Last reflection

Well, we have come to the last reflection. It has been a long course, but we have persevered. Here we are at last. The last week we really just evaluated. There isn’t much to report on. So I will talk about my modern healthcare article that I read about. It also was about evaluation. Would you look at that? 

     The CMS is updating the star ratings to Hospital Compare in February after a 14-month delay to resolve issues. The agency appears to not address some of the critics’ biggest concerns. The changes to the star ratings methodology were minimal as the CMS maintains its use of the patent variable model which analysts andhpsital have seen as an issue for the way it assigns hospital star ratings. Now, in the news star ratings preview there his one measure the continues to heavily influence how hospitals perform in the safety-of-care domain although there is still backlash from stakeholders. The new operation flips the safety-of-care domain to its original iterations “The agency calculates star ratings by weighing how hospitals perform in seven categories: mortality, safety-of-care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. The three outcome groups—readmissions, safety and mortality—are weighted the most at 22% each along with the patient experience group”. Apparently (according to Modern healthcare) these heavily weighted groups negatively impact a hospital’s overall rating.  This is important because nurses will often recruit to hospitals with high rankings. Also, patients will seek out high-ranking hospitals. Rankings affect many aspects of hospitals funding, grants, and finances as well.

Over and out,


Reflection week 15

Well, we have reached our last reflection. 

I was very intrigued by the case study. It was a somewhat random story, but it had very interesting repercussions. I’ll be honest it made me frightened to be a nurse leader because of all these difficult ethical dilemmas and legal issues. I also had an interesting finding on Modern healthcare. I wanted to share some of it: In Paradise, California there is only one acute-care hospital. They were force to evacuate as the Camp Fire closed in. There were about 600 staff members that had to pack into a conference room in the next time over. They people there revealed, “We asked the people in the room if they had lost their homes; almost everybody put their hand up in the air,” recalled Jill Kinney, a spokeswoman for the hospital, Adventist Health Feather River, which remains closed. Sadly they believe that the majority of the 100-bed hospital and 1,000 full and part time staff members lost their homes in the wildfire. There were more than 12,000 homes destroyed. It is unclear where these employees would live if they did return. People wonder, “where do they people go now?”. Further, “catastrophic wildfires like the Camp Fire can have the secondary effect of prompting long-term staffing shortages if the communities surrounding them are so devastated people decide to put down roots elsewhere”. There are many questions as to what will happen in California with the aftermath of the fire devastation. 

Reflection Week 13

So this week we talked about motivation as a part of our research. I liked finding ideas on how to motivate employees because one day we may be asked to do that as leaders of our own organization! Most significant to me was: Have opportunities for Continuous learning- If employees are engaged at work and have opportunities to improve their skills and increase their knowledge then they will be happier and more fulfilled. There should be a weekly newsletter or some sort of announcement that shows available trainings, education, classes, etc. 

Also, I was very intrigued by my modern healthcare article that I read.  It said that there was a discussion for American medical Association to talk about expanding preventative are coverage access to Canadian pharmacies. The House of Delegates will continue to debate a number of policies which will make it easier for patients to purchase drugs from licensed Canadian pharmacies. The conditions are “when product integrity can be assured”. The delegates also discussed out whether the physicians’ group should be allowed to call on private health plans to cover “evidence-based preventive services” without making patients pay an out-of-pocket expense such as a co-pay. Further discussion will talk about gun violence and whether concealed-carry permits should be allowed. I find this interesting because if we allowed guns it might make pharmacies and hospitals feel safer. Also, in terms of the expansion of care to Canada, I think that it is great. This is important to nursing because our health care system is different than any other one around the world. By universalizing our care I think it would have more positive than negative results.

