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PGC Reflection Paper

Taylor White

NUR460: Nursing Capstone

Professor McKnight

Delaware Technical Community College

July 30, 2023

Introduction

Over the past two and half years as a nurse and a student pursuing my Bachelor of

Science in Nursing I have grown tremendously as a person and nurse. I have become a well-

rounded nurse, increased my leadership skills, and have become a resource for colleagues in my

emergency room. I have had the opportunity to grow through these nursing courses and have

been able to follow many accomplished nurses in my facility to see how I can further my career

and leadership abilities. Being a well-rounded nurse is so important not only to myself but also to

my patients to keep them safe and give them the best possible care I can provide. Throughout

these courses I have been able to stay up to date on the most recent research in the medical field,

making sure my patients are receiving appropriate care. From researching wait time and nurse to

patient ratios to world-wide health issues I have been able to present so much important to my

managers and floor. This improves my own abilities and my department for the better and

decreasing morbidity and mortality. This paper will explain further how I was able to meet goal

and expectation of this nursing program.

Program Graduate Competencies #1

Program Graduate Competencies (PCGs) number 1 is “integrate general education

knowledge, skills, and aptitudes to advance nursing education and growth in professional

practice.” This PCG is relatable to everyday nursing practice, I used general knowledge and

education for each nursing class taken during my bachelor journey. I wrote a paper on ER wait

times and the effects of it on patient outcomes. I had my own general knowledge from working

in the ER on how this can affect patients and was able to use this to research the paper. I also did

a paper on nurse-to-patient ratio, something every department struggles with and is one of the

major reasons of nurse burnout and fatigue. This allowed me to advance in each of my nursing
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classes and move onto the next and advance my nursing practice by having relatable information

for arguments we have consistently with my colleagues and managers.

Program Graduate Competencies # 2

The second PCG in the program is about displaying leadership skills and promoting

patient safety. Over the past year as a nurse and student I have advanced my position as a leader

in my community and job. I have joined the professional advancement ladder at my facility, this

is program that requires interaction with the hospital and department. Meaning you are required

to be on educational committees for the hospital and department, provide educational sessions

for your department, do community service of any type, and precepting and educating new

nurses, along with taking classes and continuing education. These classes helped gain me points

in this professional ladder and gain my spot. While I also learned valuable leadership skills

during these courses like what kind of leader I am and want to be, without these classes I would

have never been able to gain this spot and accomplish my goal of becoming a leader for myself,

colleagues, and patients.

Program Graduate Competencies # 3

Competency number three revolved around taking statistics and research and using them

to support evidence-based practice related to nursing. during these classes and other classes

required in the degree I have written many evidence-based practice papers. One being the

malnutrition and resources available in Ethiopia and the healthcare that they use there. This

country lacks so much nutrition and resources that they had a 17% under five mortality rate in

2001 (Mckonnen, et al. 2005). I researched their struggles and compared them to the health

impact pyramid, researching socioeconomic factors and other levels of the pyramid and

comparing them to what we have here. This also helps me research things that we struggle with
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in the US while being more aware of what we have, and others do not. I researched ADHD and

how it can affect individuals, specifically pediatric patients, and different treatment options

available. As an ER nurse ADHD can be a devastating disorder for mental health patients.

Studies show that the prevalence for children at school age is 9.5% and has been found to persist

into young adulthood by 60-70% and 25% of these adults will also be diagnosed with antisocial

personality disorders (Townsend & Morgan, 2017). It is important to know how to treat these

patients when they present to the ER and allow them to trust me to be able to treat them. Doing

this research allowed me to gain more knowledge and be better prepared for when they do come

to the ER in the future. Evidence based research and analyzing statistics is an important skill to

have as a nurse and we need to be able to integrate it into our practice. Even when this class

ends, I plan to continue to read statistics related to my field and stay up to date on the most

evidence-based practice and research.

