Running head: MY PERSONAL RN TO BSN JOURNEY 1

My RN to BSN Journey

Christine E. Davis

Delaware Technical Community College

Capstone 460 Davis

April 26, 2020

MY PERSONAL RN TO BSN JOURNEY 2

MY COURSE GOALS

Doing clinical hours at the Milford Central Academy seemed like years ago. I took

everything for granted. I look back at my personal learning goals, and I have to laugh and that

was not that long ago. My 1st goal to teach health promotion with teenagers (PGC 7). I was able

to teach hand washing and teach/educate about some medications, mostly inhalers. But now I am

teaching my facility, co-workers and patients about tele-health, CDC policies and procedures,

and how to continually keep the facility safe, while having multiple positive cases of

Coronavirus. My 2nd goal was to have a better understanding with technology (PGC 4). During

my time at the school, I was able to see how the school nurse documented the med pass. She also

had to document every student that came down to her, including calling the parent and sending

them home with a note that they were seen. She has to cover all the bases with communicating to

the parent/POA. I am dead smack in the center with tele-health, zoom and face-time at my

facility at this time with the coronavirus pandemic. My facility is doing care-plans and meetings

via zoom. My patients are able to set up times to do face-time with their loved ones. My 3rd goal

was to learn how to be an ethical nurse while working with the students (PGC 8). In the short

time I was able to do that. The nurse had over 1,100 students to take care of and over 20 med

passes in her day. The more I worked with the kids the more I started to become comfortable. I

enjoyed teaching the kids about the importance of proper hand washing and using an inhaler

correctly. They are just like us; they want honesty and someone to trust. My ethics at my facility

right now are being torn apart. We have multiple positive COVID-19 cases in our facility. We

are having to call families and tell them the situation and to go over their code status. I have had

to ask other nurses to do it, I have become so emotional at times. Because of HIPPA there is a

fine line of what we can and can’t say, and at times this has put us in difficult situations. My 4th
MY PERSONAL RN TO BSN JOURNEY 3

goal was to be stress free during my clinical experience while I was receiving a meaningful

learning experience. Well to be truthful, I would do anything to be back in that time with the

students at the middle school. Life as a nurse is very stressful at the moment, no matter where

you work. Families are separated, loved ones are left alone, depression is setting in at work with

my patients. Face-time is not the same as a physical hug. Physical touching and face expressions

are non-existent or covered up. It is only the beginning and it has taken a toll on all of us.

GOAL 1-PGC 7

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

delivery of healthcare to diverse populations.

In the fall of 2018 in Math 255 (Statistics) my final statistics paper was on nurses coming

to work sick. It was based on 1 question-Did you come to work sick in the last year (cough, sore

throat and/or fever)? Simple yes or no answer. My claim was that the proportion of nurses that

come to work sick is more than 75% in my building. 30 nurses were asked a yes or no question

of coming to work with fever, cough, and sore throat. Now with the Coronavirus we have a

questionnaire to answer and our temperature taken before we walk into the building and before

we go home. We do not know how our facility got the coronavirus. Our long-term patients have

free will to go anywhere in the facility they want. There are multiple daily get togethers’, 4-7

patients play Wii multiple times during the day and of course dining together for every meal.

There are a few of our patients that get on the Dart bus and go shopping, go to the malls and love

going to the Dover Slots. We have nurses and CNA’s that work at multiple facilities. So, did one

of the 75% come in sick?? Good question. Was the Country too slow to start certain protocols. In

Delaware “on March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) issued

aggressive measures for nursing homes nationwide to follow with respect to safety at their
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facilities” (Delaware Health and Social Services, 2020). There is no blame game now, that would

be a waste of crucial time and energy. We need to support our patients and co-workers in this

scary-deadly time (Provision 1-9 ANA Code of Ethics).

During NUR 340, the Nursing Research class I wrote a paper on statics of

Transitional care. On October 1, 2011, the Centers for Medicare & Medicaid Services (CMS) has

started to fine hospitals for readmissions called the Health Readmissions Reduction Program

(HRRP). One in five Medicare enrollees is readmitted to the hospital within 30 days, and up to

75% of these readmissions are preventable. “Nurses play the most important role in the transition

communication process, they strategically develop and communicate the transitional care plan by

knowing what information should be communicated, and by extending a dialogue to the

receiving team and understanding what information they feel is necessary to provide the best

follow-up care possible” (Barbara, 2017). The social workers read the nurses and CNA’s

documentation and the physical therapists’ improvements or declines in order to supply the

patient with the help and equipment that is needed when they go home. We do have a lot of

repeat patients, mostly because of being non-compliant, especially the diabetics. They come back

with amputations or bad wounds. We continue to educate but there is only so much you can do

when you know they are not going to follow through.