Reflection week 12

This week I was really intrigued by the modern healthcare magazine article I read. I thought it was interesting talking about all of the bargaining and deciding where and how to cut costs. Still, I wouldn’t recommend that activity for the future because it was confusing, had little guidance, and frankly didn’t flow with what we had been learning. We definitely needed more education on that topic before assigning it. Anyway, I want to talk about the very interesting article that I read this week. It was about improving patient health literacy because there are some serious gaps in our healthcare system that are very concerning. In 2013 In Rio Grande Valley Health in McAllen, Texas it became apparent that the organization’s patients had trouble talking with the physicians about their health during doctors visits. With further depth into the problem they saw that the majority of the problem was the language barrier. Not only was it that about 7,500 of the patients in this Southern Texas border speak English as a second language. The bigger problem was that the patients felt very intimidated because their understanding of their health and the medial terminology was very minimal. Many times they would respond just “Yes, I understand”. In reality, they did not understand and many times were sent home with not any clue how to maintain their health or followup post-procedure. This is very concerning to me as a nurse because it is against my ethical values to send someone home without appropriate knowledge of their own health or how to take care of themselves. I think we need to be more wary about how much our patients actually understand. Instead of asking if they understand we should ask them to teach us back what they understand. This gives us better grasp if they truly are safe to return home with the knowledge they need.


Reflection Week 11

This week we had a lot of assignments on organization communities. We had to figure out where to put certain medical centers (surgical centers, urgent cares, etc) and determine what would help the communities, the costs, and the hospitals best. It was a challenge that I hadn’t yet confronted in nursing school. I definitely needed outside help. still it was interesting to learn the business part of nursing and how we resource hospitals and surgical centers in order to get good revenue, convenience for patients, and save on budget. 

I was also very intrigued by the modern healthcare article I read. Recently Donald Trump made some changes to Medicaid that may influence drug prices. It is causing people to ask some serious questions. As we have heard on Thursday Donald Trump made his biggest move to attack the soaring drug prices. He proposed a mandatory medicare Part B pay model that changes drug rates and how physicians are paid for those drugs. It has industry members, analysts, and advocates and politicians buying with praise while also some criticism about the plan. People have questions such as: Will the international benchmarks actually come to fruition? Something that the administration of Trump will not follow through with lowering the drug prices to the foreign prices for the same drugs (which are usually significantly lower). These changes could mean big decreases for some individuals. Only time will tell. That’s all for my reflection this week folks! Tune in for next weeks!


Budget Interview

Budgeting Interview

Connor Hutchinson

Accountant Manager


  1. What is under your scope of practice for budgeting?

Okay, budgeting the cost of the employees of my team. I budget out the equipment we assign to each person. I budget out the software licenses. I also budget out parties and social events. We budget out promotions, bonuses, and recognition.

  1. How often do you review the budget? Monthly? Yearly?  Or more often?

I review the budget monthly.

  1. What do you feel are the most important things to consider when budgeting?

Probably consider two things: the goals of the company as a whole and the goals of our team.

  1. How do you determine what areas need to be cut?

I would look at the resource utilization and determine where inefficiencies can be corrected. For example, where certain tasks don’t return that much value. Basically, time is one of the larger things we budget.

  1. What are your fund-allocation priorities when there isn’t enough money to meet all of the current demands?

Fund allocation priorities go to the team’s core deliverables to our stakeholders.

  1. What happens when you exceed your budget?

We bring it to a meeting with senior leadership and discuss whether the budget should be expanded or where cuts can be made.

  1. Who manages your spending?  Do you hire an accountant, or do you manage it?  

I manage it.

  1. Who sets the budget for your company?  If you, how do you determine what the budget is? Does someone in higher management set the budget?

The budget is determined by senior leaders and myself because I am the only one that knows the real needs of the team. I determine what the budget is because of my experience. That is what helps the most because I know the budget we need for the daily tasks.

  1. What criteria determines your budget besides employee salaries, facility costs, and materials?  

The company’s current growth.

  1. Do you overestimate when setting up a budget?

NO, I try to be exact- after all, I am an accountant.

  1. What do you do when you go over budget?  Under budget?

Over budget- talk with senior managers as we talked about before. Under budget: I would reassess the current value and determine if we can consistently meet this lower number.

  1. Do you find that you go over budget, under budget, or meet budget most often?  

Meet budget most often.

  1. If you needed to make budget cuts, what would you cut first?  Why?

We would cut resource allocation to discretionary work. Basically, the no-core. Those activities aren’t core to the business. We would like to get to them, but they don’t benefit our stakeholder correctly.


I found that interviewing Connor was helpful to my nursing career because there are a lot of decisions made on the hospital floors due to the budget. It helped me understand the things that would be cut of budget and why they would be cut. It is helpful to understand that managers have the best in mind, but sometimes budget cuts have to be made and as nurses we might be laid off because of it.