Program Graduate Competencies # 4

Number four is about integrating technology and becoming an expert to improve patient

safety. Over the last year my department had switched computer software programs. The

reasoning for the switch was so that the emergency room patients would be treated in the same

software as the admitted patients. Making the transition easier for when emergency room patients

were admitted and received by hospitalist from the ER physicians. Before the switch there was

always confusion on what treatment was given by the ER provider, when orders were placed by

the hospitalist there were either duplicate orders or important ones missing. You are also able to

now see past ER visits where patients may have been treated and sent home instead of being

admitted. This way the hospitalist could see past diagnostic tests and results to help treat them

during the current stay. While this was a hard transition for myself as a new nurse, learning a
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new program and navigating it while caring for patients, it was also necessary to keep them safe.

To become an expert, I attended classes and informational sessions to make sure I was

performing the best documentation. If things are left out of patient’s chart like medication

administration, it could be harmful to the patient with a terrible outcome. Therefore, it is always

important to be an expert in the technology used by your department and profession.

Program Graduate Competencies # 5

Advocating for our patients is most of the time as a nurse our number one job, we work

the closest with our patients and spend the most time with them. We advocate for their wants,

needs, and orders good or bad. Without this responsibility our patients would not trust us to care

for them and we could put their lives at risk. We double check medication and care orders placed

by doctors, making sure there are no mistakes and when there are we get them fixed to not cause

harm to our patients. Recently our number of patients we are seeing in the ER have grown after

the recent pandemic, leaving long wait times for sick patients and no beds for them to be treated

in. This causes deuteriation of patient’s symptoms and increases morbidity and mortality for

these patients. As nursing staff, we had to advocate for our patients and come up with a solution

of what we could do to improve their care and outcomes. With high volumes and no beds for

them to be treated, the solution was for as much treatment as possible to be performed in the

waiting room area. I was able to apart of the committee that oversaw this change, we

implemented protocols for the how procedures would be done. We decided which patients would

be treated in this area and which were brought back to a room as soon as possible. We came up

with standing orders for labs and other treatments when provider evaluation was taking too long.

This has increased the number of people we are able to see and treat and giving them the care,

they need. Without us advocating for these policies and procedures for our patients they would
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be sitting in the waiting room for hours with no treatment and eval worsening their condition and

increasing their chances morbidity. “If a patient had to wait between six to eight hours, they

were, on average, 8% more likely to die of any cause in the next 30 days” (Cassella, 2022).

Program Graduate Competencies # 6

As an ER nurse we have many patients and situations where they are sent to us because

they have little resources and this causing their health to deteriorate. Whether it be because of

lack of resources to obtain the medical care they need, financial reasons or mental health reasons.

They come to us first and we advocate for them to gain the resources they need to maintain their

health. It may be providing with medication coupons to obtain life sustaining medications,

housing resources, or mental health resources in the area. We collaborate with other

professionals like case managers, social workers, doctors, pharmacists, and mental health

professionals to get our patients the things they need to survive and gain their lives back. In the

three years I have been a nurse I have specifically learned so much about the mental health

population and was given the opportunity to learn more during my clinical rotation, I realized

how many of the homeless population also suffered from severe mental health problems as well.

I able to help advocate for a specific elderly homeless man that was struggling during his stay at

our facility with his mental health a warm and clean place to sleep after his departure from our

facility. “Chronic mental health problems were prevalent in 48% of older adults…about one

quarter also had drug or alcohol problems or physical illness and 41% also had a disability”

(Clark & Alishire, 2018). It is important as healthcare providers to advocate for our patients

needs and resources because we are often their voice and have no other means of doing so or

have exhausted their resources.

