Marvin Flores
San Antonio,TX
Summary
Dedicated and knowledgeable Registered Nurse offering 18 years of hands-on patient care experience, as well as solid record of accomplishment in management roles. Broad-based history includes medical-surgical, mother and baby, ED, acute and chronic dialysis and mental health work. Focused on delivering high-quality services to support patients dealing with multiple issues. Positive and upbeat with good listening skills and compassionate nature. Skilled at building patient trust, organizing supplies and managing crisis situations.
Overview
19
19
years of professional experience
Work History
Clinic Nurse Coordinator
Metropolitan Methodist Hospital
San Antonio, TX
01.2024 - Current
- Provided patient assessments and care plans.
- Educated patients on self-care techniques to promote better health outcomes.
- Maintained accurate patient records and documentation according to clinic standards.
- Ensured compliance with infection control policies and procedures.
- Managed inventory of supplies to ensure adequate stock levels at all times.
- Participated in multidisciplinary team meetings to discuss individual patient cases and coordinate care plans across departments.
- Assisted in the development of quality improvement initiatives within the clinic setting.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Developed strategies to improve operational procedures and reduce costs.
- Managed day-to-day operations of the department including scheduling tasks and assigning duties.
- Implemented departmental policies and standards in conjunction with management to streamline internal processes.
Nurse Clinic Supervisor, Inpatient Dialysis
University Health System
San Antonio, TX
07.2020 - 11.2023
- Providing strong leadership and guidance to nurses being a "go to person".
- Evaluating performance of staff nurses, contributing to professional development.
- Performed weekly audit of treatment flow sheets and machine disinfection logs with expected outcome over 95% consistently achieved for over 3 years. Provide timely coaching memo and re evaluation of improvement on the cited deficiencies by non-compliant staff.
- With the knowledge of the Patient Care Coordinator (PCC), I conceived and initiated the "cheat sheet tool" on treatment flow sheet documentation including the start up checklist guide applicable for both unit and bedside machines which had a great impact on the consistent achievement of an overall above 95% monthly flowsheet documentation compliance.
- Continuously finding opportunities of improvement particularly on increasing communication among the staff on the machine disinfection especially those that were used on late HD treatment. With the use of laminated tags the staff will be aware what those machines need be done preventing fall outs on disinfection and daily regeneration of portable ROs with softener.
- Actively participate with PCC, Director of Operation (DO) and Educator in conducting the unit's annual skills fair wherein I educated the staff on the different aspect involved in peritoneal dialysis treatment, central venous catheter (CVC) dressing changed, proper way of accessing its ports and packing it with either Heparin or Cathflo or Alteplase, diluted with 2.2 ml sterile water for injection and gently rolling the vial inbetween our palms until totally dissolved, and procedure on clearing a partially or completely occluded CVAD.
- Reminding and strategically assisting staff on scheduling work and education promoting timely completion of their annual e-learning requirement.
- With respect to the PCC, I assume that role when necessary. Assisting the PCC on bi weekly creation of unit's work schedule ensuring accuracy and adequacy of staff. Contingency plan in place in case outcome other than usual occur.
- Collaborating with the staff in formulating new ways to improve handoff communication with bedside RNs creating a template of questionnaire that heightens patient's safety and superb customer satisfaction.
- Performed technical audit to ensure compliance as per AAMI standards. Weekly meeting held with PCC, DO, and Biomed to discuss the findings on the audit, follow-up on scheduled monthly preventive maintenance including the monthly cultures for the water system, portable ROs and hemodialysis (HD) machines, and accurate inventory of the units machines that are tagged out of service and tagged as back up, to accommodate the influx of ESRD patients.
- Daily review of the water, chlorine, bicarb, Phoenix meter calibration, acid/bicarb wand disinfection logs for out of parameter values to include the the timers on the water softener as well as the level of salt pellets in the brine tank above water, primary and secondary carbon tanks if in sync with actual time. For out of parameter results, the opener and charge RN will notify Biomed and PCC/Supervisor, DO, and Medical Director for guidance. No treatment will be initiated for the meantime until the issue is resolved and Medical Director will order consequently.
