ACTIVITY, REFLECTION, ANALYSIS, SYNTHESIS ARAS

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A Project Paper Presented to The Faculty of the Graduate School San Pedro College, Davao City

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In Partial Fulfillment of the Requirements in Practicum on Administration in Healthcare Setting

By Joanna Kaye B. Remolar, R.N

May 7, 2010

INTRODUCTION

If Teaching is said to be the noblest profession, then teachers are the noblest professionals. According to Neeraja (2003), Nursing Education is the professional education for the preparation of nurses to enable to them to render professional nursing care to people of all ages, in all phases of health and illness, in a variety of settings. If nurses are expected to be competent, efficient, and knowledgeable in the field of clinical care, then the foundation must be strong. This foundation is structured in the nursing schools which are projected to be credible sources of nursing knowledge and anticipated to be able to pass that knowledge to nursing aspirants. Not only that, but the skills of a student nurse must be honed and settings designed to create an environment of adequate learning and exposure. Most importantly, the attitude of the nurse must be receptive, open-minded, flexible, quick, and humble at the same time to produce well-balanced and disciplined nurses. The level coordinators of the nursing department ensure that an environment conducive to learning is given to the instructor and students, so that transfer of knowledge is seamless. It is the coordinator who fixes all the minute details of arranging schedules, harmonizing inter-agency relations, and evaluating appropriately.

This subject, Practicum on Nursing Education allows me to identify the tasks and appreciate the necessity and efficiency of a coordinator so that the nursing student is shaped into a competent, intelligent nurse.

OBJECTIVES That within my 3-day practicum, I will be able to practice as a Year-Level Coordinator in San Pedro College.

Specifically, I will be able to: a. make a courtesy call to the Dean of Nursing; b. meet the level coordinators; c. interview my preceptor about the responsibilities of a level chair; d. observe the preceptors problem solving methods and ways of resolving conflict; e. identify the leadership style of the preceptor; f. suggest possible ways of resolving commonly encountered problems; g. observe how the preceptor relates to the students; h. observe how the head nurse manages her clinical instructors; and i. make a teaching plan as requested by the preceptor.

DAY 1 May 4, 2010

OBJECTIVES:

At the end of my 8-hour shift, I will be able to: a. make a courtesy call to the Dean of Nursing; b. meet the level coordinators; and c. interview my preceptor about the responsibilities of a level chair;

ACTION: My first day started at 7:30 a.m. outside the office of Mrs. Jeannie Bibera, the Dean of the Nursing Department for me to make a courtesy call. A little after 8 oclock, the secretary arrived and informed me that Mrs. Bibera had an important event to attend to, and advised us to go directly to our preceptors. So I went to the coordinators office and decided to wait for my preceptor outside. I sat on the bench near to a group of nursing students in white uniform who were also waiting for their level chair. About 9 a.m., my preceptor Mrs. Loyalda T. Lazarraga arrived. I approached her and she cordially invited me to her office. There I also met other coordinators namely Maam Suam, Maam Cuevo, and Maam Pabitay. As I took a seat on the soft bench in order to give her some time to prepare, a clinical

instructor immediately approached her regarding a concern of his. I observed that at the beginning they talked in a normal tone of voice but as their discussion got deeper, they talked in hushed voices. After a while Mrs. Lazarraga commented in a loud voice Nganong wala man ka nag ingun daan??. The c.i. promptly left. Afterwards, she called me and apologized for not being able to accommodate me immediately. I responded that it was no problem and that I am very thankful for her time. Then I asked about her responsibilities as a level chair. Her first answer was that the task of a level-coordinator is multi-tasking. She told me that her responsibilities are: make rotation schedule of 3rd year students for both concept and RLE; list the CIs who will be in-charge of the concept before the schoolyear starts and present it to the Dean for approval; sign the teachers load forms to be forwarded to the VP for academic affairs, president and dean for signature; accommodate the sick leaves of CIs; check the test questions; and verify excuse letters of students, among other tasks. She also showed me the green form for the RLE overtime, clinical supervision record form, stacks of sick leave applications, and a bigger stack of excuse slips. I commented that it seemed to be involving lots of paperwork to which she agreed. In addition, she is currently taking up her PhD in SPC, telling me that she is challenged to be at par with the energy level of her younger classmates. Its quite ironic since her admitted waterloo is writing and especially reading. But she felt that it would be unseemly if she would be the only coordinator who did not have a Masters degree, so she took it slowly, finishing it in 5 years. After getting

her degree she realized that she found thesis-making interesting, so she proceeded to her PhD.

