Ashley N Wagers

Travel Contact & Renewal 2019-2022

Harlan ARH Medical Center

Medsurg Telemetry PCU

Staff nurse role

Charting Meditech

IV Administration Plum & Braun

Ratio 6:1/Float when needed

• Basic nursing skills, Iv Administration, therapy, intake, output, patient rounding, assessment, intervention, laboratory interpretation and intervention, notification of care team, executing protocols, appropriate critical care interventions, foley Cath care and maintenance management etc.
• medication administration and monitoring for adverse reactions
• Blood administration
• Managing complex Covid patients
• Infection control protocols
• Admission and discharge
• Obtaining extensive patient history
• Cardiac drips and maintenance and management
• Notifying physician of critical labs and executing critical orders stat orders within protocols and time
• Time management and prioritization
• Orientation of new employees
• Providing compassionate and empathic care to patients
• Education of patient and family as needed
• Psychiatric patient management and de escalation procedures and techniques (CPI)
• Oxygen therapy
• Trach care
• GI care
• Conducted comprehensive patient assessments and updated individualized care plans for acute and chronic conditions.
• Administered medications and monitored responses, ensuring safe, accurate treatment delivery.
• Coordinated care with physicians, therapists, and support staff to maintain continuity across shifts.
• Documented assessments, interventions, and patient outcomes accurately in electronic medical records.
• Educated patients and families on treatment plans, discharge instructions, and symptom management.
• Prioritized urgent cases, responded to clinical changes, and escalated concerns promptly.
• Initiated IV therapy, wound care, and other bedside procedures with strong attention to safety.
• Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.

Travel Nurse with LRS Healthcare Jan 2018-March 2022.

Travel Assignment 2/3/& 4. (Renewals) Vidant Level 1 Trauma Magnet Hospital, Medical Center (1200-1500 Beds) Greenville North Carolina, Now Called ECU Medical Center, (800-900 beds)

Unit: MTCU (Medical Transitional Care Unit)

Ratio 3:1, Extremely High Acuity Complex Patients

Charting System Epic

IV Administration System: Alaris Pump

Nursing Duties Included

• Ventilated Patients Acute & Chronic
• Fast Track Stepdown & Step Up ICU CCU
• ABG & Phlebotomy were Nursing Duties Only
• Assessment & Intervention q2 Full Head to Toe Assessments required
• Education therapy
• Cardiac Drips,
• Sedation drips
• Meds like Precedex, Ativan Drips, Medazolam Drips, Propofol, Dobutamine, Dopamine, Cardizem, Amiodarone, Levophed, NeoSynephrine, among many others.
• Withdrawal protocols
• RSI protocols
• Neurological protocols and checks
• Telemetry Monitoring Interpretation and Intervention
• Art lines management
• Picc & central line management
• Bedside Procedures, paracentesis, thoracentisis, pericardialcentesis, chest tubes uni and bilaterally insertion and management, endotracheal intubation management, oral care, trach care, peg care, extensive wound care, wound vac,
• Trach and Peg Insertions maintenance and care
• Nasogastric Tube Management with and without suction application
• Dialysis
• Ecmo
• Extensive blood admin and transfusion protocols
• Endo Tool
• Sepsis Monitoring Team
• Rapid Response Team
• Code Team
• High Flow Oxygen Therapy
• IV therapy

Patient Populations and Demographics were vast, this level 1 trauma center serviced dozens of surrounding counties and drew transfers from multiple out of state regions across the country.

The MTC Unit comprised of mainly fast tracked ICU/CCU patients within 12-24 hours of immediate 1:1 care down to 3:1 care. Most common were neurological emergencies, strokes or cerebral hemorrhages, drains, patients who experienced neurological brain demise, (drowning most commonly due to location) acute cardiac interventions, pulmonary arrest patients, cardiovascular emergencies, Cath, bypass, Tcar, prep for organ transplant or donation procedures,interventional radiology support, spinal cord injuries, diabetic emergencies, DKA, and many others.

First Travel Contract, 13 week assignment.

This Facility was both an acute care and chronic care facility, best described as an L-Tach facility.

Patient population included long term care residents and acute care interventions as needed.

• Patient Care Load was 6:1/7:1
• Patients were complex, including extensive wound care treatments, wound vacs, extensive dressing changes, aseptic techniques, medsurg, basic nursing skills, up to chronic ventilator patients.
• Nursing duties included:
• Assessment and interventions, wound care, physical med counts, IV therapies, medication management, acute therapy interventions, admission with occasional discharges, and routine standard of care duties.
• Computer charting was Meditech.
• IV Therapies
• Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions, many patients full complete care status.
• Implemented care plans for patient treatment after assessing physician medical regimens.
• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
• Ventilator settings and Vent Management, Respiratory Management, Trach Care, Peg Care, Wound Management, and Medication Management.

