A Nurse Residency Program For New Nursing

A Nurse Residency Program For New Nursing
Introduction The publication from the institute of medicine has garnered much interest since its
publication in 2010 focusing on the future of nursing and the implementation of this with in the
nursing community. The nursing profession has over 3 million members and is the largest segment
of the nation's health care workforce. Working on the front lines of patient care, nurses can play a
vital role in helping realize the objectives set forth in the 2010 IOM (Institute of Medicine). One of
the recommendations is that of a nurse residency program for new nurses or nurses transitioning into
new clinical practice areas. The area I work in is home health and this is a growth area the need for a
residency program cannot be over stated home ... Show more content on Helpwriting.net ...
He theorized a three–stage model of change known as unfreezing–change–refreeze model that
requires prior learning to be rejected and replaced. Lewin 's definition of behavior in this model is "a
dynamic balance of forces working in opposing directions." Implementing a change in practice
within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to
change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded
the need for a concise plan and clear communication between nurses and management when
implementing a change of this nature. The use of Lewin's Change Management theory can support
nurses through the transitions and identify areas of strengths and resistances prior to implementing
change. Without a framework for guidance, it can be difficult to keep on track. As the demand for
home visits from nurses increases its necessities a need to prevent avoidable hospitalizations, it is
critical to attract and prepare more nurses for roles in home care. The residency program would have
input from the California Association for Health Services Home and the Infusion Nurse Society.
Providing newly graduate registered nurses support and experiences to become competent home
care nurses Providing current Option care nurses opportunities to increase their skills in clinical
teaching and become preceptors for residency nurses Providing resources
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Violence Among Nurses
Evidence Gathering Researches have proven that continuing professional nursing training is
essential in violence prevention amongst nurses. Tame (2012), conducted a study on the relationship
between horizontal violence in the operating room and continuing education found that the assess to
continuing professional education assist in strengthening nurse position and renegotiating the
boundaries in practice. In addition, decrease oppression of the operating room nurses. Similarly,
Cvetic (2011) echoed that failure in communication in the perioperative setting is the main
contributing factors to errors. Refining communication among nurses heighten ability to render
efficient and competent care to the patient. Castello, et al., (2011) found ... Show more content on
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Constructing Alternatives Healthcare regulatory agencies agreed that the negative impact of lateral
violence at work place directly affects nursing care. There have been numerous suggestions on the
guidelines on how to eradicate violence at the workplace. Unfortunately, the type of change required
for widespread adoption of new approaches to eradicate lateral violence is imperative (OSHA,
2015). Even though the OSHA (2015), stipulated policy on workplace violence such as physical
assaults which was termed as a workplace hazard, there are loop–holds in the policy. For instance,
lateral or horizontal violence was not mentioned, rather profound

St. Vincent Medical Center
St. Vincent Medical Center is located in the Bridgeport, Connecticut, in Fairfield County. It is a
520–bed, faith–based community teaching hospital that is a member of Ascension Health, the largest
Catholic, non–profit healthcare system in the country. The organization is an integrated community
health system provides a full range of inpatient and outpatient services. St. Vincent's has a very
strong commitment to patient safety and has several mandatory programs for employees that
include: relationship–based care and high reliability. As a Magnet designated organization, the
nursing professional practice model is well defined, and facilitated through shared governance
councils (St. Vincent's Medical Center, 2012).
The nursing leadership model is traditional with the exceptions of the (CNO) who also act as the
chief operating officer (COO). There are NVP that are assigned to each service line, as well as a
nurse director level. Nurse managers are assigned at the patient unit level, and there is also a clinical
nurse leader on each patient unit. Since St. Vincent's is part of a larger organization there are both
local and corporate nursing priority's and initiatives. Combine this will the rapid changes in health
care the ability to lead change and effectively communicate are of the utmost importance.
Due to the organization structure of the medical center, there are many layers and dotted lines of
reporting responsibility. This can cause conflicts due to competing

Reducing Medication Errors In Nursing
Reducing Medication Errors In Hospitals
Patient centered care and patient safety are the most important roles in nursing. "Serious medication
errors are common in hospitals and often occur during order transcription or administration of
medication" (Poon et al., 2010. p. 1). One important aspect of nursing is drug administration. It is a
multidisciplinary task including doctors, pharmacist and nurses. This paper will show evidence that
using electronic medication systems instead of paper based systems to administer medication will
reduce medication errors.
Change Model Overview The John Hopkins Nursing Evidence–Based Practice change model used
in this paper is, "Practice, the basic component of all nursing activity, reflects the translation of what
nurses know into that they do"(Dearholt, S. & Dang, D., 2012. p. 34). This model has steps to
incorporate evidence base research into the practice of nursing combined with their education and
clinical skills.
Practice Question
Step 1: Recruit Interprofessional Team Interprofessional team members will include the triad team,
pharmacist, staff nurses, charge nurse, nurse manager, IT and physicians.
Step 2: Develop and Refine the EBP Question Does using Electronic Medication Systems With
Barcodes Reduce ... Show more content on Helpwriting.net ...
Medication errors may result in a decline in patient's health increasing their hospital stay and if they
are on Medicare it will not pay for the extra days. "A common economic evaluation of health care
decision–making is a cost effective analysis, which compares costs of alternative interventions that
produce a common health outcome" (Dearholt, S. & Dang, D., 2012. p. 134). "To help prevent such
errors, technology has been developed to verify medications by incorporating bar–code verification
technology within an electronic medication–administration system (bar–code eMAR)" (Poon et al.,
2010. p.

Transformational Leadership Within A Health Care Setting
Using transformational leadership in nursing practice can increase morale, motivation, and enhance
job performance, which can ultimately improve patient outcomes and quality of care. The purpose
of this paper is to explain what exactly transformational leadership is, and how it can be used by
nurse leaders within a health care setting to inspire positive change within the working environment
to improve patient quality of patient care and improve job performance.
Introduction
As we know the healthcare system is constantly changing, therefore requiring effective leadership
among nurses. With that said leadership that promotes positive change is necessary in a health care
setting. Transformational leadership was developed by leadership expert James MacGregor Burns in
the late 1970's. Transformational leadership is considered a contemporary leadership theory.
Contemporary theories of leadership place emphasis on teamwork and collaboration, and is built
around the premise of change. "Transformational leadership is a process that motivates followers by
appealing to the higher ideas and moral values where the leader has a deep set of internal values and
ideas and is persuasive at motivating followers to act in a way that sustains the greater good rather
than their own interests" (Burns, 1978 as cited in Owen Doody & Catriona Doody, 2012, p.1212).
Therefore, when it comes to implementing transformational leadership in a healthcare setting the
nurse leader must takes on various

