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Madison Rash

Delaware Technical Community College, Department of Nursing

NUR 460: Nursing Capstone

PGC Reflection Paper

Dr. Wagamon

April 17, 2023

PGC Reflection Paper

Introduction

As I have gone through the BSN program at DTCC I have learned a lot about myself as a

nurse, and what I see for my future career as a nurse. As I progressed through the program, I

really have grown into a more confident nurse who advocates for their patients and themselves in

tough situations. I still utilize my nursing philosophy every day, especially since I have begun

precepting nurses who have recently been hired on my floor. To be successful, nursing

professionals must stay informed and involved in ongoing development opportunities. A

commitment to lifelong learning improves the quality of care and patient outcomes, enhancing

career prospects. Looking back at my goals for NUR 460, I feel as though I have met all five of

my goals. Although I didn’t have as many days for clinical as I would have liked, most of my

course goals were met through my practicum experience.

PGC #1

“Integrate general education knowledge, skills, and aptitudes to advance nursing

education and growth in professional practice”. During my practicum experience this goal was

met by following my preceptor and seeing how her days typically go. For example, we ran PCT

critical skills, which is something that must be done annually to remain in compliance with Joint

Commission. During those sessions, we educated the PCTs topics such as pressure injury

prevention and safety. We were able to draw from our own experiences as a nurse to help

educate them with ways to help prevent a hospital acquired pressure injury or preventing a fall.

During the PCT critical skills we were able to also talk about the topic of safety for our one-to-

one sitter patients and the suicidal ideation patients. We came across many situations where a

PCT would get confused when deciphering the difference in safety versus SI patients and the
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protocols that must be followed. My preceptor and I were able to use our knowledge and

education in the field of nursing and help teach the PCTs how to correctly do so moving forward.

In turn, this will help the PCTs moving forward, especially the ones who were newer to the unit

because they can now teach others who may have any questions.

PGC #2

“Demonstrate leadership skills to promote patient safety and the delivery of high-quality

healthcare.” Again, this competency was met through my time following my preceptor for my

practicum. We were able to act as a leader to promote patient safety when we were running the

PCT critical skills sessions. We also acted as a leader for patient safety and high-quality

healthcare when we addressed a concern from a nurse regarding the correct policy for restraints

on a patient with Bipap. Being able to be a resource for nurses on the floor is something that

impacts the safety and quality improvement for our patients. During this scenario, we were able

to also follow up with our CNS to look at the current policy and see if there’s something that

needs to be changed or addressed moving forward so that when this scenario happens again,

there’s an answer for everyone. This is something that comes up a lot as a floor nurse and being

able to go to our leadership such as our educator, CNS, or even our management just gives us the

support that we want and need.

PGC #3

“Apply skills of inquiry, analysis, and information literacy to support evidence-based

professional nursing practice.” For this competency, due to Joint Commission beginning to round

at the hospital, I helped my preceptor investigate certain policies regarding pain management and

safety and more. This is not something that my educator would typically do, however, it is still

something in her scope of practice. Also, my preceptor was able to explain to me what it takes to
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become and RN 3 and the importance of doing a project that follows evidence-based practice.

She was able to explain how other nurses on my floor had done this and how other nurses had

started “Making Tomorrow Happen” huddle board that is now being used on all other floor units.

Opportunities like this are what show me what it’s like to be a nurse educator and how to further

support evidence-based professional nursing practice.

PGC #4

“Integrate information management technology to improve patient outcomes.” Looking

back at my practicum experience, although it may not have felt like this competency was met, in

some ways it was. When my preceptor and I went through policies and new educational material

for her weekly meeting, we were prioritizing information that needed to be brought up in the

monthly staff meeting versus being brought up by email or simply printed and hung up in our

unit bathrooms. My preceptor was able to call onto me to help her identify what material I felt

would be beneficial in each of those categories. For example, something such as restraints and

Bipap had been brought up numerous times so we both felt that this was something to be

addressed in the monthly staff meeting. Being able to identify important information and figuring

out the best way for it to be delivered in communication is extremely important in healthcare.

Moving forward, this competency is something that I will draw back on when I begin working as

a charge nurse because I want to make sure I find the best way possible to communicate to my

peers.

