Bon Secours Memorial College of Nursing

NUR 3112P: Adult Nursing Science II Practicum

Peer Leader Practicum Experience

Student Name: _Debbie Carter____ Clinical Date: __March 31, 2016____________

The purpose of this experience is to gain leadership by:

A. Continuing to develop and refine leadership and communications skills, including time
management, giving and receiving of constructive peer feedback, and conflict resolution.
B. Incorporating critical thinking strategies to prioritize patient acuity and delegate
accordingly within the students practicum group.
C. Refine problem solving and nursing process skills by applying theoretical concepts to
practicum situations.
D. Contributing to overall care and safety of patients.
E. Conduct group post-conference

Pre-Practicum/Pre-assessment

1. Role of Peer Leader

a. For pre-assessment, conduct a general overview of all assigned patients to your
clinical group.

2. Construct a list of patients with rank acuity (top 5 only) and give rationale to validate and
support your decisions.

During Practicum

1. Role of Peer Leader

a. Get report from either the night RN or the students.
b. Make patient rounds following report.
c. Assist colleagues with care as needed.
d. Monitor that documentation being entered in Connect Care in a timely manner.
e. Monitor that all peers are administering medications on time and doing treatments
as ordered.

2. Find an article that relates to one of your peers patients and share with the practicum
members during post-conference.

3. Lead discussion of patient experiences with the practicum group.

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 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience

Post-Practicum Paperwork: Clinical Analysis

1. Finalize the acuity list by adding or subtracting pertinent information. Are there any
changes in the acuity ranking of the assignments? Give rationale.

The Top 5 (of 6) List starting with the sickest, then descending in acuity.

Room 672 79y/M Hemorrhagic Right Basal Ganglia, CVA with left sided deficits,
obstructing hydrocephalus s/p EVD placement, Enterobacter meningitis. Brooke had this
patient. She was extremely busy with him. The patient had a number of medications
throughout the day, also on contact precautions for CRE. Full-code. LOS day 12.

Room 656 73y/F - Sepsis. Pt has significant history of A-fib, Multiple sclerosis, GERD,
Chronic UTI, Hepatic encephalopathy, hyperlipidemia, hyponatremia, hypokalemia. This
patient was also scheduled to go for an endoscopic ultrasound to visualize gallstones with
pancreatitis. Patients lab values were concerning; creatinine, BUN, ammonia, and LFTs were
all elevated. This was day 7 of her hospitalization, so there was some improvement with her
Cr and BUN, but her amylase and lipase had taken a dramatic jump, hence the concern for
pancreatitis. Code status: DNR.

Room 671 57y/F Sepsis. Liver abscess, unresectable cholangiocarcinoma (bile duct
cancer), right pleural effusion, right upper abdominal pain, anemia, delirium, nausea. One of
the goals of care was pain control. This was another of Brookes patients and I did not clarify
other goals of care. Contact precautions for CRE in pleural fluid. DNR. LOS day 17.

Room 674 44y/F Closed L3 vertebral fracture. Current concerns were pain control
and clogged PEG tube. Pt was scheduled to go for a procedure to address the PEG tube, but
the procedure was bumped. The pain was also a concern because her pain medicine would
start to wear off around 3 hours. She had PRN medications scheduled every 4 and 6 hours.
Patient has an extensive medical history of CVA, syncopal events, chronic respiratory failure
and hypoxia, hypothyroidism, hypokalemia, and DM type 2. Pt is also a DNR. Her acuity
level is also based on the amount of time the patient requires. She is sick and is a needy
patient per night nurse, confirmed by student nurse.

Room 650 88y/M Acute embolic stroke. History of A-fib, Ischemic Cardiomyopathy,
and CAD. By reading this mans chart, you would think he would be a bit of a mess, but he
looks great for all he had been through this week. Pt had minimal concerns, but still on the
unit for observation. Full-code. Hospitalization day 5.

2. What problem(s) or concerns did you encounter as the peer leader? What did you do to
solve the problem(s)?

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 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience
Overall, it was a nice and calm day with our six patients. With such a small group,
I felt like there was good communication and I was able to check on people throughout
the time. I felt as though we had a great day on the unit.
There was great communication among the group. Aida went with her patient for
an ECHO. She was off the unit for a short time, but I was able to check on her other
patient and address her concerns about pain medications.
We had a smaller group since so many were out, but that may have contributed to
having a nice day. The only concern that came up was a concern with one patient related
to her Foley catheter. I was already in the room with Autumn, assisting her with this
patient. Urine was leaking and after looking at the Foley, I was unsure how check the
placement. I was able to get assistance from Ms. Roberson who was able to determine the
balloon needed about more 2 mL to fill the balloon to anchor it in. I have seen Foley
problems with male patients, where a larger tube was needed, but this was the first time I
had seen a problem like this with a female patient.

3. Describe 3 principles of servant leadership and how you portrayed each of them as a peer
leader. (Minimum 3 paragraphs. Reference in APA is required.)

I was raised with an attitude of servant leadership. I am very thankful for the
principles my parents instilled in me from a young age. I have applied these traits to my
work and my life. They easily carry from life to the workplace.
I was able to be a resource for each of my group members. I assisted by running
for supplies while someone was in a contact room, I took away meal trays, I assisted with
clean ups. I really enjoyed being an assistant to each of my cohorts. One idea that was
discussed in the article referenced was the principle of stewardship. Servant leaders
consider others as partners; they share rewards and glorify the team spirit. (Neill &
Saunders, 2008) I appreciate this quote because I believe we are equals with a common
goal to take care of our patients to the best of our ability.
The most valuable moment was when I was asked to assist with a shift
assessment. I think we all have moments were we want to talk through a situation or a
process to confirm we are doing something the right way. Where she was doing the

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 Bon Secours Memorial College of Nursing
NUR 3112P: Adult Nursing Science II Practicum
Peer Leader Practicum Experience
assessment properly, you could tell confidence was what she needed most. I was glad to
be there to listen and to lend a helping hand.
I would say three of the principles of servant leadership that I used today were
Listening, Foresight, and Commitment to Growth (Neill & Saunders, 2008). Listening
and Commitment to Growth could be grouped into one even. I was glad that we had a
smaller group where I was able to go in and listen to the concerns of proper technique,
but there was also time give affirmation and assurance (Neill & Saunders, 2008). Another
principle portrayed was foresight. I come from an emergency room background where
you constantly prepare for what is to come. Seeing that one of my cohorts had two
contact patients, I tried to be available in case there were needs. I am always glad to run
for supplies because it is a pain to gown and glove, then, gown and glove again because
you forgot extra towels or the right supplies were not stocked in the room.
I enjoyed this experience. I believe my background in leadership and years of
supporting my coworkers has prepared me for many of the situations I encountered today.
In the future, I hope to be a resource that my peers can rely on. I can see myself in the
role of charge nurse or team leader. I enjoy the mentoring aspect of being a nursing
leader and I hope to share that gift for years to come.

Resource

Neill, M., & Saunders, N. (2008). Servant leadership: Enhancing quality of care and staff
satisfaction. The Journal of Nursing Administration, 38(9), 395 400.

Rev. April 11, 2017