Reflection of Week 10

This week there were two assignments that impacted me. One was the modern healthcare article I read. it was about the infrastructure in hospitals. They are struggling to find good software to help the employees. For reasons like these, they fear an audit. Listen to what it said: In a recent survey that went out around 94% of hospitals said that their clinical documentation system or process needed some improvement. Only a third of these said they re using software customized for hospices. 84% of the majority said that clinical documentation needs improvement and that staff and clinician satisfaction has decreased. In fact, the survey outlined that the clinician work-life balance has deteriorated to 81% and reimbursement has even slowed. All of the statistics show us that many providers are concerned about surviving and audit and providing quality care and doing the right thing. The problem is that we don’t have proper infrastructure. It isn’t that there is maleficence, but needs for improvement in the systems. This is important for me because I am going into a field where there is a lot of issues. It could be stressful, it could be dangerous. To be a nurse you have to love being a nurse because there are a lot of complications and loose ends when it comes to the organization and documentation. 

I also was impacted by the discussion on managing change. We talked about uniform changes. I thought it was a good idea for these reasons. One, this is a job and we are meant to follow what they have determined is the best way to work around here. Two, this will ease confusion for patients. We are here to care for them. Three, it is a job and the nature of a job is a uniform that fits your position. I think it is a great idea that will make it a more professional environment. Plus, easier for the girls to decide what to wear! 

So I read an interesting article this week for the modern healthcare assignment. It was about insurance, which is not really a topic that I’ve delved into. It was interesting it talked about medicare. It said that Healthcare experts thought that the Affordable Care Act would get rid of Medicare Advantage, the “government-funded private health plans”  that millions of senior citizens have chosen as an alternative to original Medicare. In order to pay for the uninsured the 2010 law cut billions of dollars in federal payments to the plans. Government budget workers thought that this would lead to a sharp drop as insurers reduced benefits, exited states or left the business altogether. But they were wrong! Since 2010, enrollment in Medicare Advantage has doubled to more than 20 million enrollees, growing from 25% of Medicare beneficiaries to more than a third! This is important because insurance is one of the greatest concerns when paying for medical expenses. Our country is struggling to find balance between appropriate medical care and affordability. These programs may help. 

As nurses we are not responsible for the financial part, but we can help introduce elderly patients to the financial help that is available out there. 

Also, I want to address what I learned on staffing: 

So I am currently not working. My nurse license has not been processed. Instead, I will talk about the staffing article I read this week and how it can improve staffing in hospitals. There’s now a nursing staffing agency that operates via an App, and it’s changing the way nurse staffing occurs.

“There have always been nursing staffing agencies that have served our clientele for more than 100 years, but they have historically been using traditional, inefficient methods of scheduling via spreadsheets, fax machines, and telephone. We believe that we are the first truly on-demand, app-based nursing agency for the per-diem market,” explains Chris Caulfield, RN, FNP-C, one of the founders of IntelyCare (Links to an external site.)Links to an external site.. This AP helps organize staffing and last minute sicknesses and other tardiness. It can notify nurses of an open shift and they can accept it then and there. Gone away are those awkward, “Help me” texts, and those dreaded calls to come in and work. Those that want extra hours can take up the shifts. “There wasn’t a good solution for nursing coverage for last-minute call outs or to fill in holes in the schedulers’ calendar on a shift-by-shift basis”….but now there is!

I also added my goals for the next five years to get to career goal: 

  • What is your ultimate career goal? My ultimate career goal is to be an emergency service nurse. I do not know exactly what that will look like. I am interested in the Er and in the ICU. I haven’t worked there full-time so I am not sure it is what I will want to do. I am also interested in being on a ambulance as an emergency nurse. I don’t think I would ever want to be a life-flight nurse, though, I hear it is too scarring. 
  • What will it take to get there? I will have to get some certifications such as PALS, and ACLS. Also, a lot of hospitals want you to have a minimum of a number of ICU years under your belt. 
  • What education is involved? I will probably need a BSN. Which is coming up, woohoo! Also, those certifications that I mentioned above. 
  • What is your plan over the next 5 years to achieve your goal? My plan is to start working full time in med-surg. Once I have done my training and orientation I want to try to work in ICU. Then, I hope to transfer to ER. 


