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Transition into Practice Paper

Alyssa Bradshaw

Department of Nursing, Utah Tech University

NURS 4700: Leadership and Management

Vicki A. Welch, PH.D., RN, CNE

April 16, 2023

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Transition into Practice

As a student graduating from Utah Tech University’s registered nursing program, I feel

prepared to transition safely and successfully into practice. After several hard years and many

hours of study, I have done what it takes to learn about nursing practice and start my career as a

new graduate registered nurse. Over the past couple years, I have learned about several different

topics, especially grit. Grit is a term that means persevering to the end and doing it well. This

program has taught me how to work hard and make sure everything I do leads toward a positive

outcome. When working as a registered nurse, I will be required to take responsibility for my

actions and look for solutions to difficult situations.

Utah Tech University has five learning outcomes: patient-centered care, clinical

judgment, communication, compassionate care, and professionalism. Each of these learning

outcomes are vital to become a successful and safe registered nurse. While reflecting on the past

couple of years and my preceptorship in the resource pool, I feel I will be able to successfully

transition into my own nursing practice.

Patient-Centered Care

The first learning outcome of Utah Tech University’s nursing program is patient-centered

care. Patient-centered care encompasses many aspects of taking care of an individual. Fazio et al.

(2018) describe it as “a philosophy of care built around the needs of the individual and

contingent upon knowing the unique individual through an interpersonal relationship” (p. 10).

This means that as a nurse, I will need to be able to reflect on each of my patients and find ways

to take care of each individual according to their needs.

Fazio et al. (2018) wrote their study reviewing the person-centered care approach

specifically on patients with dementia but included acute hospitalized patients and long-term care
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residents. The article found that there were more positive outcomes from patient-centered care.

Individuals were able to have better sleeping patterns, decreased agitation, and an overall better

quality of life (Fazio et al., 2018). It also found that healthcare workers had less burnout, stress,

and job satisfaction (Fazio et al., 2018).

While completing my preceptorship in the resource pool, I have had the privilege of

providing care to many different types of people. It has ranged from small babies in the NICU to

the elderly patients on the medical surgical floor. After reflecting on my precepting journals, I

have learned that I have made several goals to improve my skills around patient centered care.

The most prevalent being to learn about my patients individually and discover how to help them

in the most effective and safe way.

One night while precepting on the cardiovascular unit, I cared for an elderly woman that

came in for a simple surgery that ended up having several complications. She had to be moved

from the medical-surgical floor to a higher acuity floor due to these complications. She was

stressed and overwhelmed with only her young granddaughter there to comfort her. I went to

assist her to the bathroom, and she continued to panic about her situation. I asked if she would

like to go for a walk. We were able to talk about her concerns not only related to her surgery but

her home life as well. After the walk, she was able to settle down and sleep for most of the night.

I think this is a good example of patient-centered care because I was able to look at her situation

and identify what she needed most in that moment.

Overall, I would like to further my efforts and improve in the learning outcome, patient-

centered care. It has proved important through my own research efforts and what I have been

taught in my schooling. I know that when I am stressed, I like to get things done quickly and

effectively, but I would like to continue to work on slowing down and looking at every one of my
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patients as an individual. As shown from my example in the cardiovascular unit “Individuals

need comfort or warmth to ‘remain in one piece’ when they may feel as though they are falling

apart” (Fazio et al., 2018, p. 11). It is an important part of my nursing practice that I do not want

to overlook.

Clinical Judgment

Clinical judgment is the second learning outcome in Utah Tech University’s nursing

program. The term clinical judgment can be defined as using one’s critical thinking skills and the

best evidence-based practice to decide the safest care for the best outcomes. There are rapid

developments in the medical community that places greater autonomy for nurses (Ludin, 2018).

They are required to look at physicians’ orders and decide how best to administer them or even if

it is appropriate to implement them at that time.

Ludin (2018) reviews the importance of nurses being able to use clinical judgment.

Nurses are facing extremely difficult challenges in their workplace. Nurses are required to use

problem-solving and critical thinking skills constantly (Ludin, 2018). As I explained, nurses are

required to know more, do more, and critically think more than ever before.

During my preceptorship, my nurse will often turn to me and ask me what I would do in

different situations. This requires me to put into practice what I have learned in school and to

utilize my critical thinking skills. One experience I have mentioned in my reflection journals is

that the physician ordered an infusion of 1,000 mL of lactated ringers to be infused over several

hours, along with an antibiotic in 100 mL of normal saline. My preceptor asked me if I would

infuse them both at the same time or do them separately. After reflecting on the patient’s

condition and what I knew from my studies, I decided to run them separately. The patient had a

couple of heart conditions and delivering the two solutions together could have caused some
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complications. This experience challenged my clinical judgment and ability to use autonomy as

a nurse.

There are several ways that I can improve my skills in clinical judgment as a registered

nurse. The main two ways are through experience and continuing education. Experience comes

with time and effort. I know the basics through my time as a licensed practical nurse and

precepting, but to really know how to safely take care and make clinical decisions is through

practice and asking questions. I plan to continue my education through study and keeping up

with the best evidence-based practice.

Communication

The third learning outcome is communication. Communication in nursing involves

speaking directly and effectively with providers, staff members, and patients. In my opinion,

there are two aspects of communication education, and therapeutic communication. We learned

about therapeutic communication during our first semester in the nursing program.

