A clinical exemplar is a story that is narrated by a nurse, or in this case a nursing student, about an experience with a patient or a clinical situation. This story writing process is a way to improve a nurse’s self-care though reflective writing. This type of writing also enhanced learning and knowledge.
Above is my clinical exemplar about a patient and situation I had during my preceptorship.
Reflecting on the SMART Goals I set for myself in January, I believe I have become a better test taker and feel more prepared for the NCLEX. Through my individual performance profiles on ATI assessments, I learned many things I could improve on to better my scores. At the beginning of the semester, I was taking tests very quicky and not reading the questions/answers very thoroughly. After reviewing the Adaptive exams, I realized many of my incorrect answers were due to not taking the time to read the questions/answers. After realizing this, I began to take the tests slower and read through the questions slower, this greatly improved my score and helped me differentiate between incorrect answers due to this or incorrect answers due to a knowledge deficit.
After taking these ATI tests, I learned different areas that I needed to improve my knowledge. Some of these areas were deficits because we had not covered the material in class yet. The other areas were content gaps I did not know I had. My plan throughout the semester to improve these gaps were through ATI remediations, reviewing content in the textbook, and learn about the topics in class. These three methods helped me develop a deeper understanding and memory of the content I often forgot. Through these methods, I am now able to answer the questions correctly through memory and understanding.
Throughout this semester, we as students have learned how important it is to have self-care in a profession like nursing. At the beginning of the semester, my last hockey season was still going on. I truly looked to hockey as a huge portion of my self-care and work/life balance. However, in March the season came to an end. This was difficult for me because I needed to discover other ways to provide self-care. I began meditating and working out. These two things helped create a base for my self-care. I believe I am much more prepared to have a work/life balance now than I was at the beginning of the semester and look forward to having the ability to do both work and other fun activities.
The skills I have learned throughout this semester will continue to help me after I graduate. The learning I have done in Transitions will help me prep for the NCLEX by taking practice questions, reading the questions slowly, and understanding why I did not answer the question correctly. These small tools will help me be the most prepared to take my boards. These skills will also help me after boards, transitioning into the field of nursing. These skills will help me time manage, prioritize, and critically think about situations.
After receiving feedback from both classmates and my professor, I revised my resume. Attached above is my final resume.
I plan to become licensed by examination in Maine. It is part of the Nurse Licensure Compact (NLC). The application for licensing in Maine is web-based and the application requires me to send official transcripts and a sign off from the director of the program. Maine also requires both criminal background checks (CBC) and finger printing. CBC must be completed prior to the date of examination and is only valid for 90 days. The CBC process is through the Maine State Board of Nursing application. To get fingerprinted, I need to travel to a location in Maine that is accepted by the Maine State Board and get go through the process of finger printing there.
After listening to the presentations from the District Attorney’s Office and Medical Professionals Health Program (MPHP), I reflected on how the Maine State Board of Nursing helps provide care and education on different issues that may arise. On the website, it provides information about being required to report suspected impairment or other issues that require disciplinary measures. There are resources for recovery on the Maine State Board of Nursing Website, including links to MPHP. I plan to protect myself and my license from legal issues by documenting in general, as well as documenting incidents through an incident report. I will also notify both the nurse manger and anyone else I need to if an issue arises.
After watching the video, “Man Gives Birth to His Child”, I reflected on my reactions and feelings if I were assigned this birthing couple/person. My first initial reaction would be to ensure I did not mess up any pronouns. I would want the family to feel safe and secure in the hospital setting. Through actions of inclusivity of their gender and sexuality, I believe they would have a greater opportunity to feel safe and comfortable. I would also treat the family the way I would treat any birthing couple and person; with compassion and patient-centered care. The birthing person had very specific wishes for his labor, as a nurse I would try to include these wishes throughout his labor. In a nutshell, my reaction and feelings would focus on inclusivity and making sure the patient and partner feel welcomed at this hospital.
To make this birthing couple feel welcomed at the hospital it is important to incorporate inclusivity into their care. Some methods to increase inclusivity in the hospital setting would include asking the individuals pronouns and making a conscious effort to say the correct pronoun and ensuring the other members of the team are aware of the correct pronouns. It is also important to explain everything to the patient prior to completing the action, this allows the patient to feel prepared and decline if they don’t feel comfortable. As nurses these actions can help make the patient and their significant others feel comfortable, especially in a vulnerable situation, like childbirth.
In a situation like the situation that was brought up in the video, using female-specific language can impact the delivery of care. Using female-specific terms for someone who identifies as a different gender can create issues with patient-centered care. The patient many feel as though the nurse is not listening or respecting their wishes, this can lead to issues with communication and comfort in the hospital setting. A short-term issue for the patient could include their time at the hospital may be uncomfortable and difficult, they may feel judged or disrespected. Regarding long-term issues, the patient may have anxiety returning to the hospital or assume all healthcare services do not respect their wishes. This can lead to extended periods without care and not attending appointments due to fear or discomfort. Every member of the health care team should be aware of the patient’s pronouns and provide inclusivity regardless of their personal beliefs. This will allow for the best care to be provided to the patient and their family.