Teamstepps Analysis Nursing
Teamwork is central to supporting plans of implementing any modifications in practice. The purpose
of this paper is to determine organizational readiness and define transformation opportunities on 2
east post–surgical nursing unit to assume a TeamSTEPPS initiative based on the results of the
TeamSTEPPS AHRQ's Organizational Readiness Assessment Checklist and Hospital Survey on
Patient Safety. Additionally, a brief description of the organization and post–surgical unit along with
staff's perceptions and attitudes of the unit, barriers in implementing change, implications for the
nurse executive to consider utilizing the TeamSTEPPS tools.
Nursing unit and organizational structure
Southside Regional Medical Center (SRMC) is a 300–licensed bed ... Show more content on
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It is vital that you begin by evaluating your unit's readiness using the tools offered by the Agency for
Healthcare Research and Quality (AHRQs) TeamSTEPPS initiative (Team Strategies and Tools to
Enhance Performance and Patient Safety) (AHRQ, 2011).
A checklist assessment was performed with assistance on the 2 East Post–Surgical unit by the Nurse
Manager (NM) and Charge Nurse (CN) to assess unit's structure and willingness to apply an
improvement opportunity utilizing the TeamSTEPPS initiative. The responses from the checklist
reflected "YES" to all questions asked, which is conducive in implementing a TeamSTEPPS
initiative. Increased levels of staff engagement and performance are considered work environments
in which people are motivated to do their best that will be beneficial for both the patient and the
success of the organization (Evans & Lindsay,

Nurse Furthering Education
The Institute of Medicine (IOM) recommends that nurses further and obtain a degree in education at
the baccalaureate level by 2020 to eighty percent. The baccalaureate degree is achievable and is
critical in changing workforce by allowing the expansion of nurse's skills and competencies in all
areas that affect the community, public health, leaderships and research. This author will obtain this
level of baccalaureate degree before the recommendation in 2015. There is a growing amount of
nurses furthering education due to the organizations are now implementing that all staff is to have a
baccalaureate degree to be hired as a staff nurse. Hospitals that are Magnet status, this is a
requirement now to hold a Magnet status. The graduate degree ... Show more content on
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Bridge courses and learning paths between undergraduate and graduate programs are created to
allow the learning progression of higher educational levels. This author has obtained these steps
throughout the career of nursing and is continuing to pursue the goals of lifelong learning. The
changing profession it is vital that continuation education credits (CEU) are maintained to hold a
license as a nurse in individual states, unfortunately in Arizona this is not the case. The CEU's
should be mandatory in all states to promote advancement in skills and continue the recommended
lifelong learning commitment. Novice or experienced nurse must take critical improvements to keep
up with the changing professions of health care delivery in a multifaceted setting and furthering
educational skills, also learning self–marketing skills. This writer is providing just this by promoting
formal education, remaining active in nursing professional associations, providing excellent
communication and professional skills at every level. The Associates Degree Nurse (ADN), only
contains the clinical skills and knowledge. With the competitive market and advancements, these
skills alone won't carry any nurse over the nurses who have obtained a BSN or

Essay On Wound Care Nurse
Change Proposal Paper: Getting a Certified Wound Care Nurse
Abstract This paper is written from the perspective of a nurse–manager for a hospital floor and
focuses on a proposed change to that floor: the addition of a certified wound care nurse. It begins by
describing the benefits of a specialized wound care nurse, the existing conditions on the hospital
floor, and how each of the stakeholders would be impacted by such a change. It utilizes Lippitt's
phases of change theory to describe how those changes would be implemented on the floor,
outlining each of the phases in implementing such a change. Introduction Wound care nurses play a
special role in the hospital environment, and hospitals without those specialized nurses may not be
able to offer the level of care as hospitals that have these specialized professionals. "Wound care
nurses, sometimes referred to as wound, ostomy, and continence (WOC) nurses, specialize in wound
management, the monitoring and treatment of wounds due to injury, disease or medical treatments.
Their work promotes the safe and rapid healing of a wide variety of wounds, from chronic bed sores
or ulcers to abscesses, feeding tube sites and recent surgical openings" (Nursing Schools, 2012).
While it may seem as if any nurse should be qualified to perform these functions, it is critical to
realize that it is a specialized field. "Their main objectives are to assess the wounds, develop a
treatment plan, clean wounds and monitor for signs of

Priority Quality Improvement Of A High Performing Health...
Priority Quality Improvement Need Identified The advancement of a high–performing health care
system that accomplishes improved access, enhanced quality, and more effectiveness, for the
susceptible, vulnerable, the uninsured, minority, children, and elderly adult, remain vital
(Commonwealth Fund, 2016). The expectations to meet this standard has been adopted by hospitals
as they are in continuous review of modalities to provide safe, effective, and efficient care for their
community. Consequently, the priority Quality Improvement area identified in the
Medsurg/Orthopedic unit of riverside hospital is "Point of Care Documentation". Members of the
Healthcare Team Involved with priority need Members that will be affected by the priority Quality
Improvement as identified in the Medsurg/Orthopedic unit, include clinical and direct care nurses,
nurse leaders and administrators, Patient Support Assistants, the multidisciplinary team, comprising
of the physicians, the physical therapists, occupational therapists, Nutritionists, Phlebotomies,
Respiratory therapists, environmentalists, and the social workers, and the hospital in general.
Complete Review of Minutes Regarding Priority Need Meanwhile, the minute of the need as
identified was reviewed. In attendance was the hospital improvement committee, Clinical Nurse
managers, Administrative nurse managers, staff nurse leadership representatives, and representatives
from the unit's joint Commission. During the proceedings, the focus

Grand Nursing Theory Essay
Applying Theory to a Practice Problem October 3, 2012 Introduction Our first class in the masters in
nursing program, has been focused on nursing theorists. We have learned about Grand Theories,
which are theories that are very broad and difficult to test and Middle Range Theories, which are
also broad theories but narrow enough to be testable. We have learned how to study the different
theories, looking at how we can utilize theories to evaluate practice. I have been in a nursing
leadership role for many years. Approximately 8 years ago, I lead a group of nurses to develop a
shared governance nursing model in our organization. Shared governance is having staff involved
with making decisions related to unit ... Show more content on Helpwriting.net ...
4) Resolution phase (Evaluation) – problem resolved, relationship is terminated. This theory was
applied to a client that had a diagnosis of intervertebral disc prolapse. The client was in severe pain.
1) Orientation phase; the client was initially reluctant to talk due to her pain. 2) Identification phase;
the client expresses the need to get relief from pain. The nurse educates the client on the pain scale
to measure pain. 3) Exploitation phase; client informs nurse that there is relief from pain when she is
in the supine position. 4) Resolution phase – client's pain was reduced and tolerable. To apply this
theory to managing in a shared governance organization, I will define the nurse as the manager, and
the client as the unit staff. The organization has asked all managers to improve their patient
satisfaction scores in the next fiscal year. The manager will use the unit council (shared governance
structure) to assist with this goal. 1) Orientation phase – the manager shares the organization goal of
improving patient satisfaction scores and shares current patient satisfaction scores and patient
comments with the unit council. The unit staff asks questions, share past experiences, and seek
resources to assist with gathering data. The manager and unit staff discuss bias and limitations of the
unit council. Roles of the unit council and the manager are defined. 2) Identification phase – the
manager and unit