• Clinical Nurse Manager PCU, Progressive Care Unit, while Taking Patients Daily, 6:1 Ratio.
• Sometimes pulled as relief to other units to take patients such as ICU, Medsurg, and ER. Including patients experiencing medical emergencies, some trauma experience, and intensive care patients and protocols included such as RSI protocols etc.
• As clinical nurse manager of PCU, my role was to maintain patient care and bed placement of the unit, staffing delegations, patient assignment per shift, unit checks, crash cart checks, stock checks, designating roles of ancillary staff, while maintaining an available resource to other nursing and ancillary staff on the unit as needed
• As clinical nurse taking patients such assignment, 6:1 ratio, admitting, discharging, medication administration, implementation of basic nursing skills, IV administration, nursing skill implementation, including wound care, IV therapy infusions, blood administration, monitoring for adverse reactions, obtaining procedural consent for pre op patients as well as pre op protocols, assessing and implementing a vast amount of critical and life saving nursing interventions as needed and notifying the care team of said interventions.
• Nursing duties included:
• Assessment every shift of patients and updating physicians and care team of change in status.
• Patient Roundings every 2 hours and as needed utilizing the in room rounding recording system.
• Collecting Specimens and monitoring laboratory results and notification of care team as appropriate per protocol.
• Management of medication Drips and cardiac drips in The ICU, including sedation drugs and other pertinent medication protocols during intubation and maintenance procedures.
• Maintained Ventilator settings and Ventilation patients pre and post assisted mechanical ventilation.
• BLS/ACLS/NIH/PALS/ as were required by the facility.
• Charting documentation was Cerner System
• IV administration system: Plum/Alaris systems.
• Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
• Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.
• Demonstrated expertise in wound management techniques resulting in accelerated healing times for patients with complex wounds or pressure injuries.
• Extensive management of PegTube Or Gastric Tube Care and Interventions, Including education with medication administration and post discharge care.
• Streamlined medication administration processes for increased safety and accuracy during busy shifts.
• Managed patients recovering from medical or surgical procedures.
• Monitored patient for reactions after administering medications and IV therapies and interventions when needed.
• Obtaining pertinent medical history upon admission and as needed
• Discharge Education to patient and families.
• Assist patients with basic ADLS and basic bedside care as needed. Including bedside toileting, hygiene, feeding, baths, etc.

• 2 North Unit, 6-7 High Acuity Step Down Cardiac Floor, Step Down Patients ICU & Telemetry with high influx of admits and discharges and transfers each shift.
• Administer BLS/ACLS life saving interventions as needed.
• Maintaining High Acuity Medication Drip Management & Cardiac Drips On Multiple Patients at once, Including but not limited to, Cardizem, Heparin, Aggronox, Amiodarone, Dopamine, Dobutamine, Nicardipine, Insulin Drips, High Concentrated Saline Drips, 3/5%, Vaprosol, Magnesium/Potassium Management etc, even sometimes initiating Nitro Drips and Levophed per hospital protocols if DNR or Awaiting Transfer back to ICU or CVICU Units, among many others.
• Contents of patient care demands were vast with varying levels of High acuity post op surgical patients, including Orthopedics and CABG patients post 24 hour fast track from CVICU, Pre and post CABG prep patients, 72 hour cardiac observation rule out MI, Pre/Post Cardiac Cath Patients, Blood Administration, as well as long term care patients, acute care patients, psychiatric inpatient care experiencing acute or R/O cardiac events, among many others
• Vast Telemetry strip interpretation training and experience.
• Medsurg/Tele nursing experience and duties including the following basic duties:
• Assessed patient conditions every shift and as needed, every 2 hour rounding, prioritized nursing interventions for acute care and all needs.
• Administered medications using the established rights of medication administration, and monitored responses to support safe treatment plans while monitoring for adverse outcomes.
• Documented patient assessments, care plans, and clinical updates in medical records, at this time was paper documentation with adaptations in the Stars System for medical orders and interventions.
• Monitored Laboratory results, notified physician and care team of critical levels or when appropriate per hospital protocol.
• Collaborated with physicians and care team members to coordinate patient care and updates as needed
• Educated patients and families on treatments, discharge instructions, and recovery steps within the standard nursing practice
• Monitored vital signs q4 hours and reported condition changes to support timely interventions when needed
• Obtained and carried out Stat Orders and protocols as appropriate when appropriate per hospital policy
• Maintained infection control practices and followed hospital safety protocols consistently.
• Supported admissions, transfers, and discharges while ensuring continuity of care.
• Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
• Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary on high acuity patients.
• Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
• Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
• Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
• Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
• Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
• Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
• Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
• Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
• Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management within my nursing scope of practice.
• Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients and their progress toward reaching established goals of care every shift and as needed
• Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
• Implemented evidence-based fall prevention strategies.
• Collaborated with interdisciplinary teams to develop comprehensive care plans for complex cases.
• Educated family members and caregivers on patient care instructions.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care, including intake and output.
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Evaluated patient histories, complaints, and current symptoms.
• Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
• Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.
• Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
• Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
• Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions when patients were Ventilated on the unit.
• Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
• Basic Nursing Skills and Functions, such as (IV insertion, Foley Catheter Insertion, Nasogastric Tube Insertion, Maintaining Gastic Tubes, Blood Administration, Lipids, Platelets, etc)