Mid Term Self Evaluation

Mid Term Self Evaluation


2 Course Clinical Objectives and 2 Personal Objectives so far in the course
Course Clinical Objective

1. Leadership Skills: Demonstrates leadership in the development of online unit communication tool. Improving communication and satisfying system requirement for documentation of continuous improvement and shared governance. Developed a blog for distribution and intake of information from staff. For example the change of process in documenting charges is communicated in person and on the blog. The blog allows staff to provide feedback regarding changes.

2. Critical Thinking: Gathers data regarding undetected deviations from policy in patient identification. Makes direct observation of patient intake procedure on mobile unit. Identify point of deviation and develops a plan to re-education staff. Numerous patient identification errors have taken place. I identified the source of error as being a failure to follow patient identification procedure at many points. A staff meeting was held and re-education begun. This included placement of reminder flyers in patient intake areas to prompt staff and educate patients.

3. Professional Accountability: Follows university’s policies, seeks own learning. Seeks opportunity to be of assistance to preceptor in projects and completes projects in timely manner. Working with preceptor’s schedule changes to accomplish clinical goals.

4. Client Advocate: Worked to correct billing issues for patients. Worked to advocate for patient privacy protection and safety in observance of patient identification policy.

5. Cultural Competence: Worked to promote culturally competent care while serving the Vietnamese community. Encouraged signage in mobile units include translations for common languages of people served.
Course Objectives and relate them to your work in your specific clinical site, by providing examples

Discuss current trends and issues in the nursing profession – Discussed the role of the Wellness Clinic and Mobile Units in emergency preparedness. Questioned about role of center in possible pandemic H1N1 response. Also discussed need for more participation and spearheading in preparation effort.

Communicate effectively, both verbally and in writing, with individuals, groups and health care providers. – Communicating with community partners via email, phone, and fax. Communicating with unit staff, delegating tasks related to patient identification policy re-education. Communicating with Nurse Practitioner regarding care of patients and flow of work.

Demonstrate critical thinking in the delivery, collaboration, and coordination of nursing care. – Assist in coordinating mobile unit scheduling at various mulitple sites while allowing for one unit to go in for service.

Incorporate professionalism and personal accountability in the implementation of nursing care. – Encouraging staff to be personally accountable to following procedures for patient safety. Encouraged to strive for excellence even when not being directly supervised. Shared personal story to staff demonstrating transparency of practice and personal accountability regarding a personal error in practice and method used in reporting and correcting error.

Function as a client advocate through collaboration with health care providers. – Worked to clear up numerous billing errors as client advocate. Clarified services provided, charges to account, insurance coverage. Developed spreadsheet and delivered to preceptor showing data related to incorrect billing.

Demonstrate leadership skills in health promotion and health maintenance of individuals and groups. – Demonstrate leadership in increasing preparations for H1N1 demand for services with fall flu season. Working to protect community through promoting preparation for individuals and families according to CDC recommendations.

Incorporate research into the practice of professional nursing. – Educate men regarding research in prostate health recommendations. Encouraging them to know their own PSA number and take ownership of their health.

Enact the nurse’s role in health promotion and health maintenance for individuals and groups from various cultures. – Coordinate culturally competent care to Vietnamese community in Arlington through utilization of translators and observing common Asian cultural norms.


Statement of your personal objectives and discuss how you have or have not accomplished them, supporting them with reasons and/or examples

· Enhance communication with peers with a focus on delegation, through the application of communication theory.
Spoke to unit at staff meeting regarding new UBC communication tool and appropriate professional communication.
· Use time management principles in the scheduling of clinical days.
Established schedule with preceptor at beginning of semester. As a professional courtesy, be flexible with preceptor as her schedule changes. Still assure that my clinical goals are being met in time allotted by adding days when needed.
· Objectively evaluate the Wellness Programs ability to meet the Fort Worth community’s needs.
Identified a need for preparation for possible increased demand of services with the H1N1 and seasonal flu this fall.
· Identify at least one opportunity for enhanced community service in the Wellness Program
Identified a need for preparation for possible increased demand of services with the H1N1 and seasonal flu this fall.
· Identify one process improvement issue in the mobile units.
Encouraged preparation of administration paper work packet in office prior to taking on the mobile unit. Utilize patient stickers to label paperwork whenever possible to streamline paperwork.
· Identify one patient safety issue in the mobile units.
Identified failure to comply with patient identification policy by numerous staff at multiple encounters within mobile unit. Worked to address the problem through re-education.
Statement and discussion of 1 way in which these items discussed above have enabled or fostered your growth as a professional nurse.

