuro-Trauma Stepdown at UPMC Presbyterian in 2012. After two years in step down and six months of applying for all jobs posted for the WomanCare Center she was hired in the Spring of 2014. Beginning as a Professional Staff Nurse, Emily not only learned the skills and practices needed Labor and Delivery, she excelled in her chosen specialty. She transitioned from a Sr. Professional Staff role focused on precepting and onboarding into the role of Triage Clinician, a job she held until 2018. Recruited by the Clinical Director of WomanCare Birth Center, Emily has been in her current position for over a year.

N420Report_Burke19 Selection Reasons Womens health related to Obstetrics and Gynecology is subject that has always interested me, the birth of my twins, an event that changed the course of my life and directed it back to nursing made me know Obstetrics was the area of Nursing wanted to pursue. Unfortunately, I have never been able to break into the specialty. One of my biggest decision to resume my studies toward my BSN after a five-year hiatus was even though I’m an RN with 10 years’ experience it’s very hard to be considered for Obstetrics without a BSN. When this class presented the opportunity to provide an immersive opportunity to view the specialty from a new perspective, I networked within my employer UPMC to identify a Nurse Leader my chosen specialty area. I feel very lucky that Emily, as I mentioned earlier, is also pursuing a higher degree and agreed to provide what was truly a wonderful experience and opportunity. Leadership and management qualities required for position First and foremost, the Nurse Leader must be a nurse. Part of the unique sisterhood, in my opinion, that exists within the profession is a shared experience of nursing school, fear of the NCLEX, our life’s touched by the patients we care for and with them we experience great highs and lows that we must compartmentalize. Building on this statement the most effective, I believe, Nurse Leaders are those who maintain their autonomy with the individuals they lead and advocate for their needs as well as the patient within the context and confines of a health care system. Welford 2002 states substantial evidence suggests that transformational leaders are not born but developed in Emily’s situation it was a change within the health care system itself the that shaped how she would lead.

N420Report_Burke19 In June of 2019, UPMC reached an agreement with Highmark to enter a long-term contract to provide Highmark members with the in-network access to the UPMC physicians and facilities. For the first time since 2014 Highmark customer could utilize UMPC services resulting in an increase of patient population creating staffing shortages, stretched resources and inadequate workflow from unit to unit. The arrival of patients from the Highmark system though anticipated created an increased workload on existing staff twofold. More patients meant staff shortages along with a flux of new hires. Soon negativity within the staff became an issue… “Leadership needs to push and drive the effort to change the culture.” (E. Snider, personal communication, November 14, 2019) Leadership and management style Emily exemplified the transformational and adaptive leader; her goals and vision were clearly defined having been shaped by the desire to drive a culture of change within her unit. Thompson (2012) identified specific skills as essential for the transformational leader to master, such as learning to work with others in an empowering way, facilitating growth and learning of staff, communication, problem-solving and decision-making. I believe Emily was well on her way mastering these skills and she applied these leadership and management concepts as part of interaction with her staff and superiors. Leadership and Management Concepts Two of the three days I was with Emily we spent a great deal of the time rounding and attending meetings with the Director of Nursing, Vice President of Nursing Operations and an outside consultant discussing and communicating the needs of the unit as it related to the infrastructure, layout and patient flow through the three of the critical areas of the WomanCare Triage, Labor and Delivery and Surgical services.

N420Report_Burke19 Part of the communication during rounding was a focus on the patient experience and utilization of ParliaQ, a web-based application created by UPMC that simplifies patient engagement with customizable interviews and real-time feedback. The consultant provided constructive performance improvement suggestions for Emily integrate into her patient interviews articulate and document the patient experience within the ParliaQ database. (Patient Experience = Interactions Perceptions. March 2019). As stated previously the increase in patient population to the WomanCare resulted in the hiring of a large block of new nurses as in right out of nursing school with no experience into a unit that had for the past five years consisted of a core staff of seasoned nurses and an occasional onboarding on one or two nurses a year to an influx of sixteen nurses hired into the department that were now in various stages of their 12 week training. Identified by Virkstis 2019 as the Experience-Complexity Gap it relates directly to how negativity and staff morale was affected by the addition of new nurses’ attempting to learn new competencies in a faster-paced care environment because there is less time to absorb new information and practice new skills. Every day I was with Emily it was easy to see her commitment to team building as she checked on the process of her new staff and made in a point to encourage and applaud their progress and provide encouragement. (Thompson 2012) Her inactions with her seasoned staff focused on appreciation and gratitude for their hard work and double duty they were pulling as nurses, mentors and preceptors. It was evident the staff felt a sense of security and trust in Emily as their leader (Fischer 2016) In one of the meeting of all the unit managers each area contributed the creation of an action plan to make use of staff to care for the higher acuity patients across the units to

