Running head: JGEORGE_N660 REFLECTION PAPER 1

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1 Running head: JGEORGE_N660 REFLECTION PAPER 1 RN to MSN Clinical Systems Leadership Self Reflection Jennifer George, RN August 08, 2015 The University of Arizona

2 JGEORGE_N660 REFLECTION PAPER 2 RN to MSN Clinical Systems Leadership Self Reflection Overview A clinical instructor during my primary nursing education influenced my appetency to pursue an advanced knowledge of the nursing process and the intricate operations held behind the scenes of an organization. This mentor enlightened me with anecdotes of her experiences throughout her 40 plus years, focusing on the innovative developments in healthcare and within the nursing practice. In addition, this mentor stressed to me that successful leaders do not instruct, but illustrate the way by example. It was with this knowledge and the possibility of future transformation that I chose to further my edification to become a guiding component in the forthcoming evolution. Entering the RN to Masters of Science program with a focus in Clinical Systems Leadership is how I purposed to begin my transition. At the beginning of the program, I set-forth personal goals to outline what I anticipated to achieve from the journey. First, it was important to obtain an improved understanding of the strategic modus operandi. Second, it was paramount to grasp what I as a future leader could execute in order to empower and advocate for others. Lastly, I felt it essential to hone my skills to become an effective, efficient and innovative leader in order to facilitate an atmosphere which is conducive to staff and the population alike. Throughout my journey, I captured various concepts. Of these concepts, the transformational leadership style and the theory of emotional intelligence are two principles that will resonate within me moving forward. These key aspects appeal to my own morals and principles and I desire to embrace and emulate them as a leader. Being a transformational leader will afford me the capacity to aspire and empower others through engaging their own ideals and

3 JGEORGE_N660 REFLECTION PAPER 3 values to actualize an additive effect to perpetuate outcomes that will exceed expectations (Renjith, G & George, 2015). In addition, emotional intelligence will influence my own commission for it grants an aptitude for self-awareness, emotional watchfulness, effective communication, recognition of social-awareness along with the implementation of relevant conflict resolution (Fletcher, 2015). Although many concepts were introduced throughout the program, these particular concepts I feel will provide me with the tools necessary to become a successful leader. Program Outcomes As a result of the knowledge obtained through the program, I was able to assist in the design, implementation and lead an innovative patient-centered care experience within an emergency department. This atmosphere at times can have poor patient satisfaction reports and extended wait times for entrance and evaluation by a care provider. By streamlining the triage process and implementing a rapid evaluation model where a patient would be evaluated by a physician within five minutes of arrival, it aimed to provide an improved patient experience. Through its implementation, the outcome produced a mitigated left without being seen and length of stay ratio, improved patient satisfaction reported through Press-Ganey and decreased wait times. Through the programs tutelage of the use of evidence based practice to deliver improved quality care and optimal patient outcomes, I learned how to collaborate with interprofessional teams to set in motion an improved protocol and policy on rapid evaluation and treatment implementation of STEMI cases. Through the utilization of evidence based practice and guidelines, the evaluation process for STEMI cases quickened enabling rapid notification of

4 JGEORGE_N660 REFLECTION PAPER 4 crucial interprofessional team members and implementation of live saving measures. As a result, the facility s door to balloon times decreased from fifty minutes to twenty minutes. Through the programs introduction of alternative therapies and healing environments, I recruited other team members and together we were able to evaluate the current status of our own health institutions emergency department and the effect it had on patient care and outcomes. Our evaluation deemed that this particular environment did not resemble an atmosphere which would be conducive to the healing process. Due to this, we approached key team members in leadership to make small changes to the surroundings, to include painting exam room calming colors, having additional options for lighting installed in rooms when the high powered fluorescent exams lights were not deemed necessary and the installation of multi-media (televisions/music) in each room to aid in distraction efforts. The outcome produced an improved patient-care experience, allowing patients to feel more at ease during their visit and providing alternatives to pass the time while they patiently awaited treatments and results. In addition to making positive changes to the environment for patients, it was crucial to address the needs of staff working within the department in order to facilitate efficient and safe care. After participating in shared governance efforts, I approached leadership with a plan to improve efforts by requesting that health information in form of technology be incorporated into each exam room. As a result, leadership found it within the budget to allot for computers to be installed in all patient exam rooms. This improved safety and care measures allowing staff to review orders, enter assessments and triages at the beside, along with adding functionality to utilize an electronic MAR with scanning capabilities to deliver safe and effective patientcentered care. The outcome produced a decrease in medication administration errors along with

