This clinical exemplar is a document that describes a meaningful experience I had with a patient during my preceptorship on a labor & delivery unit. Here I describe a patient experience and the lasting effects it has had on me and my decision to go into maternity.
My SMART goal for the semester involved studying pharmacology more by putting a hobby of mine with what I’m learning. I followed this goal for two whole weeks before I realized I didn’t have the time nor energy to fulfill it. I still wanted to fulfil my goal of practicing pharmacology, so I ended up purchasing a deck of flashcards that had visual and pneumonic aids on it to help with learning pharmacology. It was neatly organized by NCLEX topics, so I was able to go through the medications by category. The use of the flashcards took away the stress of creating them myself, but still allowed me to learn a lot. I wasn’t expecting to score as well as I did in the pharmacology adaptive exam as I did so I think the extra use of the flashcards paid off.
When reflecting on my experience with ATI and the use of remediation I did find them helpful. Stressful, but very helpful. I found that during my ATI remediations I got a lot of the same types of questions wrong (content). I also found that I’m awful at select all that apply questions because I begin to second guess myself. At the beginning of the semester, I was extremely stressed out at the thought of all the remediations we would be completing. This past month though, I’ve found that I’ve gain better habits in completing them. I’ve realized I need to break up the remediation into sections in order for me to gain anything from them. I found when I would crank out a remediation in one night, I wouldn’t remember as much as I would have if I broke it up. I’ve also learned through my remediations that I need to take my time. There were so many questions that I got wrong because I missed a word or specific wording of the question that drastically changed my answer. I found that I still made silly mistakes and were rushing throughout the remediations just because of the stress of everything else around me.
This semester I feel like I’ve learned a lot of test taking strategies and have narrowed down topics in which I need to focus on more than others in preparation in taking the NCLEX. Pharmacology and mental health are still the two topics that I need to do the most review on. Beyond the NCLEX, I’ve learned many useful skills that will help me in my future career. For example, I need to trust my gut and not second guess myself. When I second guess myself that’s when I usually do the wrong thing. My time here in the UNE nursing program, along with this course, has reinstated my lifelong problem of that procrastination only causes more stress. This will be helpful when I’m practicing as a nurse with things like charting and keeping on top of tasks. I’m excited to be going into a career in which the learning never ends.
Coming into gerontology, to be honest, I wasn’t too excited. Growing up you hear about how awful it is to get older and it made me decided early on that older adults aren’t the population I wanted to be working with. I didn’t really have a big change in heart regarding this population until we had our two guest speakers come to class and talk with us. That day was a major turning point for me and made me more open to work with older populations. It also made me reflect on how I react, behave, and interact with older adults. They gave me the insight I needed to change my views and to not look at older individuals as weak or fragile.
After that once class, on my drive home, I reflected on how I thought of my grandparents. It made me realize how much more capable they were than I thought. I was always so quick to open something or grab something off the floor for them because I thought I was helping them. Little did I know I was actually hurting them by not allowing their body to move in such a way. Since then, I’ve allowed the older adults to attempt first, then ask for help. Rather than assuming they need my help.
Another major turning point for me was the LifeBook project. I was fortunate enough to interview one of my grandmothers. A year ago, my other grandmother passed and after her passing I realized how little I knew about her outside of her being a mother and memere. The LifeBook gave me an opportunity to learn things about my gram that I didn’t know or even know how to ask. I was grateful for the opportunity to learn more about my grandmother because without this project, both her and I, probably would have never found the time to sit down and talk the way we did during that interview. Even though it was my grandmother, I felt I was learning just as many new things about her as my partner. The project gave me tools to help better work with the populations of older adults.
I love going to school at UNE because we get to do our clinical in the greater Portland area. It gives us an opportunity to see patients from all kinds of different backgrounds and demographics. Last semester I got to go all throughout MMC maternity units. One week I got to spend time in the NICU. I got to work with a patient was born at about 28-30 weeks gestation (I don’t exactly remember) and he was born to teen parents. This little baby’s home was about an hour and a half away from the hospital, north of Portland.
This situation came with many challenges, one being that the parents were teenagers and had never cared for an infant before. I worked with a great nurse that day who told me about all the education the nurses will have to give before the infant is discharged. These parents needed to learn how to change a diaper, mix bottles, warm bottles, swaddle, safe sleep, how to set up a car seat, and milestones the parents should be looking for. Another challenge that came up was the distance in which separated the infant and their parents. Due to their age and their lack of access to vehicles, it was hard for them to get to the hospital. Only one parent had their license, but they legally couldn’t drive the other. This added an extra hurdle because these parents would need to find someone else to drive them so they both could go. With them living so far away from MMC, this could be a potential issue of not being able to access the proper care quickly enough if they needed to while at home. The nurse informed me that one of the grandmas was very supportive. She did work a full-time job though, so it made it difficult for her to assist the parents. These parents needed to jump through hurdles for education, transportation, and access.
