Bon Secours Memorial College of Nursing

NUR 3112P: Adult Nursing Science II Practicum

Peer Leader Practicum Experience

Student Name: Courtney Browning

Date: 8/29/17

The purpose of this experience is to gain leadership by:

A. Continuing to develop and refine leadership and communications skills, including time
management, giving and receiving of constructive peer feedback, and conflict resolution.
B. Incorporating critical thinking strategies to prioritize patient acuity and delegate
accordingly within the student’s practicum group.
C. Refine problem solving and nursing process skills by applying theoretical concepts to
practicum situations.
D. Contributing to overall care and safety of patients.
E. Conduct group post-conference

Pre-Practicum/Pre-assessment

1. Role of Peer Leader

a. For pre-assessment, conduct a general overview of all assigned patients to your
clinical group.

2. Construct a list of patients with rank acuity (top 5 only) and give rationale to validate and
support your decisions.

I have Kellie’s patient (1111) and Megan’s patient (1112) listed as most acute because of
their hospice status. Kellie’s patient was expected to liver for hours/days when we
preassessed their charts. Kellie’s patient has status epilepticus (with a h/o complex partial
seizures w/ impairment of consciousness), had been on a ventilator, and had severe
complications from lupus. Megan’s patient had CVA, and complete right side flaccidness,
as well as changes in mental status. Her patient also had pneumonia that had turned to
sepsis, watershed infarct patterns in his left MCA region, and reduced flow in his left
cavernous carotid artery. Both patients are DNR.
My third ranking of acuity was Abby’s patient (1121), due to her severe edema and
cellulitis of both lower extremities and CO2 narcosis. She has had waxing and waning
mental status due to the CO2 retention. Her prognosis is listed as poor due to being
morbidly obese and can’t move on her own. She is also a DNR.
My fourth acuity ranking was Caitlyn’s patient, who is a quadrapalegic, has parkinson’s
and dementia as well as acute encephalopathy and pneumonia. He is listed as a DNR and
has is A/O x 0. My fifth acuity ranking is Abigail’s patient (1114), who came into the
hospital for abdominal pain, which was thought to be a SBO. She has a hx of ovarian
cancer, which has been found to have metastasized to both the liver and pancreas. She has
an issue with volume overload (including small pericardial and pleural effusion). She also
has a colostomy bag. This patient is also a DNR. I listed Abigail’s patient last because,
which her prognosis is poor, she is more stable than the previous patients listed. She is
alert and oriented x 4 according to her chart, but is not having issues with breathing,
ambulation, CVA, etc.

Rev. October 25, 2018

 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience
During Practicum

1. Role of Peer Leader

a. Get report from either the night RN or the students.
b. Make patient rounds following report.
c. Assist colleagues with care as needed.
d. Monitor that documentation being entered in Connect Care in a timely manner.
e. Monitor that all peers are administering medications on time and doing treatments
as ordered.

2. Find an article that relates to one of your peers’ patients and share with the practicum
members during post-conference.
I presented an article on Watershed Infarcts

3. Lead discussion of patient experiences with the practicum group.

Post-Practicum Paperwork: Clinical Analysis

1. Finalize the acuity list by adding or subtracting pertinent information. Are there any
changes in the acuity ranking of the assignments? Give rationale.

1) Abby (1121)
2) Abigail (1114
3) Megan (1137)
4) Caitlyn (1120)
5) Brooke (1135)

Sadly, Megan and Kellie’s patients (which were my initial top two in acuity) had both passed
between the time we preassessed and when we arrived on the floor on the morning of 8/29. This
altered my acuity ranking. Abby’s patient needed the most attention throughout the day, as she is
unable to do anything for herself and has AMS. Her pain was severe, and her CO2 level was
reported to be ~85. Abigail’s patient is in later stages of cancer, and has stopped chemo treatment
and “given up the fight”. She is acute because she’s having volume overload issues, and had a
severely distended abdomen today. Her cancer will continue to spread and cause pain/additional
problems for her. Megan received a new patient, who was admitted for acute renal failure and
had malignant neoplasm of the base of the tongue. He has cancer of the head and neck and will
need treatment. Caitlyn’s patient was to be discharged on 8/29 but was found to have a new
organism UTI diagnosis. He still is a critically ill patient. Brooke’s patient came in with a
diagnosis of small cell lung cancer, and was admitted for a port, but during her stay they found
that she had a new cancer diagnosis in her lungs and brain.

