This is the Proficiency report I wrote.I need to write another one for level 3. Below is the rubric PowerPoint.

 

 

SECTION B ‐ NARRATIVE EVALUATION BY RATING OFFICIAL

INSTRUCTIONS: Document how the nurse meets the criteria stated in the VA Nurse Qualification Standards and appropriate functional statement, other significant professional contributions, and areas needing improvement. (The narrative evaluation should be limited to the space provided except in unusual circumstances.)

 

 

Dimension: Practice Practice

Ms. Comfort F. Odole is a valuable, punctual, and dedicated staff nurse on 6C200, a busy 17‐bed medical‐surgical and telemetry unit caring for patients with complex medical issues, including long-term ventilator support and tracheostomy care on another unit when floated. She has demonstrated excellent potential as a VA staff nurse on 6C200 and has proven herself a self‐motivated team player and a leader with a positive attitude. Ms. Odole works well with the interdisciplinary team to help identify issues and concerns, ensure a caring and supportive environment for the veterans, families, and staff, and provide appropriate feedback that will help improve the veteran’s experience. She was also involved with Charge nurses on the unit to create a seamless shift by focusing on delegating care safely and cost-effectively. Ms. Odole does this by creating assignments, considering the acuity of the patients and the competencies of each nursing staff to ensure our veterans get the adequate care they need.

Practice

Ms. Odole has applied the nursing process to systems and processes at the leadership level to improve care with the adequate support of my manager (Mr. Carl Lee). She has provided leadership in applying the nursing process to veteran care, organizational processes, and systems improvements at the service level. Ms. Odole has addressed issues independently, with the charge nurses and manager, that could affect veterans and staff while facilitating safe, effective, efficient patient‐centered care as evidenced by changes in practice and patient outcomes. Ms. Odole is currently receiving charge nurse training. She always informs the nurse manager of issues and concerns that may help 6C200 become the best Dallas VA Medical Center unit.

Example: On Christmas day, 12/25/2022, Ms. Odole served as a primary nurse and charge nurse (covering for the 17 beds with two nurses)she did thorough assessments, planning, interventions, and evaluations of the patients, with no fall or any incident. As part of her professional demeanor, Ms. Odole has continually and consistently developed care planning and documentation of response to interventions.

Example: An example of a resourceful nurse, Ms. Odole, received a bedside report from the Night nurse, and during the report, she noticed that a veteran was confused and not coherent. She immediately assessed quickly and noticed the veteran had a distended bladder. Ms. Odole then scanned him immediately to find the veteran was retaining urine. The provider was notified immediately. Dr Chaudhry came right away. Ms. Odole assigned someone to document all actions, and orders were received to straight cath the patient. The GI group also ruled out a GI bleed since the patient recently had a GI procedure. The veteran was later transferred to 5A Tele for a higher level of care, where he recovered and was discharged without further incident.

Ethics Ethics

Ms. Odole believes It is her responsibility to protect the patient’s privacy, confidentiality of electronic health records, and protected health information. She treats veterans and family members with respect and maintains professional boundaries with the patients and families. Ms. Odole has always been involved as an advocate for patients, supporting patient wishes and client self‐determination.

Example:

For example, while medicating a veteran, the patient’s daughters arrived and were conversing and deciding whether the veteran would remain a full code or become a DNR. One daughter agreed to let dad remain full code, while the second disagreed. Ms. Odole was caught in their discussion and realized this was an ethnic dilemma. So, she discussed with the appropriate authority, his assigned Provider, and his status remains unchanged as a full code. The provider discussed the veteran’s DNR status further with his daughters, and the family agreed. The veteran’s status changed to DNR. The family also requested for Hospice care to be initiated. The physician ordered hospice to evaluate the veteran; the CLC was also consulted.

Resource Utilization

Ms. Odole has scrupulously used necessary resources for the betterment of the care of her patients. She has demonstrated excellent leadership skills. Ms. Odole has created a shared drive and purpose as an effective team player. She makes assignments by considering the patient’s acuity and a nurse’s competency whenever she is asked to Charge. Several times, Ms. Odole has assumed the charge nurse’s responsibility during short staffing situations due to unplanned leave.

