Transition to Professional Site

When updating my profile, I chose to add some more personality to my site, including some color and bold graphics, so that it is easily readable. I love sunflowers and sunsets, which I incorporated into my homepage. I also added an About Me page, which gives future employers a summary of my clinical experience, as well as the job offer I have currently accepted and intend to start in July.

Clinical Exemplar

Context: This is a narrative reflection of a day on an ambulatory care unit where I experienced circumstances that challenged my team’s ability to communicate and implement timely nursing interventions.

During my first shift on the ambulatory care unit (ACU), I was assigned to the endoscopy/colonoscopy wing, meaning that I was in charge of preparing and receiving clients undergoing those procedures. When I began my shift at 6AM, I was still groggy and didn’t really know what to expect. It seemed like it might be a slow day, as the clients were told to arrive two hours before their procedure time, and we only had five clients scheduled for exploratory scopes.

When our first client arrived, I walked out to the waiting room, called the name and brought the older gentleman back into the ACU to his room. As soon as they changed into their gown, I took their vitals, which were baseline for them, as they had a history of hypertension and was a current smoker. While I was finishing up the vitals, my nurse began asking the pre-procedure questions, which consisted of confirming NPO status, getting a brief health history and assessing for ambulation or balance difficulties. They reported that their last liquid consumption had been “a beer or two” the night before. At the bottom of their past medical history, a reported 60-70 beer/week habit was indicated. My nurse silently circled her mouse around that number, telling me that we needed to be paying attention to that. She took a brief social history, and clarified the information we had with the client, asking “How many drinks do you typically have in a day?”. The client mumbled, “I don’t know… 6? 7?”

Once we had finished our documentation, we left the client’s room and sat down in the charting room to debrief. My nurse explained monitored anesthesia care, also known as propofol, would be used during the client’s EGD to provide comfort to the client. She described the dangers of consuming alcohol after being sedated and voiced her concerns about how she anticipated this being a problem for the patient after we discharged him. He seemed to be strongly dependent on alcohol, and it was doubtful that he would be able to go home and not drink a beer. 

When the client returned from the procedure, they were very sleepy; almost obtunded. They were not easily arousable and would go back to sleep immediately after responding. When we took vitals, we found that their blood pressure was very low, around 60/40, and we immediately lowered the head of the bed. My nurse also increased the drip rate of the IV to give a fluid bolus to improve their volume status. We determined that their status was probably due to dehydration. After they had recovered and their pressures improved, the first thing the client asked for was a beer.

My nurse and I did some post-procedure education for the client and emphasized the importance of avoiding alcohol for the rest of the night. They were very reluctant and didn’t seem willing to go without a beer when they got home. My nurse asked what fluids they might be able to drink at home other than beer. The client informed us that they don’t drink water at home, and only drinks beer. After more questions, they added that they sometimes drink chicken broth in the morning.

Clearly, the client had a complicated and multifaceted health history; one that required interventions outside of our scope of practice and time constraints. However, listening to how my nurse communicated with the client and asked clarifying questions in a respectful, non-judgmental way was very informative and I have definitely internalized her methods of influence in this situation. She also knew when to delegate tasks and had me get repeated blood pressures while she did documentation and alerted her charge nurse of the situation. She prioritized bolusing the patient before alerting the team, making sure she did everything she could before leaving the client’s room.

This experience taught me many things, including how to identify, anticipate and address discharge concerns, how to remain calm and task-oriented during a crisis, and how to communicate in a therapeutic and nonjudgmental manner.

Transition to Professional Practice

As I moved through the semester, I noticed that I was able to move through the questions faster than I had previously been able to. Over time, I became more familiar with the exam question format and assessment techniques and was able to recognize what the question was asking me.

I felt that the ATI assessment questions were very difficult and tested very specific content, so I felt that ‘mastery’ came with repeated exposure to questions and forming association between disease states and unexpected/expected outcomes. I chose to test myself with practice questions, which gave me more experience with the topics, and helped me identify patterns in question styles and content. I used to feel very overwhelmed when faced with an ATI exam, but I have become more comfortable after doing many of them.

Work/life balance has been a huge part of my strategy to maintain my good mental health, because while I am serious about my studies and preparation for professional practice, I would not be mentally well if I didn’t see my friends, take a walk, listen to music or read a book once in a while.

I will keep the same study strategies while I prepare for the NCLEX, as I feel that ATI questions are very helpful in testing content and forming good test-taking habits. I will continue to incorporate relaxation and extra-curriculars into my life when I start my job, and I’m sure that as I grow older and get more comfortable at work, I will find new ways to excel in the nursing profession.

