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Program Graduate Competency Reflection

Melissa Haley Towe

Delaware Technical and Community College

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Program Graduate Competency Reflection

The Merriam-Wester dictionary defines the word capstone as: the high point, summit, or

crowning achievement… the word itself however, is derived from a flat stone that was used to

cover a well, it functioned much like a roof (2019). The completion of my bachelor’s degree has

been just that, the roof to my nursing degree “home.” When I started my nursing journey as a

CNA in 2011, I laid the foundation for the house that I would continue to build. My completion

of the Associates Degree Nursing program allowed me to build a strong and sturdy house on that

foundation. Now here we are in 2019, completing the Bachelor’s Degree Nursing program and

finally adding a roof to that house. As I look back on my portfolio and review the summary of

everything that I have accomplished in this program it is enlightening to see the progression. My

associates degree gave me the core knowledge, understanding, and skills that I needed to

function as a nurse. My bachelor’s degree however, broadened my knowledge base and helped

me understand and apply all aspects of the multifaceted field of nursing. Delaware Tech defines

mastery of these aspects through nine Program Graduate Competencies (PGCs). The following

will summarize how the courses and assignments throughout this program have led me to

completion of all nine PGCs defined below.

Program Graduate Competency 1

PGC 1: “Integrate general education knowledge, skills, and aptitudes to advance nursing

education and growth in professional practice” (Delaware Technical and Community College

[DTCC], 2019). Each course thus far in my entire nursing career has contributed in some way to

my achievement of this competency. Through the BSN program I have had to rely on the basics I

learned in previous courses such as Anatomy and Physiology, Pathophysiology, Ethics in

Healthcare, and even my general writing courses. I have strengthened each of these skills
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throughout this journey and learned many new ones. One of the biggest things I think I have

improved on would be APA format. This is an area that I did not firmly grasp upon completion of

my Associate’s degree. While I knew the format and the basics, I still made many errors and had

a difficult time putting APA papers together. Looking back on my assignments from the very

beginning of this program in comparison to papers I have written this semester- the difference

you will see is substantial. The BSN program has helped me specifically to become fluent in

APA, a skill that I will certainly need in the future as I plan to obtain my master’s degree.

Throughout the program I have grown to almost enjoy the writing style, almost!

Program Graduate Competency 2

PGC 2: “Demonstrate leadership skills to promote patient safety and the delivery of high

quality healthcare” (DTCC, 2019). The development of my nursing philosophy at the very

beginning of this program started my journey to completing this PGC. The course had us

examine the competencies from the Quality and Safety Education for Nurses (QSEN Institute for

short) and apply them to our nursing philosophy. From the very beginning I felt that patient

safety, and high quality patient care were two of the most important goals a nurse could have.

My nursing philosophy related the accomplishment of these goals to a nurse’s commitment to

continuing education and advancing leadership skills. I went on to further complete this PGC in

my Nursing Leadership course. Here we examined leadership theories, my final assignment was

written based on transformation leadership. Transformational leaders have the qualities that I

value most: honesty, loyalty, empowerment, commitment, energy, confidence, self-direction, and

the ability to develop and implement a vision (Finkelman, 2015). This type of leadership in the

workplace is known to yield: satisfied/invested employees who are valued as individuals, high

quality patient care, and positive patient outcomes (Finkelman, 2015). I felt that this theory
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mirrored my current traits as a leader, while also giving me a goal for how to continue to grow as

a transformational leader in the nursing field.

Program Graduate Competency 3

PGC 3: “Apply skills of inquiry, analysis, and information literacy to support evidence-

based professional nursing practice” (DTCC, 2019). Nursing Research, Informatics, and

Population and Community Health were the courses that provided me the most learning

opportunities to fine tune the skills needed to master this competency. Throughout Nursing

Research, we were tasked with choosing a problem, defining a solution and exploring that

solution’s efficacy through literature reviews. This was one of the more comprehensive writing

assignments throughout the program, and looking back now, I can see why. The assignment

taught me how to effectively do nursing research. I learned where to find quality sources of

different kinds, how to find the information that I was looking for quickly and efficiently, and

how to determine if a source was biased. Doing the research for that assignment provided me

with so many learning opportunities, but the final product gave me a newfound respect for the

importance of research in nursing. This field is ever-changing thanks to technology, which means

that the “best” way to do things is also ever-changing. Nurses need to have a commitment to

research and staying up to date in their practice to ensure they are advocating for the current best

practices for their patients.

