New York City College of Technology

 

  

My ePortfolio

 

 

Irene Gao R.N.

 

NUR 4130 Professional Nursing Practice

 

Professor: Irene R. Pearlman, MSN, MA, PMHCNS-BC, RN

 

05/09/2019

 

My nursing philosophy

 

As a registered nurse and a nursing student, focusing on patient’s need and delivering safe and excellent care to every patient has always been my standard criterion. I believe that patient’s need is always priority, every patient has their right to receive or refuse the treatment, nursing care, or other practices. As a nurse, I commit to deliver compassionate, excellent care to every patient in an ethical and caring manner. The scope of nursing care includes patient education, health promotion, patient advocacy, and collaborative process to provide an excellent care practice.

 

 

Resume

Licenses & Certification

• New York State Registered Professional Nurse
• Driver License
• Basic Life Support certificate

Education

New York City College of Technology

Skills

• Bilingual in English/Chinese
• Good computer skills, organized, detail-oriented
• Excellent skills in providing exceptional care to diverse patients.
• Excellent skills in providing intravenous therapy, central and parenteral nutrition, nasogastric tube feeding, complex wound care, monitored various drainage devices and performed tracheal suctioning.
• Excellent skills in using butterfly needle, straight needle, indwell needle and heel stick.

Professional experience

• Bellevue Hospital

Aug 6 – present

Performs physical assessment, complete and utilizing the assessment tool, and provides skilled nursing care.

• Infinicare

July 2016- March 2018

Providing physical assessment for patient, and supervise the home health aides, set up and update the plan of care.

• Prestige Care

Aug 2014- Apr 2017

Perform patient assessment and supervise the assigned aides according to standards of nursing practice; obtain and complete medical providers; and update 485 orders.

 

self-analysis

During this semester, I have accomplished the course goal and learned that provide professional nursing practice. I found it’s very important to pursue the Baccalaureate degree in nursing, because as an entry-level, associate degree is not enough. Through the study and analysis of each topic, I learned a lot about the nursing management, rights, safe working environment, and patient’s care, etc. I have learned and have a good grasp of the knowledge of the management of nursing. This is a very important and meaningful semester for me.

Individual strengths

My strength is that I love my nursing work very much, I am very concerned about the patient’s needs, and I can coordinate and handle the conflicts between my colleague. I can handle task individually and independently, and give patients the best practice of nursing care.

 

Here below is one sample of my work this semester:

Term paper

New York City College of Technology

 

 

Unlicensed Assistive Personnel and Registered Nurse

 

 

Irene Gao

 

NUR 4130 Professional Nursing Practice

 

Professor: Irene R. Pearlman, MSN, MA, PMHCNS-BC, RN

 

04/14/2019

 

Introduction:

In order to improve the shortage of nurses and decreases the costs of providing patient care, it’s essential to involved the unlicensed assistive personnel to function in a supportive role by providing patient care as delegated by the registered nurse.

Unlicensed assistive personnel (UAP) are unlicensed individuals who provide low-risk and assistive care to patient, working as a supportive role under the direct supervision of registered nurse. UAP are significant part of the health care constructors and an effort to supplement the RNs; they can free the nurses from tasks that can be completed by unlicensed personnel at a lower cost. The RN uses professional judgment to determine the most appropriate tasks to be delegate, consequence in a less RN required and less cost, therefore, the use of the registered nurse – unlicensed assistive personnel model is unassailable reality that solve the problem of shortage of nurses and reduces the higher costs of providing patient care.

Full text:

The using of the unlicensed assistive personnel in acute care has been increased over the last 20 years. The use of the less training, low wage non-licensed assistive personnel, who can perform tasks under the supervision of registered nurses or other licensed clinical providers, has been a primary strategy for hospitals to both manage professional shortages and reduce the cost of patient care. (Huston 1996 & Zimmermann 2000)

By delegate specific tasks to the non-licensed assistive personnel can allow the nurses have more time to focus on the licensure required complex patient care.

