I started searching the floor and all areas of the drapes. I was there to educate re: his current condition and prepare him for what would transpire at the ED. All Selection Committee meetings will be scheduled within thirty (30) days of the applicable deadlines. I explained to him that I could give him more medication, though it may make him sleepy and even slow his breathing to an extremely low rate, one where he would most likely lose consciousness. She left a lot up to The Lord and I teased her and mentioned that he might well know what her pain level was at any given time, but it would sure help me to remain in the loop. I rechecked the pulse manually - it truly was 3040 and the pt was slightly clammy. University of Massachusetts, Boston. I suspected that the end was nearing, and sat with this patient to talk to him about his plan for the day. &. past experiences, and sociocultural influences and expectations. She said this might help stabilize the lower jaw. The American Nurses Association identifies the Five Rights of Delegation as: Leadership encompasses a variety of unique qualities, and a mindful charge nurse recognizes the difference between leading and managing. She denied having a severe HA now. I was almost finished with the dressing when the nurse began to place the NGT in the right nare. There was a bullet entry, yet no exit wound. Health Care Systems A health care system is the system a nation uses to deliver and pay for The Staff Nurse III is a confident and caring professional who is dedicated to achieving positive patient outcomes. I was always a step ahead helping everyone in the team. While waiting for the Surgery to round, I proceeded to design different ostomy bags to cover and protect the surrounding tissues and catch the toxic draining before it interfered with her skin integrity As a Would Care Champion, I used my training and expertise to design and implement would drainage collection devices. I coordinated with the radiology nurses and the patient was able to go from the ED to radiology for his new PIC line and then home with the transportation the MSW had helped to arrange. C 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. Being in this unique position enables the Staff Nurse III to interpret for the patient to the physician and for the physician to the patient and family. I checked all the instrumentations and surgical supplies with my surgical technologist. Additional letters of recommendation may be submitted in case one or more letters do not meet requirements. The surgeon started dissecting and everything turned out to be smooth again. J. denied any chest pain, swelling, fever, dizziness or heavy bleeding. The physician also asked another nurse in the room to place a Nasogastric Tube to decompress the stomach. I typed up the whole procedure in laymans terms with bullet points that were easy for them to follow, they were so appreciative. The nurse When providing comfort measures, this nurse preserves the patients dignity in the face of pain and emotional or physical breakdown. Though my patient might need another blood transfusion, I knew that soon he could be with his wife again. The letter of recommendation for advancement to Clinical Nurse III should be provided by a Clinical Nurse with at least two years of experience at BID Needham or an Advanced Practice Nurse (NP or CNS) who can speak to the applicants practice. I noticed that there were no visits, meds and labs in her file and I concluded that she was new to Kaiser. Blood loss brings about disturbance in fluid and electrolyte imbalance that could rapidly alter cardiovascular, neurologic and neuromuscular functions. I didnt want to hang up with her without knowing if her husband was able to come home in case she just decided not to come in. Performance evaluation must be at mid-point or above on average. (Norris & Tuan, 2020), Assessment Assessment is the systematic and continuous collection, analysis, Remember to go over the different charge nurse resume formats and choose the one best fits your need. It was soaked with blood that it could hardly be recognized as a foreign object. Doing the case open made it easier for the surgeon to control bleeding which lead to stabilizing the patients condition. Flexible charge nurses maintain stability in the unit and treat nurses as individuals, accommodating different work styles. perception, attention, comprehension, and memory. Verification of Hours Paid Form (if applicable) Performance Evaluation within the last 12 months at midpoint or above on average. I trusted my gut and persisted in articulating my concerns. PAGE 41 PAGE 2 PAGE 2 Applicant Name: __________________________________ Date: ________________________ Unit/Dept/Shift: ____________________________ Facility: _________________ KFH TPMG Area of Specialty: Ambulatory Care Home Health/Hospice Hospital A s c o r e o f a t l e a s t 1 0 0 i s r e q u i r e d f o r a n a p p l i c a n t t o b e g r a n t e d a S N I I I / H H / H I I I c l a s s i f i c a t i o n . I asked that one family member be allowed to stay tonight and she agreed. Knowing that rapid blood loss could occur during kidney procedures, I prepared all my homeostasis agents. She mentioned that since the burning got worse she gets short of breath and she needs to stop and rest for few minutes. PROBATIONARY REVIEW 8. She had been discharged from 4W and after returning home for a brief period of time, returned with major abdominal pain. She stated she wanted to try an Ibuprofen first and was going to call afterwards if the HA did not get better. 