REFLECTION: Though dressed casually, Mrs. Loyalda T. Lazarraga exuded an air of confidence and authority; one who was approachable, level-headed, firm, and sure of her actions which I assume could only come from 6 years of being a coordinator. I had never been under her direct supervision when I was student so I was really glad of this opportunity to get to know her. While I waited outside her office, the students near me were also waiting for other coordinators and I reminisced that I used to be one of those students. The moment the c.i. saw maam Lazarraga, he immediately sat down in front of her to raise his concern. Maam appeared be calm at first but after she learned further of the c.i.s request, she raised her voice which promptly caused the c.i. to leave. This coincided with that Maam told me, that she was generally amiable but very horrific when she got angry, especially when she knows that she is right. While Maam was explaining all the work that she had to do, I thought that indeed, shes right: a coordinator has to be a multi-tasker. And patient, if I may add, considering all the heaps and mounds of paperwork which seemed huge enough to drown in.

If that wasnt enough, taking her PhD at the same time would make multitasking an understatement. Shes very lucky that her photographic memory

compensates more than enough for her admitted weakness in reading and writing. I guess that at one point in life though one has achieved many goals, one proceeds to higher education simply for self-fulfillment.

ANALYSIS: Courtesy call is a very important initial step. As stated in Kellys Nursing Leadership & Management (2008) regarding communicating with supervisors, observing professional courtesies is an important first step. This demonstrates respect and allows for the conversation to occur at an appropriate time and place. Dress professionally. Arrive for the appointment on time. Ellis (1997) describes anger as an irrational response that arises from one of four irrational ideas: (1) that the treatment one received was awful; (2) feeling that one cant stand having been treated so irresponsibly and unfairly; (3) believing that one should not, must not behave as he did; and (4) because one acted in a terrible manner, he is a terrible person. Marquis and Huston (2006) have identified some leadership and management roles in conflict management. The nurse assists the conflicting parties to identify techniques that may resolve the conflict and accepts differences between the parties without judgment or accusation. Kelly (2008) states that an open, honest, clear Courtesy in

communication is the key to successful conflict management.

communicating is to be encouraged. This does not include interrupting, being aggressive, or being overbearing in demeanor. Voice level should be calm and at a normal tone. This sounds easy, but it may not always be easy to do. Avillion (2005) states that Continuing Education is defined as a learning activity designed to enhance an employees professional growth and

development. Qualifications for the staff development should reflect the standards of the profession, should reflect the standards of the organization, and minimum qualifications should be upheld impartially. Furthermore, Avillion (2005) adds that adults are self-directed learners. They determine what to learn and how they want to learn it. Thus, adults may attend a mandatory program, but if they fell it is a waste of their time they probably will not acquire much new knowledge. Adults know that their time is valuable and expect education to be offered at times and in ways that are convenient for them.

SYNTHESIS: Goal Partially Met. I was able to meet the level coordinators, interview my preceptor about the responsibilities of a level chair, but was not able to make a courtesy call to the Dean herself.

DAY 2 May 5, 2010

OBJECTIVES:

At the end of my 8-hour shift, I will be able to: a. observe the preceptors problem solving methods and ways of resolving conflict; b. identify the leadership style of the preceptor; and c. observe how the preceptor relates to the students.

ACTION: Upon Maam Lazarragas arrival in the coordinators room she was immediately bombarded with problems of students. One problem was that a group of students had a schedule in the OR morning shift, but there was a miscommunication of the clinical instructors schedule. Since the coordinator-incharge was absent, Maam Lazarraga accommodated the students by listening to their problem. She called the cellphone of the ci who was supposedly on duty, but because the ci answered that she had another commitment and there was no other c.i. available, Maam Lazarraga called the head nurse of the OR of SPH to negotiate if the students could report tomorrow instead. They were on first-name basis and were obviously friends. The head nurse agreed, and the students were sent home.