Indeed, one study reported that nurses themselves perceive that unlicensed assistive personnel improve nursing efficiency in acute‐care settings (Jenkins and Joyner 2013).

However, while most professionals agree on the benefits of hiring more unlicensed assistive personnel, there are also some disagreements. They concern about that it is an alternative relationship that hiring more supportive staffs leads hospitals to hire fewer nurses. More to the point, they also concern about that will some combination of the two, depending on management strategy, hospital and region’s context? These problems are relevant to hospital’s efforts to maximize labor efficiency. It also related to the minimizing nurse burnout and turnover. Finally, of course, there is protection and improved outcomes, they are also related to the state legal issues regarding the minimum nurse to patient ratios.

Base on the Premier’s Operations Advisor database, there’s an examined trend in staffing of 25 UAP jobs and RN in United States hospitals from 2010 to 2015, based on their skill levels. It shows that changes in the staffing levels and the skill are complicated, and it needs further study to understand both the reasons behind the observed changes and their effects on the health care outcomes. However, labor efficiency is the most important goal, because it is also critically important to assess whether reduce the skill mix shifts among the UAP will impact the nurse workload, and extent to affect the patient’s quality of care and safety.

Historically, changes in the U.S. health care system, resulting in the changes in the number and type of care providers who providing care directly to the patients. To reduce the cost of care, hospitals have increased the hiring of unlicensed assistive personnel. Strategic deployment of registered nurses and the unlicensed support staff is recommended to the facilitate collaboration and improving the delivery of patient care and achieve the most effective reduction.

Something we have to mention here is that, when delegating, it is always necessary to evaluate every individual patient, tasks, and the unlicensed assistive personnel to ensure that the assignment is a safe care plan for the patient. Once a task has been decided to be delegated, the person to be delegated must have adequate education and training, documentation of the personnel’s abilities, the nurse’s evaluation of the assignment and probably a written institutional protocol for carrying the procedure.

As a registered nurse or licensed practice nurse, we have to be accountable to our patients, even if you delegate some of the care tasks to your support staff, you must understand your support staff as individuals, including their abilities and responsibilities will help you to allocate tasks safely and efficiently. To delegate properly depends on the patient’s situation, not the task itself. For example, you could reasonably ask the UAP to help a stable and mobile patient to go to bathroom, but it would be inappropriate for him/her to help an unstable patient alone.  Therefore, delegating tasks to a unlicensed assistive personnel, we also need to track, and evaluate the outcome based on the patient’s situation , and the individual capabilities of the UAP, and post-delegated tasks.

As a registered nurse, I’m working in an adult psychiatric unit. As per the hospital protocol, we usually have at least one supportive staff for each nurse, and each of us take care about 4-6 patients. Besides the assessment, education, assignment, administer the prescribed medicines, or any other intrusive skill tasks, we also need to check the patient’s activity every 15 or 30 minutes to make sure they are safe, check vital signs, make environmental rounds, offer snacks and supplies. The supportive staffs are always helpful. The supportive staffs will follow the assignment to perform those tasks, and report to the nurse any change of condition. Therefore, we can have more time to communicate with patient, to better understand the trigger of their agitation or crisis, to provide a better patient care. For example, when on the crisis, the supportive staff can help us to pick up the STAT medicine, to pull out all the emergency equipment, have all other patient stay in a safe place, provide support to our nurses, and so on. All those little things show very supportive.

First of all, for those simple, routine tasks such as making a bed, observation for patient’s behavior changes, ambulation, assisting with hygiene, delivering the meals can be delegated to a UAP. However, if the patient is medical unsteady, such as recovering from surgery, or frail, we need to work very closely with our UAP, or perform the care by ourselves when needed.

Secondary, as a registered nurse, our professional judgement is always an essential key because whether or not delegating care is appropriate isn’t always obvious.