N420Report_Burke19 compensate for the less than experience staff in critical areas. Emily brought feedback from her staff in the triage area having collaborated with her charge nurse to create and identify with the goal of problem solving, a list of nurses based on their experience who could act as a resource float for the newer nurses if triage were to be overwhelmed by patients needing more complex care delivery. (Virkstis 2019) Ironically the best way to explain Emily strength at decision making was observed on my last day during a marathon scheduling session we facetiously dubbed Krampus. Porter-O’Grady, 2003 emphasizes effective leadership is critical in delivering high-quality care, ensuring patient safety and facilitating positive staff development. The organization and coordination entailed in ensuring proper staffing and trying to give 200 employees the holiday schedule they desired should be the same as the eleven other schedules done throughout the year but it entailed so much more. The daunting task of juggling seniority, clinical expertise, staff requests, who worked what before and at times negotiation and bargaining with staff to ensure the unit was staffed on Christmas and New Year’s took the entire morning. Kouzes and Posner (2008) identified the transformational leader’s five habitual practices: modelling the way, inspiring a shared vision, challenging the process, enabling others to act and encouraging the heart. To find all these attributes in a Nurse Leader is rare but Emily possessed them all. Leadership and management qualities needed First and foremost, is to finish my BSN. Next would be making the decision as whether not I want to pursue leadership at all. I believe I possess all the qualities need to be a good leader, I have led and managed people and organizations throughout my career including the past five years as an Onsite Coordinator for inpatient dialysis. The biggest challenge was not knowing

N420Report_Burke19 when the phone was going to ring, would I get called in middle of the night to solve an issue or handle crisis management on what should be my day off. The answer is no, its not something I want. My interest is more in the area of education and patient advocacy and through this class I’ve come to realize my future lies as either an Educator or a Clinical Nurse Leader. Conclusion My greatest take away from this experience was how just how much Nurse Leaders in the hospital setting must handle daily. The scope of responsibility and time demands simultaneously come from multiple directions each with a different need. Administration requires fiscal responsibility and patient satisfaction results. Staff management is a multidimensional including but not limited to hiring, scheduling, mentoring, conflict resolution, educational and professional development. And, all this is going in an acute hospital setting where in a split second a patient condition, whether it be the mother or the baby, can become critical. It’s a lot to handle and a lot to take in, and after spending 36 hours with Emily I have the greatest respect for her and a new understanding the critical, multifaceted role of Nursing Leaders in healthcare.

N420Report_Burke19 References Fischer S .A. (2016) Transformational leadership in nursing: a concept analysis. Journal of Advanced Nursing 72(11), 2644–2653. doi: 10.1111/jan.13049 Kouzes J.M. & Posner B.Z. (2008) The Leadership Challenge. Jossey-Bass, Chichester Patient Experience = Interactions Perceptions. (2019, March 29). Retrieved November 24, 2019, from https://enterprises.upmc.com/blog/patient-experience/. Porter-O’Grady T (2003) A Different Age for Leadership, Part 1: New Context, New Content. J Nurs Adm 33: 105-110. The Womancare Birth Center, Retrieved November 24, 2019, https://www.upmc.com/locations/hospitals/magee/services/labor-and-delivery Thompson J. (2012) Transformational leadership can improve workforce competencies. Nursing Management 18(10), 21–24. Welford C. (2002) Transformational leadership in nursing: matching theory to practice. Nursing Management (Harrow) 9(4), 7–11. Virkstis, K., Herleth, A., & Rewers, L. (2019). Closing Nursing’s Experience-Complexity Gap. The Journal Of Nursing Administration, 49(12), 580–582.

N420Report_Burke19 NURS 420 External Leadership Experience Written Assignment Rubric

Possible Points

Provide background information on the individual selected (Name, Title, Educational history, Work experience, Work experience at healthcare agency)

10

Student selected individual for practicum experience Discuss what leadership and management qualities the individual feels are required for the position he/she is in; discuss how the individual attained these qualities and is continuing to advance these qualities.

5

Individual’s leadership and management style analysis using evidenced based research.

15

Leadership and management concepts observed/experienced during external experience (minimum of 5 concepts) *Identify, define, and discuss leadership and management concepts with examples of leadership and management concepts. Analysis of leadership and management concepts from perspectives of literature and/or evidencebased best practice. 7. Leadership and management qualities

50

5

Student Points

N420Report_Burke19 student needs to attain/advance for this position. 8. Grammar, Spelling, APA Format and Organization a. Grammar b. Spelling c. APA format d. Introduction, body and conclusion with use of headings and/or subheadings e. assignment named according to assignment guidelines Total: COMMENTS:

15

100...