Reflective Paper

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Reflective Paper Jenna Spotts Cedar Crest College

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2 Abstract

The purpose of this paper is to take an in-depth look at each clinical objective and to reflect back on each clinical experience. Each objective was to be met at clinical experiences along with personal objectives for each clinical experience. The purpose leadership clinical experiences was to be able to learn and grow as a leader throughout school and as a future nurse. Each objective is described in ways to be met and each objective is described in how they were met throughout the clinical experiences. There is a personal reflection to help with showing how I was able to meet each objective as well as my own personal objectives and my thoughts on the entire clinical experience. Keywords: Leadership, nursing, management, ethics

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3 Reflective Paper

Leadership is something that is taught and learned. I was assigned to complete 84 clinical hours for leadership. The clinical hours were community service, service leadership, political, nursing supervisor, management, peer, patient logistics, continuing education, research, ethics, and independent hours. Each of these experiences had a major impact on me personally and educationally. I learned something new at each experience which is so important to me. Throughout this paper is each clinical objective and how it was met. For each clinical experience I had two personal objectives and I was thankful to meet each of those objectives as well. It is important to me to always be able to learn and this class helped to show how much I have learned from previous courses and how important it is to keep learning in order to grow.

Objective One As a student nurse, I started my first nursing course terrified. I had to learn how to take care of another human, something I knew I always wanted to do since I was a young girl. Dreaming and doing it are two very different concepts. This course is where I would learn how to take care of the basic needs of another human, learn assessment skills, and how to organize care. As each semester goes on I learn new skills to add onto the previous skills that have been taught to me. Leadership is an important aspect in a nurse because we have to lead in many ways. We lead by example, by teaching, by learning, and most importantly by caring. Diversity is an important aspect in life, everyone has the right to be different, it is important to be able to look at someone and be okay with who they are. No matter what, everyone is similar on the inside of their bodies, they are similar in that they need help with their ADL’s, to cope with an illness, or a death in their family. Throughout this leadership course I

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chose different areas that would allow me to do some teaching. I was able to teach visitors at the Rodale Aquatic Center about the importance of keeping your blood pressure in check, why it is important to get the flu vaccine, and to have a low sodium diet. I was able to help junior level students on how to organize their care, how to pick out priority nursing diagnoses, and how to manage report in the morning. Being in the unknown is a very stressful situation and being able to be a teacher for those in their unknown was a very beneficial feeling. Objective Two Ethics is a considerable factor in nursing. According to the American Nurses Association the code of ethics affects all aspects of a nurse’s life, the code of ethics establishes the ethical standards of not only nurses but companies who represent health care and patients (ANA, 2015). The code of ethics is a guide to help nurses with decision-making and helps with analyzing ethical situations (ANA, 2015). While working through leadership I had to work through using the code of ethics while completing my community service. I was placed at Daybreak, a facility for people with addiction to drugs, mental health, and HIV. There was a member that was talking about something that happened, and ethically I needed to decide what I was going to say to them. It was a tough situation and decision, but the member and I were able to work through the problem at hand. I had to say what was important to give the member options, but I also had to understand that I did the best I could with the situation, even if the member didn’t want to hear the options listed. According to Marquis and Huston (2015) a leader is one who is out in front of the crowd, taking risks, achieve goals shared by the crowd, and inspire action. A manager is one who leads and directs parts or all of an organization through manipulation and deployment of resources (Marquis & Huston, 2015). To help with management skills I was able to follow a nurse

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supervisor of perioperative services. I was able to learn how to effectively communicate with other staff members about concerns. I followed a nurse manager that was extremely down to earth, she walked through her units multiple times to make sure everyone was okay, she stopped to ask how their shift was going, thanked them for coming in early or staying later, went to meetings, and was able to be extremely modest towards staff as well as myself.. She was a leader I would follow for management style. Objective Three I look at each clinical as a job interview. In order to be even considered for employment, one must be professional, early to any appointment, courteous, willing to work with others, and be respective. It would be difficult to work with anyone who couldn’t be this way, especially inn a team oriented environment. Nursing isn’t about being on your own all the time, delegation happens, we will always need help. I was always able to arrive early to any clinical experience I made, I was in the proper uniform; whether clinical uniform or professional business attire. In order to effectively communicate I was always able to email or call whoever I needed to talk to about my clinical experiences. For all of my experiences I sent out a thank you email for those who took time out of their busy day and schedule to show and teach me new skills. It is super important to be able to learn new skills, but it is also important to remember those who took the time to teach new skills. Objective Four According to Wilson, Paterson, and Kornman (2013) leadership development increases job satisfaction, increase in team work, increased culture in the workplace, and an increase in patient outcomes. Before starting leadership I almost felt as though I would be a bother towards those who were there to teach me, on the contrary it was exactly the opposite of how I felt. The