Third, to motivate the UAPs who are assigned to you, one of the best ways is to assess how well they meet the current standards of care. At that point, you need to observe the UAP whether or not they complete their tasks, then determine whether they need additional training to meet the criterion of providing care. Handoff communication is also a critical component to ensure the appropriate delegation, the accurate information about a patient’s clinical status, and care plan is transferred in timely manner to a UAP.

To motivate a UAP is also important to a better patient care, also build up a good relationship between nurses and the support staffs. We, nurses, should trust our support staffs that assigned to us, and also, our support staffs need to trust us. To ensure the end result will deliver a better patient care.

Inconclusion, to employ unlicensed assistive personnel to help nurses focus more on the complex care can effectively improve patient’s safety and quality of care while reducing the cost of care.

References:

1. https://www.bls.gov

2. The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

(Linda H. Aiken, PhD, RN, Jeannie P. Cimiotti, DNSc, RN, Douglas M. Sloane, PhD, Herbert L. Smith, PhD, Linda Flynn, PhD, RN, and Donna F. Neff, PhD, APRN, 2013)

Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217062/

3. Preparation, Roles, and Perceived Effectiveness of Unlicensed Assistive Personnel (Bonita Jenkins, EdD, RN, CNE & JoAnne Joyner, PhD, RN, PMHCNS-BC, 2013)

Retrieved from: https://www.journalofnursingregulation.com/article/S2155-8256(15)30128-9/fulltext

4. The role of unlicensed assistive personnel in patient handoff

(Glynn, Donna M. PhD, RN, ANP-BC; Saint-Aine, Rose BSN, RN; Gosselin, Meghan A. BSN, RN; Quan, Susan BSN, RN; Chute, Jessica BSN, RN, 2017)

Retrieved from: https://journals.lww.com/nursing/Fulltext/2017/03000/The_role_of_unlicensed_assistive_personnel_in.15.aspx

 

 

 

                   During the spring semester 2018, I have taken The Nursing Course Community Health Nursing. This course provides the knowledge of nursing and requires for practice as a community health nurse. It is very important to know how to achieve the goal on health promotion, disease prevention and maintenance of community health.

By the end of this semester, I analyzed my current study and I have accomplished the following aspects.

1. I participated every activities in clinical, completed every assignment on time, following the school policy, showing proper appearance in clinical, and well prepare for every clinical learning.
2. During the windshield survey, I worked with my group members in a proper cooperative manner. We walked down the street and analyzed all kinds of problems, including the medical access, education, sports, food etc. We also randomly survey people who passing by in order to collect client information, collects significant data relevant to client’s needs, and using our critical thinking skills to analyze the risks and health issues in the community.
3. I worked with my group members and showing effectively communicates to achieve the goals that provide the health needs for families in the community setting. Such as utilizes therapeutic communication skills, appropriate channels of communication, communicates clearly and effectively to meet the client’s needs. Correctly document and develop nursing interventions.
4. Our group conducted five different topics including Food Allergy, Dental Health, Flu, Nutrition, and Excises and provided good outcome for the community health. We developed a teaching plan, provided information, got the client or family involved and participated, evaluated the learning outcome.
5. We kept the data confidential when we conduct and utilize informational technology, and maintain strict confidentiality with client/ families records.
6. I learned the appropriate treatment and plan to promote community health and response to practice in community health nursing.
7. I learned to utilize and corporate nursing standards and accountability into practice. Be aware of the assigned agency’s mission.
8. I have accomplished the cooperation and communication with my group members, family members, and persons in the facility to effectively addressing the community problems, identified the health care resources through the survey, set up nursing diagnosis, set the goals and guides the clients/ families to make appropriate lifestyle and treatment choices to promote community health.
9. Throughout the investigation and study, we identify solutions to complex problems in the community, we advocated and encouraged the clients/ families to participate and achieve greater success in promoting community health.

                  In conclusion, as a community health nurse, we still have a lot to do. There are systematic and intervention plans to promote and maintain maximum community health. Using knowledge of community health nursing techniques to diagnosis the health problems in the community, promote and strengthen education to achieve the goal by developing appropriate approaches in the community health setting.