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Running Head: Program Graduate Competencies Reflection Paper

Program Graduate Competencies Reflection Paper

Howard Derby

Delaware Technical Community College

NUR 460 Nursing Capstone

December 6, 2020
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Introduction

I started the RN-BSN program reluctantly. When I got a job as an IV WIP shift nurse in

2016, I was required to sign a contract that obligated me to complete my BSN within the next

three years. I had no desire to go back to school but I have always wanted to be on the IV team,

so I took the good and accepted the bad. I am completing this program to keep my job as an IV

nurse and have no plans to complete any further education. Throughout this program, I have

been honest about why I am here and appreciate the feedback from instructors. Now that it is

ending, I am glad I completed my BSN and appreciate the programs goals. The Delaware Tech

RN-BSN program has allowed me to achieve the following nine Program Graduate

Competencies (PGC) and the ability to apply them to my nursing career.

Integrating Education into my Profession as a Nurse

The first PGC is to integrate general education knowledge, skills, and aptitudes to

advance nursing education and growth in professional setting. Working as an IV nurse and part-

time as a clinical liaison while completing the RN-BSN program, has allowed me to use the

education I learned into my role as a nurse. For example, from the global nursing course, I was

able to learn different customs of nursing which allowed me to appreciate more cultures and

reasons for different types of care. Even though I may not agree with a person’s choice of

treatment, I respect their decisions may be coming from their culture and that their beliefs are

more important than pushing medical advice on someone that is not open to it. It can be

frustrating but I am more open-minded with America’s diverse populations. Additionally, in my

nursing research course, I was introduced to more nursing literature than I normally would

voluntarily read and became more versed in current, past and future healthcare. Also, I have a

better outlook on what someone describes as “healthy” and how different that meaning becomes
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in various populations. Population health management is considered the act of identifying and

addressing the health of individuals within defined populations, but this can be done in many

different ways (Bresnick, 2017). Public and community health are important to our survival and

we need more people on the front lines that have access to researched data in order to achieve the

best healthcare possible.  I definitely have a better understanding on nursing research and how

effective it is to healthcare.

Nursing Leadership

The second PGC is to demonstrate leadership skills to promote patient safety and the

delivery of high-quality healthcare. I never had a desire to become a leader in nursing. I like to

go to work, do my job, and then go home. I don’t want to be the one that has to deal with all the

nursing responsibilities of other nurses and be forced to make the difficult decisions. After taking

the leadership course in the BSN program, I realized that nursing leadership is not just being the

boss. Nursing leadership also means being a trailblazer in your profession and being admired by

other nurses for the job you do. I believe I am very good at placing IVs and have grown

extensively while on the IV team. I have become an asset to my team and want to help new

nurses become more skilled in the process. I have taken on more teaching roles for new IV team

nurses and volunteered to complete additional trainings. On a larger scale I also believe nursing

leadership includes not always accepting whatever the major healthcare providers say is

necessary and essential. This program has taught me to be more vocal in best practices.

Additionally, I learned more about leadership in nursing while working with my

preceptor for the practicum experience. I used to work on 2C and was aware of the types of

patients but I was not aware at home much more work goes into being the charge nurse. My

preceptor takes on the charge nurse role along with her regular patient assignment. I am grateful
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to have experience her leadership roles. I also spoke with her about possible teaching

opportunities and she encouraged me to further my nursing education. She definitely broadened

my respect for how much more work charge nurses can experience during their shift. My

practicum experience was only available because I am already a nurse at Christiana or I would

most likely not have been able to participate being back on a hospital floor shift. It was a great

change of pace and made me appreciate my job as an IV nurse even more.