GOAL 2-PGC 4

PGC 4: Integrate information management technology to improve patient outcomes.

I have assisted with using telehealth with the psychiatrist and wound nurse three times a

week (this incorporates all 9 PGC’s). Telenursing is the use of “technology to deliver nursing

care and conduct nursing practice” (Schlachta-Fairchild et al., 2008). “Telehealth involves the

use of telecommunication technologies to prevent and treat illness and promote the health of
MY PERSONAL RN TO BSN JOURNEY 5

individuals and populations. Although telehealth has particular benefits for rural and underserved

populations, it is increasingly recognized for its potential to control costs while providing real-

time tools to promote wellness, prevent disease, and enable the home management of chronic

conditions” (Hall, 2014). “The importance of telehealth as a major vehicle for delivering timely

care over distance has become increasingly relevant as the world's health care needs have

become overwhelmed with chronic illness” and right now it’s needed for the coronavirus

(Dinesen et al., 2016). Beginning on “March 6, 2020, Medicare — administered by the Centers

for Medicare & Medicaid Services (CMS) — will temporarily pay clinicians to provide

telehealth services for beneficiaries residing across the entire country” (Office for Civil Rights,

2020). “It removes the telehealth stipulation that telehealth can only be provided in rural areas

with specific audio-visual equipment (Office for Civil Rights, 2020). “During the COVID-19

national emergency, which also constitutes a nationwide public health emergency, covered

health care providers subject to the HIPAA Rules may seek to communicate with patients, and

provide telehealth services, through remote communications technologies” (Office for Civil

Rights, 2020).  For the Informatics class I did my final paper on tele-health and how desperately

it was needed in rural areas. Now it is a huge part of my day, it is the way we communicate

safely.

GOAL 3-PGC 8

PGC 8: Practice professional nursing within an ethical framework.

While I was in the school and doing assessments, I was staying within HIPAA guidelines

with so many students in the room at a time, treating everyone with kindness, allowing patients

and or the kids to display their religious beliefs without judgement is within the standards of

being ethical in my nursing practice. NUR 320 Health Assessment has helped me in every
MY PERSONAL RN TO BSN JOURNEY 6

nursing assessment that I do, the kids gave me an opportunity to do different types of

assessments. I am the admission nurse at times and this class helped me do more effective

assessments when it came to why they were with us, CHF exacerbation, stroke, heart attack,

wounds ect. This class allowed me to learn the correct care plan for each illness. It has helped me

know what to look for and what extra focus was needing to be done. It has allowed me to fulfill

Provision 4 and 8 in the ANA Code of Ethics.

HOW I ACCOMPLISHED THE OTHER PGC’S

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

education and growth in professional practice.

Every class that I have taken for my RN to BSN Journey has allowed me to be the great

leader that I am today. I went outside my comfort zone in nursing by doing 2 clinical rotations at

a middle school. I am used to doing care on rehabilitation patients, hanging IV’s, wound vac’s

ect. Going to the middle school allowed me to educate at an earlier age for them to be healthier,

so one day I don’t see them in my facility. I enjoyed the kids, they actually listened to me, or I

think they did. At work I get excuses and the patients are already stuck in their ways to where

they don’t stop being noncompliant, and that is why they are there. I am in the process of reading

the power points from Delaware Health and Social Services (DHSS), Leadership and

Management, for my CEU’s to make up for the clinical hours. Some of it is a repeat from

Community. One of the power points that I really enjoyed is power point 14, Boundary spanning

leadership and the great divide, session 4, slide 8, Dwell (2019) says this perfectly “When groups

feel threatened and are so focused on their differences that they fail to see common ground,

schisms of “Us” and “Them” become more entrenched with each interaction.” I see this with the

shifts, aids complain that nothing was done during the prior shift, and nurses just use that to add
MY PERSONAL RN TO BSN JOURNEY 7

to the fire about everything. There is not one shift that gets along with the other, it drives me

crazy. I am always saying you need to work that shift to appreciate each other. Every shift has

their own expectations from the shift prior. I have even caught myself saying that when one shift

falls behind all we do during our shift is fix and catch up. During this coronavirus pandemic, I

have worked every shift and I will no longer say that. Everyone has their own issues. The way to

resolve this according to Dwell was to force everyone in a situation to be fixed for the common

good, and “While working on these significant adaptive problems, positive relationships quickly

developed between members of the groups, and a new collaborative inter-group identity

emerged”. I am seeing that every day at work right now, because more than half of the staff has

quit. We all need each other; we all have something to give that the other doesn’t have. We are all

exhausted and leaning on each other. As the supervisor I am seeing who needs a boost or a pep

talk and who is better left alone. We are all working together for the common good, to keep the

facility and ourselves safe. Because of these BSN classes I am able to be a strong leader for all

my co-workers.

