I have been attending and performing my clinical preceptorship hours in Edinburg Regional Medical Center. I have been completing my hours with the expectation to expand my knowledge in the nursing practice in a hospital setting. While attending my clinical hours I was able to assess the agency’s scope of nursing practice, nurse to patient ratio, organizational structure, analyze the nurse’s application and decision making processes, learning proper delegation to the collaborative team, conflict resolution while following the chain of command, and developmental growth opportunities and trainings. This facility has different styles of management that helps the hospital function effectively in all aspects of patient care. This experience has helped me grow as a student nurse explore and expand my abilities to perform proper nursing care. I identified my career pathway and decision to become a Medical Surgical nurse to create a strong foundation in my nursing career.
South Texas Health System’s mission is to provide the healthcare services that patients recommend to families and friends, physicians prefer for their patients, purchasers select for their clients, employees are proud of, and investors seek for long-term results. Their vision is dedicated to achieving the highest quality of compassionate care for you and your family through innovation and advanced technology. We recognize that a philosophy of Service Excellence combined with visionary leadership is our future if we are to maintain the position as the region’s healthcare leader (STHS, The History of South Texas Health System, 1997). The objectives of South Texas Health System are to provide timely, professional, effective, and efficient service to all customers. Identify key needs and assess how well we meet those needs. Continuously improve services and measure progress, hire talented and driven people, increase skills through training and experience, provide opportunities for growth within UHS, we are committed to fairness and trust with our patients, the physicians, purchasers of our services, and employees. We conduct our business according to the highest ethical standards. Work together to provide ever-improving customer service. Our team approach supersedes traditional department organization and creates a true customer focus. People at all levels of the organization participate in decision-making and process improvement. Providing compassionate care by never losing sight of the fact that we provide care and comfort to people in need, patients and families who rely upon us receive respectful and dignified treatment at all times. Innovation in service delivery invest in the development of new and better ways of delivering our services (STHS, 1997).
The organization structure pertaining to Edinburg Regional Medical Center ranking from highest to lowest is as followed: Chief Executive Officer, Chief Operating Officer, Chief nursing officer, then House Supervisor. This system helps the facility run efficiently.
The legal scope of practice for a Registered Nurse is defined by following the Nurse Practice Act. The NPA defines the scope of practice of a professional nurse as, performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures (BON, 2013). The RN is responsible and is held accountable for practicing within the legal scope of practice. The RN may perform independent nursing actions without supervision by another health care provider. The RN should focus on patient safety and is required to function within the legal scope of practice and in accordance with state law, rules and regulations, policies and procedures. It is the RN’s responsibility to provide safe care in conjunction with compassion, comprehension and safe care (BON, 2013).
Edinburg Regional Medical Center staffs their nurses at a maximum ratio of seven patients to one nurse. The shifts are in increments of 12 hours and available for day shift or night shift. They schedule two to three CNA’s depending on census. They use a system called Shift Hound where employees are able to access their schedule from a computer or phone. This system creates schedules on a monthly basis allowing nurses to request the days they are available in advance. The staffs requested shifts are approved or denied by floor supervisor. The nurse in charge tries to assign the same patients to the same nurse when possible to promote continuation of care. A case worker is always available on the floor.
The nursing care delivery system starts upon admission. Depending on physicians orders the nurse creates an appropriate plan of care for each individual patient based on their diagnosis. The nurse sets appropriate, and measurable goals for each patient. In coordination with the interdisciplinary team the plan of care is carried out appropriately. The supplies needed to provide quality care that the patient needs are readily available on the floor and within the hospital. The hospitals electronic health system allows orders to be generated promptly. Orders are distributed to the appropriate team such as the respiratory, physical therapy, occupational therapy, speech therapy, lab, radiology, and dietary. The electronic health systems allot orders to be implemented almost instantly, and makes patient care more efficient.
The decision making process is respectively dependent on interdisciplinary team’s recommendation of action and patients response to the action. This process is used to provide the best quality care for the patient. The nurse’s role and responsibility in the process is to properly assess each patient, create a plan of care specific and appropriate to each patient, implement the plan utilizing necessary disciplines, evaluate the patient’s response to the plan and alter the plan when necessary and approved by the physician.
Delegation is important during patient care. The RN cannot provide all aspects of care for the patient independently. The RN is to follow the five rights of delegation which are: right task, right circumstance, right person, right delegation, and right supervision and evaluation to protect her license. During my preceptorship rotation I observed the RN delegate appropriately with the appropriate team members. This can be difficult as the patient is the RN’s responsibility. When a task is delegated it is the RN’s responsibility to verify the task was carried out appropriately. I also observed when tasks were not carried out appropriately, for example the RN delegated the CNA to strictly measure intake and output from a particular patient. The task was not properly performed by the CNA, and the physician went after the nurse for not having the appropriate documentation for the patient.