Evidence Based Care in Nursing

The third PGC is to apply skills of inquiry, analysis, and information literacy to support

evidence-based professional nursing practice. Evidence based practice should be the most

applicable process in nursing because it provides the most realistic outcomes. Policies and

procedures must adapt and change according to what is better practice based on experience. If we

are doing something that is outdated and no longer helpful to patients, evidence of other

procedures need to be applied. These changes cannot always happen due to financial difficulties

and the fear of change but should always be researched until proven most effective no matter the

costs. Research sometimes requires change. Healthcare professionals should always strive to

integrate best current evidence with clinical expertise and patient/family preferences and values

for delivery of optimal health care (QSEN, 2019). It is important to have researched evidence,

clinical expertise and patients who strive to achieve the best possible outcome. I have used

evidence-based practice as an IV nurse when reading articles on Central line associated

bloodstream infections (CLABSI). Practices associated with prevention of CLABSI should be

followed closely and adhered to carefully so these huge mistakes cease to exist. At my job, we

have found evidence-based practice to be the best practice with access to ports remaining only
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with the IV team so infection is prevented due to having a lower number of nurses involved in

the patients’ line. The hospital pays for CLABSI so they are always supporting its prevention.

New Technology in Nursing

The fourth PGC is to integrate information management technology to improve patient

outcomes. Again, CLABSI is a problem that is a hospital acquired infection and can be one-

hundred percent avoidable. There are reoccurring recommended strategies for CLABSI

prevention that are categorized as basic principles or special approaches. Hospitals can prioritize

their efforts by initially focusing on implementing the prevention approaches listed as basic

practices (Marschall, 2014). Basic care seems to be more common and current. Basic care

includes sterile equipment, gloves, and hand hygiene. These are essential parts of not only IV

care but nursing in general. Some special approaches can be implemented in specific hospital

locations or patient populations depending on outcome data, risk assessments, and/or local

requirements (Marschall, 2014). Special approaches apply to patients with certain illnesses and

may require special dressings. These are the types of patients where the IV team should be called

anytime there is an issue with a dressing or port. The type of research used to develop these new

technologies and strategies on the prevention of CLABSI depends on internal and external

reporting of CLABSI and the facilities financial capabilities. Mandatory CLABSI training is

required to keep new technology prevention on this issue.

Advocacy in Nursing

The fifth PGC is to advocate for patients and the nursing profession with regard to

healthcare policy at the local, state, national and global level. When you decide to become a

nurse, I believe you are aware advocating for patients will be a part of the experience. I did not

think advocating for my fellow nurses would be as prevalent as it is today. We are in a pandemic
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where nurses are “heroes” to some but are not being treated as such by management. As a nurse,

my job is to promote healing while preventing harm and keeping the best interest of the patient. I

have had numerous experiences advocating for patients and acting as a nurse leader during my

12 years as an RN. One example I remember is advocating for patients when doctors order

numerous medications and the nurse calls IV team asking for several IV’s. One time a nurse

requested four sites on one patient. I told the nurse this is excessive and she needs to contact the

doctor to request a better form of access; i.e. some form of central line. Here, the patient was

intubated so I was advocating for this patient when he was unable to do so.

I have advocated for fellow nurses regarding IV assignments being changed due to

COVID. Before COVID, each nurse on the IV team was assigned to specific floors. For

example, f7E, 6E and 5E were floors found in the same assignment. Since the COVID outbreak,

Christiana hospital has designated certain floors for COVID patients, such as 7E. This would

mean that an IV team nurse would be assigned COVID and non-COVID floors. I recognized

that IV nurses going to and from COVID floors could pose problems for patients and for the

nurses. I emailed my manager and spoke to other IV staff about this issue and posed a solution to

designate all COVID floors to one IV nurses. I was able to get the IV team to vote yes on the

new assignment and we were able to isolate COVID related IV calls to one IV nurse. To

promote this change, I volunteered to take the COVID floors first. I feel advocating for other

nurses can be just as important as advocating for patients.

Patient Centered Care in Nursing

The sixth PGC is direct patient-centered care through advocacy, interprofessional

communication, collaboration, and delegation. As an IV nurse, I believe I am a huge advocate

for patient centered care because we are called when there is a special need. My favorite part of
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my job is when I am able to go to a patient who is either afraid of needles or who thinks there is

no one that can successfully place an IV on them without trouble. I feel amazing when I am able

to make their IV experience less complicated and painless. The surprised faces and compliments

make my job inspiring. IV placement is a specialized nursing task and I take pride in being

proficient in that area. I communicate with other nurses on best IV care and how to alleviate any

IV pain. My job focuses on patient centered care in their IVs being efficient and painless.

