RUNNING HEAD: Bieniek Personal Statement

NGC 634 Organization and Leadership Concepts in Healthcare Jonathan Bieniek University at Buffalo October 20, 2013

RUNNING HEAD: Bieniek Personal Statement The advanced practice nurse (APN) is not a new concept. For years, nurses have been able to advance in a specific discipline through a nurse practitioner (NP) or clinical nurse specialist (CNS) degree. In more recent times, nursing schools have moved away from the CNS program and turned their

focus towards NP programs. These nearly all require a doctorate rather than a masters degree in nursing, with a student completing such a program becoming a doctorate of nursing practice (DNP). In some cases, schools of nursing have transitioned from the CNS to a masters in nursing leadership (MNL) degree program, or some variation of it. Although these two APN programs (NP, MNL) result in a nurse being well equipped to lead the future of our countrys healthcare system, there are some distinct characteristics of each. Most obviously, the DNP is more focused on clinical practice than administration of an organization, especially immediately following graduation. Some NPs decide after years of advanced practice to use their clinical skills learned from practice and market themselves as an asset with a solid clinical perspective and leadership potential to an organization (AACN, 2006). This contrasts with the MNL nurse whose program is designed to teach the ways of organizational operation and systems thinking, and allows him or her to see leadership skills put into action during an internship (AACN, 2011). For me specifically, I would like to initially use my MNL degree to lead organizational change by working with quality improvement. I think that translational practice is fascinating and it aligns perfectly with essential IV of the AACNs (American Association of Colleges of Nursing) essentials for masters education in nursing. Even from my relatively short time working as a nurse, I have noticed a lack of progress in this area. Perhaps it is specific to my facility, but I dont see a lot of new ideas, protocols or products being implemented, despite the large, ever-growing body of knowledge being added to by nurse researchers. Every time I attend a nursing conference or lecture, I always leave feeling excited about ways I can make care better for the patient/family and how I can have a more broad influence this way, rather than at the bedside. Currently, I work for Catholic Health in an ICU in Buffalo, NY. Catholic Health was formed in 1998 under four religious sponsors and is a non-profit healthcare system that provides care to Western

RUNNING HEAD: Bieniek Personal Statement New Yorkers across a network of hospitals, primary care centers, imaging centers, and several other community ministries (Catholic Health, 2013). My ICU specializes in its care of the neurologically ill patient through our work as a New York State designated stroke center and although we focus on the neurologic patient, this is a relatively new specialty we have started at our facility. Previously, the ICU was a medical/surgical unit; we still care for these types of patients now. Since this organization is expansive, serves many patients, is a close collaborator with Catholic Medical Partners (CMP) and participates with HEALTHeLINK, it is an ideal setting for a quality improvement project. Patients have many points of contact with the healthcare system. While it is easy and perhaps common to focus on one specific point like the emergency room, it is important to broaden

the thought process. Places like primary care, ambulatory surgery and home care are often the first contact point with the healthcare system that a patient has. While not mutually exclusive, these types of settings are perhaps where screening should be implemented more heavily than in an inpatient setting, where intervention and prophylaxis would be the focus. I would like to target at-risk populations for my quality improvement project. The very first step is finding out who is at-risk. I would look at those with a low protein/albumin in their blood chemistry. Those with low Braden and nutritional intake scores would be given consideration as well. These criteria would allow for early intervention since some of these assessments/data collections are already completed while a patient is still considered well, or not hospitalized. Also, patients with comorbidities need to be given consideration. The more major or chronic diagnoses a person has, the more likely they are to have an increased number of risk factors for skin breakdown. These patients need to be identified as soon as possible because as soon as they are admitted to an emergency room, they are more likely to develop a pressure ulcer. This leads into the final population: those with decreased mobility. Patients who have poor mobility are less likely to change body position on a regular basis. This compromises circulation and puts a patient at a higher risk of developing compromised skin integrity.

RUNNING HEAD: Bieniek Personal Statement

One major reason I would like to focus on pre-screening for pressure ulcer risk factors is because skin integrity interventions can be implemented both while a patient is at home and also as soon as a patient comes to the emergency room. When a patient comes to the emergency room (ER), they may be laying on a stretcher for hours before a full nursing review of systems can be completed and that person can be identified as having a high risk for developing a pressure ulcer. I think this is an area where nursing care is lacking. I dont think that turning and positioning is enough of a prophylactic intervention to take care of this type of patient. I would like to implement other measures to ensure that patients do not develop this type of injury while hospitalized. The specific aim of this project is to improve pressure ulcer prevalence and incidence for those identified as being at-risk in the Catholic Health service area by implementing strategies such as prescreening, early intervention, prophylaxis and evidence-based nursing interventions. I think that a systems-level approach to this problem is needed and will be welcomed by the organization. Pressure ulcers are an area that is examined on a monthly basis at my hospital. Aside from turning and positioning, there doesnt seem to be much in the way of prophylactic interventions available to patients identified as being at-risk.

RUNNING HEAD: Bieniek Personal Statement References AACN. (2006). The Essentials of Doctoral Education for Advanced Practice Nursing. Retrieved September 30, 2013, from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf AACN. (2011). The Essentials of Masters Education in Nursing. Retrieved September 30, 2013, from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf Catholic Health. (2013). About Us - Catholic Health. Retrieved September 30, 2013, from http://www.chsbuffalo.org/AboutUs