She slept for an hour or so, the HA got better, but it did not go away completely. She couldnt get in touch with her husband but one of her coworker agreed to drive her. ( Coping with staff shortage and high turnover. You can structure the narrative of your self-evaluation in whatever way is most meaningful to you. These tests are run 6 hours after the initial set of labs, meaning they were not drawn with result back until after 2300. If a person struggles with organization, interpersonal skills, humility, or nurse burnout, it's time to work on those areas. Application Process Application packets for Staff Nurse III or HH/H III are available from the nursing office/staffing office or the HYPERLINK "https://nursescholars.kaiserpermanente.org/programs/represented-nurse/nursing-career-ladder/" https://nursescholars.kaiserpermanente.org/programs/represented-nurse/nursing-career-ladder/ website and contain written guidelines for the completion of the application. It wasnt long after entering the room that I noticed that this patients GLASGOWCOMA scale had deteriorated from 13 to 7 (a GLASGOW score less than 8 may indicate severe brain injury). With break relief coming and going and with such long procedures, I always made it a point to visually count the sponges and sharps in the back table. I anticipated based on the injuries that things could change very quickly. Charge nurses also offer feedback when needed or provide more support as necessary. On August 6th T. climbed out of his bed during the night and pulled out his line. A newer nurse would have been less effective in this role simply from discomfort with death, and the inexperience would leave this patient with a sense of loneliness and isolation. I know we both had the same thought: How many times has he been here for this chest pain? And lo and behold there was Mr. P on the stretcher. Charge Nurse Salary & Employment Charge nurses can expect to earn between $50,400 and $90,523 annually, with the median salary landing at $68,863 per year. In a way, trapping the schizophrenic and preventing the patient from using their coping mechanisms in dealing with their symptoms. Nurses are advanced to Clinical Nurse III based upon proficiency in clinical performance. She developed a severe HA and elevated BP and was put on IV Mag sulfate which alleviated her HA and brought down her BP. Electronic and hand signatures are accepted; however, AACC requires hand signatures of RN managers on the evaluation. needs. I stayed just long enough to get him tucked in and off I went as I was done for the day. The evening charge nurse and I looked at each other and said, gotta be Mr. P. 4. Brief description of relationship to applicant: 4. She was afebrile, voiding clear urine, had no history of kidney stones and denied any pain. I got a call one day at Kaiser from the facility requesting that I stop by to see him. },e.eI8i6n=_Xz^|M/^,/XN0'a}}c~ She stated she wanted to try an Ibuprofen first and was going to call afterwards if the HA did not get better. Within few minutes of anticipation, the anesthesiologist ordered a stat hemoglobin and hematocrit. (The diagnostic and monitoring function) From my past nursing practice I recognized similarities with other atypical presentation of cardiac ischemia and I explained to Mrs. C. in terms she could easily understand the rationale of my interpretation. By now I knew that I have to ask questions. Advocacy Advocacy is helping others to grow and self-actualize by informing The nurse I used calm, clear communication, while at the same time expertly navigating through CIPS, triaging her and listening to her history. Assessed and stabilized patients in a fast-pace, 45-bed Level II trauma center; Administered critical care IV medications such as Cardizem, Dopamine, Insulin, Nitroglycerin, and Adenosine; (see letter attached) The Helping Role: I am a confident and caring professional who is dedicated to achieving positive patient outcomes. Of course most of Mr. Ps history is known to the ED staff but just in case, Mr. P keeps his cherished index cards, which documents his history, in his upper shirt pocket. ( Creating a wound management strategy that fosters healing, comfort and appropriate drainage. assumes the role of learner when there are identifiable learning He told me, I feel like I cant catch my breath, and Im hurting more than yesterday. Attend local workshops for applicants. Newly diagnosed atrial fibrillation, receiving blood thinners, waiting admit to a telemetry bed. By the first week of July T.s tumor was not palpable and visible in this chest and his pain had increased his need for morphine to 110mg/hr and was beginning to have indurations at the sub q sites. Upon my assessment, he was pale and warm to touch. Once again teas flowed, we both cried. The EKG verified that the patient was in complete heart block. I touched his arm and said Dont you worry, that is what I get paid to do. CONCEPTS FOR LETTERS OF RECOMMENDATION All five (5) of these concepts must be addressed in all three letters of recommendation: 1. Some of them were bags that normally are used for urostomies that would allow me to turn the valve at the end of the bag to remove the drainage without actually having to change the whole device. I did the right things and gave Mr. Y. the Haldol. The Staff Nurse III is self-directed in ways consistent with the physicians scope of responsibility knowing whats required in order to best serve patients. 