2010-12-08T15:15:14-05:00 (Taylor, et al., 2019), Culture Culture is a shared system of beliefs, values, and behavioral 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.) By the time he was awake she was just fine. Omeprazole (Prilosec) can be prescribed by a doctor if symptoms dont subside. Monitoring and Ensuring the Quality of Health Care Practices First I asked the operator to page the on-call hospice nurse to see if he/she had any awareness of this patient. ( Maintaining a caring attitude towards patients even in the absence of close and frequent contact. Acid-Base Acid-base refers to the balance of hydrogen and bicarbonate ions within Knowing that my room was ready I went straight to the preoperative department to meet my patient and to receive a handoff. Cognitive abilities include reasoning, judgment, or a large area of rural residents. I gathered all the information I could and verbally reinforced the importance of the isolation and the need for compliance. Some salaries range from $16.33 to $36.11 per hour. In our Purple Book the home treatment advice presents a list of food that should be avoided (we all know that Mexican food is mostly spicy) and explains in detail about meal timing and positioning when sleeping to avoid acid reflux. 5. We hear the news: the ED is holding three medical/surgical patients, one telemetry patient, two critical patients receiving mechanical ventilation, and five psychiatric patients. Nurses who excel in managing client TThe exemplar is written in the first person. He is a nonmember, and has never been to Kaiser. 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. He then went on to say that Mr. P had been evaluated by 2 other ED physicians and we only admitted him to OBS because of the time of night. 2. When she heard that she risks death she decided to go. She developed a severe HA and elevated BP and was put on IV Mag sulfate which alleviated her HA and brought down her BP. These drains were draining fluid and lots of it. the community, the nurse must adapt to the patients environment and I quickly prioritized my patient load so as I would not be interrupted in the middle of Mr. R.s would care. It will be in her best interest to let me consult with one of my doctors to see what she/he wants us to do. EFFECTIVE MANAGEMENT OF RAPIDLY CHANGING SITUATIONS ( Skilled performance in extreme life-threatening emergencies: Rapid grasp of a problem. Some examples of successful exemplars follow. She agreed. Include details so that reviewers can visualize the situation and become engrossed in the story. I paged HBS, I gave a brief history of her past admissions and how almost everyone of them had ended in some kind of exploratory abdominal surgery. He was diagnosed with cholangitis. Who will benefit from your achievements? She couldnt remember the name of it. How did your intervention(s) affect patients, their families, your chapter members, or the community? I explained to her that with elevated BP and severe HA this could be a sign of bleeding in her brain and the ER would be the safest and best possible place to confirm or rule out the possibility of this. I stayed focused and organized at all times and was able to achieve the best outcome. As a profession we must speak up and communicate our assessments effectively, including changes in our patients condition and evaluation of our patients needs. T. and his family agreed this was a logical step in providing relief and increasing the quality of his remaining days. Selection committee vacancies are to be publicized by Nursing Administration and the PPC. in a systematic way to make a choice among alternatives related to 0000002081 00000 n The facility did have Ativan available. She could take her in but she didnt want to bring her daughter with her. Determination Act, and licensure. Candidates will be asked to clearly present either one or both exemplars. Monitoring and Ensuring the Quality of Health Care Practices: OB-GYN is not my specialty, but I have taken approximately 7,000 calls over the last 8 years in this queue. I looked into Mrs. B.s face and saw the concern, and reminded her that God had brought her this far and that He would continued to guide her through this ordeal. of sadness and yearning), social (feeling detached from others and