I asked her how she handles students. In terms of excuse slips, she interviews them before accepting their excuse. She narrates this one time a student came to her with a diagnosis of Systemic Viral Infection on her medical certificate, but when asked about her symptoms and medications, could give no answer so that she was not excused. However, in obvious cases she is not scrupulous anymore like cases of chickenpox and sore eyes, and grants them excuse slips accordingly. In terms of students complaining about their grades, she says the last word to change or recompute the grade is on the clinical instructor/lecturer. Even when the parents of the student seem toxic and threaten to go to the CHED, she never exerts pressure on the c.i., and supports whatever is the decision of the clinical instructor. She said that it would be inappropriate for her to pressure the c.i. as it would be meddlesome of her. In defense of her c.i.s, the students with failing grades are referred to the guidance counselor which calls the parents for a meeting. Unfortunately, in some cases the parents maybe are too busy to heed the call of the guidance office, so that when they come to school its too late.

REFLECTION: Students coming in and out of the office are not very common during summer, and I can only imagine the time and patience-consuming flow of people during the regular schoolyear. With the incidence of the group of students who were not able to go on duty in the OR, I realized that sometimes a coordinator

must accommodate even if it is not her scope, call the appropriate persons, and make a decision fast. In the actual sense of the word, a coordinator must coordinate. She is like a bridge which connects the school and the hospital to achieve their goals. With the case of excuse slips, I find it amusing that some students are feigning sickness and think that they will not get caught. Not being able to

answer what your manifestations were when you were sick, if you were really sick, is absurd. Im amazed that Maam still has the patience to go through the day when she finds out that the student is just malingering. Students complaining about their grade, I think, is a sensitive issue. It requires the balance of being pro-student and pro-teacher at the same time. I think that sometimes, it can be hard to say no when the student and the parent is crying in front asking to give another chance to them just to pass. It must be an emotionally taxing and trying time. With these events I conclude that Maam Lazarraga employs a democratic style of leadership because she does not force her own decision upon others nor does she let them do whatever they want. She maintains the balance of letting others participate in the decision-making while being in command.

ANALYSIS: Negotiation is psychological and verbal. Part of the preparation should have included learning about the people with whom the manager is negotiating. There are many types of personalities, and it is necessary to negotiate with most

of them.

The negotiator must have clarity in his or her communication,

assertiveness, good listening skills and flexibility. (Marquis: 2003). In addition, collaborating is an assertive and cooperative means of conflict resolution that results in a win-win solution. It enhances a persons participation in decision-making to accomplish mutual goals and therefore is the best method to resolve conflict to achieve long-term benefits. According to Neeraja (2003), the realization of educational goals and objectives by the students in a given period is measured by evaluation, which has become part and parcel of every system of education. Evaluation is an act or process that allows one to make a valuable judgment about the desirability or value of a measure. It includes both quantitative and qualitative. Evaluation of the student is a continuous ongoing process, and to assess the intellectual levels of students, cognitive tests will be performed. Marks are an outcome or evaluation of students work in terms of the whole group, and represents educational progress in school. When a student has failing marks, he is referred to the Guidance and Counseling Department. Neeraja (2003) defines Guidance as a process through which an individual is able to solve their problems and pursue a path suited to their abilities and aspirations. Guidance services must be an integral part of the school organization. On the other hand, Counseling denotes giving of advice, a specialized service of Guidance which is a helping relationship win a setting that permits help to be given and received.

Democratic Leadership is people oriented. It focuses on human aspects and builds effective teamwork. Interaction between the leader and subordinates is open, friendly, and trusting. (Venzon: 2006).

SYNTHESIS: Goal met. At the end of my 8-hour shift I was able to observe the preceptors problem solving methods and ways of resolving conflict, identify the leadership style of the preceptor and observe how the preceptor relates to the students.

DAY 3 May 6, 2010

OBJECTIVES: At the end of my 8-hour shift, I will be able to: a. suggest possible ways of resolving commonly encountered problems; b. observe how the head nurse manages her clinical instructors; and c. make a teaching plan as requested by the preceptor.

