Describe the clinical area assigned and what you initially expected to learn.
I was assigned to the Neuro Shock Trauma Intensive Care Unit at Utah Valley Regional Medical Center
Describe what you actually learned (overall evaluation) through this clinical experience.
I learned a lot through this experience. In addition to learning about a lot of different diagnoses, I learned a lot of pathophysiology. Often a patient’s diagnosis would seem simple, but by looking through the sequence of events that led to their condition I would learn step-by-step what was happening in their body. This is an incredibly useful skill that I believe I got much better at while I was there. I also learned very specific technical skills like measuring CVP, ICP, draining an EVD, measuring CO and Wedge Pressure, using an ART line, and monitoring and manipulating a dialysis machine. The most valuable lesson I learned through this experience was how to manage time well as a nurse. Often there is so much to do that you have to prioritize in order to survive. My nurse was very good at this and helped me understand its importance in the clinical setting.
Describe how your learning will impact your nursing career.
I will always try to incorporate time management into whatever area I work in, so I can be an efficient, productive nurse. I will also always try and critically think about the work that I am doing. Nursing is more than just a series of tasks, it is thinking about the tasks you are assigned and determining what order to do them in and how to modify them to help the patient. I will always try and use this skill as well as develop it further.
Describe clinical objectives and how you met each of these.
I worked with many members of the healthcare team to deliver excellent patient care. Most poignantly, I worked with doctors to help them understand my patient's condition and what my assessments meant for their care.
2. Apply principles for safe delegation and supervision of health care workers.
I was able to work with the unit's CNA in helping deliver excellent care for my patients.
3. Utilize strategies to ensure patient safety and continuity of care at admission, shift change, transfer and discharge.
I was able to assist often in giving and receiving report, and I learned some good strategies to do so. I learned to ask a lot of questions if I didn't understand so that I would know how to give the best patient care. I also learned to know my patient well so that when I needed to describe their condition to someone else on the healthcare team I was able to.
4. Prioritize time and other resources to meet individual needs of small groups of patients.
This I believe I did the most of. Although I usually only had one patient in ICU, managing time was a must. I learned to figure out the tasks that were expected of me, and then prioritize them according to the most important. Sometimes this was just efficient, but sometimes it was a matter of life and death for the patient.
5. Participate effectively in care monitoring, error prevention, incident reporting, and other quality improvement activities.
I consistently monitored my patients to make sure they were doing well. I made sure to always check their vitals every hour, and I delivered medication safely. I asked questions when I made a mistake so I would know how to improve next time.
6. Implement guidelines for evidence-based nursing practice.
Discuss your identified clinical SMART goals and how you met each of these goals.
1) Be able to carry a full patient load with minimal assistance by the end of my preceptorship.
I did not quite accomplish this goal, although I tried very hard to. Because it was the Neuro Shock Trama ICU, it is one of the most complex units in the entire hospital. As such, there were many patient treatments I had never even seen before and it would be unsafe for my nurse to not assist me with these. Over the course of the clinicals, however, I got much more self sufficient and by the end I believe I could carry as much as ¾ of the full patient load. I definitely beefed up on my clinical skills, but it is difficult to learn everything in only 8 shifts.
2) Be able to set up, program, monitor and discontinue an IV pump with minimal assistance by the end of my preceptorship.
I accomplished this goal by working every shift to understand how work the IV pumps. I asked a bunch of questions and made sure I understood the principles behind the pumps so that I could critically think through them and set them up myself. By the end of my preceptorship, I was able to do this goal quite well.
3) Give and receive report with minimal assistance by my final shift.
I accomplished this goal. I gave report twice during my preceptorship and received it three times. I was able to do this by asking my nurse if I could, and then researching my patient thoroughly and making sure I understood everything that was going on with them. Only then could I give report smoothly and effectively. Receiving report was a little more difficult, as I sometimes had to stop and ask what certain abbreviations and treatments were. Overall, I think it was a worthwhile goal that I accomplished.
4) Be able to name 5 ventilator settings and explain the basics of what they mean with minimal assistance by the end of my preceptorship.
I accomplished this goal. On my first shift I asked my nurse to help me with this and she briefed me on all the settings she knew and dealt with often on the vent. I was able to read 7 settings and tell her what they meant, as well as pass this information on to the night nurse.
5) Perform all charting for an entire shift (including head to toe assessment, I & O's, Activity, Vital signs, and end of shift assessment) with minimal assistance.
I did not quite accomplish this goal. There is a lot more charting that I ever anticipated! My nurse had to help me a lot more than I thought. Because of time constraints and the complex treatments my patients were undergoing, I was only able to do some of the charting. This goal did make me a lot better at charting, however, and I believe I will be able to do this in the future.
