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Program Graduate Competency Reflection Paper

Lewis Smiley
Delaware Technical Community College
Nursing Capstone NUR 460
Dr. Wagamon
July 24, 2023
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RN to BSN Program Graduate Competency Reflections

Throughout the RN to BSN program, I have learned so much about nursing outside of the

bedside hospital nurse. This program has given me such a broader understanding of nursing.

Nursing on the global scale, nursing at the community level, nursing regarding healthcare policy

in government (state, national, and local) and nursing with regards to ethics. Below are the

Program Graduate Competencies and how each has been met through my work in the RN to

BSN program. In PGCs #1, #2, #6, #8 and #9 there were goals and how these goals were met.

My philosophy on nursing from the beginning of this program until now has changed in how I

think of nursing as a whole. Nursing to me had always been bedside nursing since I had never

experienced anything else but bedside. Now I see how many different avenues nursing can lead

someone and how many different careers one can have as a nurse.

PGC #1: Integrate general education knowledge, skills, and aptitudes to advance nursing

education and growth in professional practice.

Regarding Program Graduate Competency (PGC) #1 my goal to integrate general

education knowledge and advance my growth in professional practice would be working with

RN3s on the ace unit and speaking with them on how they achieved it and how once I finish my

BSN, I could work on my RN3. This would be a huge step towards advancing my nursing

education and furthering my growth in professional practice. Looking through the requirements

and prerequisites for the RN3 advancement can only take you so far. Speaking to nurses that are

already RN3 could help me find the best way to achieve this goal. I was able to speak with
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charge nurses on the Ace unit that were RN3s and was able to get an understanding of the new

changes that were made to the program. Through the knowledge I have learned in this program I

have prepared myself for obtaining my RN3 and advancing myself on the clinical ladder at work.

I have also learned so much about nursing informatics that I can use to make my decision

to possibly work towards my certification or Master of Science in Nursing Informatics. I have

learned a lot about nursing management and how much different it can be then floor nursing and

how there are many different skills that are needed to be a great manager compared to a great

bedside nurse.

PGC #2: Demonstrate leadership skills to promote patient safety and the delivery of high-

quality healthcare.

A goal regarding PGC #2 will be developing my leadership skills by working with charge

nurses on ace unit and working with management on ace unit and taking part in sitting in on their

patient rounds. Sitting in on patient rounds with the management team and the charge nurse on

the ace unit will help in developing my management skills. Patient rounds on the ace unit will

show me a side of nursing that I don’t experience often being on night shift. Working alongside

the management team and sitting with case management and the medical team I can see the big

picture of the status of the unit.

Through my practicum on the Ace Unit (8 South) at Wilmington Hospital I have learned

so much about how the management team coordinates the morning rounds and how this

coordination process in rounds sets the goals for the day for each patient. Working as a night

shift nurse I have never experienced rounds and I see now how important they are and how the
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coordination between the manager, the case managers, the nurse, the pharmacist, and the doctor

set the tone for the whole day. During these rounds not only do the doctor and the nurse go

through the plan for the day regarding their acute hospital needs but the case manager and

management work towards looking at the discharge plan. They all try to collectively find the

barriers to the patient’s treatment at first and then once the patient is medically stable for

discharge, they investigate the barriers for discharge. The leadership skills of the charge nurse

and management team during rounds show me a different look into the leadership skills that I

have already developed as a nurse and charge nurse at night. The planning that goes into

organizing the whole floor and pulling the hospital team together to find answers to each

individual patient’s acute care needs and setting up discharges for not only today, but the future

takes a lot of planning and oversight.

PGC #3: Apply skills of inquiry, analysis, and information literacy to support evidence-

based professional nursing practice.

This PGC was met I would say in my nursing research class NUR 340 I applied skills of

inquiry and analysis to support evidence-based nursing practice when I was researching Catheter

Associated Urinary Tract Infections (CAUTI). In this evidence-based study they described that if

nurses not only used aseptic technique when inserting and manipulating foley catheters and

consistently evaluate the need for continued catheterization, they could decrease CAUTI in the

hospital setting. We also use similar evidence-based studies at Wilmington Hospital for us to

decrease the length of time for catheterization after surgery and even with urine retention we

always periodically do voiding trials to see if the retention has resolved, and we can remove the
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catheter. The CAUTI rates in our hospital have gone down with the evaluation of catheter use

and our focus on better aseptic techniques with catheter insertion.

