David
Bosanko
April 2024
David
Bosanko
College of Central Florida
Ocala
,
FL
United States
Particularly during his medication week, there were three instances where I felt David demonstrated exceptional clinical judgment that warrants the DAISY Award.
David has continued to diligently hold himself to a high academic standard throughout his final semester in the ADN program.
Much was the case last semester; as his clinical instructor, I have continued to receive positive feedback from David’s peers and DEU staff, pointing to his communication, critical thinking, and teamwork skills.
Particularly during his medication week, there were three instances where I felt David demonstrated exceptional clinical judgment that warrants the DAISY Award.
David was caring for a patient admitted to the ED several days prior for stroke-like symptoms. Prior to admission, this patient was started on antibiotics for a sinus infection, which were continued as an inpatient. The patient had started to complain of GI symptoms and asked David if he could refuse the antibiotic during his medication pass. David inquired as to how long the patient had been taking the antibiotic and the patient stated it had been close to two weeks. David expressed valid concerns regarding the effectiveness of prolonged antibiotic therapy and the risk for resistance. David worked with the patient’s nurse and provider to clarify how long the patient had been on antibiotics and discontinued the order.
Another patient David cared for that week had experienced a 1.2 increase in his creatinine level and decrease in GFR to 20 (from a baseline of 37) over 48 hours. Given the patient’s history of CKD, David was concerned that this patient’s recent course of post-surgical antibiotics had contributed to an AKI. David communicated to the primary nurse these concerns and the nurse said she had not noticed the change in lab values and thanked David for his attentiveness. The patient was set to be discharged that morning, and David asked the primary nurse to inform the provider if additional therapy was needed to address the likely AKI.
Lastly, David’s third patient experienced an acute hypotensive episode during AM care. The patient had just transferred from the bed to the recliner and mere minutes after, became lethargic and less responsive. Immediately, David called for the primary nurse. Both David and the primary nurse quickly identified (& implemented) interventions to improve the patient’s status. These included laying the patient’s head down, elevating the feet, calling the provider to the bedside, obtaining (& re-obtaining!) VS, and providing the patient with two boluses via rapid infusion. I was also at the bedside and was very impressed at how quickly David assessed the change in responsiveness and discerned which interventions within his scope would most help the patient.
These events all happened during a single clinical week and I feel they demonstrate David’s readiness to function as an effective floor nurse. They reflect his versatility in prioritizing care and communicating with various healthcare team members. His advocacy aimed to improve outcomes for each of his patients and furthered his reputation as a reliable, dedicated care provider.
Much was the case last semester; as his clinical instructor, I have continued to receive positive feedback from David’s peers and DEU staff, pointing to his communication, critical thinking, and teamwork skills.
Particularly during his medication week, there were three instances where I felt David demonstrated exceptional clinical judgment that warrants the DAISY Award.
David was caring for a patient admitted to the ED several days prior for stroke-like symptoms. Prior to admission, this patient was started on antibiotics for a sinus infection, which were continued as an inpatient. The patient had started to complain of GI symptoms and asked David if he could refuse the antibiotic during his medication pass. David inquired as to how long the patient had been taking the antibiotic and the patient stated it had been close to two weeks. David expressed valid concerns regarding the effectiveness of prolonged antibiotic therapy and the risk for resistance. David worked with the patient’s nurse and provider to clarify how long the patient had been on antibiotics and discontinued the order.
Another patient David cared for that week had experienced a 1.2 increase in his creatinine level and decrease in GFR to 20 (from a baseline of 37) over 48 hours. Given the patient’s history of CKD, David was concerned that this patient’s recent course of post-surgical antibiotics had contributed to an AKI. David communicated to the primary nurse these concerns and the nurse said she had not noticed the change in lab values and thanked David for his attentiveness. The patient was set to be discharged that morning, and David asked the primary nurse to inform the provider if additional therapy was needed to address the likely AKI.
Lastly, David’s third patient experienced an acute hypotensive episode during AM care. The patient had just transferred from the bed to the recliner and mere minutes after, became lethargic and less responsive. Immediately, David called for the primary nurse. Both David and the primary nurse quickly identified (& implemented) interventions to improve the patient’s status. These included laying the patient’s head down, elevating the feet, calling the provider to the bedside, obtaining (& re-obtaining!) VS, and providing the patient with two boluses via rapid infusion. I was also at the bedside and was very impressed at how quickly David assessed the change in responsiveness and discerned which interventions within his scope would most help the patient.
These events all happened during a single clinical week and I feel they demonstrate David’s readiness to function as an effective floor nurse. They reflect his versatility in prioritizing care and communicating with various healthcare team members. His advocacy aimed to improve outcomes for each of his patients and furthered his reputation as a reliable, dedicated care provider.