Patient centered care also involves teamwork and collaboration. Nurses need to demonstrate

awareness of their own strengths and limitations as a team member and within their own scope of

practice (QSEN, 2019). Most nurses should be able to place IVs but may be too busy or have

other tasks that are more demanding. My job is to help other nurses perform more efficiently by

placing their patients IV while they perform other important nursing tasks.

Global Nursing

The seventh PGC is to integrate health promotion and disease prevention practices to

positively impact the delivery of healthcare to diverse populations. During the global health

course, I really focused on vaccines since I had a brand-new baby at home I was more interested

in the effects. It was alarming how healthcare varies on the global level and the different types of

concerns in other countries. It is sad that there are countries that do not have easy access to polio

and the measles-rubella (MR) vaccine. Bangladesh in January-February, 2014, made campaigns

to increase MR vaccination coverage. Results included children who attended school were more

likely to be vaccinated than those who did not attend school (Uddin, 2016). In addition, the

measles outbreaks are upsetting and cannot always be avoided. Countries that do not have easy

access to major vaccines, need the most help. Routine measles vaccination for children,

combined with mass immunization campaigns in countries with low routine coverage, are key
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public health strategies to reduce global measles deaths (WHO, 2020). The global health class

also introduced me to the WHO foundation and website, which is something I refer to often now.

Under the WHO Global Vaccine Action Plan, measles and rubella are targeted for elimination by

2020. WHO is the lead technical agency responsible for coordination of immunization and

surveillance activities supporting all countries to achieve this goal.

Nursing Ethics

The eighth PGC is to practice professional nursing with an ethical framework. Ethics in

nursing is very important. Our ethical decisions go towards our professionalism and keep

patients trusts in healthcare. Hospitals have an obligation to the public. The public has a right to

expect that health care workers and the institutions in which they work will take all necessary

and reasonable precautions to keep them safe and minimize harm. We are in a current pandemic

and nurses’ jobs are at an all time high with stress. At my hospital, there are no visitors allowed

which can be good and bad. Sometimes the visitors are able to help a nurse with the patient

because they know that person better. Without family members, the patient is left to advocate for

themselves which is not always possible. Now, nurses have an ethical obligation to provide the

best care for their patients since the family members are not present.

Lifelong Learning in Nursing

The ninth and final PGC is to demonstrate lifelong learning that empowers personal and

professional growth. The BSN program at Del-Tech is a great program and I am glad to have

been part of the experience. Even though I was not happy about having to complete my BSN, I

am a more well-rounded and educated nurse because of this program and will continue to apply

what I have learned to my professional and personal life. I definitely will feel more confident at

work having my bachelor’s degree.

References

Bresnick, J. (2017) How do population health, public health, community health differ; What’s

the different between population health, public health and community health? Health IT

Analytics; Xtelligent healthcare media. Retrieved from

https://healthitanalytics.com/news/how-do-population-health-public-health-community-

health-differ

Marschall, J., et. al (2014). Strategies to Prevent Central Line–Associated Bloodstream

Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital

Epidemiology, 35(7), 753-771. doi:10.1086/676533. Retrieved from

https://www.jstor.org/stable/pdf/10.1086/676533.pdf?refreqid=excelsior

%3A45d3a1bcc2d59ec990fae3c6a41627c5

Uddin, J., et. al. (2016). Evaluation of impact of measles rubella campaign on vaccination

coverage and routine immunization services in Bangladesh. BMC Infectious Diseases.

Retrieved from http://www.healthdata.org/search?search_terms=immunization

QSEN Institute (2019). Quality and Safety Education for Nurses; QSEN competencies. Evidence

based practice. Retrieved from https://qsen.org/competencies/pre-licensure-

ksas/#evidence-based_practice

World Health Organization WHO (2020). Measles. Retrieved from

https://www.who.int/immunization/diseases/measles/en/