For much of my life, I was not entirely sure what direction I wanted to

pursue for a career. I have always been a cheerful person and a driven
person. However, I found myself afraid to commit to a profession, until I
found nursing or rather, nursing found me.

I graduated from Michigan State University in 2004 with a degree in
Human Biology and moved myself to Colorado later that year not knowing a
soul. This was a liberating, scary, lonely, and amazing experience all at the
same time. I had a second chance to figure out who I was and what I wanted
to become.

After multiple jobs, including one working with developmentally
delayed adults, I finally figured out that I wanted to become a nurse. I came
to this epiphany more by chance than self-reflection. I was a good listener,
and found that helping my clients with medical appointments and medical
terminology was something I really enjoyed. Nursing seemed to be a logical
and exciting next step. On my nursing school application, my reason for
applying was that I wanted to help people. In January of 2009 I was
honored to be accepted into nursing school and graduated in May of 2011
with my BSN from The University of Colorado.

Wanting to help people is a very generalized phrase, and one I
would assume most people in the nursing profession use frequently. My
definition of helping people has changed dramatically over my three years
as a nurse. According to Benner, I began my nursing career in Stage 2, or as
an advanced Beginner. An Advanced beginner demonstrates marginally
acceptable performance because the nurse has had prior experience. As an
Advanced Beginner my clinical practice objective was to help people by
making sure that I did not have a med error or that I did not cause them a
traumatic injury from the multiple times I attempted phlebotomies and IV
starts.

My second year advanced to Stage 3: Competent. I had been in
similar situation for two years and could demonstrate efficiency in my
actions most of the time. This is when I began feeling like a well-rounded
nurse and not a task-oriented nurse. I could assess a patient not just
physically but also emotionally. As a BMT/Oncology nurse the emotional
assessment is often times more important than the physical part, especially
in our End of Life Patients.

By year three, I advanced to Stage 4: Proficient. I can now cluster
care, multi-task, and guide different levels of nurses toward answers. My
practice and experience has given me almost a sixth sense." For example,
in the past years I would have transferred a patient off of our unit to step
down or ICU because my charge nurse recommended it. Whereas now I
find that I recommend transfers just because the situation "does not feel right
to me." I can perceive the patient as a whole rather than an abnormal lab or
vital sign. I understand the situation and can prepare for the future care of
the patient. I feel that I am now making recommendations to doctors and my
peers about patient situations rather than asking for recommendations.

So, what is my Philosophy of nursing? My husband once told me
that people dont start out making large unethical errors, they start by
making a series of small ones that turn into larger ones. The first unethical
mistake you make and how you handle it will determine your overall
character in your profession. My nursing philosophy is integrity. Nobody
really knows how you talk to your patients or how you care for them but
you. Integrity is what defines nurses especially in their everyday practice.

Working in a large academic institution, things can be really busy at
times. A thirteen-hour day sometimes feels like an hour and often times you
cannot remember what you did except survive the day. As I remind my
patients that they need to pee every four hours, I know that I have not drank
any liquids or gone to the bathroom once time during my entire shift.
However, the first time that you do not look up a med before giving it or do
not report an error that you have made, then you have compromised your
integrity. I promised myself that no matter the cost or how much I do not
want to do something, I would not cut corners and would make sure to hold
myself to the highest standards in health care. Nurses are intelligent,
trustworthy, and must have integrity.

My philosophies and values have changed dramatically over my past
three years as a nurse, from focusing on tasks - and becoming frustrated
when difficult patients prevented me from getting those tasks done - to
focusing on my patients overall well-being. I have become a much more
accepting and tolerant nurse. I have realized that most of the time when
patients are angry or rude, it is because they are scared. If they are
demanding and yell a lot, it is because they are scared. If they joke and
seem detached, it is because they are scared. People process in very
different ways and as a nurse it is our job not only to care for them
physically but also emotionally. Patients do not need to know and should
not have to know how bad your day is, they need you to be present and take
care of them. There are always extra things that you can do for your patient
and more ways you can help them. You can educate them more, give them a
bath, or just sit and talk with them. Time is limited and I always wish I had
more time to talk with my patients and help them navigate through scary life
changing situations. I always try to make more time for these things even if
it means a shorter lunch break or staying late at work. I have learned that in
the hospital my patients come first and that being present is the best thing
you can give to a patient.

While it is important to put your patients first at work, it is also
important to ensure that you take care of yourself outside of work. You need
this balance to stay healthy. If you dont take good care of yourself, then
you may not be able to care for other either. I feel I learned this the hard
way. In December of 2012 I had my second baby. After maternity leave, I
thought that it would be a great idea to come back to work on a night
contract so I would have more time with my kids. I quickly realized that
not sleeping was both unsafe for my ability to care for my patients and also
for my well-being. I became irritated and angry. My husband, parents,
managers, and friends all pointed out to me that I wasnt myself. I thought
about my life and what kind of a nurse I wanted to be and realized that I
wanted to be a well-balanced nurse. I wasnt exercising, eating well, or
doing anything fun. I was simply surviving and in turn I was becoming
increasingly unavailable for my patients. So, I changed my schedule to
include the things that I wanted to do at least once a week. I started learning
to knit, seeing my kids for who they are not what I wanted them to be (and
loving this even more), I started hiking again, reading at night instead of
watching TV, having date nights with my husband, connecting with friends,
being outside every chance I could, and just trying to notice the all of the
wonderful things in life like sunshine. In addition, I was able to actually
taste coffee, instead of drinking it to stay awake. Once I started doing these
things for myself, I noticed a huge difference in my mood at work and at
home. I was present for my patients because I wanted to not because I
had to. I believe in order to be a great Oncology nurse you have to care
about you too and take the time to care for yourself.