Nursing Informatics also helped me conquer an understanding of information literacy and

how technology has impacted the nursing field. It opened my eyes to how information is

managed, shared, and accessed. Population and Community Health showed me another side of

information literacy. It helped me to realize that everyone has a different level of information
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literacy, and thus educating a patient on a level that they can fully understand is key in positive

patient outcomes.

Program Graduate Competency 4

PGC 4: “Integrate information management technology to improve patient outcomes”

(DTCC, 2019). Nursing informatics taught me how technology helps to integrate information

and improve outcomes. Technology, especially computers have allowed a seamless way to share

health information between providers thus allowing for improved continuity of care. It’s also

helped prevent some errors that were common mistakes prior to computers being implemented in

the healthcare field. Prior to taking Nursing Informatics, I did not have any understanding of the

topic or how it applied to the nursing field. Throughout the course, and especially through

completion of my final written assignment, I realized how large of an impact informatics truly

has on nursing. In fact, “The quality of future patient care and nursing practice is dependent upon

nurses effectively using informatics” (Sewell, 2016, p. 3). I found the most interesting aspect of

informatics to be the access to trends/patterns in patient outcomes that it provides. By

computerizing and storing this information, it becomes useful to the nursing field for quality

improvement. When we can break down, manipulate, and categorize data, we can discover

trends, apply evidenced based practices, and improve the quality of the care we provide to our

patients (Sewell, 2016). I was able to take this knowledge and apply it in both of my practicum

experiences. I focused largely in my practicum for this course on how the implementation of

electronic health records could improve patient safety and overall patient outcomes. My

preceptor and I were able to review medication error data from the facility, utilize it to determine

highest risk areas, and then make suggestions for how to improve them. Technology makes a
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huge impact on how easy it is to collect this data, but also contributes to making the information

accessible, meaningful and useful in pursuing better patient outcomes.

Program Graduate Competency 5

PGC 5: “Advocate for patients and the nursing profession with regard to healthcare

policy at the local, state, national, and global levels” (DTCC, 2019). Nursing policy was the

course that gave me the most comprehensive understanding of this competency. Before taking

nursing policy I had minimal understanding of my own role in healthcare policy. Through the

course I successfully gained an understanding of how I can get involved directly on local, state,

national, and global levels. Nursing policy provided me the opportunity to determine who to

reach out to in my own community and state, in order to advocate for the changes that I believe

in. It also gave me a greater understanding of organizations and groups that are available for

nurses who wish to participate in advocating for their patients at these levels. My practicum

experience in Population and Community Health tied right in with healthcare policy as we were

tasked with finding a policy that applied to our selected population. My practicum was in the

mental health field and I was able to explore the Mental Health Parity and Addiction Equity Act

in great detail. Reading through a government healthcare policy was not an easy task, but at the

end of the course I had a much greater understanding of where to find healthcare policies, and

how to read them to maximize my understanding of what they entail. Mastering this competency

is pertinent to being able to fully understand how health care policies impact the field of nursing

and my patients, and how I can be involved in advocating for changes when they are needed.

