I would like feedback of my paper

I would like feedback of my paper on delegation. General Information The facility I am assigned to is in Detroit, Michigan. The facility’s name is John D. Dingell, Detroit VA Medical Center. John D. Dingell has 108 patient beds and serves honorably discharged veterans. The healthcare facility is available to more than 350,000 veteran patients throughout the state of Michigan, and its services include inpatient, and outpatient medical healthcare, emergency responses, and surgical services. The hospital also has a well-equipped pharmacy to optimize chronic disease management. The pharmacy is available for inpatient and outpatient services on a 12-hour daily schedule. My assigned area is a specific hospital segment with 20 beds (medical-surgical unit). The unit also had portable cardiac telemetry devices for recording and transmitting ECG data to a central monitoring station. The mission of the John D Dingell VAMC describes the facility’s efforts and the great need to handle our nation’s heroes. The mission statement of the Detroit VA is to offer veterans quality, timely services through care and respect for one’s physical, psychological, and spiritual health. The healthcare facility pledges to use the codes of ethics and has core values: Commitment, Advocacy, Integrity, Respect, and Excellence. (Cheney et al., 2018) The healthcare providers ensure integrity and commitment to ensuring the veterans have the best treatment and care. During preceptorship, primary care nursing was the delivery model. This nursing model gives the nurse a higher responsibility for planning care and ensuring better continuity of care. The primary care strategy is essential to ensure the nurse can handle a patient effectively. Assessment The mission statement mentions offering timely and quality services; as proof of this, veterans are serviced within 20 minutes upon arrival in the ED. After being assessed by a physician, who makes recommendations for admittance or discharge. Once the patient has been admitted, they are seen by a nurse and a physician. Orders are written within an hour of arrival at the unit. The mission summarizes the commitments of the VA hospital to serve its veterans. We did not have the opportunity to meet with the unit manager. Our contact was with the preceptor and her colleagues. The preceptor uses the democratic leadership style. (Huber & Joseph, 2022) This style incorporates decision-making from the nurses, encourages collaboration, and enhances the environment for special care delivery. This type of leadership helped the preceptor to amend communication with the healthcare providers, which helped make better decisions for the facility and the patient. (Alloubani & Akhu-Zaheya, 2018). The style was appropriate and compatible, especially for this type of unit. The milieu of the unit gave the nurses the ability to enhance the democratic leadership styles that offered more autonomy. The staff was comfortable with the type of leadership my preceptor utilized since they had a chance to air their issues and give ideas that were helpful to the healthcare delivery. The preceptor had a good relationship with the staff. She acted as an exemplary role model to staff members and us. She helped me develop professionally and gain more experience. Using prior knowledge and skills in operating the facility’s electronic health records and other systems allowed the preceptor to give me more autonomy in care delivery. When a problem arose in the unit, she would engage her teammates in handling the matter to make an amicable decision. For example, an issue in the facility involved pulling staff from our unit to another. After conferring with colleagues, the preceptor called the off-duty manager, and he explained and later verified that this floor’s staff were not allowed to be sent to man the other unit. The preceptor was efficient in her organizational strategies as she helped set up a collaborative team that ensured the services were delivered efficiently. The preceptor utilized her time efficaciously. One example was the timeliness of glucose monitoring for diabetic patients. The preceptor was very regimented about that. The preceptor was careful in her services and promoted quality assurance, especially during blood transfusions. During this time, she would check and double-check to ensure consent forms were signed and the patient’s blood was typed and crossmatched. In her communication, she embraced a direct communication strategy which helped her give directions and acquire information from the staff efficiently. The preceptor is a member of Sigma Theta Tau. This organization helps nurses to advance their knowledge which improves healthcare worldwide. According to her, the organization has a substantive impact on nursing by pushing for evidence-based practices and research. She says this organization acknowledges the need for strategic and robust leadership in nursing. Plan The best skills I have learned during this preceptorship are communication, planning, and prioritizing. Communication is vital because it improves accuracy and ensures consistency when providing care to patients. Another