5 JGEORGE_N660 REFLECTION PAPER 5 providing the staff with an increase in time to be spent with their patient building positive, trusting relationships. The program introduced evidence based care models in order to coordinate care efforts to improve patient outcomes across the healthcare continuum. In particular, the transitional care model (TCM) whose foundation is to facilitate continuity of care from one environment to another in an effort to assist patient s with resources and/or care which may be difficult to obtain (Bowman & Flood, 2015). Continuity of care across a continuum when discharging patient s from an emergency room can be difficult, as many who utilize the services of an emergency room are doing so due to lack of primary care services and/or lack of health coverage. In response to these findings, an interprofessional team collaborated within the emergency department felt it necessary to mitigate these barriers to further care. Utilizing the theory of TCM, a golden ticket was created and issued by emergency physicians to be delivered to case managers and social workers to prohibit patient s discharging the emergency room without having an established follow-up appointment. In turn, case managers/social workers investigated each individual case and established outpatient follow up appointments for each discharged patient. The outcome provided necessary resources delivered to each patient to continue their plan of care. Lastly, the program encouraged the evaluation of patient care systems and what improvements could be implemented to improve overall outcomes. After evaluation of the care system established within the emergency room, a shared governance group determined that patient s felt there was a lack of communication between themselves and the care providers. As a result, the interprofessional team deemed it necessary to improve communication efforts and

6 JGEORGE_N660 REFLECTION PAPER 6 after reviewing evidence based research, the team felt one way to improve the patient-centered environment was to increase the lines of communication. Implementation ensued of a model utilizing a process named AIDET by all care members within the patient care system, including registration, housekeeping, transportation, volunteers and care staff. AIDET is a communication model which aims to acknowledge patient s by name; introduced staff members and their purpose in the plan of care; duration of time which is to be anticipated for their visit and any procedures; explanation of procedures, results, medication administrations along with thanking the patient for choosing their organization to deliver their care (Zamora, Patel, Doherty, Alperstein & Devito, 2015). The implementation of this tool received positive feedback, improved patient satisfaction and added cohesion among the patient care system. Conclusion As the completion of the RN to MSN Clinical Systems Leadership program is coming to an end, I reflectively assess how the program has influenced personal and professional growth. I feel fortunate to have been selected to participate in such a scholarly and innovative program. Through this program, I have achieved an improved understanding of key aspects of healthcare. I have an expanded confidence in my capacity to be a successful leader in such a complex forum, allowing me to be self-aware and self-trusting in how I can empower and advocate for others while supporting my peers through healthcare innovation. I believe I will be a successful leader as I am focused, able to maintain my integrity and illustrate compassion. I believe it essential to illicit innovation, keep a positive outlook, advocate for those whose voice is not loud enough, empower those to set and achieve their goals and remember that it takes a village to produce optimal outcomes.

7 JGEORGE_N660 REFLECTION PAPER 7 References Bowman, E. H., & Flood, K. L. (2015). Care transitions, intervention and other non-nursing home transitions models. In Malone, Capezuti & Palmer (Eds.), Geriatrics Models of Care (pp ). Switzerland: Springer International Publishing. doi / Fletcher, S. (2015). 5 Reasons why emotional intelligence is critical for leaders. Lead Change Group. Retrieved from Renjith, V., G, R., & George, A. (2015). Transformational leadership in nursing. International Journal of Scientific Research & Management Studies, 2(2): ISSN Retrieved from Zamora, R., Patel, M., Doherty, B., Alperstein, A., & Devito, P. (2015). Influence of AIDET in the improving quality metrics in a small community hospital-before and after analysis. Journal of Hospital Administration, 4(3): 35. doi /jha.v4n3p35.