Professional Progress Summary

NURS 431- Transition to Professional Nursing Practice

Purpose of Assignment
The purpose of this assignment is to address the students attainment of all eight behaviors and/or
competencies that are specific outcomes of the program including: critical thinking, nursing
practice, communication, teaching, research, leadership, professionalism, and culture. This
process of self-reflection and self-evaluation is vital to discover the scope of the student nurses
personal and professional development while enrolled in the undergraduate nursing program.

Student Approach to Assignment

This paper summarizes the progression that I have made from my sophomore to senior year.
Specific examples provide insight into exactly how I grew in the eight core curriculum
objectives. I am able to highlight my personal progress as I move towards becoming a registered
nurse. This paper is an excellent reflection of my experiences in nursing school.

Reason for Inclusion of the Assignment in the Portfolio

This assignment is included in the portfolio because it showcases my progress in the eight core
curriculum behaviors of: critical thinking, nursing practice, communication, teaching, research,
leadership, professionalism, and culture. It is a required component in my portfolio that
highlights how I fulfilled a number of the end program outcomes.

Critical Thinking
Uses decision-making skills in making clinical or professional judgments.
Example: See page 5 paragraph 1 (Senior year Role Transition)
An example of a clinical scenario that requires meaningful decision making is
triaging patients that come into the ED. Acuity is a combination of patient
physical presentation, verbal complaint, and duration of symptoms. While these
factors drive acuity, there are also factors that the nurse may let effect their view
of acuity such as length of time in the waiting room, language/communication
barriers, ED management leadership, and patient volume (Wolf, 2013). At times
with low staffing and rushed sense of time, the decision making strategy is
satisficing. On a low-staffed code black shift I have seen a triage nurse make the
decision to spare time with the first available alternative and admit to the ED
patients who came in complaining of chest pain in order for them to get an EKG
in a room instead of in triage. That decision making process lead to an alternative
that is not ideal, and one that I (and the charge nurse) did not agree with when I
made the decision to preform an EKG in triage. The solution would be to staff
another tech in triage for the sole purpose of preforming EKGs. The nursing
process must be supported by the rational decision-making model in order to
 account for the probability of all outcomes; an AMI could go untreated for a
longer period of time with the decision that the triage nurse made in the
aforementioned experience.

Evaluates nursing care outcomes through the acquisition of data and the
questioning of inconsistencies

Example: See page 2 paragraph 1 (Senior year Community Health)

To sustain a program such as this, it needs affordable housing nearby and
continual incomes for their members. This is important for adherence to program
requirements, but they also need institutional and community support. Over the
course of the 6-year study, approximately a third of the programs shut down. The
major reason reported for these programs shutting their doors was the insufficient
income of the program members and their inability to therefore adhere to the
program rules. One of the members of the Norfolk program, Joe, is in this similar
situation and trying to resolve this before being forced to leave the program. This
is a trend that other institutions have experienced and have lead those institutions
down the path of closing.

Nursing Practice
Applies appropriate knowledge of major health problems to guide nursing
practice

Example: See page 1 paragraph 2 (Senior year Role Transition)

The first trauma I saw was a 80 y.o. male splenic lac from a fall in the bathtub.
He was brought to Leigh, intubated, given 4 units, and coded once there. In the
Nightingale, he coded twice given 4 more units for 8 total on arrival.
Vasopressin, Levo, and Epi was running on arrival. Massive transfusion protocol
was put in place, and his vitals on arrival were: temp 94.1 pH 6.9 HR 125 BP
82/40. RUQ, RLQ, and pelvis were positive on FAST. He had a right subclavian
central line and a femoral a-line placed in the trauma room at SNGH. After
assessment in the trauma room, he was taken to interventional radiology where I
followed and observed. While the patient did not code during the femoral cath
procedure, I was able to predict and then see runs of v-tach intermittently.

