Leadership Journal Inventory

1. * During clinical experience, examine & COMMENT on the job descriptions of various members of the nursing staff. 

During my clinical experience at Mount Sinai Brooklyn, I observed various members of the nursing staff working together to help patients. The nurses I interacted with during the practice were all registered (RN). Their responsibilities as described in the job description cut across monitoring patients, administering medications (non-intravenous), keeping patient’s records, consulting with the physicians and other healthcare providers, and educating patients. Nurses at Mount Sinai Brooklyn were also tasked with monitoring patients and recording critical signs and symptoms and any slightest change in the patient’s condition. Other responsibilities of nursing staff at the facility included planning, implementing, evaluating the patient’s care plans, collaborating with other health care teams, and modifying the treatment plan based on the responses and overall conditions.

Qualification required of the registered nurse (RN) at Mount Sinai Brooklyn, based on the adverts and memos I came across during my time at the facility, included a bachelor’s degree in nursing and a state license (passing the NCLEX-RN examination). The two were essential requalification for nurses at the hospital. Other requirements included the ACLS-certification, effective communication skills, and friendly attitude, essential when interacting with the patients and their families. There was no emphasis on a master’s degree, even though it was considered an added advantage for any institution’s job application. Most of the nursing staff were passionate about their job, friendly, and easy to interact with, suggesting that they met the majority if not all the job requirements specified in Mount Sinai Brooklyn job description charter. For instance, they could hold a long chart with patients, and most of the clients were happy.

• * During the clinical experience, participate in a group activity or co-lead pre/post conference CRITIQUE

During my clinical experience at Mount Sinai Brooklyn, I participated in morning rounds in the nurse’s office, where the nurse manager went through the list of patients admitted on the floor with the charge nurse. As for the group activity, I worked alongside three other interns in an intensive clinical care section attending terminal cancer patients demanding complex requirements. We answered the patient’s call button and worked collaboratively to ensure the safety of our patients. Active communication with the patient was essential for terminal cancer patients, and we applied this to assist our patients to express their feelings. For example, in one instance, our teams engaged a kidney cancer patient on a one-on-one step in making a paper art for the family to express his appreciation. The patient successfully created a beautiful art out of a photocopier paper, and he felt happy and motivated.

The interns were encouraged to ask questions and search for answers when they were not sure about information, reporting the search findings to the clinical preceptors. The aim for constant learning, querying, and searching for answers was one way to ensure that the nurse students fully understand the critical fundamentals of knowledge and performance necessary to attain a satisfactory rating in the clinical practicum. Besides, the standard of practice and performance was set for us every day, which increased throughout the training as the interns approach the terminal outcome.

Every intern was briefed on the mode of assessment and expectation as required by good nursing practice that learners understand how they are assessed. Understanding the assessment’s expectations and the evaluators’ requirement for improved performance is vital to improving one’s score during the practicum.

• * During clinical experience, observe leadership behaviors demonstrated by nursing leaders.  CRITIQUE AND CITE

Learning and leadership are indispensable in nursing practice. The nurse leaders, during my clinical experience, demonstrated diverse leadership behaviors. The nurse leaders inspired us to work collaboratively to pursue common goals, including enhancing patient care and gaining the practical knowledge to complement our nursing practice. An effective nurse leader must pose a distinctive set of personal traits, including integrity, emotional intelligence, critical thinking, social and communication skills, initiative, commitment to excellence, and, most importantly, respect for other staff. The nurse must also be confident to drive change in the care facility and exhibits nurse practice every time (Cline, 2015).

The nurse leaders worked closely with the interns to challenge tasks through mentoring, helping us develop emotional intelligence. The trainees received enough support to manage stressors caused by routine problems in the care facility. Grossman and Valiga (2020) write that an effective health care system demands that nurses, physicians, patients, and other stakeholders play independent roles to enhance care delivery. Challenges arise daily that do not have singular or easy solutions. As such, leaders whom only five orders and others to follow may not succeed in today’s complicated health care (Grossman & Valiga (2020). Nurse leaders must work with others as full-time partners in the context of collaboration and respect. A vital element of this socialization or relationship is mentoring others, particularly the less experienced nurses along the way (Ramseur, Fuchs, Edwards, & Humphreys, 2018).

During my clinical experience, experienced nurse leaders took their time, explaining the most effective approaches to becoming an outstanding nurse at the bedside, in the meeting room, and in any professional aspect. I did not experience workplace bullying and disruptive behaviors during my time in the organization, which I feel is attributed to partnership and collaborative working relationship among the experienced and less experienced staff. Improved teamwork, nurse retention, and inter-professional collaboration, which are essential factors for improving job satisfaction frequently are not standard norms in the health care field according to study Ramseur, Fuchs, Edwards, & Humphreys, 2018), which makes me conclude that working relationship at Mount Sinai Brooklyn Hospital is at its level. Employees were satisfied with their job most of the time, with improved patient outcomes and high staff retention. I would also like to work in the same hospital in the future.