EBP Research Essay
While many studies have examined the attitudes and barriers in implementing evidence–based
practice (EBP), not many have examined which variables lead to increased practice, knowledge, and
attitudes. In a study described in the article "Use, Knowledge, and Attitudes Toward Evidence–
Based Practice Among Nursing Staff," by White–Williams et al. in 2013, these aspects were
examined at a large Magnet hospital. A questionnaire divided among three subscales (use,
knowledge, and attitudes) was used as the method. The results of this study demonstrated how these
aspects of EBP were positively impacted by several variables among the staff and how awareness of
EBP and implementation of educational programs is necessary in the hospital's culture. These results
can be used by hospitals to look at ways to improve evidence–based practices in the clinical setting.
The study done by White–Williams et al. (2013) recognized how certain variables among the
nursing staff affected their use, knowledge, and attitudes of EBP. These variables were correlated
with a higher overall score on the ... Show more content on Helpwriting.net ...
(2013) also examined if education, whether it was hands–on workshops, research days, classes, etc.,
had an impact on the use, knowledge, and attitudes of EBP among nursing staff. The overall total
score was greater for those that had some type of EBP education. Specifically, there was a
significantly increased total score in half (12/24) of the questions among those who had been
previously educated compared to those who had not been. Because those who had been educated
about EBP had overall significantly higher scores on the attitudes subscale, it shows the importance
of targeting attitude toward the use of EBP in changing behavior. Also, the more educated staff
found EBP fundamental to their practice. Gaining knowledge is crucial in understanding the
importance of the implementation of EBP. Knowledge is the second step in implementing EBP into
the clinical

Root Cause Analysis : Root Causes Analysis
ROOT CAUSE ANALYSIS
Root cause analysis process will utilize a systematic step–by–step approach to help identify all
causative factors leading to this sentinel event. The main purpose of the Root Cause Analysis is to
understand how the event happened, why did it happen, and what can be done to prevent an event
from happening again. The first step, collect all necessary data associated with this event such as:
current policy and procedures, incident report, Mr. B's health history, environmental flowcharts,
dispensed medications, equipment and staffing factors relevant to the event. The process of
identifying causative factors can begin once all the data is collected. The goal, of a Root Cause
Analysis, is to identify interventions to prevent an event from reoccurring. Scenario: Mr. B, a 67–
year–old–man, came to the ER complaining of severe pain to his left hip and leg after falling over
his dog at home. Left leg appears shortened with swelling in his calf, bruised, and limited range of
motion.Mr. B has a history of impaired glucose tolerance and prostate cancer. Home medications
include atorvastatin and oxycodone for chronic back pain. Mr. B's labs, taken during a previous visit
with his primary care doctor, revealed elevated cholesterol and lipids. Several errors and hazards can
be identified as possible factors leading to the sentinel event. The ER appeared to be terribly
understaffed that day with only one ER physician, one RN, one LPN, and a secretary.

Certified Medical Assistant Dissemination Plan
Dissemination Plan The staff will be will be notified of the new pilot project to hire and only have
Certified Nursing Assistant and Medical Assistant administer medication, this program will begin
April 1, 2016. The current MEDT Techs that are not Certified Nursing Assistance or Medical
Assistance will have 1 year to obtain their certification for either field. The purpose of the program
is to ensure adequate learning skills and to have someone with foundational knowledge of skills
such as vital signs, basic knowledge of recognizing medical concerns and being able to make
notification to the appropriate person and then completing the directed tasks. The purpose of this
objective is to utilize this new research or evidence based information ... Show more content on
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The ideal situation is to introduce the team to program and have someone in from a practicing group
someone on the staff's level of understanding that can share their thought about the program that has
already been practiced at a like facility, the group who is practicing will be able to explain the
program and can explain on their staff's level of understating (Melnyk & Fineout–Overholt, 2005).
Individual barriers can vary based on the audience, some staff members may be less than forth
coming do to their skill sets, their lack of confidence and their complaints of doing more for less
pay. It can be a challenge yet having them be a part of the decision making will validate their
concerns and verify where we should begin (Thompson, Bell & Prevost, 1999). Just keep the EBP
positive and be willing to share the results (Melnyk and Fineout–Overholt,

Design For Change Proposal : Implementing Hourly Rounding
Design for Change Proposal: Implementing Hourly Rounding
Improving patient safety and increasing patient satisfaction while in the hospital is an ongoing issue
in hospitals. Developing a plan to make changes within hospitals is the first step in accomplishing
this task. The design plan for change is to improve patient safety, decrease risk of falls and increase
patient satisfaction by implementing intentional hourly rounding for older adult patients (over the
age of 65) admitted to a 40 bed telemetry unit at an acute care hospital. For each hourly round
preformed a preselected group of question will be asked by the nurse or nurse's assistant as well as
informing the patient when the next hourly round will be conducted.
Change Model Overview
The John Hopkins Nursing Evidence–Based Practice Model describes how practice, education and
research are the foundation for professional nursing. Practice is first, nurses need to question the
basis of their practice and utilize an evidenced based approach to validate or change their current
practice. Next is education, nurses' education is basic in the beginning however with ongoing
education nurses are able to gain new knowledge and skills throughout their careers. Finally is
research, research generates new information for the nursing profession and allows for improvement
of practice based on scientific evidence and research. (Dearholt & Dang 2012, p. 34–40).
Practice Question
Step 1: Recruit Interprofessional Team
An

Best Practice To Implementation Essay
For this written assignment, I will imagine that I am on a team in my workplace and have identified
a new best practice to implement. I will describe the steps of implementing this practice and
research about how change comes about in the workplace. I will check policies and procedures in
my workplace and may need to speak to a supervisor who has experience in this area. I will provide
literature and support on why this change needs to occur. I will provide references on this material
and a conclusion. Best Practice to Implement For my best practice to implement, I have chosen
betadine nasal swab in pre–operative patients. Prior to this new practice being implemented, the
hospital where I work would test patients prior to surgery ... Show more content on Helpwriting.net
...
Knowledge–focused triggers come from staff when they read research, attend research conferences,
or experience evidence–based practice guidelines that is published by federal or specialty
organizations (LoBiondo–Wood & Haber, 2014). You must form a team that is responsible for
establishing, implementing, and evaluating the evidence–based practice topic. Research and
literature on the topic must be retrieved. The evidence on the new practice must be graded to justify
the effectiveness of the body of evidence. Within my workplace, the first step to implementing a
new practice is a needs assessment, whether it be metric or a process based on data or outcome.
After this has been completed a research path is the next step. This is based on research team or a
governing body that gives approval or not for implementation of a new practice. Process or
procedural change goes through several different councils. Literature to Support New Practice When
trying to implement a new practice, there are several tools that must be considered to use. First, you
must ask a focused clinical question, searching literature is another important component, screening
your findings, appraising each article's findings, and applying the findings. There are many different
types of articles, such as: diagnosis articles, prognosis articles, harm articles, and meta–analysis
articles. Having the appropriate literature to support your new practice

