Running Head: Program Graduate Competencies (PGC’s) Reflection

Program Graduate Competencies (PGC) Reflection

Delaware Technical Community College

NUR 460- Nursing Capstone

Eric Granby

November 30, 2018

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As I reflect back on the last year, on where I started and how I ended up here today, I

know I have become a better nurse. Before I was a nurse, I was a leader, because I am a nurse,

and during my journey in this program, I am a better leader. My journey of nursing started over

seventeen years ago. Beginning in the military as a combat/flight medic, I traveled the world,

practice my trade, and learned so much. The progression to nursing was natural and logical and

will continue to propel me forward if I allow it to. Throughout the BSN program, the knowledge

I have gained had immediate results in my clinical practice; exposing me to many new avenues

of nursing, and becoming a better clinician.

PGC #1 General Education Integration

Integrating the nursing profession with only technical skills and evidence-based practice

would and does provide adequate patient care, checks off most blocks in an organizational

healthcare structure but would leave out one crucial factor. That is, the patient is a complex

being, and requires a more complex understanding. Nurses are expert taskmasters but are not

robots. They have empathy and emotions, life experiences and let's not forget they are humans,

too, Although some appear to have superpowers.

Preparing for the BSN program, exposed me to many areas other than the nursing

practice that has provided great depth to my training. Learning history, learning a new language,

and about the world's health problems has enhanced my diversity and ability to communicate

with others. Learning history sometimes creates a conversation with the patient and enables a

rapport to begin. Being able to at least say hello to a patient who speaks another language can set

someone at ease. Understand some of the worlds health crisis, allows me to look at the situations

with a critical eye and also understand patient populations that may arrive here in the U.S.
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PGC #2, 6, Leadership & Advocacy

You are not born a leader. It is a skill perfected daily. You do not need a fancy title,

certifications or a distinctive uniform. Yes, those mentioned above may be part of the package,

but it is not the core factor. A leader is not just a taskmaster; that's a good manager. However a

leader transcends beyond following a checklist, they inspire change when needed, foster a

welcoming environment to learn and progress. A leader can be anyone that puts forth the effort.

Under the role, a nurse is a leader or at least can be one. The nursing role, earned, should

be promoted as a leadership role. Nurses are on the front line so to speak, and encounter patients

at their most vulnerable times of life. Skills like communication, advocacy, and sound core

values like selfless service are vital traits of a leader and a nurse. A nurse communicates

effectively with multiple members of the healthcare team, act as the liaison between the patient

and doctor and document patient care. A nurse has the best interest of the patient advocates in

multiple ways: promotes evidence-based care, provided nursing education and tends to the needs

of a patient. A nurse is human, of course, and has needs that must be managed to, however, when

on duty, the nurse has a responsibility to the patient and the healthcare team, therefore, they must

be focused on their role. In the event, the focus will not be on the patients; the team needs to

know, to assist.

As a nurse and military leader, I have found that I have been able to combine my roles, to

provide the best quality care I can. I have focused my leadership style to come as close to what is

called a "Transformational Leader." Transformational leadership is a type of leadership style that

fits my ambitions to excel in each facet of my life. In an article titled, "Transformational

leadership in nursing practice" the authors describe transformational leadership as one that is
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adaptive and "motivates followers by appealing to higher ideals and moral values, where the

leader has a deep set of internal values and ideas." (Doody & Doody, 2012). If practiced right,

the followers will want to meet the goals of an organization, instead of focusing on self-interest

(Doody & Doody, 2012).

With the understanding that a nurse is a leader and that my focused leadership style is one

that is transformational, I realized that being a nurse is a two-fold process. First off, the patient

comes first, and that means you must act as they do. As a nurse, you must foster an environment

that shows the patient that you care, and enables you an opportunity to provide health education,

and encouraging them to make the appropriate lifestyle changes; undoubtedly improving their

patient outcome. The second role of the nurse is in regards to your team. These are the people

that you tend to spend more time with during the day then your family. And much like a family,

everyone relies on each other. Working in a dynamic environment like the emergency department

it can be a challenging endeavor, You are dealing with life and death on a daily basis and a lot of

times staff rely on each other for support. This support comes in many ways, sometimes cruel

humor, other times in debriefing sessions. Having the ability to lift someone's spirits, inspire

them and show that you care doesn't need to come from a manager; frankly, it should come from

your cohorts.

