NURS 3021 Week 11 Final Proposal and Reflection Example

Final Proposal and Professional Growth Reflection: An Expert Perioperative Nurse, a Novice Change Agent

Student Name

College of Nursing, Walden University

NURS 3021: Professional Nurses as Change Agents

Instructor Name

Month Day, Year

Final Proposal and Professional Growth Reflection: An Expert Perioperative Nurse, a Novice Change Agent

Part 1: Revision Table

The revised proposal standardizes the pre-surgery phone call our ambulatory surgery center makes to patients, using a scripted call 3 business days before surgery. Table 1 lists each piece of feedback and what changed.

Table 1

Feedback Received and Revisions Made

Part 1: The Revised Proposal in Brief

A perioperative nurse will call each patient 3 business days before surgery using an 8-item script covering fasting instructions, medications to hold, a responsible adult to drive them home, arrival time, and any new health problem. Concerns are passed to the surgeon's office or the anesthesia team the same day. A similar scripted call made 3 business days before surgery at another surgical center was associated with a 53% reduction in day-of-surgery cancellations, with reductions in no-shows, fasting violations, and patients without a ride home (Haufler & Harrington, 2011). The preoperative nursing assessment is also a key point in the patient's transition into surgical care, where missed information can follow the patient through the whole episode (Malley et al., 2015).

Part 1: Stakeholders, Implementation, and Evaluation

Stakeholders now include the anesthesia team, who receive flagged concerns about medications, airway history, and new symptoms; the surgeons' offices, who receive scheduling and consent concerns; the scheduling clinic, which supplies the daily list of patients to call; and the perioperative nurses who make the calls. Patients are the final stakeholder, and the script was read aloud to three volunteer patients during revision to check that it made sense over the phone.

Implementation is a 3-month trial. In month 1, two nurses make the calls from a quiet room between 10:00 and 12:00, using the 8-item script and a log sheet. In month 2, the calls extend to all scheduled patients. In month 3, the script is revised once based on the log. A nurse who cannot reach a patient after two attempts leaves a message and notes it for the surgeon's office.

Evaluation uses the day-of-surgery cancellation rate and the reason for each cancellation, compared with the 3 months before the trial, from the center's scheduling system. The call log records how many patients were reached, how long calls took, and how many concerns were passed on. The trial is judged successful if cancellations for fasting violations, missing rides, and no-shows fall and the calls average under 10 minutes, which is the limit the nurses said they could sustain.

Part 2: Where I Stand

I have worked in perioperative nursing for 14 years, and I began this course thinking of myself as an expert. By Benner's definition I am one in perioperative assessment: I recognize a patient who is not ready for surgery from a few details, often before I can explain why, and I no longer rely on checklists to see what matters (Benner, 1984). This quarter showed me that expertise in one domain does not transfer to another. In proposing change, I am an advanced beginner at best. I still lean on guidelines and templates more than judgment, and I recognize important features of a situation only after someone points them out.

The difference matters because I had assumed that clinical credibility would carry a proposal on its own. It helped: colleagues listened because they know my work. But credibility did not tell me who needed to be in the room, how long a phone call can reasonably last, or how to answer an objection without defending every detail. Those are skills of a different kind, and I have only started to learn them.

Part 2: The Evidence From This Quarter

Two moments place me there. The first was my stakeholder table in week 7, which listed surgeons, schedulers, and patients but left out anesthesia staff entirely. An expert change agent would have seen at once that a phone call about fasting and medications is partly the anesthesia team's business. I had worked beside anesthesia providers every day for 14 years and still did not see them in the table until my instructor pointed it out. That is what an advanced beginner looks like in Benner's terms: the relevant aspect is visible only when named by someone else.

The second was the barrier thread in week 8, where a colleague objected that my 14-item script would take too long on the phone. My first instinct was to defend every item, because each one was supported by a guideline. Her objection reshaped the script to 8 items, with the rest moved to written instructions. An expert, in Benner's sense, would have weighed the whole situation, the length of a real phone call and a patient's attention, rather than defending each rule on its own. I could do that at the bedside, but not yet in a proposal.

Part 2: One Commitment

My commitment for the next year is specific: by the end of next March, I will present the revised call proposal to our center's quality committee and, if approved, lead the 3-month trial myself, including the stakeholder meeting with anesthesia that I missed the first time. Leading a real trial, rather than writing about one, is the only way I know to move from advanced beginner toward competence as a change agent, just as repeated real cases once moved me toward expertise at the bedside.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Haufler, K., & Harrington, M. (2011). Using nurse-to-patient telephone calls to reduce day-of-surgery cancellations. AORN Journal, 94(1), 19-26. https://doi.org/10.1016/j.aorn.2010.12.024

Malley, A., Kenner, C., Kim, T., & Blakeney, B. (2015). The role of the nurse and the preoperative assessment in patient transitions. AORN Journal, 102(2), 181.e1-181.e9. https://doi.org/10.1016/j.aorn.2015.06.004