AH IV Reflections on the Older Adult

Over the course of this semester, we were given insight into what the aging process really looks like and got the opportunity to challenge societal beliefs surrounding the lifestyle of older clients. That was my first major takeaway from this course. It is easy, as a younger person, to assume you know what it’s like to grow older and lose some capabilities you once had. However, it is not as simple or cut and dry as we’d like to think.

When our guest speaker visited, she spoke about what her life is like now in her old age. She has lost loved ones, including her spouse, but still has a healthy social life and plenty of hobbies. She drives, she has a friend group where she lives, and she loves visiting students and speaking at universities. I realized during her conversations with us, that I’ve only ever associated growing older with loss. I never thought about what I could gain from aging, and while it does make me sad thinking about how many loved ones I will lose over the years, I know that I will also gain many more.

The second insight I will take away from this course was the humility I felt during the creation of me and my partner’s life book. Our project focused on her great aunt, who is currently in her late 70s and lives locally. Before we began the interview process, we received hundreds of photographs from over the years of her life. From the surface, her life seems idyllic, and her family looked so happy. After interviewing her and delving further into her life story, we discovered that although she is very happy in her older years, she has been through a lot and faced many challenges, including tumultuous relationships with her children and grandchildren. I realized how important this concept will be going forward in my nursing career, and I will remember not to judge a book by its cover, and to never assume anything about a client’s life.

Public Health

During my most recent clinical rotation, I was assigned to a middle-aged man who was admitted for cellulitis and had a PICC line for antibiotic administration. I met him during his second hospitalization related to this diagnosis, as it was discovered that he was not self-administering his antibiotics at home.

This client did not have a stable job or a steady source of income, while also having three kids at home, of whom he is the primary caretaker. One of his children is severely autistic and requires constant care. He is HIV+, and has been diagnosed with T2DM, ADHD, anxiety, hypertension, and asthma. He is a current smoker and has a history of substance abuse.

I can imagine that this client is always stressed. He is a single parent with multiple health problems, poor economic stability, a high school education, and now must remain hospitalized due to an acute condition. While he was able to find transportation to and from the hospital, it sems that he’s lacking support medically, socially and emotionally at home. I think the staff at the hospital should have paid more attention to his home life and taken that into consideration before he was discharged with a PICC line and IV antibiotics. Maybe he couldn’t continue his treatment due to caretaker overload, or because he didn’t receive thorough and comprehensive education about how to administer the medications. Social work or home health could have followed up with him to make sure that he was comfortable with the regimen and staying on track with his scheduled antibiotics.

I also wish that the system had provided him with resources for his family and daughter. Clearly this patient was not going to be able to balance taking care of his medical conditions and his kids, let alone afford the treatments that he needs to stay alive on top of feeding three other people. I wish that there was a more rigid policy within hospital systems that required staff members to evaluate a patient’s home life and be able to designate resources and additional support as needed.

On a personal note, I definitely could have done more investigative work regarding the client’s mental health status, support systems and access to resources. I often feel that as a student nurse, I don’t have as much of a voice, but I know that I probably could have at least advocated for this man.

Attaining and Protecting You License

I plan to get licensed in the state of Maine, which is a Nurse License Compact state.

The Maine application is web based, and requires a transcript, school certification form and a criminal background check. The criminal background check is fingerprint based, and is done electronically through the maine.gov website.  

There is an ‘Impaired Nurse Toolkit’ linked to the maine.gov website which details the mandatory reporting process, which includes information about mandatory reporting about substance abuse or alcoholism, receiving an allegation, conducting an investigation, progressive discipline, and training tools for supervisors and employees. The ‘Resources & Links’ tab on the Maine Board of Nursing website also has a wealth of information about Mandatory Reporting.

I think the best way to avoid legal issues like informed consent, malpractice, negligence, etc. is to be well-educated about state-wide nursing laws, as well as the individual institution’s guidelines that I am employed by. While there are systems in place to protect nurses, I am responsible for my own actions regarding my license, quality of care, and mandatory reporting. Nurses should not rely on malpractice insurance to prevent them from facing consequences, and instead should be focused on providing the best care they possibly can with the resources and tools that they have.

