Competencies

Competencies

Executive Summary

            My clinical preceptorship occurred at XXXX hospital telemetric unit. The patient population on the telemetric unit constitutes adults with critical conditions on the monitoring services. The five patients offered opportunities for learning and constant practice. As I finalized the 130-hour clinical requirement, I was able to meet the Nurse of the Future Core Competencies outlined by the Massachusetts Department of Higher Education and the Massachusetts Organization of Nurse Executives (Massachusetts Department of Higher Education, 2016).

The ten Nurse of the Future Core Competencies were developed with the motive to epitomize the minimum anticipations for nurses when they finalize their pre-licensure education. The competencies involve the perceptions, knowledge, and skills that new nurses should be capable of including into practice to offer competent care in the present health care setting. It was a reality that I integrated these competencies when liaising with patients, members of interdisciplinary teams, and nurses (Massachusetts Department of Higher Education, 2016).

The purpose of this paper is to outline the knowledge, attitudes, and skills that I have demonstrated for each of the Nurse of the Future Core Competencies throughout my preceptorship. These competencies consist of patient-centered care, professionalism, leadership, systems-based practice, informatics and technology, communication, teamwork and safety, quality improvement, and evidence-based practice. In the entire paper, every competency is approached separately with a vivid description offered by the Massachusetts Department of Higher Education and the Massachusetts Organization of Nurse Executives preceded by specific illustrations from my preceptorship that validate my understanding and use of the competency.

Teamwork and Collaboration

On this first day of my preceptorship, I had the chance to work with my nurse and help her with five assigned patients in the unit. There was one particular case of a male patient, Mr. G, admitted with cognitive issues and weakness resulting from a fall at his home. He had trouble walking and getting out of bed, and this made him irritated. On seeing that he did not want to be bothered much, we decided to ask for help in getting him up to make the patient less irritable, happier and willing to work with us to finalize our assessment. We opted to ask PT and OT for help, who agreed to see him shortly that very morning as my nurse informed me. The PT and OT helped the patient stand and move out of bed while we finished our assessment and went further to take a look at his skin, which revealed a lot of scratches on his back. My nurse was able to put him in for dermatology consult to look at his skin. From all the efforts put in by various professions in working together to help Mr. G ambulate, take a good assessment and time needed for him to collaborate with us, I observed that teamwork and collaboration as a part of the nursing of the future competency were applied. My nurse and I were able to experience this competency because we were able to gain the knowledge and help from PT and OT on how to manage the patient’s care regarding ambulation.

The nurse of the future states, “Uses knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served” (MDHE, 2016).

I also learned that to implement great patient care; you need to use help from other team members on the unit or other professions that are in the hospital. The help from others and their input can really make an impact on how you manage your patients’ care and needs. By working with PT, I was able to see better ways to help Mr. G out of his bed and to help motivate him to cooperate. We were successful at this because we had help from PT and OT, which clearly shows how effective team work and collaboration can be.

Informatics and Technology

My nurse and I were on a routine duty to check on a different patient when I observed the presence of blood on Mr. G as he held a tissue to his antecubital area of the arm. I quickly informed my nurse that Mr. G had pulled out his IV, and together we acted quickly to stop him from bleeding further and added pressure to the site. On realizing the patient did not like it, we took the time to explain to him that he was in the hospital and why he needed the IV in place, and that it is hospital protocol for every patient to have IV access. Once the bleeding stopped, my nurse used Versa, a small handheld phone used to communicate in hospitals by staff directly, to talk with the IV nurse and get a new IV access for the patient. After explaining the incident to the IV nurse, the problem was sorted out within no time. We then put IV netting over the IV to help prevent another incident.

The nurse of the future states, “Appreciates the use of electronic communications strategies in the delivery of patient care” (MDHE, 2016). This competency was seen when my nurse called the IV nurse to replace IV access on the patient without having to go far or find alternatives. The device enables easy communication between different professions within the hospital.