This movie was a great documentary that showcased nurses throughout the profession’s development. The documentary began by reflecting on a time before nursing was considered a major profession. The movie brought up many amazing individuals including Florence Nightingale, who was a huge component of the beginning of nursing. I enjoyed watching the movie and thought this quote, “It is hard to not find someone who’s life has been touched by a nurse” perfectly summed up the profession of nursing.
Throughout my time in nursing school at the University of New England, I have been given many different skills that will aid me in my transition to practice. However, one skill highlighted in the NURSE movie that I have truly no experience with is end of life care. Through my clinical rotations and work as a CNA, I have only had one patient that was nearing the end of their life and on hospice care. Due to this, I feel as though I have not had the opportunity to obtain of skill regarding end of life care and education regarding death. The documentary did an amazing job discussing this skill and how many nurses have created the skill into a positive tool when caring for patients.
One population that the movie highlighted that I have not yet served in my time as a nursing student, is the Native American population. The documentary did a fantastic job discussing the care of this patient population as well as how to incorporate their beliefs into the care the nurse is providing. Throughout school, I wish I had an opportunity to travel to a patient population, like a Native American community, to care for individuals there. At UNE, we have learned briefly about populations like Native American populations and how to incorporate their beliefs into our care. It was interesting to see this population be discussed in the movie about how to care and travel to these populations. One barrier that was shown in the movie was the ability to get access to care. Oftentimes, individuals may not have the resources to obtain care. These resources can include transportation or insurance. The documentary discussed way to still care for these individuals. The best example I saw while watching the movie was nurses traveling to Native American communities to provide care rather than trying to get the communities to the hospital setting. This allowed these individuals to get the care they need even when they may not have the resources to do so. After finishing this documentary, I reflected on areas I may want to improve my understand of populations and inclusion. Two areas that I would be to improve on is better understanding how to provide care of individuals that may have immigrated to the United States that may have different practices regarding medicine as well as different views for certain religions. Both populations may have strong beliefs that I would like to be inclusive with if I can. I think better understanding their beliefs would help me provide the best care for these populations. Overall, I truly appreciated this documentary and its ability to highlight to humility and compassion of the profession of nursing.
After working with the guest speakers that we were fortunate enough to have in our Transition to Practice class, I realized I needed to develop an understanding of what my strengths and weaknesses were. This self-reflection can help put me above other applicants. I think my best strength is being a student-athlete at UNE. Throughout my four years here, I have participated on the women’s varsity ice hockey team. This balance of school and sports has given me the ability to prioritize, and time manage extremely well. An average week for me during season would showcase why this is considered a strength. Throughout a week, I have practices on Monday through Thursday starting around 5 and ending around 8. I have games and travel on the weekend (Friday and Saturday). This type of schedule can create barriers to prioritizing homework and exams. However, I can time manage extremely well and prioritize homework when it is needed. Since being a student-athlete has led me to be able to time manage and prioritize, I believe it is one of my biggest strengths. Regarding weakness, I reflected on my life and came up with a weakness that I could improve on in the hospital setting. The first is having the ability to delegate tasks to others. I struggle delegating tasks because when I get on a roll, I tend to just want to do everything by myself and I also feel bad having to task someone else with the intervention. One way I plan to address this weakness is to understand that at the hospital, we are a team and teammates always work together. I think this viewpoint will help me better delegate tasks to others.
While watching the nursing report provided, I was shocked to listen to the way the nurse giving report spoke about the patient. In the 40 second clip, I was stunned to hear so many biases. Many comments that the nurse giving report said made me extremely uncomfortable. The first comment was within 5 seconds of the beginning of report when she said, “let me give you report, so I can go.” Although this comment is not necessarily related to bias, it still seems inappropriate to say to the other nurse. The second comment that made me uncomfortable was the pronunciation of the patient’s name. The nurse giving report addressed the patient’s name incorrectly and then proceeded to say “who knows where he’s from” insinuating that he is not from here due to his name. This is also an extremely inappropriate comment and shows the nurse’s bias towards the patient. The last comment that stood out to me was the comment about how the patient was injured. The patient had reported his injury was due to a sports accident related to skateboarding. However, when the nurse giving report commented on why the patient was admitted, she used air quotes when addressing the skateboard accident insinuating it was something else has caused his injury instead of a sports injury. These comments made me extremely uncomfortable and showed the reporting nurse’s biases.
These statements are extremely important to address because of many reasons. First, comments like these are inappropriate regardless of the situation or patient. Secondly, the nurse giving report is displaying a distaste for the patient and not treating the patient with the kindness and respect all patients deserve. These comments could take away from the care the patient should be receiving. These comments the nurse is making makes it seem as though she does not respect the patient enough to prove important care for him. Due to this, the patient could suffer physically after surgery and/or mentally.
