How to decrease wait times in the Emergency Room at Parrish Medical Center


Paper Details
Practicum Learning Agreement: Learning Strategies and Evidence of Accomplishments
Open the uploaded Learning Agreement (Week 1 has been done containing the Goal and Objectives. We will now work on Week 2 –Columns 2 and 3)
Complete the Draft of Learning Strategies and Evidence of Accomplishments columns of the Practicum Learning Agreement. (ONLY COLUMNS 2 AND 3 for Week 2)
Measuring Attainment of Objectives (400 words)
Each learning strategy listed in your learning agreement must be implemented and evaluated. Consider how you will measure attainment of each objective and respond to the following questions using specific examples and resources supporting your responses.
Describe how you plan to measure attainment of each practicum objective.
What difficulties might arise in your attempts to measure attainment of each practicum objective?
How might you work around these difficulties?
How accurate do you think your measures may be?
Learning Strategies (400 words)
Review the sample learning agreements and your learning objectives to determine what theories might be useful as you develop your practicum project. Respond to the questions below using at least 275 words, specific examples, and resources.
What types of learning strategies and resources will you be using for your practicum project? Why?
Provide some specific examples including the theory or theories that supports your project.
Mentor (275)
What is the value in identifying clinical or practice experts to help you achieve your learning objectives?
How do you select and work with a mentor?
Note. Evidence of Accomplishments is the documentation of your work. The document is tangible and is submitted during the NUR/590B course. All evidence of accomplishments must be submitted to the NUR/590B classroom as an attachment. A single attachment may not be more than 13 megabytes in size. Scanned items, animation, and sound in a Microsoft® PowerPoint® presentation may make file sizes too large to be submitted to the NUR/590B classroom. Zipped items are also not acceptable in the NUR/590B classroom.
The second column of the learning agreement (Week 2 Assignment) is to identify strategies (including resources) that you can use to meet your objectives. Resources can include experts in practice for a specific topic and can include others in your area besides your mentor. Resources can include the literature specific to your topic identified in the objective or literature that might help guide specific strategies that you identified as important for meeting the objective. Resources might also include equipment and the knowledge to utilize the equipment.
Strategies are specific key steps that you need to take before you can achieve the objective you outlined. This might include such things as developing a learning needs assessment tool, a staff opinion survey, a comparison of important documents, interviews, or observations etc.
To develop your learning strategies you need to think about the following:
1. Are there learning strategies for each objective?
2. Do the strategies outline the steps or actions needed to achieve the objective?
3. Are the strategies ordered correctly and flow easily?
4. What learning is needed to do the identified strategies? Is a literature review needed? Are there experts in the organization who can facilitate learning? Are there seminars or classes you can attend to help you gain the information you need to complete the strategy? Can your mentor give you feedback and input?
5. Is it easy to identify the strategies and learning resources that go with each objective?
Formatting can be very helpful to align everything in the agreement. It is helpful if you number the objectives and then number the learning resources and strategies with the same numbers to match the objectives. For example: Objective 1. Assess the learning needs of staff in preventing pressure ulcers. Strategy 1A Conduct a literature review to identify possible staff development assessment tools. Strategy 1B Select a tool and adapt it for assessing pressure ulcer prevention knowledge.
Project idea: decrease wait times in ER at Parrish Medical Center in Titusville, Fl
Objective 1: Analyze standard time lag for patients in the emergency room at Parrish Medical Center
1-A Conduct a literature analysis of at least 15 peer-reviewed articles and synthesis about the national prevalence of average emergency room wait times
1-B Consult with the quality improvement department and nurses to identify possible measurement strategies for reasons for the delay
1-C Develop a method to assess the prevalence and incidence of average wait times in emergency rooms.
1-D Create and administer a needs assessment for nursing staff as to their knowledge of how the patient waits affect them.
Objective 2: Develop a quality improvement plan for decreasing wait times.
2-A Identify members to assist in monitoring wait times.
2-B Critique strategies already implemented as to their effectiveness,
2-C Conduct a literature analysis and synthesis of effective improvement methods for preventing delays in care, concentrating on published national guidelines.
2-D Conduct a survey of the nursing staff about the barriers to admitting patients to units.
2-E Conduct a literature review for example surveys that could be used or adopted for the project.
2-F Consult with the organization’s expert for survey development to assist with developing a reliable and valid survey tool.
2-G Consult with mentor to develop a plan to administer and analyze the survey results.
This example is not meant to be all-inclusive, but to give you an example of how to complete this column of your learning agreement. Each strategy needs an Evidence of Accomplishment (Column 3 in Learning Agreement) document to demonstrate you implemented the strategy. The actual Evidence of Accomplishment (EOA) documents will be submitted in 590/B and must be ready for submission on Day 1 of that course.
A couple of recommendations for everyone:
1. Plan for APA formatted documents for all EOA documents except for maybe mentor reviews. While a summary EOA document can demonstrate higher level critical thinking, a comprehensive journal entry may be appropriate. (3a, 3b. 2b and 2d needs to be in journal and EOA documents)
2. EOA for any data should be to Submit chart or graph of data results with narrative analysis. This will meet MSN rigor better than summary.