Since deciding to credential I have found a new purpose at work. I
feel invigorated and challenged in a way I had not felt before. Before
deciding to credential, I felt I always worked hard while at work but was not
fully engaged and invested in the unit. I still loved going to work and taking
care of my patients, but found myself wondering why leadership was
pushing so many different things on the staff. Why should I specifically ask
patients if they needed to use the bathroom? Isnt it good enough that I have
asked them if they need anything else? before Ive left the room. I did not
understand that performing MAIDET, hourly rounding, LOOK report, and
assessing patient satisfaction scores DO matter to patients and make a
difference in their overall outcomes and care. I now find myself asking
patients before leaving the room very specific questions like; Do you need
to go to the bathroom? Do you need help positioning? Do you have any
pain? or Do you need help reaching any personal items? This was all the
training I learned so long ago but was unaware of how much these specific
questions matter to patient outcomes. For me credentialing has forced me to
research why we do certain things and it has helped me to find the value and
importance in these things. I now encourage my peers to become engaged
with patient care and have started holding them accountable when I dont
see them rounding on patients, doing LOOK report, or MAIDET.

Credentialing has also unveiled all of the behind the scenes things
that my leadership team had been doing without much of the rest of the staff
knowing how hard they all work for our unit. It has been exciting and
enlightening to know how much work is done daily by the leadership team
and the leaders on the unit to make UCH so great. It takes an army to make
something great and the more leaders that the unit has, the better it becomes
and the happier the staff becomes too. I have found a new respect for my
peers who have decided to credential or already have credentialed and now
know what an honor and privilege it is to be able to make such a big
difference at UCH. A lot of the credentialing projects have not just changed
units but have also changed patient outcomes hospital wide. It is exciting to
have the chance to really change things from the inside out to directly effect
patient care. Since taking this project on in October of last year, I have
caught myself thinking up new ways to make my unit better and have taken
on more projects. I encourage taking the work on instead of thinking who
would want to do all that work? Yes, it is an amazing amount of work, but
it has been so rewarding. I am proud of the work I do for the unit and am
excited to present it and change things for the better.

In April of 2014, I was honored with a promotion to a Permanent
Charge Nurse. With this comes the responsibility of leadership comes
rounding on patients. One patient in particular really influenced me and
gave me a lot of insight into my own clinical practice. R.S. was a brilliant
man who happened to have been diagnosed with cancer in 2013. However,
he learned to cope with his cancer in a very positive way and took his 100
days on our unit in stride. He decided that since he was stuck here, he was
going to help me understand what it was like to be a patient on the Bone
Marrow Transplant Unit. I was inspired and amazed by his compassion to
help me gain insight into our unit so that other cancer patients may get an
even better experience. He said that sometimes he felt isolated and alone
because staff was always in such a hurry. While he understood that we
worked on a busy unit and that at times we needed to rush off, there was
many times that if we had just sat down and talked with him, he might not
have felt like such a number or just another patient. People want to be
heard and want to know that their care is important to you. Patients, not just
cancer patients, are often thrown into life changing situations quickly and
have little time to digest these feelings until they are sitting alone in their
hospital rooms. R.S. helped me to realize that sitting and talking with your
patients even for five minutes and just listening helps them to digest what is
happening to them and makes them feel like you care. Patients remember
that you listened to them and THEIR story. It does make a difference and
helps them through some dark times. Giving them respect, some dignity,
and remembering that they are a person and not just a patient matters while
they are in the hospital. They have lives, families, jobs, and hobbies just like
the rest of us and they are not their diagnosis.

R.S. also helped me to learn that listening to what your patient is
saying and NOT saying with their body language makes a huge impact.
Patients are often times embarrassed to ask for help or do not want to
inconvenience the staff. A patient may not remember if you administered
a medication exactly on time, but they will remember if you helped them
understand why they were taking it. A patient may not remember that you
asked them if they want to take a shower, but they will remember if you
make the time to help make sure they take one daily. A patient may not
remember that you asked them if they had any pain, but they will remember
if you assessed their pain well and helped them come up with a pain
management plan. A patient may not remember that they felt nauseous but
they will remember if you stay with them and rub their back while they
vomit in an emesis bag. Nursing is not just about doing a job, it is also
about caring for people when they are many times at one of the lowest points
in their lives and helping them figure out what they need when they dont
know what that need might be. I have changed my clinical practice to dig
deeper within patients and myself and to make sure that I dont view them
only as a patient but as a person. They deserve respect and compassion to
help them through these difficult times. Thanks to R.S. I now treat all of my
patients like I would want myself or my close family and friends to be
treated in a hospital. I try to remember that what may seem intuitive and
natural when building relationships in a personal environment is often lost in
a high stress and busy environment like the hospital. I am always amazed
and honored to be involved in some of the most intimate and difficult
moments in my patients lives. I used to be scared when people would say,
Im afraid to die and quietly wish that my phone would ring so I could
rush out the door. Now I welcome these conversations and feel privileged to
be able to help them through these situations. I have become more reflective
in my practice and within myself and now know that treating people with
respect and dignity certainly does not go unnoticed by our patients.



Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical
Nursing Practice. Menlo Park: Addison-Wesley, pp. 13-34.