2. What problem(s) or concerns did you encounter as the peer leader? What did you do to
solve the problem(s)?

Rev. October 25, 2018

 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience
During my day as peer leader we ran into an issue with wireless computer networking, so none
of the WOWs were working in the patient’s room but for more than a few minutes at a time. This
complicated the schedule/order of people giving meds. Some patients may have had medications
due at a certain time, but there were others that were very concerned about staying on top of their
pain and requested to have pain medication exactly on schedule. I tried to line everyone up and
tell Mrs. Faw and the students the order 3 at a time, and then for the students I would come back
to their room when the person ahead of them had started giving medications. This worked for the
most part, but occasionally there would be an issue that slowed the process down (like someone
vomiting, needing to be cleaned up, the WOW not working properly, etc.). I just tried to keep
adjusting the schedule and changing the order if need be to keep us on track time-wise. I was
also helping in Abby’s room for a large portion of the day so balancing that and trying to keep
everyone on track was difficult. Thankfully Kellie didn’t have a patient assignment for the day so
I’d recruit her to help Abby when I needed to leave the room to get someone to go give
medications.

3. Describe 3 principles of servant leadership and how you portrayed each of them as a peer
leader. (Minimum 3 paragraphs. Reference in APA is required.)

In my role as peer leader I was there to assist my peers, but more importantly I was

functioning in a role that allowed my peers to give the best care to the patients. I thought about

my role in servant leadership throughout the day and was well aware that I was there as a leader,

but I came second in terms of needs or wants. All that I did in my position as peer leader was to

further our potential as a team and to provide excellent patient care and safe, organized

medication administration.

I feel that I exemplified the servant leadership principle of awareness during our day on the

oncology unit. As Rose points out in her article in Radiology Management Journal, awareness is

vital when you’re looking after a group and “an innate awareness of where team members are is

crucial to any leadership role” (Rose, 2017, p. 23). I knew the rooms that each of my peers were

assigned to for the day, and kept an eye out for who was giving medications and when in order to

keep a smooth flow and to maximize our time on the unit.

I also feel that “building community” was a principle that we used throughout the day in order to

be successful working as a team. I tried to make it known that I was available to help whoever

Rev. October 25, 2018

 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience
needed it, whether it be getting supplies ready to give medications or giving a bath/turning a

patient/or helping feed someone a meal. It was important for me to make myself available and

not to seclude myself from the group.

I also used foresight in my role as peer leader on Tuesday. I was working with Abby to

get her 0730 medications ready for her patient, and come to find out the night nurse had already

pulled her pantoprazole and synthroid for her. Abby had asked her if she was planning to

administer them or not, and she said that she was. The patient was ready for her breakfast tray at

0800, and expressed interest in eating that morning, which she had not done several days prior.

When the night nurse finally came in to administer the medications I asked her if we could

administer the pantoprazole at that time, but hold the synthroid until 1100 because the patient

would like to eat, and that specific medication needs to be given an hour before eating or two

hours afterwards. The night nurse agreed (reluctantly). We prevented that medication from being

given at that time, which would either have prevented the patient from eating (and risking that

she would not want to eat later), or giving a medication that mixed with breakfast, would be

ineffective or cause erratic absorption. I feel that this portrays foresight because I was thinking

further into what this would mean for the patient, and using information I had learned previously

in order to provide the best outcome for the patient.

Rose, J. (2017). Success through Servant Leadership. Radiology Management, 39(3), 21-26.

Rev. October 25, 2018