The transition from a newly graduated nurse to a fully competent Registered Nurse (RN) is a crucial period that requires extensive guidance and evaluation. This transition is particularly significant in specialized settings like hospice care, where the emotional and physical complexities of end-of-life care require a blend of clinical expertise and compassionate communication. The following essay provides a detailed summative performance evaluation of a new hire RN in a hospice setting, emphasizing the importance of professional development, skill assessment, and the role of mentorship in the nursing profession.
The practice setting for this evaluation is a hospice agency that provides care to end-of-life patients within their homes. The learner in this scenario is a new graduate associate degree RN with no experience beyond clinical rotations during their educational journey. This evaluation takes place after the learner has completed 15 days of precepting with a seasoned RN who has 15 years of hospice experience. The primary focus of this assessment is the learner’s competence in conducting the patient admission process to hospice services within the home setting. This process is a critical component of hospice care, as it sets the tone for the care relationship and ensures that the patient’s needs are thoroughly understood and addressed from the outset.
The learner’s journey begins with the preparation for the patient admission process. Prior to arriving at the potential patient’s home, the learner demonstrated initiative by obtaining the patient’s history and physical documentation from the admission coordinator. This step is vital in ensuring that the patient meets the local coverage determination (LCD) as dictated by Medicare guidelines. In this case, the patient was an 88-year-old male diagnosed with heart failure, with complications including hypertension, hyperlipidemia, and diabetes mellitus type II. The learner reviewed the documentation and determined that the patient qualified for hospice services due to an ejection fraction of 20%, shortness of breath at rest, and the inability to carry out activities of daily living without maximum assistance. This initial assessment showed the learner’s understanding of the clinical criteria necessary for hospice admission, reflecting their ability to apply theoretical knowledge to practical situations.
After determining the patient’s eligibility for hospice services, the learner contacted both the hospice physician and the primary care physician to obtain the necessary orders to admit the patient to hospice care. This step highlighted the learner’s ability to communicate effectively with other healthcare professionals, ensuring that the admission process proceeded smoothly. Additionally, the learner demonstrated organizational skills by calling the patient’s home to arrange a time for the admission and gathering the appropriate paperwork and supplies before leaving the office. This preparation is crucial in hospice care, where time and resources must be managed efficiently to provide the best possible care to patients.
Upon arrival at the patient’s home, the learner introduced herself and the observer in a professional manner. This initial interaction is critical in establishing trust and rapport with the patient and their family, which is especially important in hospice care, where patients and families often face significant emotional and psychological challenges. The learner identified the patient using their name, date of birth, and Medicare identifier, ensuring that the correct patient was being admitted to the appropriate services. This attention to detail is essential in avoiding errors and ensuring the accuracy of patient records.
The learner then began discussing how hospice services could benefit the patient and their family at this stage in the disease process. The learner’s approach was compassionate yet professional, effectively balancing the need to convey important information with the sensitivity required in end-of-life care discussions. This ability to communicate complex and sensitive information in a manner that is both clear and empathetic is a key competency for hospice nurses, as it directly impacts the patient’s and family’s experience of care.
In the subsequent steps of the admission process, the learner walked the patient and family through the consent process, ensuring that they understood the services being offered and the care plan that would be implemented. The learner then began the physical assessment of the patient, which included a comprehensive review of each body system. The learner assessed vital signs, heart and lung sounds, pulses (including peripheral pulses), bowel sounds, neurological status, height, weight, and blood sugar levels using the patient’s glucometer. This thorough assessment demonstrated the learner’s ability to conduct a complete physical examination, a crucial skill in any nursing setting.
However, during the skin assessment, the learner did not ask the patient to change position to assess the buttocks and coccyx for signs of skin breakdown. This oversight was noted by the observer, who reminded the learner of the importance of assessing all skin areas to provide a comprehensive plan of care. Skin assessments are particularly important in hospice care, where patients are often immobile or bedridden, increasing the risk of pressure ulcers and other skin integrity issues. This reminder served as a learning opportunity for the learner, highlighting the need for vigilance in every aspect of patient care.
The learner’s ability to apply theoretical knowledge in practice, combined with their organizational skills and compassionate communication, suggests that they are on the path to becoming a competent hospice nurse. However, the oversight in the skin assessment indicates that there are still areas where the learner can improve. Continuous learning and development are crucial in the nursing profession, particularly in specialized areas like hospice care, where the stakes are high, and the challenges are complex.
At nursingschooltutors.com, we emphasize the importance of comprehensive assessments and continuous learning in the development of nursing professionals. Our resources are designed to help new nurses build the skills and confidence they need to excel in their careers, whether they are just starting out or seeking to specialize in areas like hospice care. By providing access to expert guidance and practical tools, we aim to support nurses at every stage of their professional journey.
In conclusion, the summative performance evaluation of the new hire RN in this hospice setting highlights both strengths and areas for improvement. The learner demonstrated a solid understanding of the hospice admission process, effective communication with patients and healthcare professionals, and strong organizational skills. However, the need for more thorough skin assessments underscores the importance of continuous learning and vigilance in patient care. As the learner continues to develop their skills, it is essential that they receive ongoing support and mentorship to ensure that they can provide the highest quality of care to their patients.
For more resources and support in nursing education and professional development, visit
nursingschooltutors.com. Our platform offers a range of tools and guidance designed to help nurses succeed in their careers, whether they are just starting out or looking to advance in specialized fields like hospice care.
References
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Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Prentice-Hall.
National Hospice and Palliative Care Organization. (2021). Standards of practice for hospice programs. Retrieved from
https://www.nhpco.org
Gillespie, G. L., Gates, D. M., & Miller, M. (2016). Stressful incidents of physical violence against emergency nurses. The Online Journal of Issues in Nursing, 21(1).
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
