Final Blog: 4/15/12

This is my final blog for the Regis University Doctor of Nursing Practice (DNP) Program.  I have very much enjoyed the program and specifically the service learning component.  I have created and implemented simulation scenarios for the new nurse graduates of two local hospitals.  The feedback has been terrific and I have been asked to continue the work past this DNP program. 

As an educated, privileged citizen in our society, what is your role in creating a society rooted in equality and justice? Do you feel you have a responsibility and why or why not?

There are two philosophies in which I very much believe and try to emulate.   One is “pay it forward” and the other is the Charles Schulz philosophy that the people who make a difference in the lives of others are those who care; not the ones with the most credentials, the most money, or the most awards. 

I am an educated citizen. I believe that privilege comes with education.  I grew up in a household that encouraged and supported learning.  Throughout my education, I have had my families support.  They have listened, encouraged and praised me throughout the years.  Today I am a nurse educator and I believe I have the responsibility to “pay it forward”. 

I was fortunate to have family support throughout my education journey, but many of my nursing students are not so fortunate.  Many of my students are first-generation students; they do not come from families that provide the emotional support that is so helpful for college students.  I have found that the journey to becoming a nurse is much more difficult for those students with minimal support.  Because of the vast differences in financial and emotional support offered to nursing students, there is a lack of equality and justice. 

I believe that it is my responsibility to provide not only the didactic information that is a part of every nursing curriculum, but to care enough about each student  to listen, offer encouragement and praise.  With education comes privilege, but also comes responsibility.  Responsibility to provide the support and encouragement that all students need when trying to make their dreams a reality.

What have you learned about yourself and what are your future plans?

Through the service learning experience required in the DNP program, I have learned that I have something to offer that can benefit others.  This may sound like a ridiculous comment, but true none the less.  I have been an educator for over 15 years.  I have always considered myself to be good at what I do.  I know that I can benefit my students, but I have never thought that I had anything extra special to offer others outside of the classroom.   Throughout my career, I have been encouraged to present topics at conferences and write articles for publication, but I always felt that I had nothing special to offer that could be of interest to others. 

The service learning requirement forced me to leave my comfort zone and seek ways that I could provide something to the outside community.  What I have found is that I do have something to offer.  I believe we all have something to offer.  I am very thankful for the opportunity to engage in service to the community.

2/24/12

            I continue my service to the New Nurse Graduate Residency Program of St Mary Corwin Hospital and their sister facility St. Thomas More, by offering experiences with high fidelity simulation for the new nurses.  I develop and implement case scenario simulation experiences specific to the nurse’s specialty unit.  I am committed to continuing this relationship with the New Nurse Residency Program as long as they view this as beneficial.  Thus far, I have received very positive feedback from both the participants and the nursing leaders from this organization. 

            I have found that this service learning experience has benefited not only the new nurses and the facilities, but has been a tremendous learning experience for me as well.  As stated by Ash and Clayton (2009), applied learning provides students an opportunity to learn in unfamiliar environments and to interact with others unlike themselves.  I have been teaching in undergraduate nursing education for over 15 years.  The opportunity to work with the New Nurse Graduate Residency Program has provided me with a prospective of the needs of the new nurse.  This experience has enlightened me to the needs and struggles of the novice practicing nurse.  Because of this experience, I will be better able to meet the needs of my undergraduate students.

            Strengths of this service learning experience include:

·         Strong professional relationship between the agency nursing staff and myself.  Mutual trust and respect has been established. 

·         Generosity of the University to provide equipment and time in the simulation laboratory to the clinical facilities for this endeavor.

·         Individual scenarios developed specifically for the needs of each new graduate nurse participating in the experience.

·         Opportunity for the new nurse to “practice” complex nursing care in a safe learning environment. 

Shortcomings/ weaknesses of this service learning experience include:

·         Difficulty for nurses with no prior experience in simulation laboratories, being able to view the manikins as “real”.  