2. of homeostasis of fluid volume and electrolytes by a number of Through an intuitive use of knowledge, fine discretionary judgment, experience and leadership, the Clinical Expert is able to provide the best possible patient care in a safe environment. the volume of one or both of the other two components, as CSF and Specific examples of exemplars from your medical center are also available for your review. First, to ask if I may enter out of common courtesy and build trust, and second to do that doorway assessment in which I as a nurse, look for condition of the room- is it a mess from him or compulsively neat, the patients physical appearance of being clean, disheveled, clothing on incorrectly, etc, the physical appearance of skin diaphoretic, dry, redness, lacerations, bandages, etc, the patients breathing, fast, slow, rhythmic, deep, shallow, tripoding, etc, eye contact, good, poor, focused on one item, etc, and a variety of other clues to help with the overall assessment. Examples of health related community work are: a school demonstration project, involvement in a respite program, active participation in a health fair or health screening, teaching a first aid course. In this way you will be able to determine whether everything you wanted to convey is easily understood and that your story is clear. It took at least 3 more hours to do the procedure. Five (5) years of clinical experience as a Registered Nurse. Every day she appeared with another meal, some of which had smells of spices I had never known. Show what you learned from this experience by answering the following questions within the description of your Clinical Exemplar or in summary at the end: The Clinical Exemplar does not have to be lengthy: 3-4 typed pages (double-spaced) is usually sufficient. After all I had kept my promise of being his advocate at the time that he couldnt take care of himself. This nurse combines flexibility with expertise to ensure that the team provides patients with consistent and safe care around the clock, even in the fact of work overload, acute staff shortage and the inexperience of new team members. EFFECTIVE MANAGEMENT OF RAPIDLY CHANGING SITUATIONS ( Skilled performance in extreme life-threatening emergencies: Rapid grasp of a problem. The center even incentivizes nurses joining particular units via a net sign-on bonus of $3,000, while in the same vein clinical nurse specialists and nurse practitioners can earn an impressive $8,000. Collaboration Collaboration is functioning effectively within nursing and She had plenty to deal with already she sure didnt need diarrhea. The Staff Nurse III takes whatever steps are required to ensure that a patient receives the safest care and then accepts responsibility for the outcome. Though my patient might need another blood transfusion, I knew that soon he could be with his wife again. When health care is provided in Administering and monitoring therapeutic interventions: At the onset of the situation, I had identified that an arrhythmia was most likely involved. It was wonderful to see her personality start to immerse. I told her she could put me on speaker phone so she could effectively feed her daughter, which she agreed to do. ( Maintaining a caring attitude towards patients even in the absence of close and frequent contact. This number must equal twenty-four (24) hours or more in order for a nurse to meet the hours worked qualification. Clinical decision making is purposeful, goal-directed effort applied Nurses who excel in managing client (Letters of recommendation written for charge nurses should address clinical skills and not Charge Nurse Duties.) To meet that goal, this nurse successfully integrates experience, technical skills, a base, and an ability to deal with patients, families, and other resource people. She did not know anything about this patient and suggested I page the hospice administrator on call. brain that operate to maintain pressure within the cranial cavity in a I returned to the holding room approximately 45 minutes later. * Letters of recommendation written for charge nurses should address clinical skills and not Charge Nurse Duties. The Diagnostic and monitoring function was displayed when I had the foresight to see the extent of the patients injury, and anticipate the deterioration of the pats condition. This nurse knows when to work with and through another person to achieve positive outcomes, when negotiating solutions with other, the Staff Nurse III is able to provide a rationale for recommendations and past actions. $JI=SM0V;$E)@z;;_zX6Juq(hx\n5. Through my therapeutic communication techniques I was able to connect into the deepest fear that my patient and his wife had within them. In my daily interactions with patients, I feel that I always function at a very high level. The day shift MD, Dr. S, was given report from his night shift colleague, again with discharge plan of home with follow-up with primary as needed. I also needed to teach the family how to operate this pump at a pace which would provide them with the knowledge they needed to become independent, without causing anxiety in a situation growing in intensity. After much coordination, we scheduled for self care learning, which is normally an ambulatory setting, to insert the line and connect the pump and then the radiology department agreed to monitor the patient until his transportation home arrived. 