I learned that using informatics and technology within the nursing practice can be very helpful for the nurse in obtaining assistance, retrieving information about a patient, talking with other medics.

Evidence Based Practice

This particular day saw my preceptorship take a different turn from the normal daily routine with the five assigned patients as we handled Mr. M, who had come from the cath lab and had a right and left block that was stented and was on heparin drip as well. I had followed hospital protocol, check his vital signs at an interval of every 15minutes to monitor his heart to ensure no bleeding was taking place, and chart it. My nurse would then sign it. I observed my nurse interact with the patient and aspirate a little air from his bandage site to relieve some of the pressure until it was no more before removing the bandage from the incision site. We carried frequent checks to ensure there was no bleeding at the incision site. She educated me on the bandage, its importance, and its purpose. She explained that the bandage is applied to the incision site, and then 10 mL of air is put in to have pressure on the site. This is because there is a risk of bleeding when doing an artery procedure.

She also explained to me about the Nurse Driven Heparin Protocol, an Evidence-Based Practice study, done in order to help nurses monitor the drip and adjust it accordingly to the results of the PTT test without waiting for an order from a doctor. The data from the study showed better results if the nurse could monitor the heparin and adjust it herself, also for her to be able to put in an order for a PTT test for the patient for every 6 hours. The risk of patient bleeding was minimized, proving to be more convenient, easier, and safer care for the patient.

The nurse of the future states, “Uses current evidence and clinical experience to decide when to modify clinical practice” (MDHE, 2016). This competency was seen when my nurse adjusted the heparin drip by lowering it for this patient, and when she put in for a PTT test to be done in six hours.

I learned that using evidence-based practice in nursing can really be beneficial for patient care and can make life better for the patient and easier for the nurse. It can also be useful in other medical fields such as when it comes to cost, labor utilization, best procedural practices, and effectiveness of medicines. Research and data collection can lead to more efficiency and help provide the best patient care possible.

Systems-Based Practice

The patient on this particular day is Mr. V, who is in for a TAVR surgery. The nurse has time to provide proper and effective patient care as the there is an EKG technician to perform daily EKG’s on Mr. V while she ensures it is done and the EKG strip is put into the patient’s chart. As a nurse, she knows how to use resources available to her well by calling upon work resources to help implement quality and valued care. It was quite an educational experience for me as I got to see firsthand how EKG technicians performed their duties in practice. As nurses and primary caregivers, we explained to the patient the reason the EKGs were being done and that it is an EKG technician that will perform them daily and not us. We also talked to him about the TAVR procedure he was going to have and helped calm him down. The patient, in turn, was very pleasant and understanding, and it’s my belief we played our role well as therapists as well. I learned a great deal on how to communicate with patients feeling anxious and how best to go about it by saying positive things.

The nurse of the future states, “Recognizes the importance of work unit systems in providing supplies, medications, equipment, and information in a timely and accurate fashion” (MDHE, 2016). This competency was seen when my nurse explained to me about the EKG technicians and how she will use one to obtain a daily EKG for the patient. It was a good learning experience especially in time management as a nurse to give patients more time while providing effective patient care as the nurse.

Safety

The patient today Mr. H was total care and had been admitted for a fall. That means it was important to ensure his safety at all times. We had had to do frequent checks on him. I was to ensure that all the safety precautions were being implemented at all times. During one of my checks for this patient, I noticed his bed was not at the lowest level. This can be very dangerous for a fall risk patient. I applied the required standard of the procedure with a patient by greeting him and informing him of the reason I was there i.e. to check on him and lower his bed. I lowered his bed and checked to ensure everything else was in place before informing my nurse that I had lowered the bed as it was not at its lowest. She then took the step to explain the PCA (Patient care assistant) that Mr. H’s bed needed to be kept at its lowest always.