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nurse supervisor I followed was able to show me how she works with another hospital and the other floors individually to make the best possible outcome for the most amount of people. Being a supervisor is a difficult task, and she was able to show me how to effectively manage time and critically think between seven floors and make sure there was enough staff. She stated that it doesn’t always work out the way it needs to work out, but it is important to remember to keep moving forward and to work with what is given to you. Objective Five Being an advocate for a patient and other nurses is a quality that cannot be removed from a nurse’s core. There isn’t a way to care for people but then not to help them in any way a person can. Recently at a peer leadership I heard about a patient who had a Foley that was then removed because of pain, however this patient was retaining large amounts of urine, the patient was then being straight catheterized instead. I asked the student if there was a schedule for bladder scans and asked about why the patient should have the Foley instead of the numerous straight catheterizations. It is important to communicate with a patient the importance of keeping the Foley inserted into the bladder and performing interventions for the patient for pain rather than intermittent straight catheterization, simply for the reduction of infection. It is a difficult decision to inform a patient about the importance of one treatment versus another treatment even when the patient is refusing the treatment. I feel that it would be morally and ethically wrong to ignore informing a patient about different treatment options and the risks and benefits of each treatment, this goes along side informing the patient why the treatment is necessary. Objective Six In order to learn new skills and come up with new ideas to practice, one needs to be willing to learn. This was the belief I thought of each time I arrived to clinical, I not only learn

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from books and classroom, but I learn from other people such as, managers, supervisors, peers, and patients. I take what I learn from each experience and I think of how things can go different or if they should stay the same. Healthcare is always changing and even though I learned amazing things through all of my clinical experiences it is important that to be able to handle change one must be able to change as well. I love to learn but I am open to change. Prior to each clinical experience I had personal objectives that I wanted to meet, and I was able to do that for each experience. I was also able to be open to learning more than the objectives set for me and by me. To me learning is an important aspect, it keeps your brain from becoming stagnant. In order to be involved in change and new ideas being implemented into practice, we as nurses need to be open to change. Objective Seven In order to be involved in policy making it is important to remember that one needs to be involved. During my clinical experience in Harrisburg, I learned all about policy and how to be involved. It is important to join the committees that are there for change and policy, unit councils on the hospital floor, township, county, and state government. Another major area to help with being involved in the political aspect of nursing is to join the Pennsylvania State Nurses Association (PSNA) as well as the American Nurses Association (ANA). The PSNA were able to send out two members to Harrisburg to speak with my nursing class. I didn’t know that so little nurses were involved in the PSNA, we can have a major impact on nursing with such a loud voice, we can have a loud voice for politics, the unfortunate part is we don’t have this voice. I learned that change is inevitable, but what isn’t inevitable is having a voice to show concern for a change that is or is not being made in nursing. Healthcare will always change with or without the strong voices of nurses backing up the change, the important part is to be involved in the change.

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8 Objective Eight

The code of ethics is a non-negotiable code that nurses are taught to live by to guide them through the difficult decision making process of an ethical decision (ANA, 2015). An ethical decision can be something minor such as a disagreement between two coworkers to something major such as whether to chemically restrain a patient without consent. The code of ethics is an important aspect in a nurse’s life because without it there wouldn’t be a set standard on how to complete the decision making process for an ethical decision (ANA, 2015). According to Marquis and Huston (2015) authority is a power to act, this power is given to someone and they are to direct others. There are many authority positions in a hospital, for instance a manager is given the ability to hire, discipline, and fire workers in their unit. Authority is necessary in a work place, without it there would be chaos and confusion. There is also a confusion between workers in an authority position versus workers with status, status shows skill, education, level of responsibility, salary, and specialization; a worker with a high status level doesn’t have the authority to do the same actions as a manager on a unit. A worker with a high status level would be a charge nurse for the shift, this is the person that most go to looking for help and to ask questions prior to asking the nurse manager of the unit (Marquis & Huston, 2015). Personal Exploration The clinical objectives that I had made prior to each experience were accurate. Sometimes it seemed difficult to come up with objectives if I wasn’t sure what to expect from the experience. The best part about making your own objectives is that you are determined to learn those and more. Throughout each experience I not only had personal objectives for the paper but I kept making objectives in my head to meet, and I was able to learn from each experience to

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help with learning more at the next experience. I always expected to learn about the job and job qualifications for certain positions but the fact of the matter is that in any job there are so many ways to explain a position but you won’t know or understand until you experience the job. The nurse manager job is a very complex position, the manager goes throughout the units and attends meetings, is an advocate for his or her employees, works on payroll, communicates problems through the chain of command and more. It is difficult to explain the position to someone without being able to be in their shoes for a day. During clinical orientation I remember Dr. Robb stating that it is of upmost importance to have an agenda to be able to manage our time effectively throughout the clinical course. To manage my work and school schedule I needed to have an agenda and I would also put all of the appointments on my phone. I consistently would check my email for reminders for any clinical experience I signed up for. Keeping an agenda has also been beneficial for my time management skills of meeting the objectives set for the course and the personal ones I set for myself. I feel as though managing work, school, and clinical hours that having an agenda and a calendar on my phone has helped me to manage my time effectively and I don’t feel as though I would change anything for another semester. I also was able to make a checklist to help me manage what is the most important task to complete and in between each task I would study, this procedure would allow me to complete everything on time and still have some time for myself. I feel as though leadership is standing in front of those and taking charge. Leadership is something that is taught and learned. You can learn how to be a leader and the definition of a leader, although actually being able to advocate for those around you is something that a person is born with. I feel as though all of my experiences are up to date with the definition of leadership, but not every person I followed was a leader. There are those who are willing to