PGC #4: Integrate information management technology to improve patient outcomes.

In Nursing Informatics class NUR 410 we investigated information technology and how

it could improve patient outcomes. The project that I looked to for future use in a hospital was a

call bell system that would be linked to the Electronic Health Record (EHR). This technology is

out there, and I thought of even enhancing it to not only track a nurse or patient care technician

(PCT) going in and out of rooms with call bells using a badge, but also be able to connect to a

handheld to be able to describe why the nurse or PCT went into the room and chart it directly

from the room to the EHR. This would not only turn off the call bell when the nurse or PCT

entered the room, but it would also save on charting time by letting the nurse or PCT chart on

their own personal handheld what they did with the patient while they were in the room. Whether

it be toileting, mobility, turning, or nourishment this would be documented while the nurse or

PCT was walking out of the room. This would save time because the nurse or PCT would not

then have to go sit down log into a computer and document what they had done in the room, plus

also it would make sure that this occurrence was documented which sometimes if the nurse or

PCT automatically gets pulled to another room things may get missed. Attached below are the

workflow processes prior to and after the change that I envisioned:

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PGC #5: Advocate for patients and the nursing profession with regard to healthcare policy

at the local, state, national, and global levels.

This PGC was met during my Nursing Policy class NUR 420 through the investigation of

healthcare policies on the state and national level regarding the Affordable Care Act. The ACA

was enacted to broaden Medicaid coverage. The Medicaid expansion’s purpose was to give more

Americans access to health care based on their income alone and not based on if they were

disabled or had small children. It was made to cover the Medicaid gap which was evident in the

US. The ACA was a federal mandate but gave each state the right to approve or deny Medicaid

expansion. (U.S. Centers for Medicare & Medicaid Services, 2022). There is a gap in coverage

where certain states have denied the Medicaid expansion and this has left millions of Americans

without health insurance.

My personal nursing philosophy was broadened through the nursing policy class, I saw

into the whole world of nursing in politics and how nurses are a big part of hospital regulation

policy and general health care policy. It was amazing to see the depth that nursing has in the

government and how there are so many high-ranking politicians that were nurses first. It was also

interesting to find how hospital policies are put together based on government policies and

sometimes the other way around. Where policies that a hospital has put together eventually are

adopted by the state and or federal government as policies all hospitals should adhere to. Most of

these policies were put together by nurses for the safety of patients and the protection of those

same patients’ rights.

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PGC #6: Direct patient-centered care through advocacy, interprofessional communication,

collaboration, and delegation.

One goal with PGC #6, regarding management and delegation, is for me to learn more

about how dayshift charge nurses and the management team delegate. I will be focusing on this

during my clinicals by observing charge nurses and the management team on ace unit to collect

information on how they delegate tasks. Something to work on for myself is delegating tasks for

the nurse to do while I am helping them with a task and not just completing the task myself.

Even though I learned a lot through studying nursing management it is necessary to work

alongside management of an actual floor to see how things run in real life. It is essential to see

the real interactions between management and the floor nurses. This can be best addressed

through practicum work with my preceptor who is a Nursing Professional Development

Specialist and with the management team on ace unit.

Direct patient centered care through advocacy, interprofessional communication,

collaboration and delegation can all be seen in one place during rounds on the Ace Unit. I have

learned so much through observing rounds that I could have never known working night shift. I

have always worked through these aspects of patient care regarding advocacy, interprofessional

communication, collaboration, and delegation in my daily routine working as a floor nurse and

charge nurse just in different ways. By speaking with doctors regarding patient care, advocating

for my patients and other patients on the floor and collaborating with my nurse colleagues and

delegating to unlicensed personnel. This course and the practicum work on 8S helped me see a

different side to each of these aspects and it was eye opening.

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PGC #7: Integrate health promotion and disease prevention practices to positively impact

the delivery of healthcare to diverse populations.

This PGC was met with my practicum work through NUR 330. Through my work with

Joseph Demarco RN, my preceptor, in the Medical Aid Unit at Wilmington Hospital I was able

to see how the outpatient part of nursing worked. We not only worked with a diverse population

in the City of Wilmington community, but we were constantly working towards health

promotion and disease prevention. Joe would check on patients through a phone call to them

after they had either been in the Emergency Room or been admitted to the hospital. He would

work with these patients on their compliance with their medications after the hospital which may

have changed and work with their compliance with their other medical needs such as dressing

changes and physical therapies. Through observing this interaction, I have seen a very different

part of nursing. The Medical Aid Unit at Wilmington Hospital also works to triage their patients

as some of them are not sick enough to go to the Emergency Room.