“The nurse of the future demonstrates effective use of technology and standardized practices that support safe practice” (MDHE, 2016). This competency was seen when I noticed the bed was not at the lowest point and lowered it as the standard of safe practice for fall risk patients is always to have the bed lowered at the lowest point. I learned and understood why safety competency is valued inpatient care as it lessened the chances of harm to patients who were at risk of incurring harm. And as a nurse, it is a responsibility of great value too.

Quality Improvement

The patient on this particular day was a female admitted for abdominal pain and diarrhea x5 and tested for clostridium difficile. Proper precautions had to be taken, including proper signs up, proper PPE, hand hygiene, and that items were being wiped down properly after being used in the room. The nursing of the future competency that had to be applied here is a quality improvement as the nurse will have to ensure good and quality outcomes in the care process as she uses the methods collected from data about c.diff. I ensured all precautions were being implemented in the care process and educated the patient and her family about c.diff as part of the quality improvement competency. This helps increase the safety and quality of the health of the patient as they get to learn more about the disease, its cause, effects, prevention, and treatment. I had to let them know that with c.diff, hand sanitizer is not effective, but one had to use soap and water to wash hands and clean with bleach.

The nurse of the future states, “Describes approaches for improving processes and outcomes of care.” (MDHE, 2016). This competency was seen when my nurse and I educated the patient and family members about c.diff, proper hand hygiene, and that bleach needs to be used in the cleaning process. This brought out the importance of educating people which in turn improves patient care and also keeps others safe from infections as they learn how to protect themselves. I learned that implementing the proper precautions helps protect the medical personal from possibly being infected with contagious or infectious diseases in a hospital setting. Quality improvement is important because we are always finding ways to improve what we do for the good of the patient and their health and to keep them from harm.

Communication

The patient on this day, Mr. T was admitted for a TAVR procedure. He was accompanied by his daughter, who was anxious and worried about the whole procedure as she did not know what would happen. This, we later learned, was because of her father’s chronic obstructive pulmonary disease (COPD). My nurse and I talked with her and Mr. T for a while, explaining some more about the procedure Mr. T was going to have, its benefits, and, as a frequent procedure done at the hospital, he was in good hands. My nurse used therapeutic communication to calm the daughter and put her at ease and more relaxed with her father’s upcoming surgery. The more we talked and kept reassuring her about the procedure and its benefits, the more she felt calm. To make the picture clearer, I printed out information for her about the procedure as well so she could read more on it. In the end, she was very grateful and thanked us for the time we took to help her with her worries, answering her questions, and explaining more about the procedure.

The nurse of the future states, “Accepts the role and responsibility for providing health education to patients and families.” (MDHE, 2016). The communication competency was seen when my nurse and I applied therapeutic communication with the patient and his daughter about the procedure he was going to have. As nurses, we educate families and help them feel calmer about what is actually going on with their loved one so we can achieve patient satisfaction and good outcomes.

I learned that implementing proper communication and giving the right information helped patients and their families feel more comfortable, safe, and cared for. This involves explaining to them what was going to happen, answering their questions, helping them feel at ease, respecting their thoughts, and showing concern. In the end, the outcome was incredible, resulting in patient satisfaction, happiness, and overall health.

Patient-Centered Care

My nurse was assigned a patient who had been at the hospital for about a week now. Mr. H, as we later noticed after doing a full assessment on him, was experiencing some skin breakdown on his buttocks and coccyx area though it had been noted as skin was intact and the outcome indicated he had a stage one and two pressure ulcer. It was a good learning experience as it taught me to always fully assess my patients every time even when the notes say the patient is fine. I was involved in applying proper patient-centered care and effectively using my nursing skills as my nurse and I were able to discover the pressure ulcers on our patient, explain to him about his skin breakdown and educate him on the treatment to be applied. We added to his patient care plan Calazine cream, repositioning every 2 hours, vitamin C rich diet and protein-rich diet, and monitoring of the pressure ulcers. This was to ensure he would not experience any further skin breakdown. Even though he was hesitant at first, he later complied upon realizing it was for his good. We also implemented fall precautions as well as putting the proper colored socks on him and informed him that we would check on him shortly to assess his skin again and apply more cream.

