Nursing Experience (4)
4 - Twelve years as RN on the Aspen Unit
**Clinical Expertise and Critical Thinking (2) 6
1- In September of 2020, I looked up from my computer to see one of my assigned patients leave the group room and sit in a chair by the nurses' station. This female in her 20s was clearly anxious, calling out for help, but able verbalize little. As approached her, I was quickly able to recognize that she was experiencing what appeared to be an acute form of dystonic med reaction called an oculgyric crisis. I had previously seen this particular side effect simulated by patients, but knew this was an acute side effect of neuroleptic meds. But given this patient's inability to make any voluntary eye movement, paired with her marked level of fearfulness, I decided to move quickly. No appropriate PRN meds were ordered, but I was able to override benadryl injection, make a quick call to the attending and administer the injection in only a few minutes from the start of the episode. Her symptoms resolved within 25 minutes.
1 - In December 2019, after having just take my first Session of QBS training a worked with a patient who had been re-admitted a few weeks after discharge. He was very angry with his dad, whom he blamed for his re-hospitalization, and abruptly ended the call by repeatedly slamming the phone receiver extremely hard in the patient hallway. Recognizing that he had moved beyond the Help or Wait phase, I used the prompt strategy. I instructed him to talk to me in the day room in a firm, but supportive way. By replacing the negative behavior with an incongruent behavior of talking to me, not only was the patient no longer disrupting he unit, he no longer had the opportunity to rip the phone off the wall and obtain a potential weapon on the unit. He was offered a PRN medication and no longer acutely agitated after talking with the staff.
**Patient and Customer Experience (4) 10
2 - Letter From Patient R.N. (see additional documents in orange folder)
2 - Press Gainy mention in 2019
**Teamwork and Coaching (10) 20
2 - In December 2018, I was sought out by an Aspen RN. He had requested help with the new treatment plan that had been initiated just a few weeks prior. He came to my office and I was able to review the step-by step operations involved to initiate a treatment plan and add medical problems, goals, and interventions. This process is complicated, with many individual steps. This teaching lasted approximately 40 minutes.
2- In the fall of 2019, a fellow Lead RN mentioned to me that an Aspen Unit RN had struggled to fully complete a medical care plan for a patient admitted to another unit. I was able to review the steps of the this process, including the many individual steps of composing a problem, goal, and interventions in the Epic care plan. This teaching lasted approximately 30 minutes.
5 - I consistently represent the nurses in interdisciplinary team meetings on the Aspen Unit. Three times a week I am able to participate in the treatment team discussions made for each patient, as well as communicating the care updates to the other nurses working on that shift. Recent shifts include: 10-5, 10-7, 10-9, 10-12, 10-14, 10-16, 10-19, 10-21, 10-23, 10-26, 10-28, 10-30, 11-2, 11-4, 11-6.
1 - In November 2019, I worked with a patient who reported to staff that she had swallowed a paper clip, who required swift transfer to the ER. After the incident I received an e-mail from Dr. Bradley Demijon, thanking myself and fellow RN for our support of this patient.
“Just wanted to thank you for your promptness in transferring our patient off the unit to the ED this weekend. It is still unclear what the foreign body was but regardless it did require endoscopic removal which was done before the patient could suffer any serious harm, in large part thanks to your quick and thorough work. The patient and the Aspen unit are lucky to have you both!”
**Preceptorship / Trainer (5.5) 25.5
5 - I was able to train 5 new employees Carly Hartmann, Jayna Adams, Jacob Altman, Silas Kukaewkasem, and Karen Gleason. This included both days on and off the unit floor.
0.5 - Was able to have RN McKenna from Grand Valley follow me on the morning of 10-20-20. I was able to show her the tasks of assignment organization, med administration, patient interviewing, and intake assessment. She was able to ask questions, including when to intervene with escalating patients.
**Leadership (5) 30.5
5- I am the charge nurse for over 90 percent of the shifts I work on the floor. Recent shifts include: 10-5, 10-7, 10-9, 10-12, 10-14, 10-16, 10-19, 10-21, 10-23, 10-26, 10-28, 10-30, 11-2, 11-4, 11-6.
**Committee / Council (10) 40.5
8 - In 2019 I attended 8 meetings for the Master Treatment Plan Champion committee - a group tasked with updating the patient treatment plans in accordance with regulatory recommendations. This group also oversaw the MTP audits that are included in the weekly chart audit by lead RNs.
2 - In 2019 and 2020 I attended two HBS/CRS/PPG Suicide Risk Assessment Meetings regarding the way suicide risk will be identified in the electronic patient chart, providing insight into whee floor nurses currently document this information.
2- In 2019 I attended two meetings of the Downtime Procedures committee regarding the inpatient hospital's current downtime forms in relation to the various changes that have occurred since the Epic implementation at Pine Rest.
