Nursing as a career is chosen for many different reasons. Some are interested in the human body, and others want to help those in need. The nursing experience is one not easily forgotten, but often taken for granted. Nurses and their value have been weighted more heavily in the past 10 years for its relevance to the survival of medicine. The nursing shortage has created a national outcry for the need to encourage nursing as a career. “As the nursing shortage peaked nurses who were left at the bedside found working conditions unacceptable and many left the profession in search of other work”.(Allen, Jan-Feb 2008, p. 35) The shortage gave rise to the nurse being recognized as a valued and need professional. The RN to BSN programs now available to all working RN’s helps development nurses behaviors and skills as trained professionals. Before this course my nursing practice was on auto polit. I arrived to work, and started my assignment the same way every day. I start by assessing all patients assigned to me, then review their medication, and last administer prescribed medication. I would give education when it was warranted. For instance, if a patient had received a new Foley catheter and was going home with the catheter I would education them on home use. After my transition to professional nursing I recognized the legal responsibility to safe guard the patient. After this class I increased the need to make evidenced based practice (EVP) guidelines applicable to every aspect of my nursing care. My interactions with patients during this class involved how I could use EVP to safe guard my patients and provide a high level of professional nursing care. The RN-BSN program is helping me mature and develop my nursing practice as a professional learner who uses EVP to provide the best nursing care possible. Goal 1 – Evidence-Based Practice:
Reduce the time interval between when a provider writes an antibiotic order to when the patient receives the first dose. Documentation will include summarization of two patients used while fulfilling 120 work hours on my clinical unit.
Studies have shown that the by reducing the time frame of when a doctor orders an antibiotic, and when it is delivered to the patient, aides in better patient recovery. The studies I found focused on emergency rooms and community acquired pneumonia (CAP). I took some of the information and techniques used in the studies and tried to apply them to my clinical practice. “In 1997, a retrospective study for 14,069 Medicaid patients hospitalized for CAP found that, after adjustment for severity (2) and demographic factors, administration of antibiotics with 8 hours was associated with a lower 30-day mortality rate”. (Watcher, Flanders, Fee, & Pronovost, 7/1/2008, p. 29) I not only want to decrease the time of the first delivery of doctor ordered antibiotic, but I wanted to give all proceeding doses on schedule. At the facility where I work the frequency of missing doses and changed times are high likely to be greater than 2 hours. The reason I came up with the occurrence is high acuity level, and too much multi-task behavior by the nursing staff. Having the nursing staff responsible for delivery of every aspect of the patient care takes the focus off the tasks that are mostly controlled by the nurse. The nurse at my facility has to remind the respiratory therapist of treatments, hound the laboratory to draw labs on time, walk ½ mile to obtain supplies that should be delivered, and of course repetitively remind pharmacy of need for medications. I feel that if we could make the branch of support staff responsible for their part in the team effort our focus could be more on the patients, and delivery of care within our immediate control. I attempted to achieve my goal by starting with careful investigation of medications needed at the beginning of my shift. I was able to identify missing doses, and drugs that had been delayed...
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