Running head: FINAL REFLECTION NUR660 1

Final Reflection NUR660

Anne Gonzalez

University of Arizona

Final Reflection NUR660

My journey of this program started long before the first day of class in September of

2014. A friend informed me in January 2014 that it was time to go back to school to enhance our

nursing practice and leadership skills. Honestly, I did not see myself as a leader or becoming

anything more than a frontline nurse. It did not take me long to realize that any move I wanted to

make in my nursing career would require me to have a masters degree. My goals have changed

immensely since starting the program.

This program has enlightened me to the importance of why a nurse leader should have

higher education to be able to lead in a positive and productive manner. There are two key

concepts that have informed my thinking about nursing leadership: emotional intelligence and
shared governing. In my working environment the appointed charge nurse does not have the

higher education needed to be a transformational leader. I have shared my knowledge with my

charge nurse to enrich her leadership performance. Transforming into in an emotional intelligent

leader will require one to become self aware, self-regulated, socially aware, and develop social

skills (Geradi, 2015). Being an emotional intelligent leader will help in defusing and resolving

unit conflict between nurses in a nonthreatening method (Geradi, 2015).

Shared governing is an excellent working model that gives the nurse a voice to help make

the healthcare setting an optimal healing environment (Winslow, Hougan, DeGuzman, & Black,

2015). Any nurse can identify issues that need to be address on the unit. It is important after

identify the issue that a solution is presented as a method to resolve the conflict. A shared

governing unit has the ability to implement and improve clinical practice (Winslow et al., 2015).

I have seen this model in action at the Heart Center. Nurses that voice a concern are asked if they

have a solution to improve the working environment. This open forum creates positive

communication and an opportunity for process improvement.

Program Outcomes

Patient-centered care is the focus of the Heart Center and starts from when the patients

enter the office for registration. Having a procedure can be very overwhelming for anyone

regardless how many times someone has endured an angiogram. Keeping the amount of people

to a minimum of two nurses decreases the amount of anxiety experienced by the patient. All

conversation is directed toward the patient to involve the patient with care. Patient will feel

informed and confident with care that is provided to them when entering the Heart Center. I

encourage all nurses not to talk about personal matters in the presence of patients and keep cell

phones out of the patient care setting. After preparation for procedure has been completed, it is
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expected that the family is retrieved from the lobby by a nurse and is escorted to the patients prep

room. The prep nurse will inform the patient and family of expectations while waiting in the prep

area ranging from wait time to explaining the procedure in plain language.

The Heart Center recovery nurses work in a collaborative effort with Cardiac Rehab to

ensure our patients experience continuity of care. The cardiac rehab nurse provided an in-service

to the cath lab nurses; it regarded the criteria patients have to classify in, in order to be enrolled

into cardiac rehab program. The cardiac rehab nurse visits the cath lab recovery daily to speak to

patients that qualify for the program and provides recovery nurses detailed instructions for

follow up with cardiac rehab. This inter-professional effort closes the gap from cath lab to follow

up care with the cardiologist. Post coronary intervention patients need to guidance to becoming a

healthier individual and gaining a new knowledge base of their health.

I have to admit I struggled in the beginning with integrative nurse and how it helps

patients and families. My closest friend is a holistic nurse and I never truly understood her

reasoning until now. Learning to care for my patients mind, body, and spirit is a very important

aspect of my nursing practice now. When patients are told they have a new disease such as,

diabetes or sever coronary artery disease they will go through emotional and spiritual distress. As

a nurse I would help them understand the pathophysiology of disease process and how to

improve their physical health. I did not take the time to ask them how they were coping with the

news and if they would like to speak to a Chaplin for spiritual guidance. It is evident, that if a

patient does not cope effectively or if they lose faith in life the likelihood of changing ones

behavior starts to diminish. Integrative nursing is not just about music, aromatherapy, and touch;

it is caring for the whole patient to start the healing process.

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Technology has improved the care that we provide to the community. The Heart Center

has invested in the use of electronic white boards to keep families connected with loved ones that

are in procedure. Family members are provided with a number that is associated with the patient.