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advocate for family, friends, themselves, employees, and patients; there were some who were not willing to be a leader. I feel that through nursing it is important to be an advocate for those around you, it's in our nature to care, and it’s difficult to care but not advocate for them. Each clinical experience was more than I had hoped for. I was able to see how far I have come as a nursing student through peer leadership in being able to teach and guide nursing students through their clinical day and through the questions and stress of videotaping. Through patient logistics I was able to see how patients are moved around on the floor, I have seen it through working in a hospital but it was eye-opening to be able to see it from the other side and how patients are moved throughout the floor of the hospital. I was able to walk through the floor with the nurse supervisor and see how nurses and aids are moved around throughout the hospital to make sure there is enough staff for patient satisfaction. It is unfortunate when some nurses and aids have more patients then their care model design, but patients need to be taken care of. Being able to see how the hospital works from both sides of the spectrum is beneficial to every person involved, it is stressful for both parties, but highly beneficial to each side. When asked in the beginning of the semester which of us students were leaders very few of us raised our hands when all of us should. Being in nursing school sometimes makes it difficult that you are being a leader and that you are changing someone’s life, when in fact we are doing exactly that. This is why in the beginning nursing courses we are taught to build a therapeutic relationship with patients and to keep building from each semester. By the end of the semester I finally started to feel as though I am a leader, this class truly helped me to see that I am. I am able to provide patient care, answer the patient’s questions, and most importantly I am able to advocate for those patients even when I feel as though I shouldn’t because I am only a nursing student. It can be difficult to be on the floor and go up to a nurse and tell them that I

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think the patient should receive a different treatment compared to the one that they are receiving or to tell a nurse that a patient is in a lot of pain and that the intervention should be completed for them. This class has really enforced my advocacy skills, I’ve always had them but I learned how to better manage my anxiety when advocating for the patient to the nurse. This goes alone with behaviors that needed to be changed about myself as a future nurse. I always have had anxiety talking to the nurse about patient care, it shouldn’t be that way because both of us are there to take care of the patient so why should I be scared to communicate with the nurse, even the doctors. I have been able to communicate more effectively with the nurses and doctors in my other clinical experience because of this class. This class has truly brought out a leader in me that I was a little scared that I would never find. My view has changed of nursing leadership because when I started this course I didn’t think a lot would change about who I am as a nursing student, when in fact I was able to selfreflect on who I have become as a person and as a nursing student. This class has given me the ability to set aside the constant stress and be able to see how far I have come and to be proud of myself for this. I was completing my last peer leadership clinical in Nur 321 and it was the classes last 321 clinical and it was amazing to sit there and listen to the students and the clinical instructor talk about how she has watched them grow throughout the semester, and they were able to see it themselves and what they have ended the semester with versus what they started with. It was an explorative experience to remember back when I was sitting in their same shoes and how far I have come. I will be forever grateful to have that experience to always look back on.

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12 Conclusion

Over the course of the semester we were assigned to complete 84 clinical hours with the option to complete more but no less. I remember being nervous to juggle work and two clinicals at the same time. I remember thinking that I don’t understand how full-time nursing students do it. Thankfully I was able to manage completing all of my clinical hours for both experiences, this class has not only taught me about being a leader, but also how to be an effective leader, to have a voice, and very beneficial time management skills that I will take with me throughout the rest of my life. Ethical situations will always arise throughout life either in a person’s career or in their private life. It is important to think back to learning about the code of ethics and its importance in a nurse’s life. The code of ethics is a learned code but also a guide to how an ethical situation should be handled, without it there would be chaos. Leadership is learned and taught, it is important to have the want and need to be a leader; especially in nursing; but it is highly beneficial to be taught leadership skills. These skills are going to be used throughout life, leadership skills are necessary to be successful. Each clinical objective is presented to the nursing class in the beginning of the semester, it is important to remember them throughout each experience in order to be able to reflect back on each clinical. It is also important to write clinical objectives for yourself. Having the objectives gives me the chance to be able to look back at each experience to see how I have grown, what I have learned, and most importantly who I will become because of these learning experiences.

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13 References

Code of Ethics for Nurses (2001). Code of ethics for nurses with interpretive statements. Pages 1-76. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur ses Marquis, B., & Huston, C. (2015). Leadership Roles and Management Functions in Nursing. Philadelphia: Wolters Kluwer. Wilson, V., Paterson, S., & Kornman, K. (2013). Leadership development: An essential ingredient in supporting nursing unit managers. Journal of Healthcare Leadership, Pages 53-62.