The importance of hospital wide communication in South Texas Health System is crucial during all aspects of patient care. It is necessary to coordinate care and integrate the function of the organization. From giving report to receiving orders effective communication is necessary. The read back system is used to prevent miscommunication. It is to verify that the information given is correct. Communication is necessary in allowing the patient to state preferences during care. When communication is impaired with the patient it is the RN’s responsibility to find an alternate way to communicate with the patient. I observed the RN refuse an unstable patient from the ER, her communication with the ER protected her license since the patient coded right after she refused. My preceptor would always use the read back system with the physician and interdisciplinary team.
The South Texas Health System has a policy to provide safe, and quality care. When a healthcare provider identifies a problem in regards to patient care and is not able to resolve the issue it is to be presented to a higher authority by following a chain of command. During my rotation I did not witness any conflicts. I asked my preceptor about the guidelines to follow when a conflict is encountered. My preceptor stated that it important to follow the chain of command when a conflict is encountered. The chain of command at Edinburg Regional Medical Center is as followed: staff member, floor supervisor, house supervisor, nurse director. Every facility has an appropriate chain of command to follow, it is important that it is followed to properly to resolve the issue.
The hospital has staff training available during orientation and developmental pathways. The purpose of the trainings at South Texas Health System is to provide an orientation process for all employees, volunteers, or have a clinical/internship experience at South Texas Health Systems. The orientation process includes a hospital orientation, and department orientation. At UHS facilities we focus on clearly defined goals that are developed to bring about exemplary patient care. We provide our employees with the structure to achieve these goals by providing advanced technological systems, processes and practice; performance improvement and patient safety standards to foster positive patient outcomes; a collaborative practice model; evidence-based nursing practice; and education and development programs to support recruitment and retention (STHS, Employment, 2016). South Texas Health System provides opportunity for growth for their employees by providing additional trainings to keep their profession up to date with new technologies and systems.
There are different ways to manage a health care facility. The management styles I witnessed during my shift were autocratic and democratic. The charge nurse was mostly democratic. She would call huddles to update the staff on upcoming admissions and asked for their input in the patients care. The charge nurse would be autocratic at times too. In her position I believe you have to be a little of both. My preceptors were all democratic they would ask for my opinion during assessments, medication administration, and patient care.
The quality management in South Texas Health System is excellent. Most of the staff would attend to the patient’s needs. South Texas Health systems has time clocks outside of the patient’s room which reminds you to go in to the patient’s room and make sure that the patient is comfortable. Safety is the number one priority in ERMC. The hospital places yellow fall risk bands on the clients who are at risk of falling in conjunction to the band they provide the client with yellow non-slip socks, and a yellow star magnet that is placed outside of the client’s door that serves as a reminder for staff that the patient is at risk for falls. My preceptor identified each patient using two forms of identification this was one way to prevent medication administration errors. Proper hand hygiene was utilized by my preceptors and most of the staff at ERMC. South Texas Health System provides sanitizer dispensers by each patient room they require staff to foam in and foam out of the patient’s room. Hand washing is important in between patients; this prevents the possible transmission of infection from patient to patient. When a patient is at risk for self-harm or states that they want to hurt themselves the hospital rapidly places the patient on a one to one care. Per protocol they remove any type of hazard from the patient’s room. South Texas Health System prevents healthcare associated infections by implementing standard precautions for all patient’s. When a patient is suspected to be infected the hospital placed the patient on contact isolation till they receive culture analysis. The staff wipes down the “WOW’s” before every shift with antiseptic wipes in efforts to prevent any form of infection from being transmitted. ERMC has developed core measures for SEPSIS, AMI, PN, SCIP, CHF, and VTE. These core measures are readily available for the staff to direct them to initiate appropriate actions which makes the process of diagnosing the patient faster.
This amazing experience has helped me get a sense of working in a hospital setting. I was able to explore my career pathway and expand my knowledge in the profession. My professional plan is to work on the Medical Surgical floor and create a strong foundation as a new RN. The Medical Surgical floor is a complex setting where I will utilize my critical thinking skills to provide quality and compassionate care to my patients. Once I gain a good foundation I would be prepared to branch out and specialize in Labor and Delivery. I plan to continue my education and obtain my BSN, MSN and ultimately become a Nurse Practitioner.