Practice Summary Paper. Courtney Erin McFarland. Old Dominion University

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1 Running head: Practice Summary Paper1 Practice Summary Paper Courtney Erin McFarland Old Dominion University

2 Practice Summary Paper2 Practice Summary Paper The end of my journey to complete the RN-BSN program at Old Dominion University is in sight. I have always known that I wanted to obtain my bachelors degree as it has always been an important goal of mine. It makes me feel that I have more of a sense of professionalism about myself. I have always been very proactive in continuing education whether it be educational classes, in services, or continuing education case studies in medical journals. There were many reasons why I chose to complete the RN-BSN program and one is that I wanted to further my education even more, however on a professional level. Another reason why the RN-BSN journey was important to me is because I knew that holding a bachelors degree was a new requirement of nursing jobs in hospitals around me. Soon after I started the program, the hospital I worked for made it a mandatory requirement that by 2020, all registered nurses employed at that hospital would need to have a minimum education requirement of holding a bachelors degree. Throughout my journey in the RN-BSN program at ODU, I do not think my goals of completion had changed. I did feel however, that instead of me going at my own pace and for my own satisfaction, that my jobs new mandated requirements, that my completion was set to a time clock. I did move out of state to Georgia and start a career at a hospital where a bachelors degree is not a requirement of nurses and I do feel that I do not have as much stress associated with the completion of my degree. However, I miss home, and in order to come back to Virginia, and work at my employer, I will have to have the bachelors degree requirement fufilled prior to me even planning to move back home. There are eight different program outcomes that are achieved by the end of the RN-BSN program at Old Dominion University. They are commonly referred to as "The Great 8's". The

3 Practice Summary Paper3 great eights that the program focuses on are critical thinking, nursing practice, communication, teaching, research, leadership, professionalism and culture. In this practice summary paper, I will explain how I have mastered and attained The Great 8's at the completion of the Old Dominion University RN-BSN program. Critical Thinking One of the most important Great 8's of the RN-BSN program at ODU is critical thinking. Critical thinking is a fantastic attribute for any nurse to have. Before starting this program and also being a nurse in the beginning of her career, I wasn't able to critically think very effectively or quickly if in a life or death situation. For example, if I had a test question in front of me and I had to critically think in order to get the right answer, I would be able to do so. This is because I had time to be able to think out all the possibilities. In nursing in the hospital in the acute care setting, it sometimes is not easy to critically think. You have to be on your A-game all the time and be able to handle anything that is thrown at you. At the beginning of my career, if my patient decided to crash, I would panic. At the end of the program, I first take a deep breath and think about what is going on. A little bit of anxiety is good as it can help you to think clearly however, if there is too much anxiety or chaos, it can hinder thought processes. If my patient had gone into shock, respiratory distress or had chest pain, I would immediately want to treat the symptoms and not think it through completely. I would also call our rapid response team to come help. Where rapid response is a good resource to utilize whether you are a beginning nurse or a With experience and continued education, I have been able to fine tune my critical thinking skills. I am able to still use valuable resources such as rapid response, but I am also able to come up with my own interventions and or recommendations to discuss with the physician.

4 Practice Summary Paper4 Nursing Practice My own nursing practice has changed completely throughout the program. I can say that all of The Great 8's have affected my nursing practice in a positive way. I critically think better than I had before I went into the program. I am able to communicate with other healthcare professionals in effective ways in which I use proper communication. I use critical thinking and research to provide the most up-to-date evidence-based practice care to my patients that is safe. I am affiliated with such as the American Association of Critical Care Nurses and the American Holistic Nurses Association. By keeping up with research articles and evidenced-based practice articles that are supplied through these professional organizations, I can keep up to date with evidence based practice that not only involves my scope of practice in my area of expertise (cardiology). These articles also keep me up to date with other aspects of the nursing practice as well so that I am providing safe and effective care. I find myself using the evidence based practice I learn to teaching others around me what I have learned and how we can incorporate it into the practice we use in the hospital I work at. By teaching others and showing them new ways to do things based on evidence based practice I am exercising my role as being a leader and also team player. I even show my ability to critically think by taking the things that I learn and applying them to different patients with individualized care. Communication Communication is necessary and important part of nursing practice. Effective communication between healthcare professionals is critical in promoting safe patient care. Nurses must be able to communicate with others under pressure and be able to communicate