The use of numbers is to preserve patient confidentiality, this allows the family to be informed

where the patient is at in the Heart Center. Using electronic white boards has improved

communication, patient-centered care, and satisfaction of the care that is delivered. I encourage

all nurses to keep the white board updated to prevent confusion for families and other healthcare

providers. Overall, the implementation of the electronic white board has been an effective

communication tool between nurses and families.

Interdepartmental communication is a problem that I can confidently say happens in all

healthcare organizations. It is the actions we take to improve the communication between

professionals to advance care coordination and outcomes across the healthcare continuum. The

transition for patient from the outpatient to inpatient setting can be an ineffective process in my

organization. Floor nurses are reluctance to care for recovered cardiac cath patients related to

lack of leadership support and educational training. To help improve the communication and

promote knowledge of the recovery process, all nurses from other units are invited to mentor

with a cath lab nurse. Mentoring with a cath lab nurse has improved the professional relationship

with the cath lab and other nursing units. Patients, doctors, and nurses are now confident in the

care that is provided after the implementation of the cath lab mentoring program.

The healthcare system is a complex adaptive system, which is broken down into many

parts but needs all parts to be able to function appropriately (Crowell, 2016). Healthcare is a

living-breathing organism that has many gray areas and welcomes change. Leaders in a complex

adaptive system need to lead in a nonlinear manner to welcome nursing innovation. Nursing
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interventions are evidence-based that improve the care we provide to have the best possible

outcomes. I have participated as lead in committees such as, transforming care at the bedside

(TCAB) that provides the nurse with a voice to help with process improvement. The TCAB of

the cath lab improved the reporting off system between the procedural and recovery nurses. The

committee encourages all nurses to give honest feed back for improvement on the reporting

process. Fewer errors occur when all that nurses are reporting in a standardized method at the

bedside.

Conclusion

My leadership skills have improved and developed vastly with this clinical leadership

program. I was very scared to become a leader outside of the cath lab. I have applied recently for

the position of stroke coordinator. This program has enlightened me how to run a program and

network with other healthcare professionals. There were many times during this program I

thought I could not write another discussion post or module paper. I had two deaths, a life

changing scare, and countless life happens moments during this program. I was able to

overcome anything that stood in my way (even horrible group members) to perceiver and meet

my goals of finishing this program with a 4.0.

I know now what kind of leader I want to be. The guidance of this program has shown me

that I want to be transformational. I live and lead life with emotional intelligence already. I

encourage others to become aware of emotional intelligence. It is my experience that leading in

healthcare is can be an uphill struggle if resistance is met every step of the way. Having higher

education will and has help guide me to overcome barriers to make change possible. I love that I

have the knowledge now on how to develop a program. This will be beneficial as I start my DNP

program in October.
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In the future I hope to help with the process improvement of the healthcare system. I am

furthering my education to obtain a doctoral of nursing practice (DNP). It is my end goal to

develop a program to help overweight/obese workingwomen develop a healthier lifestyle.

Diabetes and hypertension is the root of all evil in chronic disease processes and I want to help

with prevention. I am starting in the cath lab a program to help my coworkers and myself

become healthy and then reach out to the wellness department of my organization. I am truly

grateful for everything I have learned from the University of Arizona and will continue my

education to achieve greatness.

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References

Crowell, D. M. (2016). Complexity leadership: Nursings role in health-care delivery (2nd ed.).

Retrieved from https://play.google.com/books/reader?

printsec=frontcover&output=reader&id=1IezCgAAQBAJ&pg=GBS.PA157

Geradi, D. (2015). Conflict engagement: Emotional and social intelligence part five of six-part

series. The American Journal of Nursing, 115(8), 60-65.

Winslow, S., Hougan, A., DeGuzman, P., & Black, A. (2015). The voice of the nurse: Whats

being said about shared governance. Nursing Management, 46(4), 46-51.

http://dx.doi.org/10.1097/01.NUMA.0000462366.91153.e2