3. Name the organizations you plan to research for the standards and regulations: QSEN, ANA, Joint Commission, DHEC, What others might apply to your project?
4. EOA must directly match the learning strategy! (2b above is not congruent)
5. Know a lesson plan and PPT are two different items/documents. Consider that the PPT is an example of a teaching/learning strategy. See information on lesson plans below….
Developing a lesson plan as a learning strategy for your educator practicum project helps you meet MSN rigor for your project and is a great way to measure attainment of objectives. Nursing faculty use lesson plans with every lecture or lab experience. Lesson plans are to teaching like care plans are to clinical nursing! There are various lesson plan formats available in the literature.
Developing a lesson plan as a learning strategy for your educator practicum project helps you meet MSN rigor for your project and is a great way to measure attainment of objectives. Nursing faculty use lesson plans with every lecture or lab experience. Lesson plans are to teaching like care plans are to clinical nursing! There are various lesson plan formats available in the literature. Below is a link to a youTube lecture on developing a lesson plan. Please review. What did you learn about writing a lesson plan that you can apply to your project?
Students earn a higher grade in NUR/590B when they understand each EOA is a separate document in APA format. All learning strategies are recorded in the journal along with what you learn as you implement the process. The EOA is another separate document that contains the results of actions described in the journal. Deleting “in the practicum journal†from your EOA will help you avoid confusion in the future.
Each EOA document needs to be named with number and letter of EOA in the name of the file. For example:
Common areas of confusion with the practicum project include confusion about information that should appear in the self-reflection journal versus an evidence of accomplishment (EOA) document.
The journal is designed to record your clinical hours (including a running total RT with each entry and each date/time listed separately–no grouping of dates), action taken related to each learning strategy (connect number and letter with learning agreement), and your reflections on the learning that occurred as you implement each learning strategy. Remember the following:
a) All journal entries need to be in chronological order by date in the far left column.
b) All evidence of accomplishments need to be done in order as written on the practicum learning agreement. Under no circumstances should students develop their projects before doing their needs assessment.
c) Avoid excessive hours of clinical time for a specific activity. Faculty will be looking to see if the time recorded is reasonable for the actions described.
d) Do not record any clinical hours in the journal before the learning agreement is approved at the end of NUR/590A.
e) Do not count clinical time for revising any practicum work or sending emails.
f) No more than 8 hours of clinical time can be recorded on a single day.
g) No more than 1.5 hours can be spent on a single day for meeting with mentor.
h) The journal is a clinical document so entries in the journal should be as accurate as in a patient’s chart.
The Evidence of Accomplishment is a collection of documents (i.e. PowerPoint, Excel displays, APA formatted papers, flyers) that showcase your results of implementing each learning strategy in your agreement and must be your original documents reflecting your critical thinking abilities. Copies of a policy written by others is not appropriate.
In most cases you should have both a document as EOA and a reflection of learning in your journal connected with clinical time.
Evidence of accomplishment are documents that reflects MSN rigor in implementing each learning strategy in APA format.
All learning strategies must be addressed in the journal entries and correctly matched with the number and letter of the learning strategy. These should be in the same order as your learning agreement (i.e. 1a prior to 1b, etc.)
The portfolio you submit before the end of NUR/590B will be all EOA documents, your journal, and your CV or resume’. You must submit all documents a one time for grading.
Each EOA must be identified by number and letter with the learning agreement
No video, zip, or pdf files are allowed in NUR/590B
Everyone will need to include a literature review as a learning strategy in Column 2 of the learning agreement. An annotated bibliography is the evidence of accomplishment (EOA) for a literature review.
The sample annotated bib is in the Center of Writing Excellence at this link:
If you do not know much about conducting a needs assessment then doing a 15 article peer-review is appropriate. If you are familiar with a needs assessment, you may want to research cultural competency first so you know what content you may want to assess. How is your learning strategy 4 different from number 2? Do you really need three different assessments (2,4, and 5)? Do you need to do a survey and interview plus create (conduct) a focus group? I am not saying that you cannot do this but it sounds like a great deal of work.
The needs assessment is an effective starting point for any project. Time to discuss ways to conduct a needs assessment. McCawley (2009) states, “…the information in a needs assessment forms the basis for a program evaluation. When the intervention results in measurable change, project managers will know they have succeeded and/or know what steps to be taken next†(p. 3). How do you plan to conduct your needs assessment?
McCawley, P. (August, 2009). Methods for Conducting an Educational Needs Assessment. Retrieved from
University of Idaho website:
Additional References
Ross, J. A & Jaafar, S. B. (2006). Participatory needs assessment. The Canadian Journal of Program Evaluation, 21(1), 131-154.
DeSilets, Lynore D, Ed,R.N., B.C. (2006). Needs assessment. The Journal of Continuing Education in Nursing, 37(4), 148-9.
A former student shared this outline found on the internet entitled “How to write your needs assessment report†. Basically it suggested the report follow the following outline:
A. Introduction
B. Purpose
C. Data Collection
D. Analysis
E. Summary of Results
F. Implications for Action
This is a good idea to keep in mind as you develop your evidence of accomplishment (EOA) for your needs assessment. Here are additional resources for writing the needs assessment report:

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