Webnurse acts as an advocate by protecting the personal rights of clients and providing all necessary information so that clients are able to make informed decisions. The annual ceremony is held during Nurses Week each year and was established in 2007 by Chesapeake Regional Medical Centers Professional Nursing Council to recognize He was uncomfortable with the proposed plan, but he felt he needed to do as he was advised. Benner, P. (1987). I looked up at her eyes and saw that what she needed right now was not more instructions she needed emotional support. The patient trusts in this nurses expertise and ability to handle even critical situations that involve life and death. Stimulation of 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. He had such a positive attitude and I could say that he was indeed very pleasing. 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). She was able to trust me and agree to go to the ER. Si@9240wvr~FV Finally there was a big relief felt by everybody in the room. Perfusion Perfusion refers to the passage of oxygenated capillary blood In this first link you will find an exemplar that demonstrates my clinical knowledge and skills in caring for the post-operative patient. POSITION TITLE 7. xb```f``. @18p_DRqK{I-{pR>|&x4a`z`"So2]JVi& bn@ The moment I met Mr. R. I had no idea of the impact I would have on his life and he mine. The narrowing of an artery caused by building up of plague and its rupture leads to clot formation also. > u kJ bjbjUU o ?g?g5 2 ~ ~ / / / 0 0 0 8 >0 "2 t 0 W 4 ( 4 : 4 4 5 k V V V V V V V $ nZ $] W Q / i k W ~ ~ 4 5 [ bW _ _ _ ~ R 4 / 5 V _ V _ _ r J * " 'T 5 # In healthcare, this can mean the difference between life and death. Responsibility of Applicants Provide the best possible documentation of his/her clinical practice, leadership, and professionalism to the Facility Selection Committee ahead of or before the deadline (March 1, July 1, or November 1). She could take up to 10 at once with no relief. - Concept Mapping. Writing the Exemplar: The exemplar should be presented as a narrative account. All of the ancillary staff had already left for lunch. interprofessional teams, fostering open communication, mutual As the chairperson of the above committee I am verifying that ________________________________(Name) attends the committee on a regular basis makes an individual contribution ___________________________Chairpersons signature Date: _____________________ Other Useful Information STAFF NURSE III, HH/H III Application The RN Clinical Ladder is optimized through a three-way supportive relationship between (a) Applicant, (b) Facility Selection Committee, and (c) Regional Appeals Committee. Five (5) years of clinical experience as a Registered Nurse. Licensure, DHHS, DHSR), Inflammatory Bowel Disorders I specifically took care of all the positioning devices that I would need to ensure proper and safe patient positioning once my patient comes in. The upper and lower jaw was loose and appeared to be floating. or compromised by illness and injury. I knew it was going to be a busy day. I am often able to assist the physicians in caring for patients because of this skill. I used that experience, my medical knowledge base, my extensive knowledge of COPS and stargate, past HX and the current symptoms to ensure that J. received the safest and timely care possible. endstream endobj 13 0 obj<> endobj 14 0 obj<> endobj 15 0 obj<>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 16 0 obj<> endobj 17 0 obj<> endobj 18 0 obj<> endobj 19 0 obj<> endobj 20 0 obj<> endobj 21 0 obj<> endobj 22 0 obj<> endobj 23 0 obj<> endobj 24 0 obj<>stream 4. X-RAY prior to the Endoctracheal Tube placement didnt show a bullet lodged anywhere in the facial region. If the nurse goes on non-paid status (no sick leave) the leave of absence cannot exceed three (3) months. My room had been scheduled for Right Laparoscopic Nephrectomy followed by 3 more cystoscopy cases. Achievement of this level of expertise is the result of the ongoing application of theory to practice for validation of the theory and expansion of the nurses experience. I explained that placing an NGT through his nose might tract into his brain and there is no clear evidence on the extent of his facial injuries. In her case many years of untreated HBP combined with possible diabetes (she felt, thirsty and urinated a lot) can cause damage to the blood vessels and increases the risk of developing blood clots. Then you put relevant pieces together and solve the mystery. In nursing terms you make the best disposition that fits patients needs. I also reminded the surgeon and anesthesiologist that units of blood were ready for our patient. See calculation below. WebOne Clinical Exemplar; Minimum of 3 professional goals; Professional Resume or Curriculum Vitae; Please be sure that your portfolio is complete prior to submission. 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