·         The simulation experiences are held at the University, rather than in the hospital.  The environment is not familiar.  Nurses do not have access to their computers, documents, supplies... that they typically rely on when caring for patients. 

            Based on the shortcomings listed above, I would like to develop and implement a simulation strategy that can take place in the hospital and on the nurses’ specialty unit.  I am going to propose that for the next scheduled simulation experience, I come dressed as a patient and simulate a complex patient care situation.  I believe this will be more realistic and beneficial for the participants of the New Nurse Graduate Residency Program. 

Reference

Ash, S. & Clayton, P. (2009). Generating, deepening, and documenting learning: The power of critical reflection in applied learning.  Journal of Applied Learning in Higher Education, 1, 25-48.    

Blog #2, December, 2011

            I have continued to work with the New Nurse Graduate Residency Program at St. Mary Corwin Hospital for my service learning experience.  As stated prior, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.  I have continued to provide each of the new nurses with an opportunity to “practice” caring for complex patients in a simulated case scenario.  The patient care scenario is developed specifically for each of the new nurses based on the nurses’ specialty unit and the identified needs of the nurse.  I have received very positive feedback from the new nurses, as well as the administrative team from the hospitals. 

            I recently received a request from this clinical agency to provide a simulation opportunity for one of their more experienced nurses who is having difficulty problem solving in complex patient care situations.    The value of providing nurses with opportunities to “practice” caring for patients in a safe learning environment is being recognized not only in the academic setting, but also in the clinical setting.  This request from the agency reinforced my belief that simulated patient care experiences can ultimately enhance patient safety. 

            I believe that the simulation experiences have benefited the new nurse graduates from St. Mary Corwin and St. Thomas More hospitals by providing them with opportunities to “practice” caring for complex patients in a safe learning environment.  I believe also, that I have benefited from this service learning experience.  It has been rewarding to provide these new nurses with patient scenarios that they may eventually encounter and allow them the opportunity to make patient care decisions, right or wrong, in a place where no one will get hurt.  My hope is that these new nurses will gain confidence, knowledge and skill.  Ultimately the patient will benefit.

Update on my blog. 10/15/11

My service learning site continues to be the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  As stated in my first posting, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role. 

           

 I continue my service to the New Nurse Graduate Residency Program by offering the participants experiences with high fidelity simulation.  I develop and implement case scenario simulation experiences specific to the nurse’s specialty unit.  Since my last post, I have had an additional 9 new nurse graduates participate in the simulation experience.  This past month, I developed and implemented scenarios for five new nurses; one who works in Emergency Department; one in the Operating Room; one in Endoscopy; and two on the Post Operative Unit. 

           

The biggest challenge with this group of students was developing Endoscopy and Operating Room scenarios.  I fretted the most over the operating room patient case, but it went very well.  The scenario that I developed for this new nurse was of a patient with a urethral obstruction caused from a foreign object placed in his urethra.  The nurse was called in at 2am for a cystoscopy procedure under local anesthesia.  Following the case, the doctor left the OR suite and the nurse and OR technician were left alone with the patient for recovery.  The patient began bleeding, the foley tubing and bag became full of blood clots and the patient became hypovolemic.  I moulaged the blood clots in the tubing and drainage bag so the visual image was extremely real in the scenario.  This new nurse did a great job of accessing support, resources and assisting the patient.

           

I believe this service learning opportunity is helping me to view the difficulties and struggles the new nurse graduates experience. I have been teaching undergraduate student for many years, and thus have been fairly sheltered to the realities of what the new nurse experience as they graduate and leave the safety net of the nursing program.  I believe that new nurses are extremely vulnerable because the healthcare environment is a complex, rapidly evolving industry and the new nurse is often expected to handle urgent and emergent patient cases.  Working with the new graduates in the simulation laboratory has provided me with a greater understanding of the demands and expectations of the new nurse, as well as the areas in which they are feeling incapable and uncomfortable. This experience will ultimately help me to be a better educator and better prepare my nursing students for the reality of clinical practice. 