important skill I learned is the proper way to insert an IV. Intravenous therapy is a vital skill for registered nurses because delivering fluids, medications, and blood parenterally will improve the patient’s condition. Since the unit had mobile telemetry units, I could utilize the ACLS training completed in school by reading cardiac strips. Furthermore, they instructed us to perform ECGs. During the preceptorship, I also learned that some medication routes could be modified if the patient was not able to tolerate the usual way it was supposed to be given. For example, a patient had issues tolerating Humalog insulin units given by using an insulin syringe. The preceptor had to modify the medication administration and use a tuberculin syringe. (Increments are smaller) The patient was also on a different medication that helped him balance his elevated A1c levels. The new medication was a sodium-dependent glucose cotransporter (empagliflozin) (Ogawa, Nako, & Ito, 2018). I researched this medication to discover the side effects, indications, and specific labs to monitor. Educating myself on the medication would assist me in patient teaching and the ability to answer intelligently when asked. Using the data collection and analysis process ensures that I will give professional patient care. Before implementing blood transfusions, care was taken, and I was well conversant with the policies. I have expanded on prior nursing knowledge about medication and the standards of practice. (Murphy et al., 2021) I have also researched current practices that student nurses can implement to give patients quality care. When I was unfamiliar with a medication, I took the time to look it up and print out the information and study it during our downtime. I anticipated nursing interventions that would keep the patients safe. My primary focus was on providing quality care. Maintaining direct lines of communication with my assigned patients assists in establishing trust. Lastly, the preceptor gave me clear guidance on prioritization of care. The preceptor instructed me that blood cultures should be completed before a patient is started on antibiotics. Learning this skill will help the provider identify the offending microorganism. Identifying the microorganism could improve patient care by allowing the provider to prescribe the correct antibiotic. Implementation The ANA decision tree for the delegation is posted in our unit, and the preceptor said most nurses use it. On matters of delegation, I was not able to perform that in my capacity. (Student nurses are not afforded this opportunity at the VA) However, when the preceptor was assigned charge nurse duties, she could utilize this tool. She used the delegation tree to assign duties to an AP and an LPN. The facility, in practice, usually follows the ANA delegation standards. (Huber & Joseph, 2022) Since I work there, I see it in practice in other areas. Evaluation John D. Dingle VAMC utilizes the consumer assessment of healthcare provider systems (CAHPS). (Parast et al., 2018) This system is used to determine the patient experience of a large patient population. This agency uses this survey tool because it is considered the industry standard for measuring patient healthcare experiences. The model tracks individual satisfaction to rate the quality of care. During the preceptorship, I helped in different ways to coordinate work and ensure better service delivery. We had a patient who feared communicating directly with a provider. The patient verbalized that his concerns were not being heard. I communicated this information to the preceptor. The preceptor helped to resolve the issue by arranging to have another provider care for the patient. The VA hospital uses CAHPS as a metric to track these patient care experiences. Every patient is offered a questionnaire upon discharge to rate their experiences. The patients have the option to complete the survey anonymously and electronically. During this preceptorship, I observed the ethical principles of nursing. Before the blood administration, I confirmed the patient’s consent and asked if the patient had any questions regarding the procedure. (nonmaleficence). I allowed for different perceptions from the patient, such as refusing medication. For example, a patient had no trust in a new prostate medication he had been prescribed. He adamantly refused it. (autonomy). We (my preceptor and I) informed the patient of the implications of medication refusal. However, he did not change his stance. (Bendtsen, 2022). During this preceptorship, I ensured better following of the healthcare mission, such as timeliness. Patients received their necessary medication on time. If a medication is unavailable, there is a system for missed medication doses. If a missed dose is recorded, all the nurse has to do is click on it, designate the reason for the missing medication, and the pharmacy will send the medication to the unit utilizing a tube system. Additionally, the facility embraced privacy and good care of the family members who came to see their patients, especially those with dementia. Patient confidentiality was always maintained. For example, one