Community-Based Practicum Reflective Journal Guidelines

Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion
Community-Based Practicum

Professional nursing meeting experience (4 hours)

Guide for Reflection Using Tanner’s (2006) Clinical Judgment Model
Introduction

What professional nursing meeting(s) did you attend and where was it located?
I attended the Virginia Board of Nursing Meeting on 9/17 at the Mayfield Road location in the Innsbrook area.
Background

Describe the purpose of this professional nursing meeting? Describe the agendas of the group and subgroup.
What type of issues did they address?

This meeting was a final hearing for three nurses, one RN and two LPN’s, to dictate the status of their professional
licensure to practice nursing. The group is the Board of Nursing, who are elected by the Governor of Virginia to
make decisions on professional licenses for nurses in the state (there is also a board of members who determine if
dentists, physicians, and massage therapists are safe to practice as well). There is no subgroup to the Virginia Board
of Nursing. The cases we saw on 9/17 were regarding drug diversion and drug-addicted nurses. The Board’s main
function is to protect the public, so they hear each case and attempt to determine whether they are safe to practice.

Noticing

What did you notice about the professional nursing meeting initially? Describe what you saw, heard and did
during the meeting?

The meeting was very formal, as to be expected as it is the nurses’ last stop in the system to determine if they’re safe
to practice nursing. It felt like a court case or a criminal proceeding to some degree because there were attorneys, a
court reporter, witnesses, and findings that were presented to the Board. The Board is giving a large amount of
documentation to review at least a week or two prior to the case being presented, this way they can review
everything beforehand (if they did not do this the cases would last much longer than they do). As students we were
expected to be quiet and watch, be respectful, and be engaging and ask questions afterwards when we were speaking
with Board members.

Interpreting

Describe what you thought about the information being discussed. Have you been involved in similar
discussion during your previous student nurse experiences? Describe the similarities and/or differences to
those encounters.

I haven’t been involved in conversations similar to the Board proceedings before in my nursing experiences so far.
I’ve heard about drug diversion and the idea of healthcare professionals being addicts – however, I had not known to
this extent. The first two cases were fairly similar, neither nurse appeared in front of the Board in person, and both
had diverted drugs from facilities at which they worked and taken the drugs themselves. They were both suspended
from practicing nursing several years ago, and placed in the Health Practitioner’s Monitoring Program, which they
both did not comply with the program’s requirements. Both of their licenses were indefinitely suspended in the end.

The second case in particular I was bothered by. The woman presenting Ms. Weant’s case kept saying “her drug of
choice”, rather that stating that she had taken dilaudid from the facility she worked at, and was presenting to
hospitals in Northern Virginia with flank pain/abdominal pain/etc. and being administered narcotic pain
medications. The phrase “drug of choice” was used at least five times, which felt biased and like an unfair
presentation of information to the Board. Of course there was a wealth of information provided to the Board on the

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times Ms. Weant had presented to hospitals and had been given dilaudid, approximately 28 times over the course of
a year or two – however, it is hard to say whether Ms. Weant truly experienced chronic pain and became addicted to
narcotics or if she created those symptoms in order to be administered the drug. Either way, she was deemed not
safe to practice (understandably so), but I felt that judgement should not have been passed upon her in this manner.

Responding

Describe stresses (both positive & negative) you experienced as you responded to the new learning or the
challenge.

I was overwhelmed by the idea that a nurse could end up at a hearing in front of the VBON by means other than
diversion of drugs. We spoke to Board members after the meetings and Mark Monson, the citizen member,
reminded us that we could be brought in for things that we “didn’t know weren’t in our scope of practice” or by
omitting something in charting/not charting correctly, etc. He told us that they’ve seen a lot of new nurses that have
come in and said, “I didn’t know I had to renew my license” and that they’d been practicing without, etc.

What role would you take being assigned to represent your unit in this group? What subcommittee would
you like to participate with and why?

I couldn’t represent my unit in particular on the VBON. There are different types of nurses with different
backgrounds in order to give the best results and outcomes for professional licensing, so I could always apply to be
an RN member of the board. There aren’t any subcommittees for the board.

Reflection-on-Action and Clinical Learning

What written evidence is available to support professional nursing groups and their impact on the
development of evidence based practice and improved patient outcomes. Cite/reference all journal articles
that contributed to the evidence.
According to G. Mallory, nursing societies are in a particularly unique position to “promote evidence based
practice”. Mallory’s article covers the ways in which the gap between research knowledge and practice can be
closed, through professional nursing groups. As covered in the article, nursing societies are able to “provide
education, information, standards, certification, discussion forums, strategies to address a specific mission, and a
community of common interest” to their members. Mallory notes that nursing societies are able to advance
evidence-based practice by supporting all phases of EBP – from the research to implementation to evaluation of its
implementation.

Mallory, G. (2010). Professional nursing societies and evidence-based practice: Strategies to cross the quality

chasm. Nursing Outlook, 58 (6), p. 279-286. doi: 10.1016/j.outlook.2010.06.005

https://www.nursingoutlook.org/article/S0029-6554(10)00267-8/pdf

What is the value of professional nursing meetings both as a part of a healthcare system and within a
professional organization?
Professional nursing meetings allow for discussion of best practice, new ideas to implement into care, evidence-
based practice and the results of that practice (creating for more buy-in to a new technique or way of providing care,
etc.).

Describe any changes in your values or feelings as a result of this experience.

I don’t have any changes in values due to this experience, but it did open my eyes to the fact that I could be called
into the VBON for a small misstep, something simple, or something that got several nurses wrapped up (like an IV
burn, don’t know what it occurred exactly, and nurses from three shifts are called in, etc.). I will be cautious and
careful and educated on what exactly I need to do to protect my license.

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Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment

Model. Journal of Nursing Education, 46(11), p. 513-516.

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