My Clinical Preceptorship - Essay Sample

Introduction

My clinical preceptorship occurred at XXXX hospital telemetric unit. The patient population on the telemetric unit constitutes adults with critical conditions on the monitoring services. The five patients offered opportunities for learning and constant practice. As I finalized the 130-hour clinical requirement, I was able to meet the ten Nurse of the Future Core Competencies outlined by the Massachusetts Department of Higher Education and the Massachusetts Organization of Nurse Executives.

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The ten Nurse of the Future Core Competencies were developed with the motive to epitomize the minimum anticipations for nurses when they finalize their pre-licensure education. The competencies involve the perceptions, knowledge, and skills that new nurses should be capable of including into practice to offer competent care in the present health care setting. It was a reality that I integrated these competencies when liaising with patients, members of interdisciplinary teams, and nurses (Massachusetts Department of Higher Education, 2016).

The purpose of this paper is to outline the knowledge, attitudes, and skills that I have demonstrated for each of the Nurse of the Future Core Competencies throughout my preceptorship. These competencies consist of patient-centered care, professionalism, leadership, systems-based practice, informatics and technology, communication, teamwork and collaboration, safety, quality improvement, and evidence-based practice. Every competency in this paper is approached separately with a vivid description offered by the Massachusetts Department of Higher Education and the Massachusetts Organization of Nurse Executives preceded by specific illustrations from my preceptorship that validate my understanding and use of the competency.

Patient-Centered Care

The Massachusetts Nurse of the Future Nursing Core Competencies states, "Assesses patient values, preferences, decisional capacity, and expressed needs as part of ongoing assessment, clinical interview, implementation of a care plan, and evaluation of care" (MDHE, 2016). My nurse was assigned a patient who had been at the hospital for about a week now. Mr. H, as we later noticed after doing a full assessment on him, was experiencing some skin breakdown on his buttocks and coccyx area. This had been wrongfully noted that his skin was intact. The outcome indicated he had a stage one and two pressure ulcer. It was a good learning experience as it taught me to always fully assess my patients every time even when the notes say the patient is fine. I was involved in applying proper patient-centered care and effectively using my nursing skills as my nurse, and I was able to discover the pressure ulcers on our patient, explain to him about his skin breakdown and educate him on the treatment to be applied. We added to his patient care plan Calazine cream, repositioning every 2 hours, vitamin C- rich diet and protein-rich diet, and monitoring of the pressure ulcers. This was to ensure he would not experience any further skin breakdown. Even though he was hesitant at first, he later complied upon realizing it was for his good. We also implemented fall precautions as well as putting the proper colored socks on him and informed him that we would check on him shortly to assess his skin again and apply more cream.

The patient-centered care competency was seen here by implementing proper care to this patient, doing a full assessment, treatment, and making proper notes in his chart. Patient-centered care is about the whole care process of the patient. It has the nurse to fully take into consideration everything of the patient's values, preferences, and needs, while doing so respects the patient to provide appropriate safe health care.

I learned that as a nurse, any patient I am assigned to, I would do my own full assessment to make sure nothing was missed previously or if there are any new changes in the patient. I also learned it is important to talk to your patient to see what they prefer or if they have any specific values or cultural needs they wish to have added in their care plan. It is important to include them in the decision-making process as well, so they feel heard and respected, and by doing this, the nurse will have patient satisfaction and good health outcomes.

Professionalism

The Massachusetts Nurse of the Future Nursing Core Competencies states, "Implements plan of care within the legal, ethical, and regulatory framework of nursing practice" (MDHE, 2016).As my nurse and I carried out our daily nursing routine, our attention was drawn to one Mr. J, who had been admitted to the unit after he fell at home and was experiencing some cognitive decline. Apart from that, he was hyperglycemic with a blood glucose level of 500, which may have caused the fall. We also made sure to implement fall precautions and to assist him with ambulating. The plan of care for him is a consult with PT and OT. The patient showed great improvement as he was doing better and was alert and oriented x3. I made an observation on how my nurse was handling him professionally as she talked to him about his diabetes, the importance of monitoring his blood glucose, and for him to describe the events leading to his fall.

The professionalism competency was seen when the nurse demonstrated her skills for plan of care for the patient and showing accountability by making sure the care was implemented effectively. Also, by taking into account his past medical history and the current information, proper decisions were made. I learned that being professional in nursing is important as well as practicing the best nursing standards and principles of care so we can deliver effective care to achieve positive health outcomes. These include morals, legal, ethical, and humanistic principles. There are many ways nurses show professionalism in practice to their patients by thoroughly assessing them, implementing a plan of care, and documenting the events of the shift, to name a few.