JoAnn Crownover 

             

Service Learning Blog: August, 2011

Blog 2:

My service learning site is the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  This grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.  My service to the New Nurse Graduate Residency Program is to offer the participants experiences with high fidelity simulation, individually developed for the nurse’s specialty unit.  The participants of the New Nurse Residency program have had the opportunity to practice patient care in a safe learning environment. 

What was the best/worst/most challenging thing that happened this semester?

My greatest challenge this semester was observing the performance of one of the new graduate nurses.  During the scenario, this particular new nurse was completely out of her scope of practice and behaved in an inappropriate manner with an interdisciplinary team member (respiratory therapist).  She was demanding and rude to the interdisciplinary team member. She never phoned a physician to resolve the patient care issue, but rather prescribed her own treatments, and demanded the same of the interdisciplinary team member.   There were two other new graduates and the New Nurse Graduate Residency Coordinator in the lab observing the scenario.  During the debriefing session, the new nurse stated that she always orders her own treatments and the respiratory therapist always administers the treatment she prescribes.  I led a lengthy discussion on “scope of practice” and “interdisciplinary collaboration”. 

I am grateful that this simulated patient care scenario occurred in a safe learning environment, and I am hopeful that this experience was beneficial for the new nurse.  I hope that she left the simulation lab with a new perspective on her role, the role of the interdisciplinary team member, and the role of the provider.  The New Nurse Graduate Residency Coordinator was able to observe this performance and will now be able to further assist this new nurse to understand her new role.  Simulation was able to bring forward an issue that must be addressed so that this new nurse will have a more successful nursing career. 

                                                                                                

What can you do differently as an individual and as a professional to support and advocate for some of the issues you encountered during your service learning experience? 

I will continue to develop and implement simulation opportunities for the new nurses participating in the New Nurse Graduate Residency Program at St Mary Corwin Hospital.  I believe that this experience can lead the new nurse to recognize areas of weakness or false impression that can be remedied, so that the nurse will have a more fulfilling career.  As an individual, and as a professional, I am compassionate to the struggles and challenges of nursing students, as well a new nurses.  There is so much to learn and the responsibilities are so tremendous in this profession.  We must support and advocate for one another.  

Service Learning Blog: June, 2011

            My service learning site continues to be the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  As stated in my first posting, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role. 

            In my previous post, I mentioned that new nurse graduates hired at either St. Mary Corwin or St. Thomas More Hospitals have the opportunity to participate in the 12 month New Nurse Graduate Residency Program.  Since that posting, these facilities now require all new nurse graduates to participate in the Residency Program.  They begin a new cohort of new graduates four times per year.

            I continue my service to the New Nurse Graduate Residency Program by offering the participants experiences with high fidelity simulation.  I develop and implement case scenario simulation experiences specific to the nurse’s specialty unit.  To date, I have developed and implemented specific high fidelity simulated case scenarios for 19 new nurse graduates.  This past month, I developed and implemented scenarios for three new nurses.  One of the new graduates work in Telemetry, the other two on the General Medical Unit.  An example of the scenarios that were developed and implemented for the nurses who work on the General Medical Unit, is:

1.    One of the nurses cared for a simulated type II diabetic patient who was being admitted with for a foot ulcer.  The purpose of the admission was for a wound consult and blood glucose control.  Shortly after the admission, the patient develops symptoms of sepsis.  The nurse is to recognize the symptoms, phone the provider, and follow through with appropriate management.

2.    The other General Medical Unit nurse admits a patient who is six weeks post partum, and presents with abdominal pain.  The woman has the 6 week old infant in her arms and has no family available to care for the infant.  During the scenario, the patient is diagnosed with cholecystitis and the nurse must prepare her for surgery.  Meanwhile, the infant remains in the patients’ arms. 