I think the NICU staff at MMC was doing a great job. The parents didn’t come in the day I was there, but they did call in. My nurse wasn’t quite sure about their financial situation but that could greatly negatively impact their lives. I got to listen to my nurse speak to the parents and I thought she did a great job using simple language to explain to them how their child was doing. The nurse was able to educate them on their condition and provide any education that was prevalent at the time. I think getting a better idea about their home and financial situation could help to paint a better picture for the infant. The infant seemed to have a small support system compromised of his parents and grandmother.
After graduation I intend on taking my licensure exam here in the state of Maine. I’m so looking forward to my preceptorship up at Maine General this month and hope that maybe a job can come from it. I’m happy too that Maine is a part of the compact states. My boyfriend lives in Massachusetts and after discussing with him the legality of getting my license in the two states, we both agreed that Maine would be the best fit for my first year (at least). I also wanted to apply to the state of Maine because with all the stress of school it seems like it’s the least complicated.
I’m fortunate that since our university is in Maine, they are well trained in helping students get their licensure. This past week we had a presentation that helped to spell out the application process and got to answer many questions my classmates and I had. Everything can be done online and I’m so happy that we can start our applications prior to finishing school, this helps to move things along much smoother!
Not only am I nervous to be a novice nurse out there, but I’m also nervous about all the changes that have occurred in healthcare over the past 2 years. With recent court rulings, I am nervous to make a mistake, especially as a new nurse. Being a nurse can be very hectic at times. With the chaos that comes with the job, to protect myself and my license, I’ve been working on always double checking. At first, I would do this because I was always second guessing myself. Now I do this to help myself form a habit to help protect myself and my patients from mistakes. I always try to triple check my medications and take my time when scanning them. Before leaving a room I always try to think, “how could my patient hurt themselves or decline once I leave?”. I’ve also finally become more comfortable asking for help. I’ve realized that potentially annoying a co-worker is a better option than causing a mistake. With all the potential things I could worry about, I’m trying to look at the positives and think of all the good things I could bring into the healthcare world. I’m so excited to graduate, pass my NCLEX, and start my nursing career here in Maine.
So much has changed since I initially wrote my About Me in February of 2021. I’ve learned so much in such a short period of time and never realized how many posts I’ve made on this site. Today I worked on changing my site, mainly by ‘cleaning up’ the look of it. It was quite cluttered with all my course work in the menu. I’ve changed my site now by putting ALL of my nursing course work under one tab. I’ve also added a resume tab that will hold my resume and clinical experiences. Lastly I’ve updated my About Me page since so much has changed!
I really enjoyed the movie NURSES. It wasn’t at all what I expected as I thought it was going to be a long movie exemplifying all the wonderful things nursing is (as it did). The movie though showed the other side of nursing, the not so pretty side. As an (almost) new nurse, I really loved hearing everyone’s opinions. I saw nurses adjust so easily to the everchanging world. I think adaptability is something I need to work on. I have a really hard time with change sometimes and that’s something, as a nurse, I’ll need to work through. I think as I’ve gained more knowledge in my course, I’ve become more adaptable, but there is still so much that I don’t know. I think my adaptability will come with experience and a drive to learn.
This film has me thinking about Public Health nursing again. It’s something we don’t get to experience in a clinical setting during school. As a public health nurse, I would address these barriers we come across every day in the field of nursing. Patients who have no health insurance, no form of transportation, or those who can’t adhere to medications because they can’t afford it. The thing I loved most about college was opening my eyes to these vulnerable populations and driving me to want to help them.
I’ve been getting more and more nervous thinking about interviews and starting my career as a nurse. I can only hope that I can advocate for my patients the same way those nurses did at the end of the movie (when the elderly couple were both dying down the hall from one another). I know I need to go into these interviews with confidence in my abilities. I know I’m a hard worked and have many different types of experiences with working with the public. I have experience in the restaurant industry, childcare, clinical settings, and other customer service roles. I’ve also helped many leadership roles. I know once I’m comfortable in a setting I really thrive as a leader. When it comes to my weaknesses though I am a bit timid to explore those. I know I need to work on adaptability and working over social “speedbumps”. I’m a social person but sometimes, in certain situations, I find myself to be mute. I know as a nurse I can’t do that, so communication is something I need to continue to work on.
I have such mixed feelings about ending the semester and being done nursing school. I’ve been in college since fall of 2016 so I’m super excited to be done but I’m very nervous about entering the nursing field. I think what I’m most worried about is entering into healthcare during these times during the pandemic. You hear so much on social media, TV, among peers, etc. Even though our healthcare system isn’t the same as it was when I decided to go into it, I am looking forward to practicing on patients. So, I very much have mixed feelings about graduating in May. After graduation my plan is to take some time off from everything and study for a month. I’d like to take my NCLEX no later than mid/end of June. I think once I get closer and see how much I really know with practice exams I’ll determine then when I should take my NCLEX.
