D024 Task 1 Professional Presence Paper Example

Establishing Professional Presence in a Post-Anesthesia Care Unit Where Holds Have Replaced Handoffs: Emotional Intelligence, a Joy in Work Map, and Three Changes

Student Name

Leavitt School of Health, Western Governors University

D024: Professional Presence and Influence, Task 1

Course Instructor

Month Day, Year

Establishing Professional Presence in a Post-Anesthesia Care Unit Where Holds Have Replaced Handoffs: Emotional Intelligence, a Joy in Work Map, and Three Changes

Introduction

Professional presence is the way a nurse's composure, attention and words affect the people around her, and it is most visible when a department is under strain. This paper is set in a composite 16-bay post-anesthesia care unit (PACU) in a 240-bed community hospital, where I work as a relief charge nurse. Over the last year the hospital added two operating rooms without adding inpatient beds, so patients who should transfer to a surgical floor within an hour now wait in the PACU for three or four. The PACU calls these waits holds. On a bad day a nurse is recovering one fresh patient from anesthesia while caring for two held patients who need dinner trays, pain reassessment and a family visit the PACU was never built to host. Staff describe the work as a treadmill. This paper describes the social and emotional intelligence skills I would use to establish professional presence in that environment, maps the factors that feed or drain joy in work there, and proposes changes that a charge nurse can actually influence.

Social and Emotional Intelligence Skills

Emotional intelligence is commonly described as noticing and regulating one's own feelings while reading and answering the feelings of others. In nursing it has been defined as a set of capacities that shape how nurses relate to patients and colleagues and how they cope with stress (Raghubir, 2018). Its relevance to safety is direct: nurses who read emotional cues accurately notice when a colleague is overwhelmed or when a patient's anxiety is masking pain, and those observations prevent errors (Codier & Codier, 2017). Four skills matter most for a charge nurse in a congested PACU.

Self-awareness is knowing what I am feeling while it is happening. When the operating room calls a fourth time to ask for a bay, my jaw tightens and I start speaking in short sentences. Staff read that tension immediately. Naming it to myself, even silently, gives me a moment to choose my tone.

Self-regulation is choosing a response instead of reacting. In practice this means that when the operating room charge nurse says a surgeon is angry about the delay, I answer with information rather than defensiveness: three held patients, bed requests placed at these times, the house supervisor paged at this time. A calm factual answer ends the argument faster than a sharp one.

Empathy is understanding another person's position well enough to predict what they need. A nurse who has held the same patient for four hours is not asking for a lecture about teamwork; she is asking for a break and for someone to notice.

Social skill is using those readings to move a group. In the PACU it means running a two-minute huddle when the board fills, assigning the next arrival to the nurse with the lightest load, and saying aloud that the delays are a system problem and not anyone's failure.

Applying the Skills to a Difficult Situation

A situation from a composite evening shows how these skills work together. At 1700 the PACU held five patients waiting for beds. A nurse I will call Dana had been assigned the same held patient since 1300, a man in his sixties after a bowel resection whose daughter had asked three times why he was still there. When the operating room announced two more arrivals, Dana said loudly, in front of the daughter, that she was done being a hotel for the rest of the hospital. The daughter looked at me.

The reactive response would have been to correct Dana in the moment. Instead I noticed my own irritation and set it aside (self-awareness and self-regulation), stepped to the bedside and told the daughter that her father was stable and that I would personally find out where his bed stood within fifteen minutes. Then I asked Dana to walk with me to the supply room. There I said that she had been carrying the heaviest assignment all afternoon and that I should have rotated it earlier (empathy). I asked what would help for the next hour. She wanted twenty minutes off the floor. I took her patient, called the house supervisor with the daughter's question, and reassigned the first new arrival to the nurse with the lightest load (social skill). After her break Dana apologized to the daughter without prompting.

The point of the example is not that the charge nurse solved the hold. She could not. The point is that presence changed what happened next: the family received information, the nurse received relief, and the team saw that frustration would be met with help rather than blame.

Joy in Work: The Mind Map

The Institute for Healthcare Improvement framework treats joy in work as something leaders create by asking staff what matters to them and removing what gets in the way, rather than by adding wellness programs on top of a broken system (Perlo et al., 2017). Nursing leaders are central to that work because they control the daily conditions staff experience (Balik, 2018). The mind map below places one main idea at the center, the loss of the PACU's purpose to boarding, and arranges nine factors around it at three levels. Each factor either feeds joy in work or impedes it.

Main idea: The PACU's purpose, recovering patients safely from anesthesia, is being crowded out by boarding held patients.

Strategies to Promote Joy in Work

Three strategies follow from the map, each aimed at a factor the charge nurse role can reach.

First, rotate held patients. A simple rule, that no nurse keeps a held patient for more than two hours without being offered a swap, addresses the uneven load at the team level and the fatigue at the individual level. It costs nothing and can start on the next shift.

Second, protect one break per nurse after 1500. The charge nurse covers the first break personally and then assigns coverage pairs at the evening huddle. Predictable relief is one of the most direct ways a leader can show staff that their wellbeing matters in practice (Perlo et al., 2017).

Third, take the hold data upward. The charge nurse can log each hold longer than two hours with the time of the bed request and the time of transfer, and bring a month of that log to the perioperative director's rounds. A leader who listens is already a strength in this department; data give that listening something to act on, including a request for an escalation standard with the house supervisor.

Reflection

Writing about Dana's shift made me see that my own presence in the PACU has depended on the day. On calm days I am patient and approachable; on congested days I become the person who answers the phone sharply and assigns by whoever is closest. Staff take their cue from the charge nurse, so on the days they most need composure I have sometimes given them the opposite. The practice I will adopt is small: before I answer any bed call after the board fills, I will take one breath and state one fact before I state any feeling. I will also ask one nurse per shift what would make tomorrow better and write the answer down, because the joy in work framework begins with asking, and I have rarely asked.

References

Balik, B. (2018). Joy in work: The vital role of nursing leadership. Nurse Leader, 16(4), 220-223. https://doi.org/10.1016/j.mnl.2018.05.006

Codier, E., & Codier, D. D. (2017). Could emotional intelligence make patients safer? American Journal of Nursing, 117(7), 58-62. https://doi.org/10.1097/01.naj.0000520946.39224.db

Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI framework for improving joy in work (IHI White Paper). Institute for Healthcare Improvement.

Raghubir, A. E. (2018). Emotional intelligence in professional nursing practice: A concept review using Rodgers's evolutionary analysis approach. International Journal of Nursing Sciences, 5(2), 126-130. https://doi.org/10.1016/j.ijnss.2018.03.004