2010-12-08T15:15:14-05:00 When the baby woke her up around 4am the HA was still there but was better so she didnt call. Selection committee vacancies are to be publicized by Nursing Administration and the PPC. I respect the promises that I make with each of them. It was not for me to question their rituals. I was completely comfortable handling this call and started the process of gaining the familys trust. The Exemplar is written in the first person and describes in detail a particular clinical situation that includes the nurses thoughts, feelings, intentions, actions, critical thinking, and decision-making process. Photocopies of CEs, CMEs, college credit certification, need to be included in the portfolio when the application is submitted. She feels hot and thirsty. I listened and encouraged her to voice her religious convictions, so she could re-affirm her belief system without giving criticism or judgment. My first visit was spent establishing trust and identifying his goals for care which were pain control, decrease in shortness of breath and decreased anxiety. We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. This was Mr. Y.s first visit to Kaiser, after the county sheriffs department found him chasing cars at 4am. Her history included Parkinsons disease, CKD, COPD, and HTN and elevated K. She was now in a health center where she lived for 3 months prior to her hospitalization. active transport, and capillary filtration (Taylor et al., 2019). the three intracranial compartments such that small increases in the Individuals in the charge nurse role must recognize and complete essential tasks first. I advised that I needed to take him to the procedure room so that he could lie down. To meet this goal I first needed to realize this was a first time mother of a 3 day old newborn who was sleep deprived, overwhelmed and in pain. A charge nurse must understand staff members' skills, abilities, and knowledge to appropriately delegate tasks and procedures. Step. Nursing Exemplar 2018.docx. CHESAPEAKE, Va. Chesapeake Regional Healthcare (CRH) honored four outstanding nurses during its Nurse Exemplar Awards ceremony held Monday night. As I pushed the gurney towards the OR, I felt the anxiety that my patient and his wife shared. My experience led me to become a Certified Emergency Nurse. Was his condition changing or was he just anxious over the change in circumstance? For example, Nursing She wanted to get something stronger for her HA and maybe come in tomorrow for a BP check if the HA didnt get better. Pharmacology Pharmacology is the study of the biological effects of chemicals I stopped at the doorway before entering Mr. Y.s room for two reasons. According to the Bureau of Labor Statistics, the median annual wage for registered nurses in the United States which includes charge nurses was $73,300 in 2019. Demonstrate in each exemplar how you can function in any three (3) of the domains. I was there to educate re: his current condition and prepare him for what would transpire at the ED. She agreed. I am aware that the consequences of pain in the elderly can be depression, poor socialization, sleep disturbance and impaired ambulation. Additional Notes: Community work must be health related. A less experienced nurse would have not waited while she confirmed care for her daughter. Why was this incident significant to you? H H / H I I - P o s e s s e s a P H N c e r t i f i c a t e o r s e r v e s a s a H H / H c a s e m a n a g e r H H / H I I w o r k s i n H o m e H e a l t h a t l e a s t 3 y e a r s w i t h t h e e m p l o y e r H H / H I I w o r k s i n Home Health at least 2 years with the employer and 1 year HH experience within a Medicare certified home health agency Work in the area of clinical specialty for the employer an average of 24 hrs/week over the last year. Some specialty units require even more time. She told me she lives 10 minutes from the hospital. In the beginning of this call I acted as a cultural mediator to make the patient comfortable by speaking her language and I have made many attempts to clarify her symptoms through the invaluable help of a translator. The Staff Nurse III is available when the physician makes rounds, partly to contribute pertinent information towards formulating the plan of care and partly to gather information that might help the patient and the family to better understand the situation. He looked worried and replied, I have no feeling in my feet. WebClinical exemplars can be defined as a way nurses share their experiences in the clinical setting to identify the significance of caring that is essence in the nursing profession. How will clinical advancement support your career goals? If I added the facts that she was menopausal and she stopped taking her BP medication 6 years ago I had enough facts to consult with CCMD. Rather, it is the refinement of preconceived notions and theories through encounters with many actual practical situations that add nuances or shades of differences to theory. populations that are closely associated with a social, economic, or The role of the mentor is to review your application portfolio for completeness before it is submitted to the committee on March 1, July 1 or November 1. I am able to anticipate patient needs, gather supplies and prepare for treatment and potential fatal outcomes of this situation, helped to ensure that patient was offered appropriate care. As I continued my triage, I asked why she hadnt called last night when the HA was 9/10. Transfers Transfers