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Summer Exemplar

Nursing graduates share significant clinical experiences

"The following exemplars offer a peek into the moments of life as a nursing student that shape and help inform who they become as professional nurses. The exemplar writing assignment is to "describe a significant moment in practice where the student had an impact on the patient or the patient had an impact on the student." One of the prompts is to "write about a time when you knew you had become a nurse". These stories from practice describe pain and pain relief, fear and courage, despair and hope and the search for health that defines the journey of all nurses and patients. The faculty of the Cedar Crest College Nursing Department are so proud of our students and all that they do in the name of healing. We hope you enjoy their stories."
~Professor Amy Edgar

These are the stories written by the July 2013 nursing graduates.
*please note that the names of all patients have been changed for confidentiality.

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Melissa Crouthamel

Monitoring and Ensuring the Quality

It was a cold early morning as I entered the local hospital heading for the medical surgical unit. This clinical experience was the first time I was expected to complete morning preparation on two patients which made me very nervous because I was used to preparing the night before. During preparation I was responsible for analyzing the patient’s current condition including: lab values, medications, history, physical, admitting diagnosis, assessments, and tests. With this information, critical thinking skills were used to analyze the situation to improving patient outcomes. According to Benner (2001), this is categorized as monitoring and ensuring the quality of health care practices.

Michael was a 55-year-old male with a history of diabetes mellitus and morbid obesity who had been bed ridden for five years. He arrived to the emergency department by ambulance and was admitted for cellulitis that morning of clinical. After introducing myself to Michael I began morning preparation; however, while in the room I noticed that he was a very enthusiastic guy with a supportive family. During the completion of morning preparation several concerns became apparent which needed review by the physician. Morning lab values showed a decreased sodium level; however, Michael was receiving half normal saline, but should have been receiving regular normal saline. Michael was also receiving two different diuretics, but his chest x-ray was negative and he had no edema present. While reading the notes for the emergency department it mentioned that his wife called 911 because she noticed a changed in his mental status and left sided facial drooping at that time. However, no computed tomography scan was ever completed to rule out a stroke and this made me wonder about the current diagnosis. Lastly, blood cultures were never taken to rule out sepsis from his cellulitis , which covered 30 percent of his body and could be responsible for the change in mental status. I was able to discuss my observations and findings with my clinical instructor who agreed with my thinking. This increased my confidence significantly.

It also gave me a great opportunity to change the patient’s outcome by communicating with the physician. I was able to ask questions and report concerns effectively and efficiently. The physician and I worked together, collaboratively to make sure our patient got the best care possible. This experience increased the positive outcome for the patient and opened my eyes to the importance of using nursing judgment. According to Benner, while physician orders provide the course of action for many nursing actions, nurses have to use judgment in seeing them through. Nurses are also expected to evaluate what they should do to offer the best possible care for their patient, rather than simply carrying out the physician orders, despite the fact that this may involve risks for nurses (Benner, 2001).

Nurses really make a difference everyday by analyzing the care of the patient and utilizing critical thinking skills for the best possible outcomes for patients and not just relying on the physician’s orders. This was a great opportunity to monitor and ensure the quality of my patient though utilizing my critical thinking skills (Benner, 2001). Furthermore, I was able to increase my confidence though communication with the physician and patient care.