Reflection Week 8

1. What did you actually learned from the unit. This week I felt was effective for the leadership lessons we learned. I will touch on this later down. I also really enjoyed the modern healthcare article I read.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why? The team activity was okay. We didn’t do any group questions for interviews, which is actually kind of nice. I like it when we can work together on a project rather than just comment on each other’s work. To be honest, I don’t care what they think about what I said, it isn’t that helpful. Collaboration is better. 

3. How you will utilize the information learned in your nursing practice.

The biggest thing that I will utilize is the technology I learned about in my Modern healthcare article. It talked about AI interpreting diabetic retinopathy. It was actually diagnosing patients. I think this is important for a number of reasons. This is important because now technological advances are making important health diagnosis. It could take away some of the responsibilities of doctors and allow them more time for other procedures or responsibilities. it could also allow more people to be diagnosed or screened in a shorter and faster amount of time. It is changing the history of healthcare. I will utilize this information because it could change the way we start to do diagnosis.  

4. You personal feelings about the material covered.I liked this week. It was nice to give feedback on the survey. I liked that we had a shorter workload, it was helpful to catch up. 

Firing/Discipline Interview

Firing/ Discipline Interview

Mark Bowler


Yield Engineering Manager


  1. How do you first approach disciplining employees?

I went into the FAB and asked the employee if he could come talk with me. I started out the conversation with “I understand you took the day off yesterday to visit your sick child in the hospital yesterday”. He confirmed this and then I confirmed that I knew this wasn’t true.

  1. What is your greatest concern when disciplining employees?

That I will hurt how hard they will work in the future. You don’t’ want to discourage them. You want to motivate them to do better.

  1. How do you decide what to focus on with disobedient or non-compliant employees?

You try to focus on what they need to do to be compliant. Tell them what they need to do to do it right. Instead of telling them all they are doing wrong.

  1. At what point do you decide to fire someone?

After multiple events of not being at work and lying about the reasons for doing so.

  1. Have you ever had to fire/discipline an employee who was a good friend to you?

Yes. It is a lot harder. I had to discipline a guy that I had worked with for many years. I had to correct his behavior. He was making comments to individuals saying that they were facts when they were only educated guesses.

  1. Do you have another supervisor present for a firing/disciplinary process?

Yes, human resources.

  1. When disciplining or firing an employee, are they able to bring a support person or representative with them to that meeting?


  1. Do you feel remorse when you have to fire someone?

In the case where the employee was disobeying I did not. When I had to lay people off I did feel remorse.

  1. In your opinion, what is the right way to fire/discipline someone?

In my opinion, you want to lay out what the concerns are and what they need to improve upon. You certainly don’t want to discourage someone who could perform more. You want to offer help to them, such as, “Perhaps we should meet more often to see your progress”.

  1. Do you conduct exit interviews when someone is fired?

The exit interview is part of the firing. The human resource team might meet with them afterwards though.  We do exit interviews only for people who are quitting the company.

  1.  What are some behaviors that lead to someone getting fired?  

Continuously being late. Not coming to work. Exceedingly poor performance- though typically we take them off with a layoff. Any physical violence can lead to a termination.

  1.   How often do you have to fire someone? Discipline someone?

Fire: I was a manager for 28 years and I only fired one person.

Discipline: This one is a harder area. It is a gray area because you have a meeting with someone once a week and you might ‘redirect’ them, so I’m not sure if that is discipline. For a formal disciple (such as writing it in their history), about every three or four years.

  1.  What is the procedure for firing someone?  Is paperwork involved?  Is upper management involved?

My manager would certainly be involved in the firing. Getting together with my boss and the human resources department is the first step and then documenting what has been done wrong. Those are the only two steps prior to the firing. Still, documentation is key when firing someone. You have to have all the issues laid out and understood.

This information was very insightful because I was actually surprised as how much they DON’T want to fire someone. 28 years is a long time to go with only firing one individual. Also, I was impressed that most of the time they will try to keep their motivation up. I think this individual that I interviewed is a pretty genuine guy. It may not be the same case with all managers. Still, I think he is a good example of a great manager. He strove to help before he laid off.