Example: See page 1 paragraph 1 (Senior year Critical Care)

My patient came into the ED two days prior with status asthmaticus. PMH of
severe asthma and HTN (steroid induced per pt). Pt was given bipap in ED but did
not tolerate, was then intubated in ED. Came to ICU with ARDS, pneumonia,
anemia, HTN (254/158), with wheezes and rales present. Was given propofol, d/c
 due to lactic acidosis (more likely caused by the continuous albuterol nebulizer
tx). Pt placed on IV Precedex for BP and sedation and low dose versed. D/c
fentanyl to decrease RASS score to wakening. Pt had steroid induced
hyperglycemia, on IV regular insulin, q2h BGL checks. Placed on spontaneous
vent setting, lung sounds became clear bilaterally, writing to communicate, d/c
tube feeding and suctioning gastric secretions to prevent aspiration on extubation

Implements traditional nursing care practices as appropriate to provide holistic health

care to diverse populations across the lifespan.
Example: See page 2 paragraph 1 (Senior year Role Transition)
Jean Watsons Theory of Caring relates to a humanistic model of patient care
concerned with promoting health, preventing illness, caring for the sick and
restoring health. Watsons model states that holistic health care is central to the
practice of nursing, and evaluates nursing as a human science of persons and
human health-illness experiences that are mediated by professional, personal,
scientific, esthetic, and ethical human transactions. The acuity of patients coming
into Norfolk General is constantly higher than other area hospitals. While many
patients are trauma that cannot be prevented by a healthy lifestyle, many more
patients are being seen due to a lack of continued healthcare to a preexisting
condition. This could be caused by a disregard, a lack of PCP/insurance, or a lack
of resources in general. Something to focus on was the patient population. Many
of the regulars that I see at work come into the ED at Sentara Leigh known for
conditions such as alcoholism where in comparison, many of the regulars at
SNGH are known for being homeless. The lower acuity (and even some of the
higher acuity) patient population is a population that does not have readily
available healthcare. Illness prevention, which is a core of the nursing health
model, is near non-existent in a solid percentage of this patient population.

Example: See page 3 paragraph 2 (Senior year Critical Care)

Grief concerns were evident in this patients family. Spiritual concerns impacted
care we had to wait for the chaplain to become available and come up to the
patient room before withdrawal of care could take place. Their spiritual needs
were addressed with the chaplain in the form of prayers and their presence during
the withdrawal of care process. Special nursing care needs for this patient revolve
around monitoring and care of the family. She is a DNR and after extubation she
was monitored on the screen outside of the room; the monitor in patient room was
turned to comfort care setting, showing the patients family nothing.

Communication
Adapts communication methods to patients with special needs
 Example: See page 5 paragraph 2 (Senior year Critical Care)
my patient was very calm while awake and still on the ventilator. After the
MD commenting on how he would not be as calm if awake and on a vent, the
patient was asked if/why he was calm. He responded through writing after I had
provided a notepad from the charge desk and a pen (for which I had to support his
hand) in the affirmative when culture was suggested as a factor in the patients
quiet demeanor.

Teaching
Provides relevant and sensitive health education information and counseling to
patients, and families, in a variety of situations and settings

Example: See page 2 paragraph 4 (Senior year Role Transition)

A trauma patient who came in for a liver laceration had family teaching weigh
heavily on the topic of end of life care and DNR/DNI teaching. Another patient
who came in for bilateral weeping leg ulcers with a history of DM, HTN, and
CRD had teaching focus on the importance of adherence to a
medication/healthcare regimen. Another trauma patient who came in for an ATV
accident leading to broken ribs and a le Fort fracture had teaching focus on the
effects of alcohol on operating machinery, and the importance of a helmet.