- Daily rounds in the treatment room inspecting discolored or stained ceiling tiles, blood stains on dialysis machines, back splash zones, cardiac monitors and its leads, TVs, wall boxes, oxygen and suction regulators, curtains dividing the treatment bays, drain pipes for build up, floor for stripped or loose tiles, sharp containers must not be over 3/4 full, needles must have its guard engaged, biohazard trash must contain used dialyzer and bloodlines including syringes with over 1 ml blood in it. Regular trash must only contain used empty syringes, plastics, empty saline bags, and other essential trash.
- Conducting one of four weekly infection control audit and addressing on the spot fall outs and same day inservice huddle for the staff.
- Auditing incident report on blood loss occurred during dialysis treatment, conducting stand down huddle to collaborate with staff on the reasons and ways to avert frequency of its occurrence. Outcome, observed trend decreased significantly to zero.
- Collected and documented vital signs to track current patient conditions.
- Auditing weekly logs on all plumbed eye wash stations and plumbed shower. For the bottled eye wash, log is filled monthly checking for discoloration, leak, integrity, and expiration. Checking crash cart readiness and its expiration dates on the pads, on emergency medicines list, defibrillator fully charged, full portable O2 tank seen on the indicator, working suction and presence of the back board. Glucometer, passed daily control test and expiration of its control solution, must be 3 months from its initial use and or expiration date on the bottle whichever comes first.
- Daily inspection of the treatment, water, equipment, and supply rooms for cleanliness and orderliness and addressed immediately with the Techs assigned for any fall outs or non-compliance.
- Established and maintained positive relationships with residents, physicians, hospital staff, patients and families through collaborative communication with the pursuit to provide high standard quality of care.
- Holding regular huddle creating opportunity to mentor and coach nursing staff, and listening to concerns and providing counsel.
- Completing daily rounds of nursing department while upholding acceptable nursing standard
- Collaborated with department managers to correct problems and improve services.
- Maintained quality care systems, standards and HIPAA confidentiality.
- Pursued opportunities and leveraged expertise to optimize patient care, improve outcomes and optimize performance of nursing team members.
- Train staff RN to assume charge RN role, inspire them to join unit or hospital-wide committees and facilitate in-service huddle wherein the staff are given the task to present informative topics or chosen policy applicable to dialysis.
- Member of the CAP committee spear heading the Technical Review and Flow sheet audits for the units Gemba board that track trends of the fallouts and providing solutions to improvement its outcome toward achieving 100% compliance.
- Actively participate on organized mock code blue, monthly fire drill for our unit and encourage staff to seek those opportunities of learning through our Center for Learning Excellence.
- Actively assisting the PCC in counseling the staff with respect, empathy, and integrity in mind, on the cited performance or attitude towards work or coworker.
- Collaborate with the staff in providing education to the patients like on elevated potassium, fluid overload and all regarding the reasons, ways to prevent there occurrence and importance of adhering to their scheduled dialysis treatment. Promoting longevity of use on their AVF/AVG or CVC access by washing the AV access with soap and water and keeping the CVC dressing dry and intact at all time, reporting any unusual sensation or discoloration, and any signs of impending infection to their access. Collected data that will improve the mentioned subjects will be used to revise policies pending review and approval of the governing body.
- Retraining and re education of staff when policies and procedures were not followed like on start up of the dialysis machine. Staff must check the appropriate disinfection in the log prior day , rinsed for 15 minutes and check for residual chlorine must be less than 0.5 ppm, water hardness of the ROs must be less than 10 ppm and again at the end of the day for unit treatment, total residual chlorine must be less than 0.1 ppm initially then every 4 hrs or before the initiation of the succeeding patient.
- Supervise delegated task to unit clerk on ordering supplies, correcting the dropped treatment charges prior day, and strict hand hygiene, use of appropriate PPE and HIPAA implementation for the unit staff and rounding providers.
- Actively performing one of the four weekly Joint Commission Resource electronic tracer that validates staff practice on preventing infection like good hand hygiene and use of PPEs, the separation of clean vs dirty items, work environment cleanliness, performing procedures as per policies and procedures applicable to dialysis and more.
- Received Gold award during the Valentine's week winter storm in 2021 for staying overnight and worked tirelessly for 24 hours. Two outpatient dialysis clinics were down at that time.