Leadership

The Massachusetts Nurse of the Future Nursing Core Competencies states, "Identifies leadership skills essential to the practice of nursing."(MDHE, 2016). During our normal routine check, we came across a patient who was experiencing back pain and arthritis pain. He described and rated his pain as 7 out of 10 and that he was sore when we asked him to, after inquiring whether we had some lidocaine patches and pain killer for his arthritis pain. After listening to him, we assured him we would talk to his doctor about it and see what we can do after assessing him. The assessment revealed he was having pain, which we advocated for him to his doctor. After presenting our observations to the MD, the doctor wrote an order for him for the lidocaine patches and small pain medication to help with the arthritis pain. We also advised the patient with some non-pharmacological ways to help with his pain as well. This enabled me to see the protocol involved when handling a patient experiencing pain.

The leadership competency was seen here by advocating for the patient to his doctor about what the patient needed at the time. By doing this, we were achieving patient-centered care as well as effective communication between the patient and doctor. We were showing leadership by solving the problem for the patient after listening to him and respecting his feelings as well as letting him be part of the decision making. In the end, we had a common goal, and that was to manage his pain safely and properly.

This taught me the importance of assessing the patient so as to provide the best patient care possible. Treating pain is a sensitive issue, and proper assessment should be done, and the protocol followed. Leadership, I believe, comes in many ways in a work unit, and as a nurse, advocating for your patients is one of them as well as implementing the best care for them.

Systems-Based Practice

The Massachusetts Nurse of the Future Nursing Core Competencies states,, "Recognizes the importance of work unit systems in providing supplies, medications, equipment, and information in a timely and accurate fashion" (MDHE, 2016). The patient on this particular day is Mr. V, who is in for a Transcatheter aortic valve replacement (TAVR) surgery. The nurse has time to provide proper and effective patient care as there is an electrocardiogram(EKG) technician to perform daily EKG's on Mr. V while she ensures it is done and the EKG strip is put into the patient's chart. As a nurse, she knows how to use resources available to her well by calling upon work resources to help implement quality and valued care. It was quite an educational experience for me as I got to see firsthand how EKG technicians performed their duties in practice. As nurses and primary caregivers, we explained to the patient the reason the EKG is being done and that it is an EKG technician that will perform them daily and not us. We also talked to him about the TAVR procedure he was going to have and helped calm him down. The patient, in turn, was very pleasant and understanding, and it is my belief we played our role well as therapists as well. I learned a great deal on how to communicate with patients feeling anxious and how best to go about it by saying positive things.

This competency was seen when my nurse explained to me about the EKG technicians and how she will use one to obtain a daily EKG for the patient. It was a good learning experience, especially in time management as a nurse to give patients more time while providing effective patient care as the nurse.

Informatics and Technology

The Massachusetts Nurse of the Future Nursing Core Competencies states, "Appreciates the use of electronic communications strategies in the delivery of patient care" (MDHE, 2016). My nurse and I were on a routine duty to check on a different patient when I observed blood on Mr. G as he held a tissue to his antecubital area of the arm. I quickly informed my nurse that Mr. G had pulled out his IV, and together we acted quickly to stop him from bleeding further and added pressure to the site. On realizing the patient did not like it, we took the time to explain to him that he was in the hospital and why he needed the IV in place, and that it is hospital protocol for every patient to have IV access. Once the bleeding stopped, my nurse used Versa, a small handheld phone used to communicate in hospitals by staff directly, to talk with the IV nurse and get a new IV access for the patient. After explaining the incident to the IV nurse, the problem was sorted out within no time. We then put IV netting over the IV to help prevent another incident.

This competency was seen when my nurse called the IV nurse to replace IV access on the patient without having to go far or find alternatives. The device enables easy communication between different professions within the hospital.

I learned that using informatics and technology within the nursing practice can be very helpful for the nurse in obtaining assistance, retrieving information about a patient, talking with other medics.

Communication

The Massachusetts Nurse of the Future Nursing Core Competencies states, "Accepts the role and responsibility for providing health education to patients and families." (MDHE, 2016). The patient on this day, Mr. T was admitted for a TAVR procedure. He was accompanied by his daughter, who was anxious and worried about the whole procedure as she did not know what would happen. This, we later learned, was because of her father's chronic obstructive pulmonary disease (COPD). My nurse and I talked with her and Mr. T for a while, explaining some more about the procedure Mr. T was going to have, its benefits, and, as a frequent procedure done...