My experience in this clinical with community health has reinforced to me the need to continue my education. The community needs nursing to seek higher education and help fill the gaps in the current healthcare system. My preceptor has inspired me that an individual can make a significant difference in the community they serve.

Communication Style

Week 3: July5-July11



One of my personal objectives in this class is to improve communication with coworkers. This objective came out of an awareness of my tendency to run into situations where others feel I have been offensive. The thing is, I actually make an effort not to be offensive. So when it occurs I am usually surprised that whatever I said has offended someone. Feedback I have received has included "it's not what you said, it's how you said it" and "I can't explain it, but there is something about the way you said that" or "it is just something about your tone". I think there is a kind bluntness to my communication. I am not intentionally rude so I say it kindly but it is blunt nonetheless.


This week with my preceptor, I assisted her with the resolution of an incident report. Actually, there were three incidents committed by 1 person on 1 day. This high level of error led to the Risk Manager of the facility contacting Rosemary to discuss the employees job placement. In the discussions, we uncovered that there was actually a process improvement issue across the board. Staff are not following the patient identification policy and there are HIPAA violations occurring because of it.


My blunt tendencies, were revealed as Rosemary and I discussed the employee and her future. I asked Rosemary what is the turning point in the employees relationship with the company. When does it become a move toward releasing them? She stated that it is all about the attitude. That if an employee does not want to take steps to improve themselves and is resistant to the correction then it is probably time for them to go. I was ready to give up on the employee.


I was witness to numerous conversations about this employees future and livelihood. I learned from the different types of communication techniques demonstrated by Rosemary and the Risk Manager. Especially in the way they spoke about this sensitive issue with respect for the employee. Not just the words used but the content of their conversation. They were working on developing a plan that would help this employee be successful. They weren't ready to give up on her. Even if this particular job assignment "wasn't a good match" for her they weren't ready to give up. There was no apparent bluntness.


7/7: 7 hours
7/10: 4 hours
Total: 24/60

Two for the Price of One

Week 2: June 14-20th

This week I began my clinical experience. My preceptor is Rosemary an RN with a Masters in Public Health. She oversees the Wellness for Life center of a hospital in downtown Fort Worth. This includes the mobile health clinics that are used to serve the community and provide health fairs for corporations. She also oversees health fairs and a few other outpatient clinical sites at the hospital itself.

Rosemary was my first choice in preceptor because I am interested in community health. In my past experience, I have worked with FNPs who developed and operated mobile health clinics to serve people in outlying areas without access to care. I wanted to know what was involved in the management of this type of service.

I had 2 clinical days this week one in the office and one in the field. The day in the office I observed Rosemary work on time and resource management. We also had a meeting about Magnet re-certification. As part of the Magnet preparation, we realized the unit needed to document it's CI project and form a functioning UBC. The problem is that the "unit" (the people who make the unit) are mobile. I proposed a mobile UBC. I am developing a blog UBC, where the unit can access the information from UBC and submit comments while in the field. Within the blog, I will document the CI project that they have been working on, meeting the two goals for Magnet preparation.

My second day was at a corporate health fair where they were performing men's health screenings for employees. The focus was on early detection, education, and encouraging regular PCP visits while building hospital loyalty. I spent most of my day with Gayle an RN with a Masters in Nursing Education who was helping Rosemary. Gayle runs the prostate cancer education center and is the head of the nursing research board for the facility.

Gayle talked to me in depth about the behind the scenes funding that goes on in our facility. She was a wealth of information about the politics in funding. She also shared her passion for prostate cancer and men's health. I watched as she educated the men, using EBP, with the most current information available on prostate cancer. She also shared how she is working to develop a new service for patients who are diagnosed with lung cancer.

At the end of my day, I felt glad to contribute and grateful for the wealth of knowledge these two ladies shared with me. My preceptorship is going to be a great experience!

6/16: 7 hours
6/19: 6 hours
Total: 13 hours

Preceptor Selection

Week 1: June 7-13th

The task of selecting a preceptor came as an unexpected one. It was another frustration in the lack of preparation I have felt through this BSN process. It is easy to feel disconnected from the University when you are an online student. The school of nursing has failed to provide leadership for online RN-BSN students that is consistent. For the task of finding a preceptor, it would have been helpful to make us aware in the leadership class that we would be completing clinical hours and we could have been locating a preceptor over the break.