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

healthcare.

Greenleaf first came up with the principle of servant leadership in a 1970 essay titled

“The Servant as Leader.” “Greenleaf 's servant-leadership writings have made a deep, lasting

impression on leaders, educators, and many others who are concerned with issues of leadership,

management, service, and personal growth” (Spears & Lawrence, 2016). The set of

characteristics central to the development of servant leaders: Listening, empathy, healing,

awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of

people, building community among staff (Spears & Lawrence, 2016). According to Hoch,
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Bommer, and Dulebohn-Dongyuan (2018) Greenleaf wrote “The servant as a leader begins with

the natural feeling that one wants to serve, to serve first, then conscious choice brings one to

aspire to lead.” “Servant leadership truly offers hope and guidance for a new era in human

development, and for the creation of better, more caring institutions” (Spears & Lawrence,

2016).

Part of my facility is for long-term patients, while in the Policy class I learned how bad

funding is for long-term patients. I have seen patients have to give up everything they have

worked their whole life for to stay with us. I advocate for great care, better meals and educate on

how to help keep costs down. The geriatric population is only going to keep getting bigger, and

our facility needs to stay on top of things to be able to take care of this growing population. With

Policy I now realize how big a nurse’s voice can be in changing and bettering the health care

system. In the TCU I see patients run out of insurance and are given a 24 hour time to go

warning. This is devastating to the patient and family; they are usually back within 6 months. I

am educating my aids and nurses on the importance of documentation on their need of assistance

and if it changes to make me aware so that I can let physical therapy reassess them, to make sure

that they are not leaving to soon. The insurance company needs documentation of everything,

and we are the advocators for our patients. My shift has the greatest opportunity of seeing the

sundowners (change in mental status), and at the end of the day the extra assistance they need

due to being tired, sitting in their chair, and their pain level from the days physical therapy.

“Isolate symptomatic patients as soon as possible. Set up separate, well-ventilated

triage areas, place patients with suspected or confirmed COVID-19 in private rooms with door

closed and private bathroom (as possible), prioritize AIIRs for patients undergoing aerosol-
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generating procedures” (CDC, 2020). As of April 20th we have over 70 positive patients in our

facility, I have lost count on how many have passed. I do not know how many of my co-workers

are positive, I know over 13. We have “dirty areas” and “clean areas”, we are doing everything

in our power to stop this spread. We are wearing advanced droplet PPE: N95 mask, goggles,

shields, and hair coverings. We are constantly being educated on how to stop the spreading of

this deadly disease.

During this stressful time, I cannot imagine not coming into work to guide and stand by

my fellow co-workers. I cannot imagine me not ever wanting to take care of someone no matter

their diagnosis. So, I have told my administration and my co-workers that I will come to work

every day I am scheduled and extra days if I am needed. This disease will not take the

compassion, the empathy, or the Servant Leader out of me or my personality.

During the NUR 330 Population and community Health course I learned the about the

resources that were in the community, which most are one mile from my job. This has helped me

out tremendously by giving resources to my patients and their family. As a nurse it’s my

responsibility to get the information out. I have so many patients that rotate in and out of my

facility, it will benefit them if I am able to give them as many community resources that I can.

Even if they are not from the area, I can easily look up resources that are available in their

community. Knowing how to find these resources has helped me keep up with which ones are

available and which ones are closed due to the coronavirus.

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

professional nursing practice.

MY PERSONAL RN TO BSN JOURNEY 10

In World History II I learned how diseases were spread on boats back in the 1600’s and it

is still true today. Closed spaces has caused the spread of many disease in the world from the

beginning till now, and I am sure COVID-19 is not the last pandemic this world will endure.

According to Tognotti (2013) “Over the centuries, from the time of the Black Death to the first

pandemics of the twenty-first century, public health control measures have been an essential way

to reduce contact between persons sick with a disease and persons susceptible to the disease, in

the absence of pharmaceutical interventions, such measures helped contain infection, delay the

spread of disease, avert terror and death, and maintain the infrastructure of society” (Tognotti,

2013). “Quarantine and other public health practices are effective and valuable ways to control

communicable disease outbreaks and public anxiety” (Tognotti, 2013). And quarantine is saving

our lives today. Public Health practices of staying at home, wearing a mask when going out if

needed, and closing all non-essential stores is also saving lives.

