NR 631- Nurse Executive Concluding Graduate Experience

After completing the literature review, the information suggests that falls and mobilizing patients are still an issue that all healthcare organizations face. There have been many evidence- based interventions put into place including bed alarms, sitters, and purposeful rounding to assist with decreasing the number of falls. My practicum project was brought to light as the theory to decrease falls occur when mobility is increased for patients. Thirty five percent of hospitalized older patients develop reduced function due to increased time lying in bed that increases their risk of falls and related injury (Cho et al., 2018). The issue that comes with mobility is that it is the least performed and least documented nursing activity (Dewitt et al., 2019). The information I gathered during the literature review allowed me to see what areas need to be addressed when my project is implemented. As a bedside nurse on a busy med surg unit, the information from the literature review is consistent with my own personal experience. The barriers suggested by Popoola and Montgomery; including staffing levels, time and workload, resources, knowledge and training, stress, patient safety, and noncompliant patients are seen at every healthcare organization and make it difficult for the bedside nurse to document mobility at the time the patient was mobilized (Popoola et al., 2021; Montgomery et al., 2021). A majority of the literature was regarding implementation of a mobile electronic health record system to allow for documentation at the bedside. My project is to implement a flowsheet on my organizations mobile electronic health record called the ROVER. This will allow nursing staff to document on the mobile flowsheet in real time when the patient is mobilized. This will help to increase compliance with mobilizing a patient three times per day and increase compliance with documentation. My goal for the project is to increase mobility documentation to 82% from 69%. Along with the literature regarding a mobile electric health record, other 10 literature relates to my project because it allows me to see possible barriers that will impact the implementation to my project such as nurses being resistant to the change. Vossebeld suggested that including bedside nurses in the changes will help with bedside nurses participating in the change when it is implemented (Vossebeld et al., 2019). I feel that including the user that the change will impact is important to the implantation phase as it needs to be something the user will feel flows in their workflow and make charting easier. The literature suggests that a mobile electronic health record can be used in healthcare organizations to decrease the amount of time nurses are spending documenting and increase patient nurse interaction from 7.84 to 9.30 minutes per hour (Ehrler et al., 2021). During a time like now with the COVID pandemic, hospitals are short staffed and nurses are taking on more patient nurse ratio assignments. Nurses will be more willing to mobilize and document the mobility occurrence if they have the flowsheet at the tip of their fingers. Analysis of the Literature After completing the literature review, it was proven that there are many barriers’ nurses face when it comes to mobilizing patients and documenting mobility. The studies completed by Ehrler et al., Perez- Marti et al., Kim et al., and Vossebeld et al., proved that implementing a mobile electronic health record to use for documenting had many benefits. Although the studies completed regarding the mobile electronic health record did not exclusively test the theory that it would improve mobility documentation compliance, my personal theory is that it will improve the ease for documenting mobility and overall improve the metrics behind mobility documentation for the organization. My practicum project is important because by implementing a mobile electronic health record, nurses are given more time to interact with their patients and also increase documentation 11 on mobility. Increasing mobility will help to decrease falls in patients because it reduces the amount of time a patient spends lying in bed. Lying in bed can lead to muscle atrophy and increase the chance of a fall when a patient attempts to ambulate after an increased time of being in bed. Apart from reducing falls and increasing mobility documentation compliance, this project will help to reduce the costs hospitals face when a patient falls. In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls which leaves the costs of follow up care and treatment to the hospital (Fehlberg et al., 2018). Conclusion Documentation is an important aspect of nursing and tracking quality improvement metrics. With the introduction of the electronic health record, documentation requirements have increased by 30% (Anderson et al., 2018). With the increase of documentation requirements per shift, mobility is one of the top missed nursing activities. By implementing a mobile electronic health record to allow nursing staff to document mobility in real time, I predict that mobility documentation will increase from 69% to 82% in a six-month time period. 12 Reflection on Course Outcome Achievement CO 1: Apply evidence- based leadership skills and concepts in the planning of an executive- level practice change project. For course outcome one, I have progressed throughout this course and have met this course outcome by working with my mentor and establishing a practicum project that was based on my organizations needs. After establishing my practicum project and PICOT question, I began working with organizational members in the Falls Prevention Committee to further develop the project. I used the nurse sensitive indicators to see what the organizational goal for mobility needs to be and what the organization is currently at for mobility. CO2: Develop an evidenced- based foundation to lead organizational change using current knowledge, standards of practice, and research from current literature. For course outcome two, I have progressed throughout this course and have met this course outcome by discussing with my mentor current practice being done to increase mobility at an organizational level. I completed a literature review to get an understanding of current evidenced- based practice on my practicum topic and used that data in my practicum project. I discussed with bedside nursing staff barriers of the current practice of mobility and received input on how to improve mobility documentation compliance alongside my practicum project. CO 3: Exemplify professional values and scholarship that support the role of a student in a practicum setting during the planning phases of a practice change project. For course outcome three, I have progressed throughout this course and have met this course outcome by completing many project management tools to assist with the planning phase 13 of my practicum project. I met with my mentor on a weekly basis to discuss my goals as a leader and my mentor assisted with developing my leadership skills and development as a leader. I attended a conference with other leadership that displayed their change projects that allowed me to meet other members in leadership.