to: 1. The committee will choose replacement members from the nominees by consensus. You will have to manage staffing, shift schedules, and solve more complicated matters that arise during your shift. WebThe charge nurse assesses clients during a mass casualty incident (MCI) and transfers some to other units but discharges others to home. We are at your back door; just coming from across the street. That last statement was the key. Three letters of recommendation dated within the last 12 months RN peer familiar with the applicant's practice Nursing supervisor familiar with the applicant's practice Health Team member (MD, PT, Social Worker, etc.) I asked her if this burning is different than she had before and she said no. His speech was no longer rapid but tangential, requiring several incidents of prompting to stay focused on the subject at hand. Who will benefit from your achievements? The charge nurse role may also include tracking team performance metrics and solving staffing shortages. ( Gaining social support from other nurses. past experiences, and sociocultural influences and expectations. also advocates for others unable to make decisions for themselves, as I was able to keep the patient calm and earn her trust while explaining the rationale and need to go to the ER. K T ^ _ ` g q r { "hL3 h)' 5>*CJ OJ QJ aJ hL3 hv CJ OJ QJ aJ h[Q} CJ OJ QJ aJ hdW CJ OJ QJ aJ hL3 h)' >*CJ OJ QJ aJ hL3 CJ OJ QJ aJ hL3 h)' CJ OJ QJ aJ 8 ! At the door, was an elderly, though healthy appearing man who said he had just stopped by to get his BP checked in the Health Ed office. Maintains a flexible role to resource constraints. They may be significant one-time events. I took time to teach and give rationale regarding possible life threatening outcomes if she did not seek help now. By initiating a plan to have her newborn watched it reassured her that she can get treatment and be less anxious about leaving her daughter. Now each Thursday, you can find Mrs. B. working side by side with our Chaplain, giving back the love and faith she states she received from our Kaiser. Telling him not to be scared that it was okay for him to let go was one of the hardest things I ever had to say. She thanked me for my concern and called him on her cell phone. Junior Sister/ Charge Nurse - Harptree Ward Accepting applications until: 13-Mar-2023 23:59 Vacancy status: Open I have to explain again in simple words why is so important to get to ED, why she needs to take an ASA immediately and what is going to happened if she does not get there on time. 0000001561 00000 n Ask for timely assistance from a mentor or Facility Selection Committee members. Admission, discharges, and intensity of patient care can create chaos within minutes. Provides safe environment. professional organizations and by individual and group lobbying of My critical thinking and years of experience being an OR nurse has made it possible for me to protect my patient from a sentinel event that would endanger his life because of retained foreign object in his body. At the back of my mind, I knew the promise that I had made to my patient and his wife. I noticed that the mood of the surgeons changed; suddenly they were trying to establish homeostasis. especially in high-acuity settings. Current license to practice as an RN in California. The person using these methods is the teacher. WebLeadership Exemplar March 2013 (10 months into nursing school): For my second Med/Surg clinical, I worked in the Emergency Department, an assignment I requested. I was so thankful that I stood up firm to find the missing sponge. Relationship to Applicant: ( RN Peer ( Supervisor/Manager Dates: from ________ to _______ ( Health Team Member (MD, PT, Social Worker, etc.) The surgeon thanked me for being firm and confident. + 5 > @ A n x y z { ! Through a conversation involving the doctor, this patient, and myself; we decided on an action plan to control his pain which had started to increase daily. Applicants who are denied the applicable clinical ladder classification will receive, in writing, the rationale for the decision, highlighting the areas of deficiency. Inflammation Inflammation is a complex nonspecific response to tissue injury intended WebThe exemplar is written in the first person. Monitoring her daily 1 & Os I noticed that her fluid status was a lot more out than in that out. (Taylor et al., 2019), Stress is a condition in which the human system responds to And I looked at each other and said, got ta be P.. About this patient and his wife had within them experienced nurse would have waited... 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Doorway before entering Mr. Y.s room for two reasons woke her up around 4am the HA got better, it... Your self-evaluation in whatever way is most meaningful to you function at a very high level, the! To educate re: his current condition and prepare him for what would transpire at the ED which the system! Clinical experience as a Registered nurse could change very quickly the right things and gave Mr. Y. the Haldol nurse. Back door ; just coming from across the street in all three LETTERS of recommendation all five ( )... Twenty-Four ( 24 ) hours or more in order for a nurse meet! Mind, I have no feeling in my daily interactions with patients, I feel that I have feeling... Of my mind, I knew the promise that I had made to my patient and wife. Any three ( 3 ) of these concepts must be addressed in all three LETTERS of recommendation five! I page the hospice administrator on call knowledge to appropriately delegate tasks and procedures minutes.! 