Staff Nurse II - TDI West/ UH Inpatient Dialysis
University Health System
San Antonio, TX
09.2017 - 07.2020
- Reviewed all the logs in the morning before the HD treatments start. On the water log, made sure the water system was adequately rinsed, readings from water hardness through RO rejection percent were within required parameters, salt pellets in the brine tank above the water, total residual chlorine log must read <0.1 ppm and read every 3 hours thereafter. Bicarbonate tank must be disinfected and checked for absence of disinfectant prior mixing bicarb solution and its conductivity must read plus or minus 2 of the base conductivity with the use of a Phoenix meter. Phoenix meters must be disinfected, checked for absence of disinfectant and recalibrated as needed prior its use. At the end of the day Phoenix meter must be rinsed with RO water then Neocare solution, then wiped it with bleach solution wipes prior storage. Acid storage tanks must have adequate acid in them. Mixed acid prior transferring it to it s appropriate tank must have a documentation that the unit Biomed and RN checked the pH, temperature with the use of a Hydrometer.
- Inspect the crash cart daily prior start of HD treatment in the unit. The seals on its drawers must be intact, Defibrillator machine and chest pads are connected and ready to go, full oxygen tank available including its tubing and accessories same as the suction machine and algorithm for BLS and ACLS. Assignment of individual role during Code Blue or on Rapid response events must be delegated appropriately among the staff present in the unit.
- Maintained designated evacuation routes for the unit passable at all times in case of an adverse event. Emergency "take off" supply cart must be accessible and portable. Supplies in it routinely checked monthly and recorded on the attached log. Reinforcing unit awareness to all staff by conducting on spot brain jogging will significantly lessen response time to execute effectively RACE and PASS.
- Collaborate with unit's patient care technicians on inspecting and reporting immediately the HD/portable machines were properly disinfected prior day as documented on its individual disinfection logs, wiped down efficiently including the back splash areas of the multiple bays in the HD unit, occular inspection of the presence of the hand crank behind the HD machine and always plugged on the red outlet or outlets equip with emergency back up power. At the end of the day, will round in treatment room of the unit expecting HD machines were disinfected appropriately and documented. For the machines needing disinfection and regeneration found in the equipment room, they should be tagged properly as to what it needs be done and coordinate it to the night RNs, and the RNs with late treatments, thereby achieving a 100% compliance rating on machine disinfection.
- Aware of the units HD/portable machines that are up and running in contrast with the patients census to be able to plan and implement a cost effective productivity.
- With the use of a questionnaire template put together for the unit in collecting important information during handoff report from patient's primary RN, we were able to gather a brief, clear perspective of patient's current status thus direct us to working collaboratively with other disciplines towards achieving a single goal of care of individual patients.
- Continuously implementing a culture of best practices that were proven effective in research, in caring for our patients aim at mainly on infection prevention starting on the care of the patients access, central lines or AV fistulas or grafts and re education of patients the importance of their "life line" and adherence to treatment and nutrition.
- Provided patients and loved ones with information about conditions, treatments, possible outcomes and at-home care will promote patient adherence to treatment and unwavering support by the family will greatly play a big role in their success.
- Promoted self-advocacy in patients to aid in mitigating family and health, care-provider relationships throughout treatment.
- Planned treatments and carried out physical and pharmacological interventions.
- Completed thorough and accurate documentation of care in full compliance with standards established by the institution.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
- Promoting patient safety by way of proper identification using 2 identifiers, having the patient's consent signed together with provider and a witness, treatment order and serology result in the EMR, advocating for infection prevention starting with hand hygiene and washing of AV access with soap and water thoroughly and keeping CVC dressing dry and intact to include assessing possible signs of infection like discoloration, warm sensation, sensitivity, swelling, presence of exudate, fever and chills.
- Timely notification of the provider on the occurrence of intradialytic complications, intervention made and outcome, modification of order and or desire of patient to shorten and signed AMA despite the teaching on the risk of not complying with prescribed treatment time.
- Keeping work flow easy through dynamic teamwork, respect and professionalism towards coworkers and patients.
- Resolved conflicts between staff members in a timely manner while maintaining professionalism.
- Always with high spirit and willingness to respond to customer queries and complaints and perform service recovery prudently.
