Clinical Journal Leadership Nursing (Medical-Surgical

Clinical Journal

Leadership nursing (medical-surgical floor)

Clinical journal: Days 1-3

Clinical day 1

Discuss clinical patterns in a variety of healthcare settings.

On the first day of my observation, I met my preceptor, the nurse I will be 'shadowing' and working with throughout the semester. She briefed me as to what I should expect during my experience. Medical-surgical units tend to get a wide variety of medical cases, spanning everything from geriatric care, to patients with heart conditions and broken bones -- even drug-related issues. "Be prepared for everything" she told me, explaining that working on such a diverse unit was often a test of a nurse's emotional and physical endurance just as much as a test of nursing knowledge. Many different psychological profiles as well as complaints are present on a medical-surgical unit, and a nurse must be flexible enough to deal with all of them. She also noted that a common organizational pattern manifest in healthcare organizations is to 'dump' many unclassifiable, unwanted, and difficult-to-treat cases on the medical-surgical unit, due to its lack of specificity, in terms of the type of patients admitted. This can often cause tempers to be short, because of the stress under which many of the workers operate. My preceptor also discussed different ethical considerations that might arise during my 'shadowing,' such as the need to preserve patient confidentiality, and to act in a respectful manner to patients and keep them at ease.

Clinical day 2

Objective 6: Collaborate with other health professionals to plan change in a variety of healthcare settings

Today, while reviewing a patient's chart with my preceptor I noticed that the patient's potassium level was low. After I pointed this out to my preceptor, I suggested that the patient should receive a potassium supplement. My preceptor notified the nurse practitioner on the unit and she ordered potassium supplement for the patient. This example illustrates the importance of collaboration and facilitating communication on the unit.

Communication is the key to understanding: the key to patient understanding and effective nurse-administrator communications, and nurse-to-nurse communications. This is particularly true on a medical surgical unit, given the diversity of patients that are represented there. The cause of the patient's complaint may not necessarily be immediately obvious, and the nurse must act as a fact-finder to determine it. The nurse must 'read' the patient's personality, and know whether acting firm or sensitive is the best way to deal with the individual. A nurse must always comport herself in a professional manner, but needs to take a different tone with a child vs. An adult; a person in a dissociated state vs. A man experiencing chest pains. Communications decisions, much like medical decisions, must often be undertaken in a split second. The first few minutes of the encounter can set the tone of the entire client-nurse interaction, even the tone of the patient's entire experience on the unit.

Effective communication is also required with other healthcare professionals on the unit, including but not limited to doctors, other nurses, and physician's assistants. 'Triage' -- deciding what patients and procedures are of highest priority, establishing standard operating procedures to deal with being short-staffed, and using time and resources in an effective manner demand that all affected personnel are kept 'in the loop.'

Clinical day 3

Objective 7: Evaluate available resources to facilitate planned change in healthcare settings

I have observed with my own eyes the difficulty of staffing the medical-surgical unit due to the shortage of nurses on the unit. Even the best nurses find themselves forced to work long hours, including back-to-back shifts, and overnight hours. While this is expected from time to time, a lack of staff can result in even the best healthcare professionals feeling stressed at times. Finite resources result in imperfect conditions for all healthcare workers.