1- I was a participant in a Root Cause Analysis in December of 2019. Because of the confidential nature of these meetings I am unable to disclose more, but I was able to give thorough explanations to inquiries regarding the Aspen Unit during this assembly.
1 -In October 2020, I met with the head pharmacist to review the Medication Administration SOP with the primary objective of ensuring all content is consistent with current PR pharmacy, Pyxis, and Epic.
**Department / Unit Quality Initiatives (5) 45.5
5 - Every week I spend three to four hours auditing 4 patient charts and all seclusion and restraint incidents. This data is sent directly to quality department. To do this well is time consuming, both in analyzing the data, but also in contacting and educating individuals to amend or correct data. In 2019 and 2020 this has tallied over 500 audits.
Professional Honors (2) 47.5
2 - Two DAISY Award nominations in 2019-20 (see add. documents)
** Education (11) 58.5
5 - As the Lead RN, I work with the CSM and lead Psych Tech to coordinate our staff meetings. In the months we do not have meetings, we often will send out unit newsletter. Here is a sample of some of the Power points I have made for our meetings and the “Nursing Notes” I create for the newsletters.
4 - In accordance with regulatory requirements, the inpatient treatment plans underwent significant changes. In addition, many RNs continued to struggle with making medical care plans within Epic. To meet these hospital-wide needs, I was able to create an Epic Tip Sheet and a Q and A style PowerPoint. This PowerPoint was shared with the Education Department for training new employees in 2019.
2 - In May of 2020, I was able to spend a day rounding on all of the inpatient units, educating on the multiple steps involved to find COVID results using the Care Everywhere feature in Epic. This component of Epic was unfamiliar to most floor nurses, but essential to care for new admissions awaiting a result. I was able to make a "decision tree" style diagram to leave as a resource on the unit.
Professional Certifications (10) 68.5
10 - ANCC Certified in 2016
Professional Organizations (2) 70.5
APNA member since 2016
Advanced Degree (4) 74.5
4 - BSN from Calvin University
Other Activities (26) 100 .5
5- Over the past two years I have reviewed all the submitted portfolios for all the nurses on level II and III of the RN PRIDE ladder. This has included approximately 15 portfolios.
5- It is my job to perform annual performance reviews with the RNs on the Aspen Unit. So far in 2020, I have completed reviews for Kerri, Josh, Ethan, Megan, Tammy, Karen, and Silas.
4- The creation of the ED Sendout Report in Epic has been widely approved by nurses at Pine Rest for its ease of access and breadth of information made readily available in pressured situations. However the existing ER paperwork filled out by the floor nurses remained highly time consuming and redundant. So starting with a blank slate, I created a new, single sheet cover page to accompany the ED Sendout report. After many edits and revisions, I was able to submit the new document that is the basis for the document used by all PR hospital units today.
4 - In the Spring of 2020 I was asked to investigate a case of suspected medication diversion on the Aspen unit. Through my experience as an Epic CredentialedTrainer and by reviewing many charts as the lead RN, I was able to identify the data modified by the nurse that indicated suspicious activity and compile a 14 page document with many Epic screenshots. I was also able to participate in a phone call to a Michigan licencing official about this case.
2 - I was twice trained and certified to use the Turtle Shield in Emergency situations, in December 2018 and December 2019.
2 - In the spring of 2019, I reviewed all of the paper downtime forms currently available in the case of an outage with Epic. I was able to mark up the current available documents to show what was inconsistent with current documentation in Epic.
1 - In June 2020, I was requested to update treatment plan section of the RN Skills Orientation binder.
1- In September of 2019, I was able to edit and proofread an Aspen Unit guide made by Pedro Carmago. This document was submitted to the unit's lead tech and is still used for new hires today.
1- In September of 2019 I came in fort two hours to assist in an open Epic lab, as part of the Clinical Cruise of Nations. This gave staff an early look at the biggest change of the first Epic upgrade at Pine Rest, the storyboard.
1- In 2019 I was taken off my floor assignment for a day to work on a complex task within a specific patient chart within Epic. This particular patient had been falsely readmitted into the inpatient hospital under the original episode within Epic. For payment reasons, a new episode needed to be created. My job was to un-chart the medication administrations on the old inpatient episode and re-chart them in the new episode. Using a little used feature of the MAR, I was able to specify the name of the nurse who gave every med, if this ever needed to be retrieved later.
Traditional CEUs (9) 108.5
7- Creating a Culture of Nursing Excellence in Behavioral Health (see add. documents for certificate)
1 - Pain Management and Ethics: What’s the Right Thing To Do? (see add. documents for certificate)
1 - Effective Pain Management is More Than Just a Number (see add. documents for certificate)