Clinical Log: NGR 6723L

Student Name: Donna Matthews, BSN, RN PCCN

Preceptor Name: Joy Parchment, MSN, RN, NE-BC
Clinical Location: Orlando Health System
This clinical log is a confidential personal journal and intended only to document participation and facilitate student/CON
faculty communication/evaluation. This lab requires a total of 135 clinical hours completed and the log submitted no later than
Friday, April 24. Both evaluation forms are due at the same time.
Review the course objectives and develop objectives specific to your learning environment in collaboration with your preceptor. This
activity is to be undertaken no later than the first week of the semester and individualized objectives must be approved by your course
instructor.
Course Objectives:
1.

Evaluate the role of the nurse leader in ensuring that the philosophy and structure of nursing services provides for the delivery of effective nursing care.

2.

Determine strategies used by the nurse leader to maintain proficiency, communicate and collaborate effectively, participate in policy and decision
making, and serve as an advocate for both staff and the recipients of nursing care.

3.

Evaluate the role of the nurse leader in the administration of fiscal resources and the acquisition, allocation and utilization of fiscal resources.

4.

Assess the use of the nursing process as the supporting framework for direction of patient care services including data acquisition, records and recordkeeping, planning, implementation, evaluation and provision of resources to optimize use of this process.

5.

Help implement processes used to ensure that the practice climate enables nurses to practice in accordance with their professional education, promotes
professional growth and fosters a participative working environment.

6.

Identify the components of the quality assurance/quality improvement program, the mechanisms to resolve problems and improve care, and evaluate

outcomes.
7.

Participate in implementation of procedures and processes which guide nurse participation in ethical decision making.

8.

Demonstrate understanding of the mechanisms used to promote evidence based administrative and nursing practice, including the use of research.

9.

Analyze personnel and practice policies to determine their effectiveness in promoting equality and continuity of nursing services and cultural
competence in the provision of client care.

(Insert Individualized Objectives Here)

1. Contrast hiring and onboarding processes utilizing peer interview, Orlando Healths nursing professional practice model and behavioral based questions with
traditional methods grounded clinical questions under the direction of assigned Nursing Operations Manager.
2. Participate in leadership educational opportunities under the direction of preceptor (e.g. conferences, leadership development series) to evaluate effectiveness
of program for novice leader
3. Assist the nursing operations manager with development of budget based on equipment needs and needed FTEs.
4. Participate in executive quality rounds and the collection of nursing sensitive and patient safety data as directed by preceptor and NDNQI coordinators.
5. Evaluate role of Shared Governance Councils under direction of preceptor.
6. Analyze effectiveness of Orlando Health SAFE teams in preventing harm events (e.g. CAUTIs, CLABSI, and falls).
7. Participate in an ethical committee meeting to evaluate the process for ethical decision-making.
8. Attend nursing research council meetings to gain an understanding of the research process, for the purpose of participating in a nursing research study
9. Assess cultural competency validation methods under the direction of the Director for Cultural Diversity and Language Services

Week
(insert date of
participation)
Week 1

Hours
Completed
(Running
Total)
5

Activity

Met with preceptor to develop plan

Analysis of Experience
(Insights, Lessons Learned, Leadership Techniques
Observed)
Value of rounding on patients and staff to determine

(_1/15/15__)

for clinical experiences. Attended

Press Ganey Leadership rounding
conference.
Conferenced with Director of
operational performance
improvement, SAFE team
Coordinator, and a Nursing
Operation Manager
Met Director of Cultural diversity,
Attended Nursing Operational
Redesign Committee meeting,
participated in Operational
Leadership meeting and met with
CFO of South Lake Hospital

Week 2 (_1/22,
1/23__)

6/11

Week 3 (_1/26,
1/27, 1/29__)

13/24

Week 4 (_2/2,
2/3, 2/4, 2/6__)

17/41

Participated in group GN interview

process using behavioral based
questions, participated in CNO
quality meetings at DPH,
Shadowed NOM of newly
combined unit at DPH. Participated
in mock survey and met with TJC
mock surveyor, TJC survey
planning, workforce planning
meeting, participated in Infection
control meeting

Week 5 (2/10,

13/54

Assisted NOM in data gathering

consistency of processes and delivery of care.