• * During the clinical experience, ascertain how work assignments are made or assist clinical faculty with making clinical assignments. CRITIQUE

This section helps the clinical faculty with making clinical assignments. Since the faculty is adopting a teaching approach that emphasizes self-directed learning (SDL) and adult learning theories, the best way to make a clinical assignment is to let the students self-select clinical assignments. In self-selecting clinical assignments, students should arrive at the clinical facility or hospital in the morning of the scheduled experience. This follows by reviewing unit data provided by the instructor and speaking with the nurse leader in charge of the patient’s interest in assessing. Once the students select the patient, which should be a minimum of 2 patients in every assessment, they should review the patient’s medical records, documenting the ward number and initials on the team assignment sheet posted in the station.

The nurse leader from the faculty in charge of the groups should be available on the phone, if assistance is required, for questions concerning the assignment, and review the assignment for its relevance before starting the clinical experience. The nurse instructor changes the assignment if there is a feeling that it does not help meet the student’s learning needs. The instructor must also verify the assignment objectives with other faculty staff concerning the activities and clinical goals that the learners should focus on in every clinical experience.

• * During the clinical experience, observe & COMMENT on the delegation of client care. CITE

Delegation often entails the assignment of tasks or activities related to patient care to unregistered or unlicensed assistive nurses while the registered nurse retains accountability for the patient outcomes. The decision making deal concerning the responsibilities to delegate relied upon the registered nurse but strictly following the state’s nursing practice laws and other guidelines provided by the “American Nurses Association (ANA)” and the “National Council of State Boards of Nursing (NCSBN).”

Nurse practice rules give the registered nurse the authority to select tasks and situations to delegate or assign work. However, the decision should be based on a thorough assessment of the assistive personnel’s desired outcome and competency. The patient’s needs, the staff’s skills and position description, the health care facility’s procedures and policies, and the legal facets, including the state’s scope of health care and nurses and assistants mode of practice, are all factors for consideration when delegating (Gravlin & Bittner 2010). The “Five Rights of Delegation” applied in all the decision makings concerning delegation of task.

The 5Rs of delegation in nursing requires that the “right person must be assigned to the right tasks and jobs under the right circumstances.” After it is established through assessment that the RN can delegate, the RN must then communicate with assistive nurses, directing them to complete the task. The communication should be two-way traffic, where the RN assesses the assistive nurse’s level of understanding of the assigned tasks and advising where necessary (National Council of State Boards of Nursing. 2016). The assistive nurse is expected to ask questions and seek clarifications concerning the assigned task and expectations.

• * During the clinical experience, evaluate how information is communicated between shifts.  CRITIQUE Ie. Change of shift report. CITE

Transfer of vital information and duties for patient’s care during the shifts from one nurse or physician to another is a fundamental communication element in the health care setting. This essential transfer process is called the handoff and facilitates the transition of critical reports and continuity of the treatment and care processes (Birmingham, Buffum, Blegen, & Lyndon, 2015). Mount Sinai Brooklyn hospital adopted the “SBAR (a situation, background, assessment, recommendations)” model, a standard reporting process, which provides a communication framework between the healthcare providers concerning the patient’s condition. SBAR provided an orderly and structured method of transmitting correct, critical, and crucial data in developing patient situations and routine handoffs (Ting, Peng, Lin, & Hsiao, 2017).

The transfer of report began by the nursing handing-off describing the clinical situation in a standardized format: “I am (nurse name) on the ward (x) calling about (patient name) because (reason).” This is followed by a detailed description of the background information concerning the situation based on the patient’s medical records and progress. The nurse also had to provide a thorough assessment of the patient at hand and, lastly, recommending the possible steps essential for improving the patient’s condition (Ting, Peng, Lin, & Hsiao, 2017). The adoption of SBAR during the change of shift report provided a meaningful and effective approach to transfer duty and accountability of patient care, reducing chances of errors during the process, and building team cohesion.

References

Birmingham, P., Buffum, M. D., Blegen, M. A., & Lyndon, A. (2015). Handoffs and patient safety: grasping the story and painting a full picture. Western journal of nursing research, 37(11), 1458-1478.

Cline, S. (2015). Nurse leader resilience. Nursing Administration Quarterly, 39(2), 117-122.

Gravlin, G., & Bittner, N. P. (2010). Nurses’ and nursing assistants’ reports of missed care and delegation. JONA: The Journal of Nursing Administration, 40(7/8), 329-335.

Grossman, S. C., & Valiga, T. M. (2020). The new leadership challenge: Creating the future of nursing. FA Davis.

National Council of State Boards of Nursing (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14.

Ramseur, P., Fuchs, M. A., Edwards, P., & Humphreys, J. (2018). The implementation of a structured nursing leadership development program for succession planning in a health system. JONA: The Journal of Nursing Administration, 48(1), 25-30.

Ting, W. H., Peng, F. S., Lin, H. H., & Hsiao, S. M. (2017). The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department. Taiwanese journal of obstetrics and gynecology, 56(2), 171-174.