           

            This project continues to be very successful.  Simulated case scenario experiences provide the new nurses with opportunities to learn in a safe environment.  The new graduates are able to “practice” problem solving and prioritizing, as well as communication and interdisciplinary collaboration. 

            To date, I have spent approximately 100 hours on this project with the St Mary Corwin New Nurse Graduate Residency Program.  My role in this endeavor continues as both a consultant, and a provider of services.  I plan to continue this collaborative effort in assisting St. Mary Corwin and St. Thomas More with their New Nurse Graduate Residency Program.  As the need arises, I plan to develop new scenarios specifically geared for the needs of the facility and the needs of the new nurse graduates.  I see this as a challenge in the near future because the next cohort of new graduates are all perioperative nurses.  I am not sure at this point how to implement this type of scenario, but I look forward to this challenge!!

Service Learning Blog: April, 2011

Blog 2:

Are people you came in contact with through this experience having some needs met through the community activities?

My service learning site is the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  This grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.     My service to the New Nurse Graduate Residency Program is to offer the participants experiences with high fidelity simulation.

The participants of the New Nurse Residency program have had the opportunity to practice patient care in a safe learning environment.  Specific patient situations and/or health issues have been identified by the coordinator for the residency program and the Unit Managers.  Simulation scenarios were then developed and implemented to address these situations and health issues, thus providing the new graduate nurse an opportunity to practice patient care in difficult situations.  Each simulation experience is followed by a structured debriefing session which includes reflection and suggestions for improved care.

Are community activities like these necessary and/or sufficient to fulfill these community and individual needs? Do you see other means to do so?

The use of simulation in nursing education for students, as well as new graduate nurses, is a fairly new teaching/learning strategy.  According to  Lindsay (2010), the use of simulation technology allows for the creation of a patient scenario.  A patient care situation can be identified as potentially troublesome, and a scenario can be developed that will provide opportunities for guided learning for inexperienced nurses.  Simulation experiences can focus on technical skills, symptom management, communication, compassion, cultural competence, and interdisciplinary collaboration.  The value of simulation experiences in nursing has been studied extensively in the last few years, and research strongly supports the use of this learning methodology (Sperlazza and Cangelosi (2010). 

Simulation activities, although not a requisite for development of expert nurse competencies, does provide the opportunities to nurture the new nurse graduates, with the overall goal of improved patient care and health outcomes.

What was the best/worst/most challenging thing that happened this semester?

The greatest challenge with this service learning project is scheduling of the simulation experiences.  St. Mary Corwin Hospital does not have a simulation laboratory within their facility, so therefore the new nurse graduates come to the Colorado State University-Pueblo (CSU-Pueblo) nursing simulation lab.  They also do not have any personnel trained to develop or implement simulation scenarios, thus my expertise in this specialty is the reason for our partnership.  Offering simulation experiences to the New Graduate Nurse Residency participants is based on availability of myself and the lab.  We must work around the schedule of the Undergraduate and Graduate students of CSU-Pueblo.  There have been two requests for simulation days in the past two months that I was unable to accommodate.  

What are your future service learning plans?

To date, I have developed and implemented specific high fidelity simulated case scenarios for 12 new nurses who are participating in the New Nurse Graduate Residency Program.   I have not provided any simulation experiences for the new graduates since my last blog.  The New Nurse Graduate Residency Program Coordinator schedules simulation experiences for the participants quarterly.  We have arranged for another simulation opportunity the end of May, 2011.  I plan to continue the partnership with St. Mary Corwin Hospital New Nurse Graduate Residency Program. 

References:

Lindsay, J.  (2010).  Introducing nursing students to pediatric end-of-life issues using simulation.  Dimensions of Critical Care Nursing, 29(4), 175-178.  

Sperlazza, E., & Cangelosi, P.  (2009).  The power of pretend:  Using simulation to teach end-of-life care.  Nurse Educator, 34(6), 276-280.