Evidence Based Practice
According to CLPNA (2005), "nurses should ddemonstrate knowledge of the elements and impact
of nursing research and evidence–based practice such as improved quality of practice and changes to
practice based on new data. This competency is crucial for the professionalism in nursing practice".
So being in the nursing profession, we should participate in continuous quality improvement and
evidence based changes to nursing practice. According to Mccrae (2012), "The legitimacy of any
profession is built on its ability to generate and apply theory" (p. 222). Evidence–based practice
promotes using best evidence to make decisions to improve quality of care for individuals, groups,
communities, and systems (Schaffer, Sandau, & Diedrick, 2013, p.1206).

The Patient Education Program Will Increase Patient Safety
The patient education program will increase patient safety and will improve HCAHPS medication
communication scores . A patient's understanding of medications is very important to a satisfactory
patient experience and it also improves safety and quality. A recent study shows that only 35% of
patients knew the side effects of their medication (Hays, Ron D., et al. "Physician Communication
When Prescribing New Medications.") Archives of Internal Medicine 166, no. 17 (2006): 1855–62
Many health care organizations have used Lewin's theory to recognize human behavior as it relates
to change and patterns of resistance to change, the model encompasses three distinct phases known
as unfreezing, moving and freezing or refreezing (Bozak, 2003). The purpose of the model is to
distinguish factors that can impede change from happening; forces that are in opposition to change
often called restraining or 'static forces' and forces that promote change, referred to as 'driving
forces'. When health care organizations fully understand what behaviors drive or oppose change,
then work to reinforce the positive driving forces, change can happen successfully (Bozak, 2003).
Unfreezing Stage In Lewin's 'unfreezing' stage, an understanding of the difficulties related to the
recognized problem is sought and "strategies are developed to reinforce the driving forces and
weaken or reduce the restraining forces" (Bozak, 2003, p. 81). Unfreezing involves identifying key
players

Effective Approaches in Leadership and Management...
NRS 451Nursing Management and Leadership
Effective Approaches in Leadership and Management Nurses demonstrate the core values of
professionally caring for others in two different prospects. Huber (2014), notes that "nurses have
two basic roles: care providers and care coordinators" (p. 3). Most significantly nurses are valued in
the setting of patient care, while the coordinator role revolves around management and organizing
care, using thinking skills to coordinate complex activities. Nursing is multifaceted, although direct
quality patient care is of significance, a positive leader or manager is also essential to support the
recent changes to healthcare requirements. Having the right blend of qualities is vital to becoming a
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A roll out date with 'super users' available to troubleshoot and maintain staff productivity and
compliance would be beneficial. The last aspect of strategic management is evaluating the
effectiveness of strategies used. Huber (2014), describes "analysis needs to review four areas:
strengths, weaknesses, opportunities, and threats (SWOT)" (p. 334). Through prioritization, the
threats are avoided, weakness are lessened and strengths are empowered to increase patient safety
with medication administration, by insuring patients receive "the right drug at the right time to the
right patient" (Weston & Roberts, 2013. para. 11). Most importunately, applying shared governance
or allowing decision making amongst the staff, allows leaders to inforce equality in the nursing
workforce. Shared governance is an important current focus in nursing practice, as the desire for
increased autonomy and accountability is encouraged with voicing of nursing opinions to assist in
better quality healthcare. Huber (2014) mentions that shared governance "is a partnership between
management and clinical staff. Research suggests that registered nurses who are empowered to
make decisions through shared governance have higher nurse autonomy and increased confidence in
decision making " (p. 249). As discussed, positive personality qualities, use of strategic management
and including the partnership of shared governance all directly facilitates a leader or mangers

The Dangers Of Nurse Fatigue
Fatigue is defined as a feeling of weariness, tiredness, or lack of energy (Philips, 2013). Fatigue is a
subjective feeling and has been described by people as "feeling tired all the time" and "feeling
weak" and it can be influenced by physiological, psychological, behavioral, and environmental
factors (Campbell, 2011). Nurse fatigue is an issue that has been a major concern for patient safety
and the wellbeing of nurses. Nurse fatigue can be attributed to working 12–hour shifts, working
night shifts, working several back–to–back shifts and working overtime (Rogers, 2008). This paper
will investigate and analyze the dangers of nurse fatigue and will explore strategies for
implementing changes to reduce nurse fatigue.
Situation Assessment ... Show more content on Helpwriting.net ...
Fatigue and sleepiness, tendency to fall asleep, go hand in hand as nurses struggle to stay awake
during long, consecutive, day or night shifts. For example, in the Staff Nurse Fatigue and Patient
Safety Study, the number of nurses who reported an error or a near miss had less hours of sleep than
the nurses who did not report an error or a near miss, and it was determined that there is a 3.4
percent chance of a nursing error when nurses get 6 hours of sleep or less in the prior 24 hours;
another study found that the chances of making an error was three times higher when nurses worked
more than 12.5 hours per shift (Rogers, 2008). In the Staff Nurse Fatigue and Patient Safety Study,
over two thirds of the participants reported that they struggle to stay awake while working and 20
percent reported incidence of falling asleep during their shift (Rogers, 2008). Nurses also do not get
adequate breaks while working long shifts, according to the Agency of Healthcare Research and
Quality (AHRQ) less than 50% of work breaks for are away from patient care, which means nurses
never truly get a chance to relax (Phillips, 2014). Not only is the patient safety at risk when nurses
are fatigued, but the well being of nurses is at stake as well. While nurses are fatigued they are
risking their

Peplau Nursing Theory Essay
The study which has been outlined earlier, if conducted can either support or refute if nurses will
need increased education and training on Electronic Health Records formerly known as EHR's. If
this study is conducted, nurses will know whether or not the education and training they are
receiving traditionally on EHR's is sufficient for gaining interpersonal relationships with their
patients. Interpersonal relationships include patient rapport, effective nursing interventions, and
patient safety. Nurses will know whether or not time is being sufficiently spent with the patient or if
it is being occupied with EHR input because of lack of education, understanding and training.
Nursing Theory Peplau's theory on interpersonal relationships defines four phases on how to gain a
quality nurse–patient relationship. These four phases include orientation, identification, exploitation,
and resolution (Peplau, 1952). If this study is conducted and shows a need for an increase in
education and training in electronic charting to fulfill adequate care for patients, Peplau's nursing
theory will reiterate the importance of gaining an interpersonal relationship with patients. Peplau's
theory will change by implementing the first phase, orientation in EHR use. The orientation phase is
coming to know your patient and being their major information source. The role of being a major
information source will be done personally by the nurse giving proper time to gain a relationship .
The