Program Graduate Competencies #7

One of the benefits of following the hospitalist group during my clinical rotation was to

be able to see patients and observe a higher level of care then what I normally provide. I was able

to learn and observe a different way of education that physicians provide to their patients and the

responsibility they must help patient prevent further complications from their illness. On one

clinical day I observed by preceptor educate her newly diagnosed diabetic patient on the

importance and use of Insulin. This is a lifesaving medication for a patient with diabetes but can

be very overwhelming and scary for a patient at first. I was able to assist in demonstration of use

of an insulin pen, observe explanation of when to use the medication and when to seek medical

assistance related to the disease. Seeing the gratefulness and relief in the patient after the

educational session was rewarding as a healthcare provider. Knowing that you were able to help

prevent complications of the disease makes you feel accomplished that you helped save one

more life from mortality.

Program Graduate Competencies # 8

During my behavioral health rotation in clinicals ethical framework was the basis of their

work. Many patients go through their mental health problems alone with fear of sharing with

friends and family members. As they fear judgement and burdening them with their problems,

which is why we are often the ones they trust with their problems. Therefore, majority of their

care would be confidential even when family or friends would call to check on their loved ones.

Permission would always need to be given to speak freely to the patient’s family and friends, and

anything said against their wishes would be unethical nursing practice. This is something I saw

often that the family or friends would struggle with, they care deeply for the patient, and want to

help in any way possible. But ethically we must respect our patients wishes and keep their visits

and medical are private unless otherwise advised by the patients or if for their safety.
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Program Graduate Competencies # 9

By being on the professional advancement ladder I am committing myself to lifelong

learning and education, which complies with the 9th and last PGC. I will always be required to

give educational sessions to my colleagues and hospital. This mean I must be educated on

current nursing practice whether it be generalized or department specific. Currently I attend

quarterly a trauma specific educational opportunity where we can freely and safely work through

real life trauma situations and learn. This gives me the opportunity to learn new skills,

equipment, and nursing practice on working mannequins without harming a patient. While also

preparing myself to care for patients in this situation in the future. I am also a part of the

committee that hosts these educational sessions and often participate in break out education

sessions on specific topics, forcing myself to stay up to date and knowledgeable in my area. I

also plan to continue my education and career one day and obtain my master’s in nursing, this

will help continue my education and advance my career for myself and my patients.

PCG’s and My Nursing Philosophy

My nursing philosophy was based on Flourence Nightengales belief that creating a calm

and therapeutic environment improved patient outcome. Every experience I have had with the 9

PCG’s has been me as a nurse creating a safer and better environment for my patients. Whether

its educating, researching, or implanting new an old practice that have been proven to keep

patients safe. Like states previously we are with our patients the most out of any medical staff

involved in their care. We create the environment they are cared for in and creating less stress

and a trusting environment can mean everything to our patients. This is often to the worst day of

their lives even when it seems like a minor problem to us. Doing things like advocating for their

needs, providing with simple resources like blankets and water, and making them feel like their
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voice is heard can cause them less stress. It has been shown that less stress improves patient’s

outcomes and reduced complications. Implementing each PCG in my nursing practice creates a

well-rounded nursing practice for myself and allows my patients environment to be safe, calmer,

and therapeutic for their health and healing process.

Resources

Cassella, C. (2022). Waiting over 5 hours in ER is linked to higher death rates, new data show.

Science alert. Retrieved from https://www.sciencealert.com/long-waits-in-the-

emergency-room-are-risking-patient-lives

Clark, C., Ailshire, J. (2018). Profiles of older homeless adults with chronic mental health

problems in los angeles county. Natural library of medicine. Doi:

10.1093/geroni/igy031.3616

Mckonnen, A., Jones, N., Tefera, B. (2005). Tackling child malnutrition in ethiopia: do the

sustainable development poverty reduction programme’s underlying policy assumptions

reflect local realities? Young Lives: An international Study of Childhood Poverty.

Townsend, M., & Morgan, K. (2018). Children and adolescents. Essentials of Psychiatric

Mental Health Nursing (7th ed., pp 626-667). Philadelphia, PA: F. A. Davis Company.