The whole world, nurses, doctors, everyone is applying skills of inquiry, analysis and

information literacy into this virus. The information is changing daily on how the virus is living,

dying and spreading. Every hour there is something new that is being found out. The CDC and

State is continuously giving us new ideas or a protocol to follow. It is very confusing and even

more frustrating, especially when 1 thing is said one time then you have to turn everything

upside down to change it. As the supervisor it is my responsibility that I know what is going on

and to educate everyone in the facility. For now, we know through evidenced based practice that

social distancing and PPE, is a start on controlling this virus. For a vaccine, I don’t believe we

will have any evidence based information on this pandemic for some time.

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

local, state, national, and global levels.

MY PERSONAL RN TO BSN JOURNEY 11

During the NUR 420 Nursing Policy I wrote my papers on long-term care and financing.

This is one of the quotes I found interesting; An article that was written in 1985 by Mechanic

still holds true today, 35 years later “as more of the population enters the ages associated with

disability and dependence, our failure to develop a coherent policy of long-term care that

protects the elderly and their families at the period of greatest vulnerability will increase and

become a more explosive social issue.” I have witnessed patients getting rid of lifelong savings

to receive Medicaid, you are only allowed to have $2,000 in assets to qualify. Washington state

passed House Bill 1087, Public Long-Term Care Insurance, which in 2022 working citizens of

Washington will be able to put money into a trust fund for use of long-term care services,

payment to caregivers, respite, or anything needed in the home to accommodate the older adult

(Bunis, 2019). This would benefit the whole United States; putting money away at an early age

for just long-term care would be beneficial.

My facility is long-term and a rehabilitation every patient and resident in our facility is

vulnerable. “Based on what we know now, those at high-risk for severe illness from COVID-19

are: People aged 65 years and older and people who live in a nursing home or long-term care

facility” (CDC, 2020). In March 2020 Governor John Carney, along with the Delaware

Department of Health and Social Services (DHSS), announced “a coordinated statewide plan to

ensure individuals with symptoms consistent with coronavirus disease 2019 (COVID-19) have

access to safe and efficient testing in Delaware.” “Tests will be administered at no cost to the

patients” (Delaware Health and Social Services, 2020). This is a sigh of relief to our patients, it’s

one more lab that they don’t have to worry about paying for and have peace of mind to get this

test done. As of April 8th, we are no longer testing. Because we had 11 positives come back from

the lab, everyone that shows a sign or symptom of COVID-19 is considered positive. As of April
MY PERSONAL RN TO BSN JOURNEY 12

17th, we are considering everyone to be positive, it is spreading like wild-fire. Again, we cannot

put the blame on anyone, we are doing all we can to save our patients and ourselves form this

deadly disease.

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

collaboration, and delegation.

We are advocating for our patients/residents by following CDC policies, assisting with

the psychiatrist with tele-health meeting, and mostly we are keeping ourselves safe for them. We

are talking with their loved ones to keep them updated, for their ease of mind. We are

continuously keeping our supply of PPE count up for all of our safety. My facility is in contact

with the CDC almost hourly while at work, things are continually changing. I need to keep my

facility, co-workers, and patients safe. I am continually educating staff with the proper way to

don and doff PPE, reminding them of social distancing and properly assessing patients for signs

and symptoms of COVID. This pandemic has changed all of us forever, we go to work in fear.

Evidenced based practice is at the forefront of my daily nursing life. We no longer allow any one

into the building but scheduled staff. We have stopped communal dining; we have doors to the

units shut so that no patient or worker can go from unit to unit. The carts have been changed so

that the primary nurses and aids are with each other with the same patients throughout the shift.

We have given long-term nurses back all the long-term patients. We have a special locked down

area for isolation and suspected COVID-19 cases. Daily, before we enter the building, we are

putting on our N95’s, gowns, goggles, hair protectors and face shields. I do not see most of the

nurses or aids at all during my shift. They are to stay in that area only, not to spread anything to

different areas of the facility. We are no longer accepting any new admissions, to help keep the
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virus out of the facility. It’s eerie, you truly feel so alone. There is no more joking and hanging

out with co-workers, this has changed us forever.

The paper that I wrote for the NUR 320 Health Assessments class was on aspiration. This

has assisted me in knowing when to get an order for speech to step in or as a nursing judgement

to change the patients’ diet and fluid consistency. This is so important with my stroke patients.