Career Development

Evan Carrell

2/6/2022

Career Development

The nurses and other speakers in the video demonstrated so much compassion for their patients and are clearly very devoted to excellent patient care. Their commitment allowed me to realize that I need to develop the ability to leave work at the door, learn how to avoid compassion fatigue, and be truly invested in a patient’s emotional, physical and spiritual wellbeing. It’s also important to understand the privilege we as nurses have of being a part of the end or beginning of someone’s life. I can imagine that it’s a very humbling feeling and I hope to carry that humility with me for the entirety of my career.

Over the course of the video, I saw a few different patient populations that I have not yet had a chance to serve, including indigenous communities and pediatrics. What was far more striking was the home health nurse discussing her experiences in rural areas serving Native Americans. Home health nurses see a wide variety of clients, many of which have no access to healthcare. Their clients may be of any age, stage of life or background and may suffer from any kind of illness.

Many barriers to patient care are seen in the film. This is especially true during the discussion about home health care. Barriers mentioned include; geographical location of the patient, weather, language differences, lack of cell service, difficult road conditions for EMS, religious or traditional beliefs, education, and health literacy.  

The practice of cultural humility also applies to this scenario. In order to successfully care for diverse populations, healthcare workers must leave the concept of western medicine superiority at the door. Nurses should not force anyone to believe that western medication is ‘better’ than the healing process that the individual believes in or practices. You must leave their decisions and ideologies up to them. Of course, the process of patient education is still very important and cannot be left out of a conversation, but it is important to validate traditional medicine practices, if that is what the patient feels comfortable with.

On a similar note, in my own practice I plan on working toward a communicative relationship between my patients and myself, so that I am able to meet their needs as best I can. I think it’s very important to meet a patient where they’re at, rather than expect them to change their ideologies and opinions to suit the rest of the world. The best way to ensure equity is to create a learning environment for both you and the patient.


Reflecting on the guest speakers and recorded Career Services presentation:

In order to set myself apart from other applicants, I will be sure to practice answering difficult questions, be confident, but show that I am adaptable and willing to learn. I will talk about my experiences and how they have given me a unique set of skills to be able to excel in a nursing position.

My strengths include my experience as a phlebotomist over the past 3 years, as I have had the opportunity to work at a level 1 trauma center on every unit. I am trained to be able to draw blood from anyone that walks in the door, from newborns to the elderly. I have also always worked at least two jobs, and my resumé shows that I am capable of keeping a job, but also successfully managing my time well enough to work while being a full-time student.

My challenges include my tendency to expect excellence from myself. I find that I get very frustrated when I can’t do something well right away, but I plan on working toward being patient and kind to myself.

Prepare for Transition

After graduation, I am most excited about having a set work schedule. I have been in school for ~18 years now, and I came straight from my first Bachelor’s Degree to the ABSN program. I’ve spent so much time planning what my career will look like, and I’m so excited to start working and have my focus shift from assignments and due dates to actually mastering skills and making a salary. I am fortunate enough to have a group of friends that are in nursing school with me or are in school to be health professionals, so I’m sure we will all have a big celebration once we’re done with school in May. I will be honest; I am anxious about getting the job I want and passing the NCLEX. In preparation for that, I will be using ATI as a study tool as well as UWorld, which I’ve heard is helpful for preparing students. In general, I tend to procrastinate, so I will be sure to stick with a regimented and scheduled plan of attack for when and how long I study.

The NurseLogic modules stressed the importance of quality improvement, and I found that I learned quite a bit about the processes of how changes are implemented and modified. I also learned that there are so many different variables involved in patient education, and we as nurses are responsible for evaluating a patient’s ability to learn, as well as to determine how patients best learn, which are both impacted by their individual barriers to learning. Finally, the information regarding the NCLEX on the ‘Testing and Remediation’ module was very enlightening. We haven’t learned much about the actual format or focus of the exam, and it was helpful to hear and learn about the resources available as well.

Disaster Nursing 444

In the event of a disaster, nurses are expected to utilize their healthcare knowledge in addition to communication, teamwork, and proper use and understanding of equipment. Arguably the most important responsibility of the nurse is understanding the chain of command, such as the HEICS (Hospital Emergency Incident Command System). In this model, roles are formally structured with clear lines of authority and accountability, thereby increasing efficacy and patient safety.

It is understandable to see the ethical dilemma given the contradiction of the two ANA provisions. However, I think the best way to answer that is by implementing prioritization, casualty triage, and considering justice and equity. There is no cut and dry answer here, beyond evaluating the situation as it happens and acting accordingly, as nurses deserve priority care just as much as a civilian does.

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