For instance, Ms. Odole has evaluated veterans requiring special resources such as a sitter, a single room, and so on, and their continued needs to conserve resources to provide for the veteran’s continued safety. Assessing veterans to determine elevated needs and make appropriate arrangements for their safety is the importance of using resources to support her critical thinking and judgment skills.

Ms. Odole has utilized the VA Internet to obtain medication information and other patient education materials to share with patients and fellow staff members. She also serves as medication cart leader and ensures all medications are labeled properly and expired medications are removed immediately. Ms. Odole has dedicated herself to the responsibility for maintaining unit equipment and provides feedback to the manager when equipment is not serviceable.

Dimension: Professional Development Performance

Ms. Odole stays abreast of VA policies and procedures and is careful to adhere to them and standards of care from other relevant regulations. She seeks feedback on my performance from both nursing staff and manager and she constantly strives for excellence. Ms. Odole has taken advantage opportunities to increase my knowledge and enhance his nursing practice. For instance, she has used the vein‐finder to perfect her IV insertion skills. On the unit, Ms. Odole can say she perform IV insertion without vein finder now. Her enthusiasm in the use of the ultrasound vein‐finder was remarkable and she shared the knowledge with her colleagues to increase the professional nursing practice on 6C200 and 6C100.

Education/Career Development

Over the course of the year, Ms. Odole has planned to further her education to improve patient care outcomes. Also, to education patients, family members and staff. For example, Ms. Odole usually reminds the housekeepers assigned to 6C200 to change the emptied hand sanitizer by the Veteran’s doorway. She always asks for a new container, so the people who enter that room can sanitize their hands and prevent spread of infectious diseases. Another example, Ms. Odole had to correct a Nursing Assistant when she did not use appropriate PPE in a contact isolation room. Ms. Odole educated the tech on the appropriate way to use PPE and why it is important. She relayed to her the repercussions of violating a standard of practice. She makes an extra effort to explain the rationale to the tech for the purpose of promoting better compliance.

Dimension: Collaboration Collegiality

Ms. Odole has been complimented for her attention to detail, and the thoroughness of her instructions to nursing staff. She provides feedback to the manager regarding the practice of others. She is also a member of the care team in providing for the care and needs of the client, including pharmacy, social work, case management, laboratory, providers, wound care and other services, as appropriate. Ms. Odole has worked with various groups to improve performance measures such as reducing falls, missing medications, PRN effectiveness, and verification of high risk/high alert medications.

Collaboration

Ms. Odole works in collaboration with team members to achieve goals as per the patient care plan. She collaborates with 6C200 staff, the Nurse Manager, SDS, and another interdisciplinary team members. For instance, when new patients are admitted to the unit with actual or potential skin breakdown, Ms. Odole places a wound care consult during her initial assessment. She also advocates for the patient to receive an air mattress and appropriate wound management orders. Furthermore, Ms. Odole utilizes the Elsevier education system, during her downtime, to educate herself and remind her colleagues to keep their education up to date as well.

Dimension: Scientific Inquiry Quality of Care

Ms. Odole has participated in quality improvement activities on 6C200. She ensures PRN effectiveness reports are ran every two hours during her tour, monitors missed medications, audits charts for compliance with admission and daily assessments, promote the flu/pneumonia vaccines for all veterans, and ensures high risk/high alert medications are verified as required and per VA policies. Whenever Ms. Odole was given the opportunity to charge on the unit, she does it to the best of her ability.

Research

Ms. Odole reviews a lot of evidence‐based literature and nursing journals to improve the quality of her nursing care, nursing process, and interventions. Currently, she is reviewing articles and journals on suicidal prevention. These

initiatives are to improve patient centered care by sharing the evidenced‐based practice articles and increase her knowledge base.

Goals for 2023‐2024

1. Member of the Unit Based Committees/shared governance council.2. Participates in making sure the unit receives supplies that is desperately needed for patient cares from Logistics. 3. Shadow the unit manager for full awareness of all unit responsibilitiesWorks with all other charge nurses, on the unit, to get acquainted with the flow of the unit and how to ensure.