This candidate exemplifies integrity, honesty and accountability by the following.  He is very dependable and reports to work when scheduled.  He is flexible with his schedule to fit the needs of the unit.  He is very eager to advance in his career, as he is one of my most experienced Preceptors and has recently embraced the role of Charge Nurse.  These roles require patience, holding yourself and others accountable, and exemplifying a leader by being an approachable resource for the staff.  He recognizes abnormal values and/or acute changes in patient conditions and promptly reports them to the supervising Charge Nurse and provider.  He also communicates patient information promptly and with 100% accuracy.  This candidate is an excellent role model for other staff to reflect on.

He is such an asset to our team and the hospital.  He serves on our Nurse Quality and Research Council.  He is responsible for reporting on the unit QI initiatives and disseminating the evidence-based changes in practice proposed by other departments and patient care units to our unit.  He is an active member of our unit-based Balanced Scorecard Committee and has just taken on the responsibility of improving the cleanliness of the unit.  He is an active member of our unit-based Work Council and helps facilitate onboarding of new employees and improve work culture.  As our unit transitioned from centralized telemetry to unit-based, he didn’t skip a beat and volunteered to be a Cardiac Monitoring Champion.  He wholeheartedly embraced this role and is an excellent resource to all staff when it comes to reading telemetry strips.  He is one of our unit Hand Hygiene Auditors and Champions and is responsible for attending the meetings and performing monthly audits.  He is also a Duke MOVES Coach and is responsible for attending quarterly meetings and educating and validating staff on lift equipment.

His residency project focused on evidence-based practice for prefilled 0.9% sodium chloride (normal saline [NS]) syringes.  He noticed that the prefilled NS syringes were routinely used to dilute and reconstitute intravenous medications.  He searched the literature and determined that the U.S. Food and Drug Administration regulated the prefilled NS syringes as a medical device, not as medication.  Therefore, they are not approved for the dilution or reconstitution of intravenous medications.  Further research revealed this was not a problem specific to DUHS.  The Institute for Safe Medication Practices (ISMP) found in a survey of 977 practitioners that 81% of respondents reported diluting an intravenous medication with a prefilled saline syringe.  There are several risks associated with this practice.  He reviewed DUHS policies and determined that no policy restricting the use of prefilled NS flush syringes to dilute or reconstitute intravenous medications existed.  Therefore, he recommended that the current policy be revised to increase patient safety and ensure proper use of the prefilled NS syringe.

This phenomenal nurse is easy to approach and is an excellent team payer to exemplify high-quality patient care.  A few months ago, this candidate had a patient who came to us from the Emergency Department on oxygen the night before, yet by 8 a.m. went into respiratory failure.  This candidate alerted the Rapid Response Team, which responded and stabilized the patient.  However, the patient needed an ICU bed, which was not available.  This candidate stayed with this patient, at the bedside, helping the provider team, while ensuring his other four patients were being taken care of.  As I was passing by his patient’s room, the candidate would say things like: “Room 11 needs his PRN pain meds on time, we need to get ahead of the pain;” or, “Room 13’s wife is supposed to come at 10 a.m. to meet with the Palliative Team, please let them know.”  He kept ownership of his other patients, even under pressure, making sure that all the patients’ needs were met appropriately and on time.

This great candidate approaches patient care with empathy, which allows him to take on patients’ perspectives and better understand their unique needs, preferences and values.  A colleague shared:  “He is a team player whom I have personally witnessed, first-hand, help to deescalate a situation with one of his coworker’s patients with which he was familiar.  The patient was adamant that she wanted to be discharged home that day and acted out in front of staff. … This candidate entered the room, as he already had a rapport with this patient, and did what he could to calm her down and reassured her that the hospital was where she needed to be at that moment until we could come up with a safe discharge plan. … This process took nearly 35 minutes, and he also had a full patient assignment for which he was responsible.  He, however, stepped up to assist a staff member who was struggling and put the needs and safety of the patient first, which is all we can ask.”

Amazingly, this candidate embraces his nursing career every day and continues to excel himself to new opportunities and challenges to improve patient care, and does it with role-modeling our Swanson’s Theory of Caring and “Living Our Values.”