As a nurse, I am part of a team of healthcare professionals with the goal of providing

quality care. Working in a dynamic environment such as the emergency room, you encounter a

plethora of personalities both patients and colleagues. Being flexible, communicating effectively,

advocating for your patients and team members and having the ability to promote an

environment of fluidity is vital. A transformational leader can do that.

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PGC #3,7 Evidence-based Practice & Population Health Promotion/ Disease Prevention

Nurses are leaders and patient advocates. Part of being a patient advocate is providing

evidence-based practices. That entails having the ability to use the proper resources.

Understanding how to find nursing research, how to read it and how to apply it is a vital part of

the nursing practice. Understand the value of qualitative and quantitative analysis, and how

researchers generate hypothesizes, data, and use it to evidence practice is essential. However, I

learned to do not envy their role but do respect it. I focused on patient demographics that I serve

in my community, specifically the black and Latino patient population. My research has shown

that these demographics have a higher risk of the more significant burden of disease like diabetes

(Chow, Foster, Gonzales, & LaShawn, 2012). More interestingly, that although race and genetics

plays a vital role in being at risk for diabetes, social economics plays the most significant role

(Chow et al., 2012).

Understanding my patient demographics and the diseases they are prone to. I furthered

my knowledge and utilized research about ways they can prevent complications of disease and

also how to manage them. I found that social economics also played a huge role in how diseases

were self-managed but also that race and environment did as well. For example, African &

Mexican Americans living areas where there was a lack of healthy food access were more prone

to diabetes (Gaskin, D., Thorpe, R., McGinity, E., Bower, K., Rohde, H., Young, LaVeist, T.,

2014). Also, knowing that although patients know modifying lifestyles were important, they did

not know to what extent.

Taking the knowledge and having a better understanding. Has provided me with the

insight to ask the right questions, give the proper feedback and overall be a better advocate for
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my patients and steer them in the right direction for a better quality of life and adherence to their

treatment plan.

PGC # 4 Using Technology to improve patient outcomes

As a healthcare professional somewhere along the way you have heard the saying, "if it

wasn't documented, it wasn't done." A very true statement in the nursing profession. So much so,

it may seem like nurses spend most of their time documenting on patients. However, in the last

decade or so, technology has increased, allowing an avenue for patient documentation via

electronic health records (EHR). And although it can appear to be a daunting task, the facts prove

that patient care has improved.

According to the article, "Using Electronic Health Records to Improve Quality and

Efficiency: The Experiences of Leading Hospitals," nine hospitals were surveyed on the impact

that EHR's had on patient safety. All nine hospitals were convinced that use of EHR's was "life-

saving" (Silow-Carroll, Edwards, & Rodin, 2012, p. 18). The showed that medications errors

were greatly reduced and lives were saved (Silow-Carroll et al., 2012). Thus reinforcing my

knowledge that technology play a vital role in improving patient outcomes. Furthermore, here

Delaware, we are experiencing a opioid epidemic. One tool being used is called, "Delaware

Health Information Network" or DHIN. The DHIN is a searchable database of patient clinical

history and allows providers to access vital patient information across different organizations

(Delaware Health Information Network, 2018). The DHIN has proved crucial in the area of

opioid abuse. Per the DIHN guidelines for emergency room providers, Patients who are found to

receive prescriptions for controlled substances from multiple providers should not receive

additional prescriptions for controlled substances from the ED." ("Delaware Emergency
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Department Opioid Prescribing Guidelines," 2016). Effectively, a provider can access the central

database, identify patients who have been treated multiple times for similar complaints and help

prevent the drug-seeking behavior ("Delaware Emergency Department Opioid Prescribing

Guidelines," 2016). Additionally, the DIHN also provides trends in care for chronic conditions

and can allow providers to coordinate care to a specialist of all payer types ("Delaware

Emergency Department Opioid Prescribing Guidelines," 2016).