Behavior based questions can help determine cultural fit of

applicants. Multiple quality and performance projects
ongoing simultaneously and on a continual basis. Overview
of data/quality processes as relates to nursing department
and indicators
Learned of cultural resource nurse program and diversity
training programs in place. Operational redesign committee
is participative in nature and is a venue to evaluate products
used by nurses as well evaluating the role of nursing staff.
Ops Leadership meeting discussed quality scores and
ongoing improvement efforts, financial ramifications and
future plans for expansions. Obtained high-level overview
of budgeting process and learned what case-mix index
means and how effects reimbursement.
Take aways from GN interview. Panel used standardized
questions and rating scale. Using this method, interview
panel had consensus of opinion regarding likelihood of
candidates success. Participation in TJC mock survey
increased knowledge of standards. Workforce planning
meeting included long term and short term needs and
benefits of over hiring to cover anticipated turnover and
shortages due to illnesses/vacations or use of agency staff
(contract and per diem), prioritizing what items to
concentrate on for pending TJC survey, prioritize what items
on risk assessment for nursing leaders to work on in their
departments
Quality data comes from multiple sources and deep diving

2/11, 2/12,
2/13___)

Week 6 (2/16,
2/18, 2/20___)

and preparing presentation for

quality collaborative meeting.
Participated in CUSP/CAUTI
webinar by HEN, patient safety
meeting regarding fall prevention
plan and procurement of fall
prevention equipment, Participated
in nursing research council
meeting, Participated in quality
collaborative meeting

13/67

Participated in the professional

development council for Orlando
Health via phone conference,
participated in South Lake Hospital
Nursing/Pharmacy Leadership
meeting, Spent 9 hours with
Cardiovascular Service Line
Administrator, assisted in meetings

into harm events is necessary to determine root cause and

prevent repeat occurrences. Data presented from the
viewpoint of patient safety not nurses made mistakes
Quality is all about patient safety. Learned about data driver
diagrams and assisted in creating one for UPC goal of
improving HCAPP scores. Goals cannot be too broad or
they will be unattainable. At nursing research council
learned how bedside nurses can participate in research and
partner with a trained researcher. Also, discussed at this
meeting why research is important and how to translate
studies into EBP. Purchasing new equipment for fall
prevention program debated cost vs. benefit. Benefit to
patients far outweighed the cost. Small-scale trial to be
conducted on unit with most members on fall team before
implementing purchases on other units.
Assisted in meetings regarding changes to service line
including absorbing a new unit into the service line.
Discussed how this would affect service line, needs for
developing new staff and how to establish direct oversight
for this unit. Participated in staff coaching. Lessons learned
include admistrators/directors are responsible for strategic
planning needed to carry out the mission and vision of the
organization, while managers are responsible for the day to
day operations of assigned areas of responsibility to assist in
achieving the mission and vision of the organization.
Leadership techniques observed manager coaching to
include positive feedback and reinforcement for newly hired
ANM, also direct firm actions from the administrator
regarding improper communication among staff and

Week 7 (_2/222/28__)

21/88

Met with leader of CAUTI SAFE

Team and core measure concurrent
reviewer. Met with CFO discussed
productivity. Attended Operational
leadership meeting with CNO.
Attended Unit practice Council
Chair meeting, developing
professional practice model.
Attended Orlando Health Quality
Retreat

Week 8 (3/13/7___)

11/99

Participated in executive quality

rounds with primary preceptor and
executive team. Assisted assigned
NOM with preparations for
employee mediation meeting for
terminated employee

navigating through the HR process for dealing with same.

Benefits of real time review allows for corrective action to
be taken regarding documentation fallouts but most
importantly allows for on the spot teaching to occur.
Concurrent review has many benefits but takes 1-2 FTE to
accomplish. Resource use has to be balanced with facility
needs. At Ops Leadership meeting discussed staffing needs
for the opening of 2 units one of which is free-standing short
term rehab unit. Discussed pros/cons of sign on
bonuses/staffing with agency. At the conference attended
several sessions that highlighted improved efficiency and
safety. Attended lecture on high-impact leadership that
changed focus from what is important to us (health care
providers)? to what is important to them (healthcare
consumers)? When focus is shifted in this manner,
everything we do takes on an entirely new meaning.
Ethical decisions in employee terminations include many
areas from black and white (policy violations) to many
shades of gray (i.e. behavior, performance) and must be
handled differently. Careful documentation must be
maintained in the employee file to support the decision
making process and HR should be closely involved.
The quality rounds focused on new GEMBA boards that the
facility was implementing, how the employees viewed their
personal safety at work and ability to remain free from
injury. Also joy in the workplace was investigated. Prior to
rounding on the units, the facility leadership team was very
transparent with harm events that had occurred in the facility
and executives from other facilities in the system all shared

ideas on how to prevent them from occurring in the future at

all sites.
Week 9 (3/163/20___)
Week 10 (3/233/27)

8/107

Week 11 (3/304/3)

13/120

Week 12 (4/64/10)

10/130

Week 13
(_4/13-4/17)