The nurse of the future states, “Assesses patient values, preferences, decisional capacity, and expressed needs as part of ongoing assessment, clinical interview, implementation of a care plan, and evaluation of care” (MDHE, 2016). The patient-centered care competency was seen here by implementing proper care to this patient, doing a full assessment, treatment, and making proper notes in his chart. Patient-centered care is about the whole care process of the patient. It has the nurse to fully take into consideration everything of the patient’s values, preferences, and needs, while doing so respects the patient to provide appropriate safe health care.

I learned that as a nurse any patient I am assigned to I would do my own full assessment to make sure nothing was missed previously or if there are any new changes in the patient. I also learned it is important to talk to your patient, to see what they prefer or if they have any specific values or cultural needs they wish to have added in their care plan.  It’s important to include them in the decision-making process as well, so they feel heard and respected, and by doing this, the nurse will have patient satisfaction and good health outcomes.

Leadership

During our normal routine check, we came across a patient who was experiencing back pain and arthritis pain. He described and rated his pain as 7 out of 10 and that he was sore when we asked him to, after inquiring whether we had some lidocaine patches and pain killer for his arthritis pain. After listening to him, we assured him we would talk to his doctor about it and see what we can do after assessing him. The assessment revealed he was having pain, which we advocated for him to his doctor. After presenting our observations to the MD, the doctor wrote an order for him for the lidocaine patches and small pain medication to help with the arthritis pain. We also advised the patient with some nonpharmacological ways to help with his pain as well. This enabled me to see the protocol involved when handling a patient experiencing pain.

The nurse of the future states, “Identifies leadership skills essential to the practice of nursing.”(MDHE, 2016). The leadership competency was seen here by advocating for the patient to his doctor about what the patient needed at the time. By doing this, we were achieving patient-centered care as well as effective communication between the patient and doctor. We were showing leadership by solving the problem for the patient after listening to him and respecting his feelings as well as letting him be part of the decision making. In the end, we had a common goal, and that was to manage his pain safely and properly.

This taught me the importance of assessing the patient so as to provide the best patient care possible. Treating pain is a sensitive issue, and proper assessment should be done, and the protocol followed. Leadership, I believe, comes in many ways in a work unit, and as a nurse, advocating for your patients is one of them as well as implementing the best care for them.

Professionalism

As my nurse and I carried out our daily nursing routine, our attention was drawn to one Mr. J, who had been admitted to the unit after he fell at home and was experiencing some cognitive decline. Apart from that, he was hyperglycemic with a blood glucose level of 500, which may have caused the fall. We also made sure to implement fall precautions and to assist him with ambulating. The plan of care for him is a consult with PT and OT. The patient showed great improvement as he was doing better and was alert and oriented x3. I made an observation on how my nurse was handling him professionally as she talked to him about his diabetes, the importance of monitoring his blood glucose, and for him to describe the events leading to his fall. The nurse of the future states, “Implements plan of care within the legal, ethical, and regulatory framework of nursing practice” (MDHE, 2016).

The professionalism competency was seen when the nurse demonstrated her skills for plan of care for the patient and showing accountability by making sure the care was implemented effectively. Also by taking into account his past medical history and the current information, proper decisions are made. I learned that being professional in nursing is important as well as practicing the best nursing standards and principles of care so we can deliver effective care to achieve positive health outcomes. These include morals, legal, ethical, and humanistic principles. There are many ways nurses show professionalism in practice to their patients by thoroughly assessing them, implementing a plan of care, and documenting the events of the shift, to name a few.

References

Massachusetts Department of Higher Education. (2016). Massachusetts Nurse of the Future Nursing Core Competencies. Retrieved from http://www.mass.edu/nahi/documents/nofrncompetencies_updated_march2016.pdf