Technology in healthcare has proven to be a vital asset to enhance patient care. As it

improves, then patient care should as well. Using EHR's and centralized databases like the DIHN

can help communication amongst other healthcare providers and healthcare facilities. Thus

preventing medical errors and coordinate better care for each patient.

PGC # 5 Patient Advocate Regarding Healthcare Policy

In a recent Gallup poll, nurses were rated number one for being the most honest and

ethical profession (Gallup, Inc, 2017). It is not a big surprise considering nurses are with people

in their most vulnerable times of need. However, the level of importance conveyed in the poll is

enormous. It shows how vital the role a nurse plays in a patients care.

In my opinion, the primary function of a nurse is an advocate. Nurses are leaders of their

patients care, advocates, and liaisons between the patient and the healthcare team. In the text,

Leadership & Managment for Nurses: Core Competencies for Quality Care, the following

Synergy Model provides a definition of Advocacy and moral agency as it applies in nursing:

“working on another’s behalf and representing the concerns of the patient/family and nursing

staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns

within and outside the clinical setting” (Finkelman, 2016, p. 114). This definition clearly states
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the nurse advocates for the patient/family and also the nursing staff. We all should know our role

as patient advocate. But what about advocating for your patients outside the walls of an exam

room or hospital. Moreover, what about advocating for our fellow nurses and the roles we have.

One way that nurses can advocate for patients outside the walls of a hospital is by

presenting identified problems to local, state, and federal governments. Lobbying for changes

seems reasonable considering the nurse spends the most time with a patient. However, in a

Gallup poll, nurses are underrepresented where health policies are being developed (Gallup,

2010). What's more, the primary influencers of health policies were government and health

insurance executives (Gallup, 2010). One way to increase the nursing presence, locally, in

Delaware is to be part of the fight against the opioid crisis. In 2017, Governor Carney passed

Senate Bill 111 (SB 111) of a Behavioral Health Consortium which called for a consortium of

professionals from community leaders, police officers to health care providers to figure out

productive ways to help folks afflicted by substance abuse and mental disorders (Delaware

News, 2017). Furthermore, an exciting and relevant fact is that Lt Governor Hall-Long, a nurse

and nursing educator was one of the most prominent advocates and sponsors of this bill. The

efforts of the consortium have already produced yields. Due to their efforts, Narcan is being

offered to folks by Behavioral health organizations, and currently, Narcan is available without a

prescription at pharmacies (Horn, 2018). I have seen first hand the effects of this bill, and patient

advocacy, working in the emergency room.

The Affordable Care Act (ACA) of 2010, was passed with the noble intention of

providing healthcare coverage to millions of uninsured (Anderson, 2014). However, the health

care coverage expansion did not cover providing actual care to patients. Therefore there has been
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a massive influx of patients at facilities and the lack of healthcare professionals; current

providers were overloaded (Anderson, 2014). The US Bureau of Labor Statistics projects over

one million additional nurses will be needed to avoid further shortages. Increased patients and

patient acuity is a current problem where staffing is low. Patient to nurse ratios is concerning and

have the potential to cause burn out and nursing care errors. One way to advocate for a change,

other than voicing your concern to hospital leadership is to lobby Congress to pass H.R 2329-

Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017, which

specifies nurse-to-patient ratios by unit (Schakowsky, 2017). Now, this does not precisely cure

the problem the ACA inadvertently caused, that would have to be directed towards colleges and

universities to promote the nursing career. However, having mandatory nurse-to-patient ratios

would help keep the nurse safe, allow them to provide enhanced patient care, ultimately

advocating for the patient, the family who wants their loved ones to get better, and your nursing

staff.

As a nurse, you spend most of your time with your patients, get to the know them, and

often find out critical things that the doctor needs to know and wasn't told when they examined

the patient. It is up to the nurse to provide the best advocacy available through ongoing

professional education and liaisoning with the health care team and patient. There is an untapped

potential for nurses to advocate health care policies at a local, states and federal governmental

level. Furthermore, nurses can support their fellow teammates in the same manner, and should.