Implementing Fixed Patient For Nurse Ratios
Implementing Fixed Patient–to–Nurse Ratios in High–Volume High–Acuity Settings
Striving for excellent patient care is the cornerstone of nursing. However, delivery of innovative
care requires nurses to take initiative in finding issues and concerns in current clinical practices to
promote change that leads to optimal patient outcomes. One current issue in clinical practice is the
varying patient–to–nurse ratios (PNRs) amongst different hospitals (Aiken et al., 2012). Having
high PNRs may lead to nurse burnout, medical errors, and ineffective nursing care (Aiken et al.,
2012; Karavasiliadou & Athanasakis, 2014). The solution would be to regulate PNRs, especially in
areas such as the emergency room. To initiate this change, a task force would have to be established
to use current data and research as evidence to propose the change, implement the change and
evaluate its effectiveness.
Change Model Overview
The Johns Hopkins Nursing Evidence–Based Practice (JHNEBP) process can be used to facilitate
change. This process serves as a guideline to access, combine, and implement research into nursing
practice. According to Dearholt and Dang (2012), the JHNEBP is an 18–step process that occurs in
three phases. Phase one of the JHNEBP contains steps 1 through 5 and can be summarized as the
practice question phase where the issue is identified (Dearholt & Dang, 2012). Phase two is the
evidence phase containing steps 6 through 10 and is where search for evidence pertaining to the
issue

Essay On Nursing Leadership Competency
Nursing leadership competency is a very important to me as an employee, it can mean the difference
between having a chaotic or smooth workday. It is the responsibility of the manager to put forth a
plan on how and what needs to be done. Communication, vision, trust, adaptability is essential for a
leader when implementing changes and dealing with subordinates working toward a group goal
(Huber, 2014). In this discussion board, I will explain why understanding and effectively managing
change and innovation is an essential leadership competency is important in the workplace. In
additions to providing two examples from my own nursing experiences and applying the change
theory elements as it applies to the nursing process.
The nursing field ... Show more content on Helpwriting.net ...
The need for the EMR was to help with becoming compliant with physician order entry and
increasing patient safety relating to meaningful use. As an ER staff nurse, I was approached by my
manager to be a super user and part of the team for the new EMR. It was a long process over several
months of planning and collaborating with the builders of the system and receiving input from the
staff on what would be useful. All the ER staff received appropriate in class training in addition to
online access to practice. Physicians were also given scribes to assist with a smooth transition. I
have to say the implementation and evaluation process went very smooth with minimal disruptions
to the ER flow. I continued to teach the EMR class to new arrivals and remained a super user in the
department until I transferred to another facility. This was by far one of my favorite experiences as a
nurse. Here is an example of a failed roll–out project that was chosen for. As a nurse working in
vascular assess area during a monthly staff meeting, a group of us were delegated with specific
instructions to start a project to place small chlorhexidine gluconate (CHG) patch on ultrasound
peripheral intravenous catheters (PIVs) in patients in the intensive care unit (ICU). This project was
to last a month or more, no specific time was given. There was no planning in place or input from
the staff that was requested during the implementation of this project. The purpose was to see if this
would decrease the chances of infection, phlebitis, infiltrates, and increasing its longevity of the PIV.
This sounded good but there was no information or evidence of a problem in our facility on how
often PIVs were discontinued due to these symptoms. During the evaluation process, we assessed
each patient's PIV insertion site daily. We were instructed tell the floor nurses to

The Importance Of Evidence Based Practice In Nursing
The focal point of this discussion is to create an organized method to bring evidence base practice
(EBP) awareness to the forefront, increase knowledge to health care nursing in prevention and
management as they are confronted daily with clinical problems, lack of up–to– date EBP research.
Nurses will develop the skills for early detection by exploiting the four–stage framework model in
their organization and validating the need for implementation of accessible current evidence base
research to bring about optimal patient care and safety.
The plan is to establish multiple educational workshops for all nursing staff of various specialties, to
include chief nurse officers, managers and risk management. This ensures uniformity of education to
maximize optimal patient care in bridging the gap from the bedside to benchmark. The education
department, alongside with organizational learning coordinators will have the task of constructing
computer basic learning (CBL) modules with the input of experts from all specialties to obtain an
interprofessional insight. Special budget is allocated as the organization recognizes the benefits of
teaching and implementing evidence based practice which outweighs standardize outdated
information, in view of up keeping the institution's core measures. Upper management, nurse
educators will attend a specialize training to become familiar with the tools and accessing material
on their respective floor. They will schedule nurses in groups for a series of training, skill
competencies and provide an incentive for attendance, may be earning CEU's, recognition and/or
opportunity of clinical ladder. The National Database of Nursing Quality Indicators (NDNQI)
collects nursing–unit level data on healthcare safety and quality measures. This database can be used
as a tool to compare the institution's performance with the national benchmark.
Do
Establish a pilot study to promote translational science and evaluate its impact in clinical nursing in
one department before implementing it within the hospital. Allocate special budget to establish
multiple educational workshops, such as an "In–Service" training for staff in different specialties.
Educators and specialists will collaborate to develop

Nursing Leadership Priorities
Two nursing leadership priorities, nurse retention and increasing the education level of the registered
nurse (RN) are crucial to the safety of the patients and the stability and respectability of the nursing
profession at Children's Hospital. In order to implement these leadership priorities, the objective is
to reinvent the organizational culture of nursing at Children's Hospital through the use of
transformational leadership and innovation theory.
I. NURSE RETENTION
A. Nurse retention affects quality of care and costs to the organization.
1. The quality of patient care is enhanced by nurse retention. The National Database of Nursing
Quality Indicators (NDNQI) indicates that years of nursing experience is related to a decrease in
patient ... Show more content on Helpwriting.net ...
Transformational leadership in nursing is positively related to job satisfaction, decreased burnout,
and overall staff well–being, and nurse retention (Weberg, 2010)
2. Transformational leaders who inspire, stimulate intellect, have charisma and provide individual
consideration have a positive impact on nurse retention (Huber, 2014)
3. Transformational leadership can inspire nurses to attain higher levels of education, including the
BSN.
B. Organizational culture change related to nursing retention and increasing the educational level of
the RN can be accomplished by using Innovation Theory.
1. Innovation theory involves leadership being creative, abandoning the obsolete, and implementing
new processes and ways of thinking (Huber, 2014).
2. Leaders who use Innovation Theory for change are charismatic, self–confident, and ambitious
(Huber, 2014).
C. Analyze current data on nurse retention and the current BSN percentage of nurses on staff, set
goals within the organization, implement leadership strategies to achieve these goals, then measure
outcomes in the next four years.
1. The organization should set a goal of retaining 80% of the nursing staff each year over the next
four

