The last word(s)

It is hard to believe we have moved to the end of our course of study. Today was the first Saturday since August 2010 that I  awakened without any plans for the day. I can appreciate the intensity required to accomplish this course completion and head to graduation. Of all the things I've learned, the single most useful tool is the advanced leadership needed in clinical bedside nursing and how to fill that gap. After that consideration, there are hundreds of facts, tips,  tools, processes, methodologies, resources and theories in my fore brain.

I believe I will be blessed with opportunities to continue working with the uploading of rural clinical practice guidelines. I may reach my final career goal, but I am not sure.......

My ultimate career goal is to establish Level I Cardiac Emergency Rooms across the country. It might happen, it might not, but I am working to identify the resources needed by the rural hospitals when cardiac conditions require tertiary care. I have ten years to make this happen.

I hope that all that read this final blog, reach their clinical destiny and make a difference. I am honored to have spent my life as a nurse and hope you all are as well. I want to thank each of you for support, hanging in there and being part of our inaugural DNP class.

Take care,
Julie Benz

Reflections upon DEAL learning

The DEAL Model applied to Service Learning at The American Heart Association

               Describing the experiences at The American Heart Association (AHA) is exciting. I have volunteered for a team of providers, stakeholders, politicians and system administrators in health care. The group is called Colorado Mission Life Line® and in the last year has gained momentum in finding resolution to the leveling the delivery of heart care in Colorado. I led a team, with a cardiologist from Greeley, to evidence base the guidelines for emergent care in rural hospital settings.  We completed our project in January 2012 and presented to the full body meeting with acceptance at our last monthly meeting.

               Examining our work in light of the Regis Mission and Values finds our project to be rural focused, unbiased by health care markets, steep in evidence and research while being useful for stakeholders. The Articulated Learning inspired from the MLL work is obvious to our team. This is the group membership which inspired me to seek clinical doctoral education. The team is varied in focus but together makes the product strong, effective, tangible and desired by facilities. We laugh and liken the AHA to “Switzerland” and allegiances, biases and corporate roles are shed at the door step of meeting environment. This project will carry into the future and I would hope we develop emergency care in the state and country which is considerate of the level of cardiac services provided in the MLL work.

Sustaining the Commitment

               The next phase for the MLL team is to bring our work to all rural and critical access hospital facilities. The team asked the leaders of our Evidence Based Guideline Team to lead the “Hospital Engagement” team. We will define the product, how to present it, ask for physician support/volunteers and take the work to each rural and critical access facility. We are considering having an Emergency Room Physician and a Cardiologist, with one nurse do each live presentation. There are more than 50 facilities to consider and I am hoping for a grant which will allow us to offer this work in workshop format and cover regions of the state. We are investing in those facilities and including their stakeholders in our current and future work efforts.

Strengths and Shortcomings of the Service Learning Commitment

               It is easy to identify the time, energy, phone work groups, processing and redesign which builds a statewide project. All of these components could be seen as a burden but also feel like an honor. The team is very supportive of creating a new process and recognizes the pitfalls with stakeholders, missed opportunities and challenges in the rural health care setting. Rural care is under-funded, under-staffed and lacks resources. We have identified some needs and the rural care givers would like solutions which have “fit” for their setting, do not overarch the urban care design and will be successful in a wide number of settings. The challenges seem to outweigh the assets. This had consumed over ten hours each month. The team has been together for three years and at this point in time, we refresh each other with new ideas, solutions, funding possibilities and energy. I have learned to appreciate the diversity of this team. I believe our real strength comes from variety of points of view, life experiences and the contributions of all.

                It is not a short-term project for any of us. I have shared my student experience, superimposed over the work of the team and have found my support in the kind words of the members. I am hard pressed to not admit the strengths, benefits, knowledge and privilege of the MLL team far over-ride any short comings in time or energy. Please visit our work at http://mlcommunity.heart.org/stemi-directory/state/25

Ash, S. L., & Clayton, P. H. (2009). Generating, deepening, and documenting learning: The power of critical reflection in applied learning. Journal of Applied Learning in Higher Education, 1, 25-48.