PGC # 8 Ethical Framework

In an article titled, "HAVE HOSPITALS BECOME INEFFICIENT NURSING

FACTORIES?", A summation of a nursing convention guest speaker, Professor Maben, who

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spoke of the future of nursing from a global and national perspective ("HAVE HOSPITALS

BECOME INEFFICIENT NURSING FACTORIES?" 2017, p. 6). The presented argument is

that despite the increase in technology, advances in healthcare, patients prefer face-to-face

interactions ("HAVE HOSPITALS BECOME INEFFICIENT NURSING FACTORIES?" 2017,

p. 6). The cautionary revelations throughout this article explain that, with an aging population,

chronic conditions on the rise, and a shortage of nursing staff, hospitals have become an

assembly line of healthcare workers checking off boxes in the patient's electronic health record

(EHR). And do not build meaningful relationships with their patients ("HAVE HOSPITALS

BECOME INEFFICIENT NURSING FACTORIES?" 2017, p. 6). Furthermore, the article

explains there is no sure way to combat this concern. I argue, however, there is.

Currently in my organization, the core values we are expected to adhere too. One of the

core values of St Francis is Reverence- "We honor the sacredness and dignity of every

person" (Saint Francis Healthcare, n.d.) which is in alignment with the American Nurses

Associations, "Code of Ethics.". My argument is that by living and practicing the values of an

organization like mine, it is one avenue of approach to combat the issues the article discusses

(hospitals are inefficient nursing factories). This application of organizations mission and values

can also enhance patient care while using technology. How? Well, instead of entering a patients

room with our eyes glued to the computer screen, a rapport must be built; a trusting relationship

is paramount. Yes, you must document your assessment, but perhaps explaining what you are

doing, and practicing eye contact, while doing so, will help. At least, this is something I have

exercised during my patient assessments.

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Technology is great and has proven its purpose in healthcare. However, one must not

forget that healthcare involves human interaction. Human interaction is something that

technology cannot provide, and despite the "hustle and bustle" of some organizations, a healthy

balance must be developed to enhance patient care while simultaneously accomplishing all the

necessary/mandatory task required through the use of technology (e.g., electronic healthcare

records). Time will tell, and the patients will judge.

PGC # 9: Lifelong Learning for Personal and Professional Growth

Earning my nursing license opened the door to a wide variety of lifelong learning. I have

had the opportunity to obtain many certificates that enable me to provide enhanced patient care:

Trauma Nursing Core Course, Emergency Nursing Pediatric Course, AHA instructor, Tactical

Combat Casualty Care, and many more. Within the next year, I will test for my Certified

Emergency Nursing certification. Achieving this will give me the ability to enhance my

organization's capabilities, and with hope motivate my peers to do so too. But more importantly,

the journey of preparation for the certification has and will increase my knowledge which will

translate to better care for my patients; a true testament of the importance of lifelong learning.

Earning my bachelors of science in nursing (BSN) is a milestone in my career, opening doors to

much more employment opportunities, but most importantly, has afforded me so much

knowledge and insight. I am a global learner, learning best on the job, getting my hands dirty.

Reading and preparing and then getting out into the world and applying my knowledge. During

my clinical hours, I was in the community witnessing the health disparities. I researched those

disparities and learned vital evidence-based practices for patient demographics I serve. Thus
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enabling my abilities to provide my patients with insight and better disease management skills.

My BSN journey provided me with a better understanding of the worlds health crisis and also

understanding how nurses can be part of a more significant change in healthcare policies.

Furthermore, during my walk, I witnessed how nursing leadership operates and received

valuable mentoring from nursing leaders. Providing me with humbling confidence and

reassurance that my leadership background in the military can translate to the civilian sector.

The initial apprehension I had when starting the BSN program has been replaced with a refined

obligation to better serve in my capacity as an evidenced-based clinician and afforded me with

great insight into the abilities of a nurse.