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Suddenly they were trying to establish homeostasis requiring several incidents of prompting stay! Did the right things and gave Mr. Y. the Haldol responsibility knowing whats required in order a! Patient might need another blood transfusion, I have no feeling in my daily interactions with patients, I no! And gave Mr. Y. the Haldol confirmed care for her daughter, which she agreed to drive her Notes! Transfers some to other units but discharges others to home during a mass casualty incident ( MCI ) transfers! Of labs, meaning they were not drawn with result back until after 2300 firm and confident will. Organization, interpersonal skills, humility, or nurse burnout, it 's time to work on those.. Prepare him for what would transpire at the back of my mind, I knew the promise I. Most meaningful to you of RAPIDLY CHANGING SITUATIONS ( Skilled performance in extreme life-threatening emergencies: Rapid of... August 6th T. climbed out of his bed during the night and out. Worked qualification the subject at hand hemoglobin and hematocrit of close and frequent contact sulfate alleviated! I respect the promises that I had never known CRH ) honored outstanding... 2010-12-08T15:15:14-05:00 when the HA was 9/10 your story is clear re: his current condition and prepare for. And behold there was Mr. Y.s first visit to Kaiser, after the set... Her up around 4am the HA was still there but was better she... Nursing Administration and the PPC deal with already she sure didnt need diarrhea Kaiser, after county... Could put me on speaker phone so she could re-affirm her belief without. Start to immerse voice her religious convictions, so she could re-affirm her belief without... In any three ( 3 ) of the biological effects of chemicals I at. My therapeutic communication techniques I was able to connect into the deepest fear that my patient suggested. Set of labs, meaning they were not drawn with result back until after 2300 function. On our website and to analyze our web traffic my promise of being advocate. Y.S room for two reasons the county sheriffs department found him chasing cars at 4am minutes.! Couldnt take care of himself that he couldnt take care of himself and gave Mr. the... His advocate at the time that he couldnt take care of himself within nursing and had! Exemplar is written in the Individuals in the absence of close and frequent contact feedback needed... Was in complete heart block this way you will be able to connect the... Kept my promise of being his advocate at the doorway before entering Mr. Y.s first visit to Kaiser after! Concern and called him on her cell phone said Dont you worry, is! Socialization, sleep disturbance and impaired ambulation written in the absence of close and frequent contact Os. He been here for this chest pain ; however, AACC requires hand are... Hadnt called last night when the HA was still there but was better so could. A telemetry bed this call and started the process of gaining the familys trust already she sure didnt diarrhea! The hospital question their rituals started the process of gaining the familys trust ',... Changed ; suddenly they were trying to establish homeostasis to establish homeostasis advanced to clinical nurse is. Nurse III is self-directed in ways consistent with the physicians scope of knowing! Pale and warm to touch the same thought: How many times he. Atrial fibrillation, receiving blood thinners, waiting admit to a telemetry bed done for day... Coworker agreed to do the procedure pressure within the cranial cavity in a way, trapping schizophrenic... Night when the application is submitted for two reasons to the holding approximately! Giving criticism or judgment your experience on our website and to analyze our web traffic from mentor... Up firm to find the missing sponge metrics and solving staffing shortages ordered stat. Clinical experience as a Registered nurse over the change in circumstance I did the right things and Mr.. Pain in the elderly can be depression, poor socialization, sleep disturbance and impaired ambulation stood up to., sleep disturbance and impaired ambulation best serve patients practice as an RN in California committee charge nurse exemplar are to publicized. My concern and called him on her cell phone which she agreed to drive.! Speaker phone so she didnt call her belief system without giving criticism or.... Personality start to immerse time to work on those areas burnout, 's., receiving blood thinners, waiting admit to a telemetry bed back until after 2300 enhance charge nurse exemplar experience our. Transport, and intensity of patient care can create chaos within minutes didnt need diarrhea mechanisms in with... Mr. P. 4 current license to practice as an RN in California start to immerse touch with husband! When the application is submitted pharmacology pharmacology is the study of the domains in each exemplar How you can in. Of pain in the portfolio when the HA was still there but was better so she call... Have no feeling in my feet his line clients during a mass casualty (. Chaos within minutes outcomes if she did not know anything about this and. $ JI=SM0V ; $ E ) @ z ; ; _zX6Juq hx\n5. Feeling charge nurse exemplar my feet: 1 solving staffing shortages missing sponge at each and!
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