of my assigned patients had a visitor that identified herself as his sister. The visitor wanted to know the patient’s diagnosis. I instructed the visitor that the patient had to give permission for that information to be divulged. The visitor verbalized that she was not comfortable asking the patient. I reiterated that that information could not be shared without the patients consent. Speaking of leadership styles, I used to think the best course would be the autocratic type of leadership. However, during my preceptorship, I understood the need for communication and embracing the ideas and decisions of other group members. I changed to the democratic type of leadership. This style was more effective, and it ensured interprofessional cooperation. I learned the art of being a team player. This style helps other team members better understand the aspect of collaboration. My skills helped me to handle the telemetry monitors well, communicating with the physicians and pharmacy. My problem-solving style was one of intuitive thinking. A problem was identified, and different solutions paths could be evaluated. (Ahmady & Shahbazi, 2020) One example I can think of involves a BKA (below-the-knee amputation) patient. The patient complained about severe pain and said he had never felt pure relief since amputation. He said this was one of the many surgical procedures that he had endured. The patient was currently on Tylenol #4. After checking his allergies, I suggested replacing it with Neurontin. The preceptor backed the suggestion, and I paged the physician. After the preceptor consulted with the doctor and the patient, the patient was administered the new medication. Evaluation of the alternative medication was completed. The patient reported feeling better and verbalized that he was pain-free. If faced with such a situation again, I would not choose any other option since the patient’s main goal was to be free from pain. Pain needs immediate intervention, and the best possible solution should be considered. Pain can be a deterrent to feeling well. Pain can also lead to depression and interfere with a person’s daily life. The preceptor accorded me the best communication, and the other RNs offered much advice on passing the NCLEX. The preceptor was open to answering all of my many questions. The team was extremely positive and had clearly defined expectations. I was impressed by their collaborative problem-solving techniques. I had a planned schedule that helped me accomplish my goals initially. One main component of my plan was to learn a new clinical procedure daily. The plan changed as I continued. The increase in the patient-to-staff ratio prompted this. However, I had to learn different time management strategies, such as arriving early and allowing time to look over the staffing schedule and patient roster. By scrutinizing the patient census and the assignment of each staff member, I could prioritize the diagnoses for my patients and plan my entire day better. References Ahmady, S., & Shahbazi, S. (2020). Impact of social problem-solving training on nursing students’ critical thinking and decision making. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-00487-x Bendtsen, K. (2022). Ethical considerations in Cardiovascular Nursing. Cardiac Vascular Nurse Certification Review. https://doi.org/10.1891/9780826173249.0007 Alloubani, A., & Akhu-Zaheya, L. (2018). Leadership styles and theories. Leadership Styles and Nursing Care Management, 1-23. https://doi.org/10.2174/9781681087450118010003 Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., Fortney, J., Burgess, J. F., & Pyne, J. M. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3346-9 Gokhale, S., Desai, B., Twing, A., Dickens, H., & Shroff, A. (2020). Same-day discharge after outpatient PCI in a VA hospital: Shared decision making and the VA mission act. Cardiovascular Revascularization Medicine, 21(11), 1369-1373. https://doi.org/10.1016/j.carrev.2020.04.033 Rankin V. (2022). Leadership and Management Principles D. Huber & M.L. Joseph (Ed.), Leadership and Nursing Care Management (7th ed., pp. 106). Elsevier. Huber D. (2022). Leadership and Management Principles D. Huber & M.L. Joseph (Ed.), Leadership and Nursing Care Management (7th ed., pp. 10). Elsevier. Murphy, M. F., Harris, A., & Neuberger, J. (2021). Consent for blood transfusion: Summary of recommendations from the Advisory Committee for the safety of blood, tissues, and organs (SABTO). Clinical Medicine, 21(3), 201-203. https://doi.org/10.7861/clinmed.2020-1035 Ogawa, S., Nako, K., & Ito, S. (2018). Effects of sodium-glucose cotransporter two inhibitors on hypoglycemia in brittle diabetic patients with decreased endogenous insulin secretion. Endocrinology, Diabetes & Metabolism, 2(1). https://doi.org/10.1002/edm2.44 Parast, L., Haas, A., Tolpadi, A., Elliott, M. N., Teno, J., Zaslavsky, A. M., & Price, R. A. (2018). Effects of caregiver and decedent characteristics on CAHPS hospice survey scores. Journal of Pain and Symptom Management, 56(4). https://doi.org/10.1016/j.jpainsymman.2018.07.014 SCIENCE HEALTH SCIENCE NURSING NURS 433

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