6/136

Per our email conversation No

clinical hours. Joint Commission is
at my facility this week.
Participated in meetings regarding
verbal orders, financial priorities,
developing a professional practice
model and leadership development

Participated in meetings regarding

annual clinical education
requirements for nursing staff,
hospital executive leadership, and
participated in GN hiring event
Participated in quality meetings for
CLABSI/CAUTI, Participated in
meetings to redefine/reorganize the
policy and procedure committee.
On line classes for OHS leadership
development
Participated in direct report book
club, participated in meetings to

Assisted CNO, nursing managers, physicians understand the

realities of verbal orders. Helped to develop plan regarding
verbal orders to include empowering nurses to tell the MD
you need to use CPOE, communication plan regarding
process and timelines. Assisted CNO in beginning to
evaluate the cost vs. benefits of implementing the use of
single patient use items such as disposable telemetry
leads/BP cuffs. Must evaluate cost (approximately
$1million/year) against infection control and quality of
devices used. Assisted CNO and unit practice council chairs
in developing a professional practice model to include
foundational nursing theorist to base model upon.
Assisted to develop educational plan to meet requirements to
maintain certifications. Participated in interviewing newly
licensed nurses using behavioral based questions and
reviewing of transcripts/degrees.
Assisted in revamping policy and procedure committee, to
include defining role of committee, process for bringing
policies to committee and approval and routing of policies.
Leadership development classes focused on law for leaders
especially FMLA, what constitutes protected job status,
qualifications for workers compensation.
In order to encourage thinking about quality processes, the
facility purchased all managers, ANM and charge nurses

evaluate different IV diabetes

management tools and evaluate
different peripheral IV access
devices

copies of same book. Different units were assigned to lead

the discussion on different chapters. This promoted
engagement and learning. New IV products were evaluated
on cost and ease of use (determined by a pilot study). Upon
evaluation found that devices did not meet the INS guideline
for use with a stabilization device, so at this time the facility
will stay with current product to promote EBP.

Week 14 (___)
Provide a brief strategic assessment of the outcomes achieved related to each of the identified personal objectives noted above
and your plan to integrate the learning into your academic development and professional practice:
Objective 1: Was able to successfully compare hiring practices at site with current facility. Plans are underway to work with
HR to streamline the interview scheduling process and applying targeted behavior based questions has already helped us avoid
hiring some people who look good on paper
Objective 2: The leadership development program at the orientation site had a lot of good information. I was able to share it
with the person at our site who is developing a charge nurse curriculum and he was able to incorporate many of the ideas into
our educational program.
Objective 3: Met with the CFO to review budget and productivity. We were able to change the productivity to account for
fixed FTEs such as rapid responders and monitor techs which are required to be fully staffed no matter the unit census. Flex
staffing to account for changes in census. Participated in several meetings to evaluate new products for cost/benefits.
Cheapest isnt always the best choice.
Objective 4: The executive quality rounds showed the importance of transparency. Even though no one likes to talk about
harm events and bad outcomes, if they are hidden and swept under the rug, the circumstances that led up to the event cannot
be changed.
Objective 5: Shared governance councils come in many forms, nursing redesign, safety committees and unit practice councils.
Having and encouraging shared governance increases engagement and ownership of practice.

Objective 6: Implementation of SAFE teams has decreased harm events. This has been done through engagement of bedside
nurses, real time evaluation instead of retrospective and providing resource nurses/mentors for the bedside nurse to reach out
to. While we are unable to fully implement SAFE teams at this time, I would like to borrow the audit tools and use in peer
to peer auditing of the previous shift. This will also reinforce and teach the RN who is performing the audit what to look for.
Objective 7: There were no meetings of the ethics committee during my practicum experience. However, I was able to
participate in end-of-life discussions where family members wanted to override advanced directives. During such meetings it
is imperative to set aside personal beliefs and advocate for the patient and assist the family to make a decision they can live
with.
Objective 8: Attending the research council meeting brought home the fact that research doesnt have to be complicated and
isnt reserved only for large institutions. We have started a journal club on our unit and currently the staff members are
learning how to evaluate articles. We would like for them to be able to research the latest evidence to be able to implement
evidence based practices to carry out any changes they suggest. We are going to implement the rule of If you want to change
the way we do things, show me the evidence.
Objective 9: Cultural competency is very important. While our units are predominantly female and Caucasian, we do have
people from the Caribbean Islands, Latin America, Western Europe, African-American, Pacific Islands and even Russia.
During my practicum experience I definitely learned about resources available at the main hospital in our system. I would like
to send employees to the diversity classes that are offered and develop Cultural Resource nurses. After all, respecting our
patients cultures is just as important as being able to start a difficult IV.