Program Graduate Competency 6

PGC 6: “Direct patient-centered care through advocacy, interprofessional

communication, collaboration, and delegation” (DTCC, 2019). My practicum experiences

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provided me with the best opportunities to show proficiency in this competency. In Population

and Community Health, I observed a nurse in the admissions department of a mental health

facility. I was able to see the process of admitting patients, how they determine who meets in-

patient criteria, and what they do with those who do not. Throughout the clinical experience I

observed how the department splits up their duties, and how the care of the patient transfers

hands many times as tasks are delegated from the admissions nurse to the unit nurses, or to

outpatient service providers. I was able to collaborate with the nursing staff there. We discussed

the lack of resources available for mental health patients in our state and the gaps in the care of

this population. These topics became the focus for my final written assignment in the course. I

even had opportunities for interprofessional communication while reaching out to the community

resources available in this area. I spoke with the professionals and the volunteers at these places

to discuss what kind of assistance they could provide to this population. The practicum

experience proved to be the most valuable source of information for the final assignment. I

learned so much working with the patients, the nurses, and the staff in the community. I truly

gained a painfully clear picture of the needs of the mental health community from that

experience, and used that information to create a thorough and comprehensive final project for

the course.

Nursing Leadership also helped me to this achieve this competency. It helped me

understand the details and decision making associated with delegation in a more in depth way. I

completed a self-reflection exercise and that taught me more about myself and the unique way

that I tend to try to resolve conflict or communicate/collaborate with others. Through Nursing

Leadership, I gained an understanding of several different communication and leadership styles

that improved my ability to communicate within my profession.

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Program Graduate Competency 7

PGC 7: “Integrate health promotion and disease prevention practices to positively impact

the delivery of healthcare to diverse populations” (DTCC, 2019). It is hard to identify all of the

experiences that helped me master this competency. I feel like health promotion and disease

prevention came up in some way in every single course throughout this program. In Population

and Community health, I gained a better understanding of how diversity in populations can affect

health status. In Global Health, I spent hours looking at the various healthcare issues and trends

that occur in different places in the world and comparing them to those that occur all over the

world. The course was fantastic and informative. It provided so many great avenues for research

and opportunities for expanding my knowledge on global healthcare issues. In Health

Assessment, I completed a physical assessment on a patient and drafted a care plan related to her

specific health concerns. I included community supports and resources for addressing those

health care concerns and improving her overall health status.

Lastly, my nursing philosophy has always included the aspect of health promotion. In the

very first draft of my nursing philosophy I defined a patient as anyone that nurses can provide a

service to; not just the patients we are assigned to but also their family members, and all

members of our community. I did and still do believe that nurses should foster the health and

safety of everyone, those in our homes, work places, communities, etc. I have always felt that

nursing in its simplest form should not know any boundaries, and that all health care providers

should strive to improve all aspects of health in those around us when possible to do so. This is

one of the most profound beliefs I have in regards to nursing and it remains the foundation of my

philosophy.

Program Graduate Competency 8

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PGC 8: “Practice professional nursing within an ethical framework” (DTCC, 2019).

Ethics in Healthcare was the single most beneficial course in my mastery of this competency. I

had taken some level of ethics in high school and again for my associates degree, but the course

for the bachelor’s degree level put the icing on the cake. I learned the ins and outs of all of the

ethical principles in more detail. I completed assignments that helped me to better understand my

own views. Through both the professional and personal code of ethics assignments I recognized

that I had different values for myself personally and professionally. I was able to reflect on how

some of my personal values could impact how I practice nursing. I gained a better understanding

of how all of these principles play a role in nursing and how they impact the way we provide

care to our patients. I also gained a better sense of self-awareness and greater appreciation for the

importance self-regulation. While writing my nursing philosophy I addressed the importance for

nurses to have an accurate sense of self-awareness, but even more importantly to have self-

regulation in their professional practice. The Ethics in Healthcare course helped me further

understand where I am at in both of these areas, and see opportunities for continued growth and

improvement.

Program Graduate Competency 9

PGC 9: “Demonstrate lifelong learning that empowers personal and professional growth”

(DTCC, 2019). Nursing philosophy was the course that initiated my achievement of this

competency. As the very first course in this degree program, it forced me to evaluate what it

meant to be a nurse. The course was a great reflection for me on why I chose to pursue nursing,

why I am choosing to continue pursuing it, and specifically what it meant to me to be a nurse. As

I developed my philosophy I felt that lifelong learning and continuing education were essential

commitments to make to my professional career. I still hold true to this value. The nursing field
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is ever-changing and we cannot be the best if we do no continue to grow and change with it. A

nurse’s commitment to lifelong learning is essential in making sure we stay current in our

practice and provide our patients with the best outcomes.

