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Since the beginning of nursing school, as students, we have learned about all the different aspects included in managing patient care successfully. During each clinical experience, I have had the opportunity to implement and improve skills, such as the Quality and Safety Education for Nursing (QSEN) competencies. The purpose of this paper is to discuss QSEN competencies, delegation, and handoff reporting, and reflect how I achieved these concepts in my experiences as a manager of patient care.
There are six focus areas within QSEN including, patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and patient safety. The first competency, patient-centered care is defined as ensuring the patient is the source of control. By respecting patient preferences, values, and providing continuous education, the patient will be empowered to make safe, informed decisions (Murray, 2017). During my practicum experience, I achieved this concept by improving communication and providing culturally competent care. My patient was a young Hispanic man, who primarily spoke Spanish.
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I believe by providing direct communication, I was able to establish a therapeutic relationship and potentially positively impact his overall healthcare experience. Another competency is teamwork and collaboration. Murray (2017), defines teamwork and collaboration as effective communication within nursing and interprofessional teams to share pertinent patient information and provide the highest level of care possible. In a recent clinical experience, I recall a patient who was going to be discharged. Due to his current homeless status, he not only needed to be accepted by a homeless shelter but also required a filled prescription. The nursing and interprofessional team worked together to discharge the patient with all the necessary resources.
According to Murray (2017), evidence-based practice is using up to date evidence to provide optimal healthcare. During my practicum experience, I was able to use evidence-based practice when verifying if certain medications were compatible with the intravenous fluids a patient was receiving. This allowed me to ensure I provide safe, quality care. Quality improvement is the fourth QSEN competency, and it is defined as a continuous process of using resources to collect data and monitor patient outcomes. During my clinical experience, I achieved this competency by successfully using the hospital’s clinical manager system to verify information, such as how long the patient had a foley catheter in place. This allowed me to assess whether the device was truly necessary and potentially prevent a catheter-associated urinary tract infection (CAUTI).
Informatics is defined as using technology to efficiently communicate pertinent information to the interdisciplinary team. During a recent clinical experience, I achieved this competency by improving my ability to navigate the hospitals’ clinical manager system. This allowed me to fully know where to look and obtain important patient information, all while also protecting their privacy. Patient safety is the last competency and it is defined as simply ensuring to protect the patient from potential harm (Murray, 2017). I achieved this competency in a recent clinical experience by ensuring a patient who was a fall risk, had their bed lowered to the lowest level, bed alarm was activated, call light was within reach, and sensory aids were in place.
According to Yoder-Wise (2019), delegation is the transfer of responsibility to a competent member of your team, while remaining accountable for the outcome. Delegation can promote teamwork and collaboration, improve patient care, and reduce stress on a unit. During my practicum experience, I was able to gain more practice with delegation. One day, it was close to lunchtime, when I had a patient return from a procedure. This patient would require routine vital sign assessments. As I was preparing to round on my other assigned patients, I knew I would not be able to meet the routine vital sign assessments. By delegating this task, I was able to focus on current responsibilities.
Another skill I was able to practice and improve during my clinical experiences was hand off reporting. Handoff reporting is providing another nurse or healthcare provider with pertinent patient information. This may occur at changes of shift, when the patient is transferred to another facility, or when communicating a change in patient health status (Yoder-Wise, 2019). When providing a handoff report, it is important to include all important information about the patient to minimize miscommunication and confusion and ensure quality patient care. During my practicum experience, my preceptor was always kind and supportive which allowed me to be comfortable when providing a handoff report. I was nervous at first because I truly did not want to miss any important detail, but with each handoff, I became more confident in my abilities.
For this clinical experience, I looked forward to continuing to participate in patient care in the acute care setting. I looked forward to being able to continue practicing and improving successfully managing a full nurse assignment. A problem I remember during my practicum experience was when a physician was completing rounds and meeting with an assigned patient. As I listened, I noticed the physician would not let the patient explain his personal experiences with his health condition. It was an experience where poor communication took place. The patient stopped making eye contact with the physician and no longer attempted to explain his experience. When the physician walked out, the patient explained a potential reason as to why his blood pressure had been elevated.
He also explained a schedule he and his cardiologist had agreed regarding when he should take his blood pressure medicine, which was different than the schedule he was following during his hospitalization. This important information did not take long to know. I feel like many physicians are too focused on discharging their patients and not fully getting to know patients’ health experiences. During my experiences as a manager of care, I have come to recognize all that is involved in patient care. Many things can put a halt to a patient’s progression, and it is important to remain flexible, to adapt, and to strive to provide the highest level of care possible.
During my practicum experience, one of my main goals was to manage a full nurse assignment independently. Although there were days, I was able to achieve this, there were also days I had to accept an unexpected setback. These were moments I needed my preceptor’s guidance to help meet patients’ needs. My clinical experiences have allowed me to improve and become confident in my nursing skills, and with additional practice, I will be a successful manager of patient care
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