It may seem like I am just complaining. In fact, I am looking at the process of being an online RN-BSN student from the management/professional nursing perspective and seeing opportunity for improvement. When your BSN program is unorganized and no on seems to be planning ahead or know what is coming next, what does that say about the quality of the program? What does it say about the professionalism of the program?

In every setting there are ways to improve the process. Who is the professional nursing leader that is evaluating the process and working on improving it? I have recently begun to ask this question in my clinical setting (as well as at TWU). I have recognized the strengths in my manager and some opportunities. Our unit is in a time of transition and watching her 'lead' us through has revealed she may not be up to the task.

When I realized I needed to find a preceptor I sent an email to my manager and the department director on the same day. While they both are very busy with many responsibilities the director got back to me within 24 hours. Within a few days she had sought out information from me about what I desired in my clinical experience and contacted a potential preceptor. By four days later I had an emailed preceptor agreement.

My manager responded to me 8 days after my original email. 8 days. I received her email on the day I completed my first clinical. This slow response and unprofessional behavior makes it difficult to respect her as my 'leader'. It did however reinforce a lesson to go to the right resource person. It also gave me new respect for my director.

Unofficially Underway!

Summer semester is unofficially underway. I am nervous about this class and maintaining my GPA. Since spring semester ended I had surgery and am off work until July. Now trying to figure out how to get in the clinical hours for this course is weighing heavily on me. My biggest concern is that my employer won't let me precept at our facility because I am on disability...so I am just having to wait it out and see what happens.

I have been involved in leadership in some way or another all my life. From leading a group of girls on the school yard to being both formal and informal leader on my current unit. It is funny that even while I am off work, the issues on the unit are being brought to me via email or facebook!

I enjoy helping my coworkers navigate conflict situation. I am thinking about this role in the development of my personal objectives for this class. I think I need to improve my communication style and techniques. Some of the problems I have had relationally at work revolve around communication. My manager recently told me she thought I would fit well into a CI position. So these are some of the things I am considering to discuss with my as yet unknown preceptor.

Nurses as Teachers - a Magnet force

Well almost everyday I work, I have a student assigned to my patients. Sometimes I enjoy the students and sometimes I just wish they would go away! This past week I went 2 for 3. So I have decided to take a new approach with them. First thing in the morning I ask them what they would like to get out of the day, and what they expect from me. Essentially asking them their personal objectives for their clinical experience. Working in mother/baby, often the students have no interest in that department. So given they don't really want to learn about the nursing process related to that patient population, what else can I teach them?

So yesterday I had a fun loving, outgoing male 26 year old, working on his second degree. He doesn't intend to work mother baby so I taught him time management and critical thinking. I made him think through things: Me: "Can you get the patient some jello" Student: "Sure, where is it?" Me: "In the pantry behind the desk" Student:"There wasn't any in there" Me"Where did you look?" Student:"In the fridge" Me:"Try looking in the door of the fridge" Student: "Oh, OK"
He returns victoriously with the jello in hand. Me:"What is she going to do with that jello" Student: "eat it????" Me: "Is she going to do some Jello shots?" Student:"Ohhh, a spoooon!"

Eventually the patient got the jello and a spoon! Actually the critical thinking came with the diabetic patient who prior to pregnancy had been on oral meds with insulin therapy started during pregnancy. She was post op 12 hours on clear liquids 1800 ADA which was presented on a tray as non-diabetic juice, jello & popsicles....Me: "What do you think about this tray?"

So going the extra mile to teach while providing patient care and learning an ever evolving process related to the EHR, is exhausting! But very rewarding...and at the end of the day my student said "I really learned a lot today. Thank you" He was surprised and grateful and I realized I like teaching! Oh oh...double masters??? FNP and Education?

Crunch Time

Well at this point in the semester it begins to feel like you are home free. This feeling is deceptive. It is actually the busiest time of the semester. All papers start coming due, while the weekly work stays on pace. Meanwhile I am feeling more ahead than before, wrong! I am feeling the presence of these five classes waiting anxiously to register for the final 2 this summer. Mentally there is something to registering for the final step! Of course for me that the end of the beginning and in the fall the Masters program. I have applied and await notice of acceptance.