My Capstone Practicum experience gave me the opportunity to do just that. In the very

beginning of the course I made five generic goals for my practicum experience. The first was to

utilize inquiry and analysis skills to identify at least one area of patient care that could use

improvement in my clinical setting. On my second day of practicum I was observing my

preceptor writing medication orders on a paper chart, and identified the lack of any electronic

health system as a barrier to safe patient care. My second goal was to use the above identified

area of deficiency and utilize interprofessional communication and collaboration skills to begin

to develop a solution. On day three of practicum I was able to start working on this goal. My

preceptor and I spoke with the director of nursing about implementing electronic health records

or automated medication dispensing units and learned that the facility would soon be

implementing electronic medication dispensing units. My third goal was to advocate for the

proposed improvements by speaking with management at the facility to discuss what barriers to

implementation may be present. I was also able to complete this goal during our conversation

with the Director of Nursing. He advised that the facility is owned by a larger company and that

funding for things such as electronic health records or computerized systems had to first be

approved by the corporate company. This is an ongoing barrier to safe patient care at the facility

as corporate presently continues to deny additional funding for computerized charting. My fourth

goal was to identify at least one potential solution to any barriers listed by facility management.

My preceptor and I were successful in completing this goal. We spent a lot of time discussing

cost as a barrier and trying to find assistance to combat this barrier. We ended up finding federal
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funding grants for computerized systems through Delaware Health and Social Services. We also

found incentive programs for providers on the Delaware Medical Assistance Program website,

we reached out and sent them an email requesting more information but did not get a reply. My

final goal for the practicum experience was to find and apply an evidenced based nursing

practice to defend my proposed solution. On my final day of practicum, I provided an evidenced

based article to both my preceptor and the Director of Nursing on the barriers to implementing

electronic systems and solutions to overcome them. Being that I am employed at the facility, I

have since been able to see the full implementation of the automated medication dispensing

systems on all units in the hospital. Though this is only the first step in a long process of needed

improvements, it was a very exciting step to see take place. I plan to continue to follow up on the

implementation of computerized systems and to continue to be an advocate for this change at my

facility.

My commitment to lifelong learning has been evident for quite some time. I started my

nursing career in high school but knew that it was what I wanted to do long before that. I have

continued to pursue the next level of education my entire life, and I plan to continue to do so. I

plan to start my master’s degree in the fall of 2020. While my continuing education will help me

continue lifelong learning, I plan to also get more involved in nursing organizations in the state

and continue to take all opportunities to grow professionally.

Conclusion

In summary completing this Capstone course has truly been the summit of this

educational climb. I would not be who I am or where I am today without the exceptional staff at

Delaware Tech. The Associates Degree Nursing program was the absolute hardest thing I have

ever done, but it went above and beyond in preparing me for my career as a nurse. I felt so
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confident in the program they designed that I waited for the BSN program at Delaware Tech

because I knew that it would be thorough- and it has not let me down. There are so many

differences in the education I obtained through these two degrees but I feel that the final product

has prepared me to be the best nurse that I can be. I look forward to taking everything Delaware

Tech has provided me with and moving forward in both my career and my education.
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References

“Capstone." Merriam-Webster.com. 2019. Retrieved from: https:// www.merriam-webster.com

Delaware Technical Community College. (2019). Bachelor of science in nursing. Retrieved from

https://www.dtcc.edu/academics/programs-study/bsn

Finkelman, A., (2015). Leadership and Management for Nurses: Core Competencies for Quality

Care, 3rd Edition. Upper Saddle River, NJ: Pearson Education.

QSEN competencies. (2017). Retrieved from The QSEN Institute website: http://qsen.org/

competencies/pre-licensure-ksas/

Sewell, J. P. (2016). Informatics and nursing: Opportunities and challenges (5th ed.).

Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.