5 Practice Summary Paper5 clearly and articulate to prevent errors. A popular trend in healthcare today is read back methods were the status quo is to read back orders or important information in order to make sure they are heard correctly. It is also important that communication is clear between healthcare professionals when coordinating care. At the beginning of the program I was able to bring forth the proper people who could assist in patient care such as case managers, social workers, physicians when patients needed clarifications of certain things. At the end of the program, I am able to coordinate care for my patients. I am able to communicate with doctors and other healthcare professionals about the needs of patients. I am also able to explain things to my patients (within my scope of practice) that the patient did not understand or need help with. For example, if the patient was involved with the case manager speaking about details regarding care but the family member wasn't there and the patient wished for them to hear what the case manager had to say, I am able to comprehend what the case manager said. If they needed further clarification, I could always call the case manager back. Another example is that I can calmly and effectively speak to a physician on the phone and give him/her the necessary information about the patient needed to make a decision. For example, I can call the physician and tell them the patients name, a brief summary and what is going on with the patient and what my recommendations are and ask them for orders. This is a SBAR format which is the common way to quickly and effectively communicate with others in healthcare. My last example is about coordinating care. I was able to recently assess the need for my patient to qualify for home oxygen. I documented the assessment I made on oxygen demand needs for my patient in his chart, contacted the oxygen company and had a transport tank as well

6 Practice Summary Paper6 as a home unit delivered to his house. I also was able to set up a ride to his home in a ambulance as he was unable to ride in a car due to his disabilities. I wouldn't have been able to do that if I didn't gain the case management and leadership skills that I obtained in the RN-BSN program. Research Nursing research is constantly occurring everywhere every day. Nursing research develops into evidence based practice which constantly changes nursing practice. In the RN-BSN program I have had many opportunities through various assignments to conduct my own research to prove a point in an assignment. Research assignments about advocacy for nurses and patients, staffing ratios, medication errors and infection control. My group project in Nursing Nursing Science course, was an evidence based practice paper written about stethoscopes and infection control. Our research paper was constructed based on solid research from primary sourced studies. We also included evidence-based practice research which shown that there was a correlation between increased infection risk associated with stethoscopes that were not cleaned between uses very similar to those infection risks associated with unwashed hands. Since this was a group paper, we communicated via a variety of different pathways to make sure that our paper would be clear and concise and argue the point we were trying to make based on our research. I learned that evidence-based practice provided solid research to make the arguments in research and persuasive articles more believable. Leadership Prior to this nursing program, I was not really in tune with case management, leadership and management. At the beginning of the program, I had a difficult time even delegating parts of care to others such as CNA's. The important thing that I grasped out of the RN-BSN program is

7 Practice Summary Paper7 that it is ok to delegate to others. The nurse has many different tasks on her plate and it is extremely helpful when you can ask others to help you check off your to-do list. It promotes teamwork. I also became a leader as well during the program as I became a preceptor for new nurses as they oriented to the unit I worked on. I learned the difference between leadership and management. I feel that I would be a better leader than a manager as I tend not to like to manage other people and a unit but help and lead them. I have learned that I am a great mentor that fosters learning to new nurses and nursing students as they are on the floors learning their ways as they become great nurses. One of the assignments I enjoyed writing was a nurse leadership paper in Nursing 490W - Nursing Leadership. The paper involved me interviewing a nurse I felt was a great nursing leader. Professionalism Publicized articles are edited and revised with a fine tooth comb prior to their publication. In the RN-BSN program, it was required that we would use APA guidelines to write our papers and assignments. We were also graded that our grammar and punctuation were proper. This helped us prep for the possibility that in our professional careers that we may too one day write a professional article that will be publicized somewhere. In order to be thought of as professional, it is a standard to be able to have a well thought out, put together paper that is clear and concise. In the program, I was able to start organizing my papers prior to writing them by making outlines in order to include everything into the paper. I would print a very large rubric with check mark spots where I could check off every requirement of the paper prior to my submission. Using professional primary sources to reference and instead of secondary sources or pages that do not hold professional quality material (i.e. Wikipedia) and knowing how to professionally cite and