My CNA’s are trained well to notice any pocketing, coughing with drinking, or eating and if they

are having difficulty swallowing. As a nurse we highly depend on our CNA’s to provide and

inform us immediately with any change.

While I was at Milford Central Academy school, I heard about the collaboration of the

nurse, the principle, the mother, and her primary physician find a way to help the girl that tried to

kill herself with a bottle of ibuprofen. It was an injustice that Meadowwood had no place for the

girl to go, the mother does not have the means to treat this child effectively. I witnessed and was

part of the collaboration, delegating and us advocating by staying quiet to teachers and the little

girls’ friends of her diagnosis of having a brain stem tumor and having a short time to live.

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

We are being educated every day, almost every hour. The CDC is continually changing

what we need to do to stay safe. It is a lot of responsibility on my shoulders to make sure the 3-

11 shift is educated and to educate and pass on any new information to the 11-7 shift. And to

communicate for them to pass any new information to the to the administration when they come

in the following morning. The RN classes were a steppingstone, the BSN classes have allowed

me to learn and use those skills that I personally and professionally developed while I was in

these courses. Now I am using them efficiently and not double guessing myself, my confidence

has grown along with my development of being a great nurse. I am still not sure if I want to
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pursue my MSN immediately. I am very interest in geriatric and end of life classes. Delaware

Technical College offers Communications classes like Human and Oral communication,

Informatic classes to help me with the updated medical systems. There are classes like the

communications and business classes that I would be interested in because I am not involved in

the financial aspect of my patients and facility now. I feel like knowing a little more than I do

would help in their course of care. The communications is a big one for me, because I know I

don’t like confrontation and I don’t like anyone mad at me. Knowing how to get things done

appropriately without confrontation or knowing how to handle it would help with being a

stronger leader. I have so many opportunities in my facility now, I arrive early so that I can sit

with the unit manager and DON to catch up on the day, learn new CDC protocols and if there has

been anything else that I need to be especially aware of. I know that doing the BSN courses has

allowed me to be where I am at now especially with what is going on in my facility. The courses

have built up my knowledge and my confidence, and with this I am assisting everyone in my

facility when it is needed, without me questioning myself. I am looking forward to reading this in

6 months and to see my growth and improved leadership skills.

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MY PERSONAL RN TO BSN JOURNEY 15

References

Barbara, D. (May 24, 2017). The important role nurses play in care transition and reducing

readmissions. The Connected Clinician. Retrieved from

http://www.theconnectedclinician.com/the-important-role-nurses-play-in-care-transition-

and-reducing-readmissions/

Bunis, D. (2019, May 19). Washington State enacts public long-term care insurance. AARP.

Retrieved from https://www.aarp.org/politics-society/advocacy/info-2019/washington-

long-term-care-law.html

CDC. (2020). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-

recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov

%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html

Delaware Health and Social Services. (2020, March 20). Governor Carney, DHSS announce

Statewide COVID-19 Testing Plan in Coordination with Delaware Health Care Systems.

Retrieved from https://news.delaware.gov/2020/03/20/governor-carney-dhss-announce-

statewide-covid-19-testing-plan-in-coordination-with-delaware-health-care-systems/

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., … Oestergaard,

C. U. (2016). Personalized Telehealth in the Future: A Global Research Agenda. Journal

of Medical Internet Research, 18(3), 52. https://doi-

org.libproxy.dtcc.edu/10.2196/jmir.5257
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Dwelle, T. (2019). Leadership and Management: Boundary spanning leadership and the great

divide, session 4. [Power Point slide 14]. Delaware Health and Social Services, Division

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Greenleaf, R. (1977). Servant leadership: A journey into the nature of legitimate power and

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Hall, J., & McGraw, D. (2014). For telehealth to succeed, privacy and security risks must be

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Hoch, J., Bommer, W., & Dulebohn-Dongyuan, J. (2018). Do Ethical, Authentic, and Servant

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Analysis. Journal of Management, 44(2). Retrieved from http://julia-

hoch.com/yahoo_site_admin/assets/docs/Hoch_et_al_JOM_in_press.325122725.pdf

Mechanic, D. (1985). Challenges in long-term policy. Health Affairs 6(2). Retrieved from

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.6.2.22

Office for Civil Rights. (2020, March 30). Notification of Enforcement Discretion for Telehealth

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Schlachta-Fairchild L, Elfrink V, Deickman A. (April, 2008). Patient safety, telenursing, and

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Spears, L., & Lawrence M. (2014). Practicing servant-leadership: Succeeding

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leadership.doc

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