Through this community rotation I saw what it was like to be an outpatient nurse in the

community setting and it was eye opening, and this made me take a different look at my nursing

philosophy. There were so many ways that the community nurse must try to communicate with

their patients to keep them on task. In the hospital our patients are in their rooms, and we don’t

have to find them or try to find ways to contact them. This makes for some frustration on the part

of the community nurse but also when you can get through and make a difference in that

person’s life that you have finally got in contact with and helped them with their health care

needs at their home it is amazing. Nursing is such a rewarding career and now I see how it can be

just as rewarding outside of the bedside nurse.

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PGC #8: Practice professional nursing within an ethical framework.

A goal related to PGC #8 is to look more into the ethical policies and the ethics

committee at Christiana Care through working with my preceptor Debbie who is an educator and

working with management on the ace unit to get a better understanding of how the ethics policies

relate to the everyday workings of the hospital. Debbie Lykens my preceptor has also set up a

meeting with Dr. Curtin who is the Chief of Geriatric Medicine at Christiana Care plus also the

medical director of the Acute Care of the Elderly (ACE) Unit and the medical director of the We

Improve Senior Health (WISH) program. My preceptor Debbie also set up a meeting with the

program director of the WISH program Denise Lyons. Denise lead to the development of the

WISH program at Christiana Care in 2001 and worked towards the geriatric review course at

Christiana Care and since then 400 nurses have earned gerontological nursing certifications from

the American Nurses Credentialing Center (ANCC).

Through the meetings with Dr. Curtin and Denise Lyons I have seen such a different side

to ethical nursing in the care of the elderly patient. There have been such great strides from the

beginning of the We Improve Senior Health (WISH) program that Dr. Curtin and Denise Lyons

started in 2001 to now with how elderly patients are treated. The elderly patient through the

WISH program is given a specific framework that is related to their own specific disease

processes as an elderly patient and treated uniquely rather than treated the same as every other

patient. This has so much to do with treating these patients with ethical considerations so that

they can have specific care plans tailored to their needs. The WISH program has worked so

seamlessly on the ACE unit, but the end game is for the WISH policies to be used throughout the

whole hospital in every unit. The WISH program also considers end of life needs and Do Not

Resuscitate (DNR) orders. Also, the WISH program considers the needs of patients with
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dementia and stroke histories since this is impacting a lot of elderly patients. It incorporates

family involvement and teaching to relay information accurately.

Throughout the BSN program I have also changed my philosophy on thinking as a nurse.

I feel that I learned a lot of things in the ethics class that I could use in my nursing practice today.

The class opened my eyes to certain situations that I have never been a part of but also gave me a

new understanding of how I could have handled something different in my previous nursing

interactions. There were many scenarios that have come up before and I have a much better

understanding and new outlook on how I would handle those interactions in the future.

PGC #9: Demonstrate lifelong learning that empowers personal and professional growth.

For a goal regarding PGC #9 I will be working with the management team on ace unit

and looking towards lifelong learning and possibly moving towards a career in nursing

management. Lifelong learning through the advancement into nursing management can be best

accomplished through working with the management team on the ace unit who were at one time

floor nursers and are now nurse management and with my preceptor who is a nurse educator now

and once was a floor nurse. Finding the best way to transition will help with accomplishing my

goal of lifelong learning.

For my lifelong learning plan to start after I complete my BSN, I will be first working on

my RN3 which is an advancement in the clinical ladder at Christiana Care. In addition to

obtaining my RN3 I would like to in the future look towards possibly becoming a nursing

informaticist. To start a career in nursing informatics I would either need a graduate certificate in

nursing informatics requiring 12 credits or go for my Master of Science in Nursing informatics

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requiring 36 credits with 6 credits of practicum included. The certificate program will not only

give you information about nursing informatics if you are not definitely sure of changing your

career to informatics but also get you in possibly at a lower-level nursing informaticist. The

master’s program will be more suited to a complete career in nursing informatics and if I was

looking to change my career to nursing informatics.

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References

U.S. Centers for Medicare & Medicaid Services (2022). Medicaid expansion & what it means for you.

Healthcare.gov. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/