Nursing Dress Codes
Abstract The purpose of this paper is to offer a summary and synthesis of some of the more recent
research regarding implementing mandatory dress codes. The tradition of nursing attire has changed
over the years. The history of nursing uniforms includes wearing solid white skirts, shoes, and white
cap. These white garments typically signified nursing roles and differentiated nurses from other staff
members. Common questions that arise within medical institutions includes: what are the
advantages of implementing mandatory dress codes? Should nurses be required to wear traditional
white uniforms? Should personal individuality be preserved? How will patient care be impacted?
Regardless of the point of view, most positions tend to agree that ... Show more content on
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Is this self–expression beneficial to our patients and our nurses? Personal self–expression has lead to
the assortment of styles seen in the nursing wardrobe; moreover, LaSala & Nelson (2005) states that
dress can reflect the individual's personality, but should not be distracting or too casual for the work
setting. In association with personal expression within the workplace, Spragley & Francis (2006)
argue that nurses often say they want to be recognized for their knowledge, competence, and
experience, not for what they are wearing. To consider the creative of nursing apparel, the
department or work environment would be the best indicator of suitability. Perhaps, colors and
patterns can be considered appropriate in certain departments of nursing, such as pediatrics.
According to Matziou et al. (2009), studies report that the nurses' uniform influences the children's
mood and that of their parents, especially in pediatric hospitals; furthermore, the uniform of the
nurses should be specially designed to be functional and representative of their role. Multicolored
nurses' uniforms are those most preferred by both the children and their parents. For instance,
cartoon characters worn on scrub attire may be considered distracting, and inappropriate in medical
units such as oncology. Albert et al. (2009) adds that patients and visitors may perceive nurses as

Adopting New Technologies in Nursing
Adopting New Technologies into Nursing Lisa M. Ehret
Walden University
Transforming Nursing and Healthcare through Information Technology
NURS 6051N–20
July 10, 2015
Adopting New Technologies into Nursing The healthcare system is a continuously evolving
spectrum. Nurses must take great strides in learning and adapting to new technologies to meet the
standards of the health care system. One significant change that has occurred throughout the last few
years is the transition from paper charting to utilizing electronic health record (EHR) systems. This
technological change is a major development that has the potential to significantly impact the
nursing role and overall ... Show more content on Helpwriting.net ...
15). Thus, if possible, emphasizing the simple aspects of the chosen EHR while avoiding excessive
complexity during design will be an important aspect to avoid obstacles in the adoption of the new
practice. As the nurse facilitator, realization that the older generation may be confronted with
difficulty regarding technological innovation is crucial. Providing constructive, and tolerant
instruction will help with successful adaption of the new EHR for these individuals. Adequate
training and instruction, while ensuring user–friendly technology was the base of the design for the
new EHR will help ensure simplicity and encourage positive outlook from staff and increase rates of
adaptation. Thus, emphasizing simplicity of use while avoiding complexity will give health care
workers a positive stance on their capabilities regarding the utilization of a new EHR.
Trialability
The fourth aspect of successful implementation is trialability. As described by Rogers (2003),
"Trialability is the degree to which an innovation may be experimented with on a limited basis". An
easy way to interpret this aspect is that the more practice, the easier a concept becomes or "practice
makes perfect". As the nurse facilitator, one must recognize and understand that adequate training
and available resources are the basis for trialability and success. Thus, the more the nurses who
utilize the new EHR, the faster a successful adaptation occurs. It is during this part of the

Case Study : Patient Safety And The Knowledge Of Santiago...
Background/Facts :
Patient safety is one of the main concerns in many hospitals. The present case study deals with
medication use and the knowledge of Santiago's health leaders to solve safety and billing problems.
Santiago health system comprises of one large hospital campus and two small satellite hospitals
which includes 556 bed hospital, cardiac care center, cancer center, and outpatient surgery center.Dr
Trubelli is a warm hearted pediatrician and former chief of staff of the SCC and now hold the
position of Medical director of Information systems. Throughout his career he has addressed many
medical errors and wants to implement the new system of administration i.e. bar code medications.
This system helps nurses to verify all the drugs along the bedside using electronic verification and to
prevent medical errors. The pharmacy department at SCC wants to adopt bar code system to ensure
safety using codes on medications but their main concern is that all the medications don't come with
bar codes. All the drugs should be packed, compounded and delivered with printed bar codes to
implement this system. Changes should be made to the pharmacy technician work flow as
implementing the bar code system results in billing changes, dose charging at administration and
they are not aware of the responsibilities and roles of the IS staff. Changes are also necessary in the
nursing department as most of the nurses face the difficulty in using bar codes at the point of care. In
SCC the

The Role Of Electronic And The Media
section barriers are discussed. In the context of this model, the role of electronic and media in
promoting awareness, willingness of nursing staff and review committee to revise policies and
curriculum, and cost and feasibility of infrastructural changes are discussed in detail.
Role of electronic and print media in promoting awareness: Any policy to gain momentum must
have public support. The public must be convinced of its importance through repeated exposure and
explained the repercussions of not implementing the policy. The role of print and electronic media
lacks in certain areas creating little value to any event or program that highlights the importance of
implementing fall–prevention programs through formal training of nursing staff.
Revision in current policies: Previous policies must be evaluated to assess the need and room for
revision before policy implementation. This is agenda entrance level of policy formulation model of
Cobb and Elder (1983). Current policies would be reviewed thoroughly to minimize conflicting
policy by the review board by the graduate student. The education departments are task with the
duties to write policies and implement all nursing related education at ARMC. The review board
will be established by a nursing committee and would be a time–consuming task. This critical task
of the review entails consistency, commitment, and motivation and is vulnerable to inadvertent
changes created by the institution.
Revision in current courses to

Nur/598 Essay
Implementation of SBAR Training Program Sandeep Bains NUR/598 February 18th, 2013 Margaret
L. Colucciello
Section D: Implementation Plan 1. Proposed Solution Implementation Plan The first step in
implementing this project will be for the author of this evidence–based practice SBAR (situation,
background, assessment, and recommendation) program to approach the Director of ... Show more
content on Helpwriting.net ...
The staff attending the educational session will receive the guide to take home and brochures on
SBAR (Joint Commission, 2006). The author will set up the flyers to sent the information about the
educational sessions, including venue, dates, class size, contact phone numbers, and program times
to physician's offices, local bulletin boards, and to all nursing departments. The advertisement will
be placed in the local newspaper with the same information listing in the flyers. The SBAR
educational program will develop by the author with the assistance of nursing director, and
multidisciplinary team and will be presented by the multidisciplinary team appointed by the project
director. Nutritious snacks, drinks, and lunch will provide by the Brampton Civic Hospital. 2.
Resources Needed for Solution Implementation The multidisciplinary team consists of managers,
nursing educators, and physicians are salaried employees and will prepare and provide these
educational sessions during non– patient care hours and with no extra pay. The team will not only
teach the SBAR tool and also provide educational sessions that provides information on
communication styles, and strategies for collaborative communication. To keep the cost down, the
author will present the majority of the education sessions and only one day for physicians in the
series of classes. Brampton Civic Hospital is a teaching facility, has the auditorium,