ACTION:

On my 3rd day of practicum, I asked my preceptor about her most and least liked tasks as a coordinator. She thought about it and said that because of her 6-year experience she had already gotten used to the all the tasks of a coordinator. But one of her pet peeves is collecting and badgering her c.i.s to submit the grades on time. She sets her deadline and she expects her c.i.s to follow it since she still has to encode it herself and pass it to the registrar. She admits that she really gets angry and admonishes her c.i.s when they do not meet the deadline. As if on cue, someone from the other side of the room yelled to no one in particular, Kinsa pa daw nay utang sa registrar dira, pamayad na daw mo! which earned chuckles from the coordinators. Maam said that it was a good thing her c.is had all passed their grades on time this summer. Then I

asked how she handles instructors under her supervision who have more seniority than her, and she says that she does not have any problem with them and treats them with respect. In fact, its the younger c.is who seem to have a problem of passing their grades on time. Aware of the fact that she could talk 120 words per minute when she was angry, she thought that she was not retaining her position as coordinator with the replacement of three coordinators. She received one feedback which said she should shut up her mouth once in a while, which she found offending. But it was quite a pleasant surprise when she learned that after the secret ballot voting, she gathered the highest votes of being retained as a coordinator, though it would also have been alright for her to be back as a clinical instructor. She accepts that the position of a coordinator is only a temporary position and they could be replaced anytime, with the final decision in the hands of the President. Maam Lazarraga also told me that one of the new inclusions for the program of the students is the appraisal, which serves as a question and answer portion and a sort of review. I commended the program since this was what I had in mind to suggest to her, so that the students will be able to rationalize the answers well. Afterwards, I proceeded to make my teaching plan as she requested. Thus my practicum was concluded.

REFLECTION: I share with my preceptor the same pet peeve, which is not meeting deadlines. I also do not like it when my co-workers do not do as they say

because the work of other people will also be put on hold. It is quite a wake-up call to the newer instructors upon knowing that the senior instructors are able to submit their grades on time .I guess that is where professionalism with experience shows. I applauded my preceptor for getting the highest number of votes as to retaining her position as a coordinator, a clear indication that she is doing her job excellently. Though some may have commented her on being too nagging, most instructors say that she is justified since what shes saying is right. With the replacement of coordinators, though each one of them was oriented from the start that it was a temporary position and they could be replaced anytime, I couldnt help but wonder if the coordinators who were to be replaced had accepted the decision of the majority without getting hurt. It was good to know that a rationalization was added to the curriculum. This would be of great help to the students. When I was a student, I would often think that there should be a program which would explain the answers on the exam, so that we would get it right the next time. Otherwise, we would be committing the same mistakes again and again. And we did. So I found the appraisal to be a really good move of my preceptor.

ANALYSIS: There are three basic steps to time management. The first step requires that time be set aside for planning and establishing priorities. The second step entails completing the highest-priority task whenever possible. In the final step, the person must reprioritize the tasks to be accomplished based on new information received. Being overwhelmed by work and time constraints lead to increased errors, the omission of important tasks, and the general feelings of stress and ineffectiveness. In performance appraisals, actual performance, not intent, is evaluated. Performance appraisals let employees know the level of their job performance as well as any expectations the organization may have of them. Performance

appraisal also generates information for salary adjustments, promotions, transfers, disciplinary actions, and terminations. When monitoring and assessing work performance are carried out by peers rather than by supervisors, it is referred to as peer review. It provides the employee with valuable feedback that can promote growth. Peers who work together have a level of insight into each others practice, and peer review provides them with an opportunity to receive better feedback about self-improvement. Interpersonal conflict happens between two or more people with differing values, goals and beliefs. The person experiencing this conflict may experience opposition in upward, downward, horizontal, or diagonal communication. Highly developed verbal communication skills are critical for the leader/manager. One of the most important verbal communication skills is the art of assertive

communication, which allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another persons rights.

SYNTHESIS:

Goal met. At the end of my practicum, I was able to suggest possible ways of resolving commonly encountered problems, observe how the head nurse manages her clinical instructors, and make a teaching plan as requested by the preceptor.

REFERENCES:

Avillion, A. (2003). Nurse Educator Manual: Essential Skills and Guidelines for Effective Practice. USA: HCPro, Inc

Kelly, P. (2008). Nursing Leadership & Management (2nd ed.). New York: Delmar Learning.

Marquis. B. and Huton, C. (2003). Leadership Roles and Management Functions In Nursing: Theory, Concepts, and Applications (4th ed.) Philadelphia: Lippincott, Williams & Wilkins.

Neeraja, KP. (2003). Textbook of Nursing Education. India: Jaypee Brothers Medical Publishers Ltd.

Venzon, L. and Nagtalon, J. (2006). Nursing Management: Towards Quality Care. (3rd ed.). Quezon City: C&E Publishing, Inc.