Even though May seems far away, I know it will come up very fast. I know I need to prepare myself to take my NCLEX as well as starting my job as a nurse. My biggest struggle is medications. This semester I’ve set a goal to go over at least 3 medications every week thoroughly. I would hate to get to my NCLEX and miss questions on small mistakes over medications. I plan on writing these drugs down on my iPad. I really enjoy drawing, so I hope to not only make this a good way to learn but I wanted to make it fun. I know I won’t have time to draw every medication so if I write down the content about it, I will be satisfied. I can go back and add anything I want later. With this my hope is by May I will have thoroughly gone through around 45 drugs. I plan on grouping types of drugs (BB, ACE, ARBS, statins, etc) so in reality it will be more.
Lastly for the Nurse Logic 2.0 Modules I learned a few things form them. It was nice to get a brush up on discharge procedures, specifically the education that went along with it. It reinforces that I need to be thinking about patient education with everything. It was also nice to brush up on patient priority. I know it’s so important to prioritize as a nurse. Lastly, these exams really engrained how much I need to study my medications. They are so important, and I can’t go into a situation and not know what I’m giving. I hope that with these ATI tests, what I’m learning in my courses, and practice NCLEX questions I’ll be prepared to take the exam and move into the nursing field.
When I first decided I wanted to go into nursing the thought of natural disasters came to my mind. Worried about what my role would be and more worried that I won’t be prepared. During a disaster, of any kind, a nurse will play an important role. Nurses are responsible in helping to initiate the start of the disaster protocol. They also will work to triage patients and evacuate ones that can. Lasty a nurse can help to treat people during disasters. Nurses have many hats to wear when it comes to disaster nursing. Therefore, having a plan and sticking to it is very important, so people don’t get confused about what their role entails.
Nurses are very compassionate people. It’s no wonder why nurses are seen as one of the most trustworthy professionals. I’ve seen a lot of nurses be selfless because they are. When it comes to disaster nursing though this may cause an ethical dilemma within themselves. When looking at the ANA code we see some contradictions, or what I believe to cause contradictions. I feel like the self provision being #5 while patient is #2 just goes to show how nurses think as to what they believe is important. I personally know that I would feel selfish putting myself before a patient. But as we’ve seen with nursing burnout, nurses need to start thinking of themselves first. I feel like the way these provisions are written it almost makes provision #5 seem more as a choice rather than a duty to self. I think a lot of nurses, in the event of a disaster, would have personal ethical dilemmas regarding these provisions.
In a world full of difference, death is the one thing we all share. We will all reach the end of our road one way but the way in which we go out is unknown, for most. When I first heard of death with dignity it was not called that, but rather referred to as euthanasia or physician-assisted suicide. I first heard of these terms in high school and remember how bad they sounded. Just the name alone it doesn’t sound like a pleasant thing, and it reminded me of putting down an animal. Once I was educated about the topic I went back to thinking of animals. I thought this sounded negative because it reminded me of putting down animals but then I remember we do this prior to the pain and suffering the animal will endure. I remember finding out my childhood cat had cancer all throughout his body. Rather than treatments and surgeries we decided to end his suffering and put him down. Why can’t we do this for humans?
Come to find out years later we can do this to humans. I grew up in a religious household but never grasped to their principals or beliefs so ethically this doesn’t challenge my beliefs. I believe, like all patients, even terminally ill ones should have a say in their care. This can include treatments, surgeries, and death. I know personally if I was given a terminal illness, I would want to remember my life as the way I intended it to be. This wouldn’t include being sick all the time, going in and out of hospitals, and being so fatigued form treatments, I can’t spend time with loved ones. As a future nurse, it is ingrained into our minds and practice to advocate for our patients. Some might look at this and think we are harming our patients. The way I see it is that our job is to “do no harm”. By providing patients with options and allowing them to choose their care, I believe this is causing far less harm than removing that choice. Patient safety goes beyond getting better and improving. Sometimes it’s the ability to identify the patients needs and helping them choose what’s best. Nurses are also here to help protect our patient’s autonomy by advocating. If someone would rather die as they are now, rather than enduring pain and suffering then that is the patient’s choice and medical professionals should be in support of them.
I think death is so scary because it’s so unknown to us. Most of us have no idea when/where/ or how we will pass and that is terrifying. By giving that choice to someone it can bring them comfort. Rather than spending their last months fearing the inevitable, they can have the choice as to how/ when/ and where. It can also provide comfort to their family since the decision will be placed in the hands of the patient and not loved ones. Family will also not have to watch their loved one suffer for a prolonged amount of time. All patients should have the choice.
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