Critical Information About A Patient 's Plan Of Care
Specific problem requiring change and Situation description: The shift report between the off–going
and oncoming nurses must include all of the critical information about a patient's plan of care. This
information must be communicated. The change of shift report that is done incorrectly can be a
result of missed information and poor communication between nurses, affecting their ability to
deliver safe and efficient care for the patients. This problem occurs not just at one but at most
hospitals, where inter–shift report still continues to take place at the nursing station without
inclusion or a visual of the patient until the report is done. As I witnessed shift report in the hallways
or at the nursing stations of SCVMC of the 33 bed mother and baby unit, I noticed that at times
unnecessary information is received and critical information may not be communicated. On the
other hand, at Redwood City Kaiser neuroscience unit bedside inter–shift nursing report works well
and I have witnessed better nurse–patient relationship, lower incidents of falls, strong teamwork, as
well as improved nurse accountability and prioritization at the beginning of the shift. As evidence
shows in the article "Improving Client and Nurse Satisfaction Through the Utilization of Bedside
Report", there is a direct correlation between the bedside report and both client and nurse
satisfaction in care settings, validating the importance of changing to bedside report (Vines, Dupler,
Guido, 2014). I

The Factors Affecting The Work Environment On Health...
Literature Review In the recent years, there has been viable evidence that shows that other factors in
the work environment may also be strong push factors for retention (Burns, Bradley and Weiner,
2012, pg.445). The factors that contribute to forcing workers to leave the public sector include:
"workload and staff shortages are contributing to burnout, high absenteeism, stress, depression, low
morale, and de–motivation" (Burns, Bradley and Weiner, 2012, pg.445). It is also shown that poor
working conditions also contributes to preventing staff morale and motivation and it also contributes
directly to recruitment and retention (Burns, Bradley and Weiner, 2012, pg445). According to Burns,
Bradley and Weiner (2012), "one strategy being used to alleviate health worker shortages and to
improve access and quality of health services is task–shifting, or the delegation of tasks that would
traditionally fall within the scope of practice of doctors or nurses to other health who have
undergone shorter periods of training" (Burns, Bradley and Weiner, 2012, pg.445). In so by
implementing task–shifting, the work load that all nurses have to handle on a daily basis is split up
with easier duties falling on other health professionals with less experience. Also another strategy of
combating nursing retention is by offering nonfinancial incentives instead of financial incentives
which can help to motivate workers (Burns, Bradley and Weiner, 2012, pg.444). The offering on
nonfinancial

Nt1330 Unit 3 Paper
The hospital will establish policies and standards that protect patient privacy of the health care
information. These policies should determine levels of access to the EHR. The Cerner® system will
provide many layers of protection. A major piece of maintaining patient privacy is managing access
to the EHR. This is accomplished through password management. The system will require case
sensitive passwords with mandated password change every 90 days. There is employee badge swipe
access that automatically enters the user log in ID but requires the password be entered. If a user has
not accessed the system in a designated time period, which will be determined by the hospital
(typically 90 days) then the system will automatically drop the ... Show more content on
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An error can cost the hospital hundreds of thousands of dollars. Utilizing technology to prevent
errors will result in cost savings to the hospital. Implementing CPOE will not only save in
prevention of medication errors but also in the decreased time spent in order verification due to
illegible handwriting. Elimination of paper documents except as backup for downtime events will
provide cost savings to the organization. Savings will come from decreased printing cost as well as
decreased cost of storage of paper charts, decreased cost of scanning paper documents into the EHR,
decreased printing and decrease cost of document destruction. Another measure that implementation
of EHR may affect will be patient satisfaction. Its impact on patient satisfaction will be difficult to
quantify. It is anticipated that staff will be more knowledge about the patient and will have more
time to spend with the patient both factors are known to improve patient satisfaction. Patient
satisfaction is reported publicly so scores can affect selection of the hospital as a place for treatment
and patient's willingness to recommend or return. Active Nursing

Electronic Health Care Case Study
The implementation of new information technology systems into existing organizations is not a new
concept as the possible process improvements for a business can be fairly obvious when compared
to more traditional non–computer based processes. One sector, which for the most part is
transitioning into using information systems in an attempt to improve processes, is the health sector.
This report observes and analyses multiple real life cases of health care providers from the United
States who have decided to upgrade from traditional paper based patient charts to computer based
Electronic Health Records (EHR). It should be noted that all of the case studies observed in this
report were created by the Centre for Aging Services Technologies who describe themselves as
being "focused on development, evaluation and adoption of emerging technologies" in the medical
sector. The Centre for Aging Services Technologies is an international group made up of 400
technology companies research universities and government representatives. The United States
government describes Electronic Health Records as being "digital versions of a patients paper chart"
(Healthit.gov, 2014). Electronic health records typically include information on patients including
the patient's medical history, medications the patient takes, treatment plans, immunization dates,
allergies, radiology images and test results. With this being said it would first seem that EHR's are
simple data collection and storage

Planned Change Of Maternal Child Health
Planned Change in Maternal Child Health For many years organizations have faced challenges in
trying to promote interdisciplinary team collaboration and shared governance. Many have attempted
the trial and error method with the use of different nursing care delivery systems to meet the
concerns of our ever–changing healthcare world. A shared–governance model is one professional
practice model used to improve nursing practice through collaboration of nurses, patients, and other
care providers. This model encourages professionals to have a voice and represents an avenue where
staff can get involved in how nursing care is delivered, and furthermore promotes collaboration
between professionals. The Maternal Child Health (MCH) unit at ... Show more content on
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The professional nurse is an asset simply because much of what drives success within an
organization is the fruit of labor. In order for this continued performance to strive it is necessary that
an organization be designed to allow professionals to participate in the practice and help shape the
environment in which patient care occurs which ultimately brings us back to this notion of shared
governance.
The goal for SLMC is to have a unit based interdisciplinary design with the use of a Collaborative
Care Committee (CCC) as a vehicle in implementing shared governance, and increase
interdisciplinary team collaboration. According to Suby (2012), "shared governance models create
decentralized systems in which decision making lies with bedside staff nurses whose role becomes
the source of innovative solutions; the managers role is one of facilitation and support to assist staff
nurses in changing practice to better care for the needs of the patient". This CCC will allow for staff
nurses and nursing management as well as providers to work together to promote autonomy,
accountability, leadership and empowerment, all of which are elements of shared governance and
also important factors to address when trying to improve quality of care.
Alignment with the Organization's Values
Having the Collaborative Care Committee at SLMC would positively impact the organization by
promoting working conditions where employees would be motivated and satisfied