8 Practice Summary Paper8 reference their uses in papers was also important to learn. The assignment that I feel that exhibits professionalism the best is the advocacy assignment letter to a Virginian Congressman. I had an issue and a solution that I saw was necessary to change and my outlet to discuss this change to the congressman was a letter on the issue. If the letter was written unprofessionally without thought and grammar and punctuation checks and without primary sources of research supporting my solution, the congressman wouldn't think twice about my letter. However, if it was professional and was stated clearly and concisely and had the elements of a professional letter, the congressman may consider the issue and opt to change the common practice. Culture I have always been intrigued by different cultures and religions. During my time while I was in school obtaining my Associates Degree in Nursing, I took a religion of the world class. So much of cultures in the world are based on religion or belief systems. I have become more culturally competent throughout my nursing career and the RN-BSN program has helped me to become even more culturally aware. I had the opportunity in the Global Health nursing 458 class to research the culture of Mexico and discuss my findings in a wiki page assignment. In the Community Health Nursing 492 class, I participated in a Healthy People 2020 project where we identified obesity in a region of the United States and attributed culture as one of the reasons why it was a normalcy in that area. We offered an educational plan which provided many resources to help fix the obesity problem and we tailored the education to fit the cultural needs of people in the area affected. These two assignments helped me to identify the necessity of culturecentered care for patients and how important it is. I feel that I am more sensitive to cultural needs

9 Practice Summary Paper9 of people that I take care of. I would want someone to take into consideration my cultural heritage as well if I was in the hospital. Teaching I have always enjoyed teaching others - especially nursing students. I have also enjoyed teaching my patients as well. In Nursing 402, the Career Pathway Development course in the RN-BSN program, I wrote a paper in regards to intake and output and the balancing act. In summary, the paper discussed why there is such a large problem in measuring and documenting intake and output of the patient population in which this is an extremely important measurement to monitor. In writing my paper, it discussed how I taught my audience - nursing staff - the importance and how to correct the deficit. The paper required me to perform a needs assessment to identify my targeted teaching audience to assess how they learned. I also had to research my subject in depth to make sure I had accurate information. I took the information that I had researched and I taught it to my nursing unit as a part of the assignment. Even beyond the assignment, I use the information to educate my patients on how to monitor themselves once they go home so that they prevent the risk of readmission. I have even educated a few physicians that have been concerned with inaccuracies. Appraisal and Summary I have never been a believer that a nurse that holds a bachelors degree is a better nurse than a nurse that holds a certificate or associates degree in nursing. As nurses we all take the same NCLEX state board test in order to become licensed Registered Nurses. I never understood the hype of the differences between associates degree nurses and bachelors degree nurses. Now

10 Practice Summary Paper10 that I am nearing the end of the program where I have not only worked as a nurse but also worked as I am obtaining my bachelors degree in nursing, I feel that there is a difference. Nurses that do hold bachelor's degree have more of an aspect of leadership and management under their wing that is different than the associate degree nurse. This enables them to better be able to take on positions where they can be a leader, mentor or manager, such as mentoring new nurses being a preceptor, being a charge nurse or hold a significant position on a committee. I had the pleasure of learning about many different nursing theorists and their theories during my journey on the RN-BSN journey. My two favorite nursing theorists have always been Virginia Henderson and of course Florence Nightingale. Now that I have had the opportunity to learn of other s and be able to adapt their theories to case studies and my practice, I have found that I like those theorists as well. The one part of nursing theory that has stuck with me throughout my coursework in the RN-BSN program has been holistic nursing. I have found that my personal theory of nursing definitely is a holistic view of nursing. Treating the patient individually is majorly important. Nursing practice must be tailored to each person differently. In order to properly treat the patient, you need to not only treat them physically but mentally as well. A good nurse must take into consideration their religion, culture and belief systems as well as consider their socioeconomic background. My nursing practice has definitely changed as a result of my enrollment in the RN-BSN program at ODU because I feel that I am a better trained nurse. I am better able to manage patient care and in all aspects. I can be a nurse, but I can also use my case management skills that I have obtained to act as other resources and easily handle situations if those resources are not readily available. I understand processes better in healthcare such as throughput, cost effective

11 Practice Summary Paper11 care and I also understand reimbursement better. The bachelors degree program helped me as a nurse see the bigger picture in healthcare. Conclusion I am very happy that I am at the end of this program. It was a lot of work but it was incredibly worth it. I feel complete as I have satisfied one of my life goals and now I can check it off my list. The Great 8's are definitely important parts of nursing care that a well educated nurse will have a great understanding of in order to provide superior nursing care to his/her patients. I truly feel that I have mastered each one as I know my nursing practice has improved dramatically since beginning the RN-BSN journey. I feel that I will continue to use my education obtained during my RN-BSN journey to further my education even more and help teach others.

12 Practice Summary Paper12 Honor Code Pledge: I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned. Signed: Courtney Erin McFarland, RN October 28, 2015