- Precept and train newly hired staff regarding policies and operations of the unit, on how to properly operate the HD and peritoneal machines as well as independently able to resolve the issue of individual machines in timely manner thereby increasing productivity and cost effective care.
- Instruct and reinforce the skills and knowledge gained by the Techs promoting efficiency of work and self-worth.
- Received Gold award twice due to selfless support to the unit during the snowstorm back in December 2017, when there was staffing shortage in TDI and driving through slick, icy road without thinking about my own safety.
- Recognized excellent performance among staff members through rewards and recognition programs.
Staff Nurse
Fresenius Medical Care NA
San Antonio, TX
03.2010 - 07.2017
- Recorded patients' medical history, vital statistics and test results in electronic medical records.
- Developed care plans complete with effective nursing measures to improve patients' mental and physical health.
- Evaluated patients to develop and update treatment plans while anticipating day-to-day needs.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Educating patients on access related infection prevention that changed tremendously the practice and compliance of the patients regarding thorough washing of the AV access in the unit setting.
- Active access infection surveillance utilized catching the early stage of infection proliferation and prompt treatment averted the condition towards developing into a septicemia on one of the patient with button hole AV access.
- Collaborated with the other RNs on anemia management thereby seen with improved levels of Hemoglobin by the patients in the unit.
- Through constant teachings on self care with the patients, they tend to adhere religiously with their scheduled dialysis treatment with confidence knowing that their a genuine care they received from the staff.
Charge Nurse
Dimmit County Memorial Hospital
Carrizo Springs, TX
12.2004 - 02.2010
- Coordinated, tasked and supervised nurses, LVNs and ancillary staff based on staffing requirements.
- Coordinated and performed patient admissions, transfers, education and discharges.
- Collaborated with multidisciplinary healthcare specialists to devise, implement and modify plans of care defining patient outcome goals
- Trained and mentored new RNs, LVNs on best practices, hospital policies and standards of care.
- Organized and delegated tasks during rapid response and high-pressure code situations thereby survival of patients was at its utmost.
- Built and maintained strong working relationships between nursing department and other disciplines.
- Oversaw medication administration, monitored distribution and documented responses.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Educated patients, caregivers and families on diagnoses, treatment and disease prevention.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Prepared medical equipment and tools to aid physician during examination and treatment of patients.
- Acquired training and certifications on ACLS, PALS, and TNCC ( Trauma Nursing Core Course) for Emergency Department duties.
- Timely assessment and appropriate treatment on critically ill and trauma patients arriving in ED lessen their mortality rate thus increasing recovery and survival.
- Professionalism, respect and integrity at all times when dealing with diverse population from people coming from across the border to the locale that obviously misused alcohol and those in recovery.
Education
Bachelor of Science - Nursing
Union Christian College
San Fernando, La Union PhilippinesSkills
- Patient Care
- Clinical Quality Improvement
- Patient Advocacy
- Staff Education
- Mentoring and Coaching
- Team Development
- Care Planning
- Electronic Charting
- Compliance Monitoring
- Clinical Issues Understanding
- Decision Making
- Interdisciplinary Collaboration
Relevant Skills
- Computer literacy - Words, Excel, Sunrise, Epic, Proton and E-cube, Pyxis, Omni cell
- Communication - SBAR, TRIAGE
Volunteer Activities
- Taft HS - Band Booster Member
- San Antonio Food Bank - Adult Inpatient Dialysis University Hospital - job: warehouse sorting and packing
Affiliations
- Biking on the weekend with coworkers
- Gardening and cooking
Accomplishments
- Gold awards - TDI outpatient dialysis clinic during the snowstorm of December, 2017
- Gold awards - Inpatient Dialysis February, 2021 week long Texas freeze
Timeline
Clinic Nurse Coordinator
Metropolitan Methodist Hospital
01.2024 - Current
Nurse Clinic Supervisor, Inpatient Dialysis
University Health System
07.2020 - 11.2023
Staff Nurse II - TDI West/ UH Inpatient Dialysis
University Health System
09.2017 - 07.2020
Staff Nurse
Fresenius Medical Care NA
03.2010 - 07.2017
Charge Nurse
Dimmit County Memorial Hospital
12.2004 - 02.2010
Bachelor of Science - Nursing
Union Christian College
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