Application Of The Nursing Staff At Dwu Virtual Hospital
In the nursing field change is a daily reality. The continuing improvements in health care mean that
there are continually changing ways to provide health care. Anyone who has been in the nursing
field for any amount of time is sure to have uttered the words "Do you remember when we used
to...?" From a nursing point of view not all change is positive, and not all change is welcomed.
Every change is however aimed at providing the best care and achieving the best possible outcome
for the patient. This project will outline the process that will be used to introduce the nursing staff
here at DWU Virtual Hospital to the change of implementing electronic medical records.
Change Model
Leaders have a selection of change theories to review ... Show more content on Helpwriting.net ...
This plan will begin with smaller unit meetings led by the unit manager. Next, training sessions in
virtual patient records will be led first by managers and then by peers. In the third and final stage the
EMR will be implemented and all staff will be responsible for ensuring the proper use of the EMR.
Change Plan Design To initiate the plan we will begin with the first stage of Lewins Theory,
unfreezing. The unfreezing process is the process of creating a time frame for staff to become ready
for the change (Huber, 2014). Management will need to inform staff of the upcoming change. This
should be done in a small unit meeting with only the nurses and unit manager present. Keeping the
meeting small will help prevent any feelings of being intimidated and will go along with the shared
governance system recently instituted. In this meeting the manger will present researched facts
regarding EMR implementations. Among these facts would be the fact that having an EMR will
save time. Nursing staff will have access to all previous records and will no longer need to wait for
other departments to obtain these records (Gagnon et al. 2010). Also having an EMR system
encourages teamwork between the healthcare and support personnel in a facility (Gagnon et al.
2010). For example, nursing will be able to look at the radiology and lab schedule and coordinate
with them on times for patient testing. During this meeting

Novice to Expert Nurse Leader
NOVICE TO EXPERT NURSE LEADER
By
Gwen Travis
Gonzaga University
NURS 553
The path to nursing leadership most often progresses from novice to expert nurse and then onto a
novice nurse manager. The novice nurse manager is asked to lead and rarely given the tools or
knowledge to be successful in this new role. The Dreyfus Model of Skill Acquisition discussed by
Patricia Benner includes the following five levels of competency in the clinical nurse (Benner,
1982): * Level I – NOVICE – beginners with no experience with practice situations and an inability
to use discretionary judgment. * Level II – ADVANCED BEGINNER – actions/decisions are based
on prior experience in actual situations. * Level III – COMPETENT – actions ... Show more content
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If the use of the latest, high–quality research is vital to optimal patient outcomes it can also transfer
over to the development of staff and nursing leaders. Better trained nurses and leaders are more able
to perform their jobs which should lead to the goals of improved patient care and expert staff
retention. As research shows, there are several key factors involved in the

The Importance Of Nursing Leadership
Nursing guidance is a complex but essential part of the nursing workforce. Guidance can come in
the form of management and in the form of leadership. The two terms are often used
interchangeably, but do not always mean the same thing. The nurse manager is often someone who
has authority from the facility to be in management. The nursing leader may not have authority over
other nurses, but may be a strong guide in the workplace for other nurses and nursing staff. Nursing
as a profession is ever–changing and increasingly challenging. Nurse managers are tasked with an
enormous variety of functions in their respective workplaces, budgeting, scheduling, hiring,
disciplinary actions, implementing facility policies and procedures, and the ... Show more content on
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While patient care is at the center of what nurse leaders do as well, the help and support they give
their fellow nurses is very important. Nurse leaders are the background to the nursing care. Effective
nurse leaders can promote a positive workforce and a healthy work place for other nurses.
Workplace dynamics is an essential part of how each nurse functions. Nurses, being mentally and
physically stressed, need to have support and guidance from a nurse leader to feel confident about
performance. The impact of nursing leaders can be a positive and guiding force for the younger or
more inexperienced nurse. Having strong relationships with solid leaders can instill values in the
beginning stages of a newer nurses' career. Gaining insight and core concepts from a more
experienced leader can make a world of difference in the way a new nurse performs, provides
patient care, and sets future goals for themselves. A newer nurse with a positive role model and
nurse leader can model themselves to become a leader for future nurses. Future nurses and the future
of the nursing practice can positively benefit from having a revolving new nurse– nurse leader cycle.
With a profession as dynamic as nursing, the involvement of positive leaders and role models is
essential for the practice to grow and inspire a nursing force that not only adapts and changes with
the profession, but leads and strives for promoting the improvement

Quality Improvement Plan
Measures
"We will find our baseline measurement using nurse surveys, audits and observation timings. We
will track what steps are covered and how long each step takes and the number of occurrences of
near misses due to inefficient handoffs relating to patient safety. We will also measure our patient
baseline data from current patient satisfaction surveys" N. Guyse (personal communication,
February 22, 2014). Currently we are inefficient and unsafe with handoff practices due to missing or
incomplete information, multiple processes used between the nursing staff, and multiple report out
processes being practiced on the floor. Multiple processes are causing confusion and incidental
overtime. With multiple processes, information is being missed between nursing staff, which is a
safety concern due to the increased errors. Our organization is working on the creation of one
standardized process used between all employees to ensure that all handoffs are efficient and safe.
"We have implemented a group report out for nursing staff in conjunction with the beside report
outs" N. Guyse (personal communication, February 22, 2014).
Sample measures through patient and nurse satisfaction surveys and observations will be used to
show if we are making improvements with the change. Run charts will be used to show if
improvements are taking place over time and will help with improvements by depicting how well
the handoff process is performing. They will help in determining when changes are

Reducing Medication Errors During Long Term Care Facility...
Reducing Medication Errors in Long–Term Care Facility
One of the critical core components of Skilled Nursing Facility is medication administration. As
cited by Tenhunen, Tanner, and Dahlen (2014), they stated that 88% of the residents living in the
nursing homes are aged 65 years old and older. They discussed that every five of administered
medications in nursing home has one probability of error. This means that about half of the residents
have the possibility of two or more medication errors daily. This applies to the Pasadena Care Center
(PCC) because its residents are mostly older adults who require medications on a daily basis.
Moreover, residents are prescribed with multiple medications, which make them vulnerable to
medication errors. The staff at PCC is trying their best to ensure safe medication administration,
however, it still in need of a major change. The goal of the proposed change is to decrease the
medication errors in this organization to ensure patient safety.
Background
The PCC is a Skilled Nursing Facility and is licensed for 99 beds. It provides specialized care
services ranging from short–term, long–term, and hospice care. The residents come from different
racial background and were diagnosed with acute to chronic medical conditions. The majority of
residents are older adults and often taking numerous medications, which put them at risk for
medication errors. As discussed by Lane, Troyer, Dienemann, Laditka, and Blanchette (2014), older
individuals

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