In the next two years, I will seek more opportunity in my military career, becoming a

flight nurse which will entail travel and training. Afterwards, I will work towards my master’s of

science in nursing (MSN). I have no plans on staying a staff nurse for my entire career. It is an

important step, but my ultimate goal will be to translate all of my leadership experience into a

role of education or personnel management. The ultimate goal is to become the best nurse I can

be, optimize my potential and achieve balance in my life.

Conclusion

I am a military leader, nurse, husband, father, son, and active member of my community. My

journey through the BSN program has proved to be very beneficial in my career as a nurse I am

glad I leaped. I have improved my knowledge base for my patient demographics, learned how

important research and technology is, learned that nurses have many roles to include healthcare

policy and overall I have determined how to be a better patient advocate. By maximizing my
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potential, earning multiple degrees, and receiving a multitude of training, I want to make an

impact on the patients I serve. Accomplishing my academic goals will hopefully gain me

opportunities of employment that provide a more purposeful and meaningful impact and also

give me the ability to maximize my time with my family. My passion and purpose are to serve

others. My life is one of servitude and its an experience worth maximizing to the fullest.
Program Graduate Competencies (PGC’s) Reflection 14 of 15

References

Anderson, A. (2014, March 18). The Impact of the Affordable Care Act on the Health Care

Workforce. https://www.heritage.org/health-care-reform/report/the-impact-the-affordable-

care-act-the-health-care-workforce

Chow, E., Foster, H., Gonzales, V., & LaShawn, L. (2012, July). The Disparate Impact of

Diabetes on Racial/Ethnic Minority Populations. Retrieved from http://

clinical.diabetesjournals.org/content/30/3/130.full

Delaware Emergency Department Opioid Prescribing Guidelines. (2016). https://www.acep.org/

uploadedFiles/ACEP/Membership/Sections_of_Membership/qips/article

Delaware%20Emergency%20DepartmentOpioid%20Prescribing%20

Guidelines%20Revised%20 1221....pdf

Delaware Health Information Network. (2018). About DHIN. https://dhin.org/about/

Delaware News. (2017, August 17). Governor Carney Signs Legislation Forming a Behavioral

Health Consortium and Addiction Action Committee in Delaware. https://

news.delaware.gov/2017/08/17/governor-carney-signs-legislation-forming

-behavioral-health-consortium-addiction-action-committee-delaware/

Doody, O., & Doody, C. M. (2012). Transformational leadership in nursing practice. British

Journal Of Nursing, 21(20), 1212-1218.

Finkelman, A. W. (2016). Leadership & Management for Nurses: Core Competencies for Quality

Care (3rd ed.). Pearson.

Gallup. (2010). Nursing leadership from bedside to boardroom: Opinion leaders' perception.

newcareersinnursing.org/sites/default/files-attachments/Top%20Line%20Report
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Gallup, Inc. (2017, December 26). Nurses Keep Healthy Lead as Most Honest, Ethical

Profession. Retrieved from https://news.gallup.com/poll/224639/nurses-keep-

healthy-lead-honest ethicalprofession.aspxg_source=CATEGORY

_SOCIAL_POLICY_ISSUES&g_medium=topic& g_campaign=tiles

Gaskin, D., Thorpe, R., McGinty, E., Bower, K., Rohde, C., Young, H., … LaVeist, T. (2014,

November). Disparities in Diabetes: The Nexus of Race, Poverty, and Place. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021012/

HAVE HOSPITALS BECOME INEFFICIENT NURSING FACTORIES?. (2017). Australian

Nursing & Midwifery Journal, 25(4), 6.

Horn, B. (2018, July 19). Overdose deaths inspire doctor's effort to give Wilmington's homeless

naloxone. Delaware News Journal.

Saint Francis Healthcare. (n.d.). About Us | Wilmington Health Care Provider. Retrieved from

https://www.stfrancishealthcare.org/about-us/#missionvalues

Schakowsky, J. (2017, May 18). H.R.2392: Nurse Staffing Standards for Hospital Patient Safety

and Quality Care Act of 2017. Retrieved from https://www.congress.gov/bill/115th-

congress/house-bill/2392?r=9

Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using Electronic Health Records to

Improve Quality and Efficiency: The Experiences of Leading Hospitals. The Common

Wealth Fund, 18-19.