Leadership
Assumes a leadership role within ones scope of practice as a designer, manager,
and coordinator of health care to meet the special needs of vulnerable populations
in a variety of practice settings

Example: See page 3 paragraph 1 (Senior year - Rehab)

With a blood pressure of 102/52 and a heart rate 56, a patient received Atenolol.
When I brought the patients vitals to the attention of the RN before
administration, the RN said that no alert popped up on the computer so she did not
notice and furthermore did not feel uncomfortable giving that medication. That
morning, the patient received their medication in the gym. At that time, PT had
that patient get up and walk from their wheelchair to a designated point and back
with the assistance of a walker. Minutes after that, morning medication was
administered. Later in the day, the patient was back in the gym for a second round
of PT. At that time (11:15 AM, 3 hours post morning medications) the patient
could not take forward steps immediately after standing like he could that
morning. When the PT asked if they patient was dizzy, the patient answered yes,
very dizzy. The patient then took a significant amount of time before trying to
move forward, after which he could only walk a few steps before stopping. I
assumed the task of bringing this to the attention of the RN the second day as well
 as bringing it to the attention of the physician who gave a verbal order to the RN
to hold BP meds.

Articulates the values of the profession and the role of the nurse as member of the
interdisciplinary health care team

Example: See page 4 paragraph 1 (Senior year - Rehab)

I also set a goal of talking to the therapists more in order to obtain a larger view
of everything the job of a PT/OT entails. Through that, I was able to observe
PT/OT preforming passive and active therapy such as stacking cones, picking up
and tossing beanbags, use of parallel bars, resistance exercises such as pushing
against the armrest of a wheelchair while seated, squeezing a ball between
affected and unaffected hands, walking up and down stairs, passive stretching
with the therapist straightening a pts knees, tilt table used to stand, and
weightlifting. I was also able to talk to them more about which muscle groups the
exercises were helping and how the process of stretching and toning worked in
this patient population.

Delegates and supervises the nursing care given by others while retaining the
accountability for the quality of care given to the patient.
Example: See page 4 paragraph 2 (Senior year Critical Care)
I am in a position of comfort in establishing a therapeutic relationship and
communicating with the patient and family due to previous experience in
healthcare job positions. Working in hospice and home care have both really
prepared me for family need care. Working and communicating with staff is
comfortable through preparation while working in the ED at Leigh in the capacity
as an ED Tech. I was therefore able to delegate the acquisition of and explanation
of a DNR/DNI to a Tech on the floor while I was operating as a student nurse. I
followed through to find that the Tech had called the chaplain and the attending
physician in order to complete the task, and had answered any questions the
family had that could be answered by the Tech.

Professionalism
Advocates for professional standards of practice using organizational and political
processes.
Example: See page 1 paragraph 4 (Senior year - Rehab)
Though they seem to be worried about HIPAA on the surface, I have personally
observed the nursing staff discussing their practice of giving medications (and
 removing/applying hip & sacrum Mepilexes) in the public dinning room and was
told that you would think its a HIPAA violation, but weve always done it that
way. The nursing staff refuse to wear gloves in nearly any situation that would
conventionally call for gloves. When dispensing medications, the nursing staff
opens, removes, and cuts PO meds without gloves. Nystatin oral suspension was
administered with a toothette without gloves. Even the physicians and PT/OT
staff do not wear gloves. A patient with a known infection and a large incision
running vertically down their right leg had a previous dressing of only SteriStrips.
While assessing the patients incision for wound healing, a physician without
gloves palpated the wound site along the edges of the incision by manually
approximating the edges with both hands. After this, they pushed on the wound up
and down the patients leg. They then ran the back of their hand along the incision
line. The PT staff member holding the patients leg did the same quickly after the
physician. The physician without preforming hand hygiene then brushed the
hair in her face behind her ear, picked up her clipboard and pen, and moved on to
assessing the next patient. These concerns were brought up with the clinical
instructor, who then passed the information on to the nursing course coordinator.

Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle, and age.
Example: See page 5 paragraph 2 (Senior year Critical Care)
Culture and ethnicity impacted care in the way that my patient was very calm
while awake and still on the ventilator. After the MD commenting on how he
would not be as calm if awake and on a vent, the patient was asked if/why he was
calm. He responded through writing after I had provided a notepad from the
charge desk and a pen (for which I had to support his hand) in the affirmative
when culture was suggested as a factor in the patients quiet demeanor.