For much of my life, I was not entirely sure what direction I wanted to pursue for
a as my career. I have always been a happycheerful person and a driven person.
However, I found myself scared afraid to commit to a profession, until I found nursing or rather, nursing it found me. I graduated from Michigan State University in 2004 with a degree in Human Biology. I moved to and moved by myself to Colorado later that year not knowing a soul. This was a liberating, scary, lonely, and amazing experience all at the same time. In a way I had a second chance to figure out who I was and what I wanted to become. I had a series ofAfter multiple jobs, including a jobone working with dDevelopmentally dDelayed aAdults, which is where I finally figured out that I wanted to become a nurse. I came to this epiphany more by chanceluck than self-reflection. Somehow, I wasI 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 how the manymultiple times I stabbed them attempting ed phlebotomies and IV starts. My second year I was advanced toin 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. Being 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 have entered into 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: where . For example, beforein the past years I would have transfer ed a patient off of our unit to step down or ICU because my charge nurse recommended it. Whereas now I should, I now find Ifind that I recommend transfers just because the situation does not feel right to me. Now, I can perceive the patient as a whole rather than an abnormal lab or vital sign. Not only do I understand the situation but 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, wWhat is my pPhilosophy 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. MSo, my nursing philosophy is Formatted: Font color: Black Formatted: Font color: Black, Not Highlight Formatted: Font color: Black Formatted: Font color: Black, Not Highlight Formatted: Font color: Black Formatted: Font color: Black, Not Highlight Formatted: Font color: Black, Not Highlight Formatted: Font color: Black 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 teaching hospitallarge academic institution, things are really, really,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. I find that, even aAs I remind my patients that they need to pee void every four hours, I know that I havent drank any liquids or drank approximately 0 mls of water and gone to the bathroom one timeonce during my entire shift. Even so, 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 medically 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 more 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 with and talk them. I wish I had more time to talk with my patients and help them navigate through scary life changing situations, but I always try to make time. 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 to bethis balance to stayd and healthy yourself. If you dont take good care of yourself, then you may not be able to care for other s either.people well. 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 asso 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 at life. 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 and started doing something that I wanted to do at least once a week. I to include the things that :started learning to knit, seeing my kids for who they are not what I wanted them to be (and loving this even more), sI 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 and Formatted: Font color: Black, Highlight Comment [WB1]: Run on sentence but cant figure our right now how to change it. Formatted: Font color: Black, Highlight Comment [WB2]: Contradicts itself? actually taste the ing coffee now , not without just drinking it to stay awake. Once I started doing these things for myself, I noticed a huge difference in my mood at work and home. I was present for my patients because I wanted to and just 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 loved 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 AIDET, 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 AIDET. 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 this year2014, I had thewas honored with a promotion of being promoted to a Permanent Charge Nurse. With this comes the responsibility of leadership 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.
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