Community-Based Practicum Reflective Journal Guidelines

Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion
Community-Based Practicum
Professional nursing meeting experience (4 hours)
Guide for Reflection Using Tanner’s (2006) Clinical Judgment Model
Introduction

What professional nursing meeting(s) did you attend and where was it located?
I attended the Nursing Quality Outcome Council meeting which took place at St. Mary’s in the education center,
Room 163
Background

Describe the purpose of this professional nursing meeting? Describe the agendas of the group and subgroup.
What type of issues did they address?

The purpose of the meeting was to “identify and establish priorities for the Nursing Division to advance professional
nursing practice and impact outcomes. To empower Unit Councils by providing a mechanism for their chairpersons
to share and receive information.” per the agenda provided by Laura Carlstrom, RN. The meeting opened with a
prayer and reflection for the day, much like a daily huddle, and a recap of the dates for upcoming meetings. Other
topics addressed included night shift committee and the scheduling of the cafeteria, dining on call, and catering
hours being shifted. We then discussed falls, which addressed each unit’s fall record for the fiscal year, including
goals, outcomes, evaluation, and recommendations for improvements. The next topic was about CAUTIs and again,
we recognized the units with 0 CAUTIs for the year. The same approach was taken as far as discussing goals,
outcomes, evaluation, and recommendations for how to improve the hospitals incidents. We then discussed new C-
diff lab testing, Aramark representatives came in to address questions and concerns, and the meetings final topic was
a shift in culture concerning the process for informed consent. The meeting ended with a recap of 5 takeaways.
This was a wonderful recap of the issues discussed and ways to make forward progress and improving procedures
and processes. The 5 takeaways were: 1. Aramark: If a bed needs to be replaced and/or repaired there is a 1-800
number to call and a sticker on the bed to confirm the piece of equipment. The bed also needs to be entered into
Quantros for risk management purposes. 2. Informed Consent: It is NOT the RNs job to obtain consent even though
the culture has historically put more of that work on the RN. The physician MUST have the conversation about
risks/benefits and also MUST fill out the blanks on the forms. The RN should just confirm the conversation
happened and sign for that verification. 3. Sepsis: Although this wasn’t on the agenda, we had a speaker talk about
proper charting and ensuring that during SBAR report specifics are given about where the patient is in the sepsis
bundle process. 4. C-diff: New testing will include 2 different results that must both be positive. If the two results
are different an automatic DNA test will be ordered for confirmation. 5. CAUTIs: Proper care is using the CHG
wipes to clean the catheters and soap and water to clean the perineum.

Noticing

What did you notice about the professional nursing meeting initially? Describe what you saw, heard and did
during the meeting?

When I decided to go to this meeting I wasn’t sure what it was and what RNs would be present, however, walking in
I immediately recognized several RN’s from different units across the hospital. I recognized a NICU, L&D, psych,
med-surg and ICU nurse that I’d personally shadowed during clinicals, so I knew the meeting was for all different
disciplines. It was eventually made known by the chair, Laura Carlstrom, RN, that the meeting was for all the unit
leaders to go back and disperse the information to their teams. I heard a lot of conversations around each topic and
noticed that all the nurses did a great job with chiming in on most topics. During the meeting I sat and observed
from the side set of chairs with the other nursing students in attendance.

Interpreting

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Describe what you thought about the information being discussed. Have you been involved in similar
discussion during your previous student nurse experiences? Describe the similarities and/or differences to
those encounters.

I thought most of the topics discussed were very interesting. Some were major hot topics, such as the issue of
available working beds and how to get them fixed and/or replaced in a timely fashion. Another hot topic was the
change in the process of informed consent. As a student we are taught that the physician obtains consent and fills
out the form, and the RN is strictly there to verify consent was given and sign off. The difference was that all of
these nurses, for years, have filled in the consent form for the practitioners, even though that is technically out of the
RN scope. So having this new shift mandating that the burden of obtaining consent AND filling out the form blanks
is being given back to the physicians, was obviously met with push-back because they were all hesitant that the
physicians weren’t going to comply. It was apparent that tough conversations were going to have to happen and
there was a lot of anxiety with that. I feel like the two nurses heading up the initiative were very accommodating
and ensured everyone that the physicians were getting the same information. They set a future date of Nov 1 to
begin strictly implementing the new protocols so as not to “shock the system.” I haven’t experienced similar
discussions prior to this meeting.

Responding

Describe stresses (both positive & negative) you experienced as you responded to the new learning or the
challenge.

A stressor experienced was hearing the hot topic issues, such as properly functioning equipment, being such an issue
with every unit’s ability to give proper care to their patients. These issues can’t be fixed overnight, and it directly
impacts nursing since the RNs are the ones on the front line of care. One positive experience during the meeting was
the feeling that every unit was present and the unit leaders were very active and vocal about what needed to happen
in order to benefits the staff RNs on their units. I felt like they were all being advocates for the other nurses on their
units and made sure that questions and concerns were being addressed.

Reflection-in-Action. What role would you take being assigned to represent your unit in this group? What
subcommittee would you like to participate with and why?

In order to be in this meeting you needed to be a unit leader. If I were a unit RN leader on my unit, the expectation
would be that I would come to these meetings with things our unit was doing successfully, to share with other unit to
help them run better. I didn’t learn of any sub-committees within this group.

Reflection-on-Action and Clinical Learning

What written evidence is available to support professional nursing groups and their impact on the
development of evidence based practice and improved patient outcomes. Cite/reference all journal articles
that contributed to the evidence.
What is the value of professional nursing meetings both as a part of a healthcare system and within a
professional organization?
According to the Online Journal of Issues in Nursing, “associations in nursing are critical for generating the energy,
flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients
and nurses, and the trust of society’. (Matthews, 2012)
When groups of nurses come together to talk about the newest research and best practices in their units, those ideas
are filtered to other units and patient outcomes can be improved for the entire organization.
Describe any changes in your values or feelings as a result of this experience.

I wasn’t aware that there was this much working involvement between RNs from all the units in the hospital. It was
nice to see that collaboration and exchange of information in an organized fashion. I feel that after seeing this group
in action that I have a greater appreciation for the RN unit leaders and the service they provide to the units that they
serve. They seem to truly care about the success of their units and the outcomes for their patients.

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 Community-Based Practicum Reflective Journal Guidelines

References

Matthews, J. H. (2012). Role of Professional Organizations in Advocating for the Nursing Profession. The Online

Journal of Issues in Nursing, 17. doi:10.3912/OJIN.Vol17No01Man03.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment

Model. Journal of Nursing Education, 46(11), p. 513-516.

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