My initial reaction if I was the nurse receiving this report would be extremely shocked and then have a difficult time responding to the initial comments. However, after my shock subsided, I would feel upset and angry with the words and biases the nurse giving report was saying. I do think I would be able to address the comments the nurse was making. I also think I would bring these comments to the attention of the charge nurse to further discuss the actions that should be taken.
One of the most uncomfortable situations I have witnessed that displayed bias was in my first clinical rotation. This specific rotation was on a rehab unit with patients recovering from knee, hip, etc. surgery that typically received opioid pain medication. I was in a room with a patient taking a head-to-toe assessment when the rounding team of providers stopped in. I stepped out of the room to give the patient and providers time to speak. While in the hallway I was taking notes on my head-to-toe findings, when I heard one the providers begin to discuss pain management. The patient was upset with the topic and the provider became upset with the patient. After they left the room, the provider addressed the group and said the patient was only upset because they were a drug addict and did not deserve pain medication due to their addiction. The provider then went on to say the patient was from a certain town that was known for addiction and assumed that was why the patient was so upset about the change in medication. One of the other providers asked if the patient could be upset because the change to his medication was not previously discussed with them. The original provider laughed and said no the only possible explanation was the patient being a drug addict. This was the first time I have ever witnessed a bias in the hospital and was shocked to no one truly stand up for the patient.
As I progress towards graduation and the end of my nursing schooling, I have many mixed emotions. I am excited to begin working in a hospital and taking care of patients. I am also excited to take everything I learned from nursing school and incorporate it into what I am learning at the hospital throughout my orientation and first few years. Although I am very excited to begin my new journey of becoming a nurse, I am also very anxious about it! My biggest fear currently is taking the NCLEX. I believe this is my biggest fear because it is standing in between me and becoming a true registered nurse. However, I am grateful for classes, such as transition to practice, that is preparing me to take the NCLEX. Through these classes and studying small sections of different material each day for 30 minutes, I feel as though I will be able to attain my goal.
In Transition to Practice, I watched modules on four major Nursing Logics. I learned many helpful concepts from these modules. For the first Nursing Logic, Knowledge and Clinical Judgement, I learned different strategies that will help me succeed. These strategies included meaningful reading, sticking to a routine, and foundational thinking. These three concepts will help me when studying for nursing classes but also when I am prepping for the NCLEX. In the second Nursing Logic, Nursing Concepts, I learned about new technology, web-based information, and good resources. These concepts are important to me because many patients will look up what is going on with them on the internet. Through this module, I will now be able to give patient safe and helpful internet resources. In the third Nursing Logic, Priority Setting Frameworks, I learned about survival potential and the different categories within that, I also re-learned about safety reduction, and ABCs. Although I already had knowledge on airway, breathing, and circulation (ABCs) and safety reduction, I believe it was extremely helpful to re-learn the material. Lastly, in the fourth Nursing Logic, Testing and Remediation, I learned how to prep and take a standardized test, like the NLCEX. I also learned how to properly read the questions and critically think about the answer. Lastly, I learned about the NCLEX and ways to properly take the test. Although I am very nervous for my upcoming future, especially the NCLEX, I know my nursing classes and materials like the Nursing Logic will help me when taking the exam.
After finishing the dissemination project, we looked for thoughtful and important responses from the unit we did our project for. The response was that the staff that did the survey agreed on the feasibility of improvement of sleep quality because it is something many individuals in the hospital struggle with. They also agree that it was feasible to implement the new practices within their unit to better the outcome for patients overall. Their feedback included difficulty accessing certain interventions to improve sleep. Having the accessibility of fans, aromatherapy, white noise machines can be difficult. Other feedback that was important to consider was the cost of the sleep interventions. Overall, the unit staff responded very well to the project and look forward to trying to implement these new practices into their daily practices for patients.
This project taught me many different things that can be used within my future practice of nursing. First, I learned that I can effectively and efficiently work with others to create a great outcome. In the hospital, the staff are always working together to provide the best care for the patients. I know I can work well with others which is extremely important for my future position in the nursing world. Through working on this project, I was able to dissect evidence-based articles to create a project that can improve the overall outcome for the patients. I now understand that I can work through scholarly articles to work on a project which will greatly benefit me in the future because nursing improves through new evidence-based practices.
I have learned many things about myself from this project. By working on this project with a group helped me learn a different approach of working on projects. We were able to break up the work into equal parts and discuss our parts with the rest of the team to continuously improve the project. This process helped us succeed with this project. As a team member, I realized I did not have to control the entire project. Oftentimes I enjoy being the leader and leading the team. However, this project I allowed myself to let others lead and follow by example. Before this project, I always viewed myself as only a leader that could not follow others, but this project allowed me to discover a new part of myself which I think improves my ability to work in groups.
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