Hashim (2017) goes into depth about the importance of effective and therapeutic

communication. “Communication skills needed for patient-centered care include eliciting the

patient’s agenda with open-ended questions, especially early on; not interrupting the patient; and

engaging in focused active listening” (Hashim, 2017, p. 29). Patients’ views on their health are

important. Understanding the way the patients feel, what their expectations are, and what they

understand about their health can help us as healthcare workers provide the best therapeutic

communication (Hashim, 2017).

While reflecting on my preceptorship, I had an experience in the observation unit at St.

George Regional that required me to use my communication skills. We were getting ready to

discharge a patient that had just had a procedure done. It was very important to explain what to
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do in an event where the procedure site started bleeding due to the procedure being through an

artery. My preceptor went over the paperwork with me and then allowed me to do the education.

Overall, I think this experience turned out well. I was able to explain the importance of applying

pressure and when to call the doctor or 911. I allowed time for the patients and family to ask

questions.

As I transition into practice, I have set goals to improve my communication. I know that

writing out what I want to tell the doctor will help me effectively provide the most important

data. It will allow me to explain what my concerns are so the patient can get the best

interventions to help them improve. I want to be able to speak better to patients and allow them

to fully express themselves. Hashim (2017) found that physicians, on average, interrupt patients

within 16 seconds. Allowing patients to fully explain themselves and their concerns can lead to

better outcomes.

Compassionate Care

The fourth learning outcome in Utah Tech University’s Nursing program is

compassionate care. Being able to provide compassionate care to patients is a vital part of

nursing. As nurses, we are to be empathetic with our patients, and have the responsibility to

provide a safe space for each and every one of them (Henderson & Jones, 2017). We need to

encourage the sharing of stories and concerns and make sure the patients feel that they can share

these experiences with us (Henderson & Jones, 2017).

Another important aspect of providing compassionate care is acknowledging personal

values and beliefs (Henderson & Jones, 2017). By being able to do this we will be able to

provide for a patient without our own prejudices getting in the way. It can be difficult to give
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care to a patient without what they are saying, doing, or had done get in the way of our best

performing selves.

During my preceptorship, we had a patient who had recently lost his wife and then had a

new diagnosis of Parkinson’s disease. He was anxious to be in the hospital by himself. While

doing his assessment, I was able to ask him some questions to get to know him better. By asking

open-ended questions he was able to start expressing his concerns, anxieties, and grief. After a

while, I learned that he needed to talk and get his feelings out. I listened to him intently while we

talked and was able to be a support to him in this difficult time. This taught me how important it

is to have compassion and empathy for each of my patients.

As I have gone through my preceptorship, I have been able to recognize some of my own

prejudices toward people. I have learned that it can be hard to put your values aside and help

someone who has done something contrary to my beliefs and values. By recognizing this I will

be able to provide better care for each one of my patients. Another thing I would like to work on

is empathy. I have a hard time remembering that these patients are going through extremely

difficult things, and I want to be able to empathize with them.

Professionalism

The final learning outcome for Utah Tech University’s nursing program is

professionalism. Professionalism is extremely important when working in this field. There are

many legal and ethical parts of nursing. It is important to document, keep in line with HIPAA,

and understand ethical values in nursing. Nurses have the responsibility to keep up with

professional standards. Vázquez-Calatayud et al. (2021) found that when nurses are aware and

do the proper training required to learn about professionalism, they are able to meet the stresses
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of their role. They gain confidence and relationship skills in their workplace (Vázquez-Calatayud

et al., 2021).

In my precepting experience, I took care of a man that had done numerous amounts of

illegal drugs and was transported by EMS because of some side effects he was having. He was

very ungrateful and caused a lot of issues while in the emergency department. I had a hard time

giving this man my full attention because of some of the things he had done. After he was

admitted I asked my nurse how she was able to remain professional with him. She explained that

it has taken practice and reflection to overcome her biases and help every person that comes

through the emergency department equally.

After reflecting on the learning outcome of professionalism there are several things I can

improve on. I think one thing could be knowing how to maintain a professional boundary with

patients. I think this will come with time and working in an acute care setting. I have only

worked in long-term care facilities, so I see the same residents every time I go to work. This

environment can make it difficult to keep professional boundaries. Another thing I would like to

improve on is acknowledging my biases and areas where I may be prejudiced and working on

ways to overcome them.

Conclusion

Through reflection of my experiences in Utah Tech University’s nursing program, I feel

prepared to start my career as a nurse. I have had practice with my skills, learned the material,

and had a successful preceptorship. The learning outcomes outlined by Utah Tech University’s

nursing program will allow me to be a competent and accountable nurse.

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References

Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care

for individuals with dementia. The Gerontologist, 58(1), 10-19.

https://doi.org/10.1093/geront/gnx122

Hashim, M. J. (2017). Patient-centered communication: Basic skills. The American Academy of

Family Physicians, 95(1), 29–34.

https://doi.org/https://www.aafp.org/pubs/afp/issues/2017/0101/p29.html

Henderson, A., & Jones, J. (2017). Developing and maintaining compassionate care in nursing.

Nursing Standard, 32(4), 60–69. https://doi.org/10.7748/ns.2017.e10895

Ludin, S. M. (2018). Does good critical thinking equal effective decision-making among critical

care nurses? A cross-sectional survey. Intensive and Critical Care Nursing, 44, 1–10.

https://doi.org/10.1016/j.iccn.2017.06.002

Vázquez-Calatayud, M., Errasti-Ibarrondo, B., & Choperena, A. (2021). Nurses’ continuing

professional development: A systematic literature review. Nurse Education in Practice, 50,

1–9. https://doi.org/10.1016/j.nepr.2020.102963