NU298CL Unit 2 Goal Revision Memo Example

A Camera Above the Bed Took the Admission History: A Goal Revision Memo From a Composite Night-Shift Immersion, Rewriting Two Learning Contract Goals, Keeping Two and Printing the Reason for Every Edit Beside the Original Wording

[Student Name]

Purdue University Global

NU298CL: Capstone Clinical

Unit 2 Goal Revision Memo

[Instructor Name]

[Date]

The unit, virtual nursing program and preceptors are composite; the memo revises the student's own goals, and the reply block is left for the preceptor and faculty.

Memo

To: [Preceptor] and [clinical faculty] From: [Student], NU298CL Re: Revisions to learning contract goals after three shifts Date: [Week 2]

What Changed on the Unit

On my third night, during an admission, a screen above the bed switched on and a virtual nurse, working remotely, began the admission interview: history, medications, advance directive and education. The bedside nurse's part became the physical assessment, skin check, belongings and orientation. Nobody had mentioned the program in orientation. Virtual nursing models of this kind divide admission and discharge tasks between a remote nurse and the bedside nurse to free bedside time (Schuelke et al., 2019). I also found that I will work with [three] different preceptors across the immersion, not one, because of night-shift scheduling.

Goal 2, Revised

Original, in short: do the bedside part of each admission within an hour of arrival. Revised: "Complete the bedside portion of an admission within one hour of arrival, coordinating with the virtual nurse by reviewing the interview record before my assessment and reporting any discrepancy, such as a medication the patient mentions at the bedside that is missing from the record." Reason: the unit already divides the work this way. The original goal still fits, but it missed the coordination that makes the split safe. Discrepancies between what a patient tells the camera and what they say at the bedside are where errors can enter.

The goal did not get easier; it moved to the seam between two nurses, where something could fall through.

Goal 3, Revised

Original, in short: script every provider call in SBAR form and make it myself while the preceptor listens. Revised: "Script each provider call in SBAR form and place it with whichever preceptor is on that night listening, and keep a one-page briefing sheet of my goals and progress so each new preceptor knows what to watch for." Reason: with three preceptors, feedback was fragmented. One preceptor did not know I was supposed to make the calls. A briefing sheet at the start of each shift makes the goal visible to whoever is on, and the SBAR structure itself stays the same (Haig et al., 2006).

Goals 1 and 4, Left Alone

Goal 1, from three patients to five, is on track: I carried four patients on shifts 4 and 5. Goal 4, charting within the shift, is also on track. Neither was affected by the virtual nurse or the rotating preceptors, so neither changes. Keeping them unchanged shows that revision is a response to the unit, not a way to lower the bar.

Evidence and Dates

The target dates for goals 2 and 3 are unchanged. Evidence for goal 2 now includes a discrepancy log; for goal 3, the briefing sheet signed by each preceptor at the end of the shift (Knowles, 1986).

How the Preceptors Responded

The preceptor on night four read the briefing sheet and immediately handed me the phone for the next call; the preceptor on night five suggested adding a line about which patients I was carrying, so that she could choose which call to give me. Both responses made the goal work better than the original wording would have. The virtual nurse, when I introduced myself on camera, offered to flag anything a patient told her that I should check at the bedside, which turned the discrepancy log into a two-way exchange.

What I Learned From Having to Revise

A contract written before seeing the unit makes assumptions. Mine assumed one preceptor and a traditional admission. Revising early, with reasons in writing, is better than discovering at the end that a goal measured something the unit does not do.

What Would Make Me Revise Again

I will revisit the contract at midterm. If the unit changes its admission process again, if I am assigned to a different unit for part of the immersion, or if a goal is met early, I will write another short memo in the same format. A goal met early is a reason to raise it, for example to six patients or to taking report on two admissions at once, not a reason to stop measuring.

Reply

Preceptor: ______ Faculty: ______

References

Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. The Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3

Knowles, M. S. (1986). Using learning contracts: Practical approaches to individualizing and structuring learning. Jossey-Bass.

Schuelke, S., Aurit, S., Connot, N., & Denney, S. (2019). Virtual nursing: The new reality in quality care. Nursing Administration Quarterly, 43(4), 322-328. https://doi.org/10.1097/NAQ.0000000000000376