PGC #5

“Advocate for patients and the nursing profession with regard to healthcare policy at the

local, state, national, and global levels.” Advocating for our patients and the nursing profession

in general, is something that we strive to do every day. Working with my preceptor, we went
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through the new educational material that was being published for nurse educators to see and go

through. A big part of my job is not only caring for my patients but advocating for them and

educating them and their family. While we may not have specifically advocated for our patients

during my practicum, we still did in a way because we reviewed new material that we felt we

should educate our nurses on, so that way, in turn, we are able to better care for our patients.

PGC #6

“Direct patient-centered care through advocacy, interprofessional communication,

collaboration, and delegation.” Following my unit educator, I was able to gain experience and

knowledge related to being a good leader in my career but also on my floor specifically, which

will be extremely valuable for me as I begin training for charge nurse. Collaborating with other

members of the team such as the CNS and our management team, we were able to successfully

prepare for Joint Commission and we were also able to address RN concerns through

interprofessional collaboration. Seeing how interprofessional communication happened from

“behind the scenes” was interesting and it made me realize that our management, our CNS, and

unit educator truly do care about the staff and their concerns and our overall workplace.

PGC #7

“Integrate health promotion and disease prevention practices to positively impact the

delivery of healthcare to diverse populations.” When mt preceptor and I ran the PCT’s critical

skills, this is a topic that was talked about and was integrated into an online quizzing game called

Kahoot. Some questions touched on foley care, pressure injury prevention, and patient safety.

These topics were required to be a part of critical skills; therefore, we also educated the PCTs on

these topics as well, especially when questions arose.

PGC #8

“Practice professional nursing within an ethical framework.” Because this competency is

not as specific as the others, the BSN program and my practicum experience helped me to follow

this. In my everyday care as a nurse, I am constantly adhering to this competency and going

above it as well.

PGC #9

“Demonstrate lifelong learning that empowers personal and professional growth.”

Through my practicum experience I will be following my nurse educator. This experience helped

me understand the role that my nurse educator plays for my floor and the heart failure floor. I

was also able to gain knowledge regarding what it takes to become a nurse educator and other

roles that nurse educators play in the hospital. I have thought about going back to school for my

MSN, but unsure what specialty and following my preceptor allowed me to see what it is like to

be a unit educator. I enjoy helping others learn, which is a big reason why I chose to follow my

nurse educator and learn more about this role and how to get there. There are many routes to take

in nursing and being a nurse educator has its own roles throughout the hospital system.

The Final Class of my BSN

Throughout my nursing education at DTCC, I have been taught to be a thorough nurse

that advocates for their patients and always willing to learn. When beginning the final class to

complete my BSN degree, I did not know what to expect. I wasn’t sure if it would be a class like

my previous practicum-based class, or like my regular BSN classes. I have found that this final

BSN class was a great way to finish my degree. This class challenged me to think about how I

have evolved as a new nurse which led me to creating my own nursing philosophy and analyzing

what I want for my future as a nurse. The goals that I set for myself through the SWOT Analysis
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were achieved. I have begun to apply to be a part of a team such as the “skin rounds” team. I

have also set a goal to begin studying to take my Progressive Care Certified Nurse exam in the

fall of this year. Two years into nursing and I have met majority of the goals I have set for

myself. I have begun precepting more nurses and am planning to train for charge nurse soon. My

future in nursing has always had some aspect of education and I feel that my practicum

experience helped me to identify what I may want to do in my future. I really enjoyed learning

about what it takes to be a unit-based educator and to be a part of a leadership team. I’m not sure

at what point in my career I’d want to move into this role; however, I have a strong feeling it is a

path I may eventually take. Completing my BSN degree is not only a major accomplishment for

myself; however, it is an accomplishment in my career as well. According to Porat-Dahlerbruch

and Aiken, “given the complexity of modern-day care, it should come as no surprise that a

better-educated nurse workforce is associated with better patient outcomes” (2022). Working at a

hospital that is magnet recognized means that a certain percentage of nurses need to hold BSN

degrees. When I began my career at Christiana Care Hospital, I signed a contract stating that I

had to complete my BSN degree within three years of hire. Although I would have completed

my BSN degree regardless, this made me finish it in a timely manner. Over the years there has

been a substantial amount of research that states that hospitals with a higher number of nurses

that hold a BSN experience a significantly lower number of deaths, have shorter hospital stays,

and fewer readmissions, while also having lower Medicare expenditures per patient (Porat-

Dahlerbruch & Aiken, 2022). According to a recent study published, they found that “every 10%

increase in the proportion of BSN nurses in a hospital resulted in a 5.5% decrease in surgical

patient mortality. This means that hospitals with 80% of the nursing staff holding a BSN by any

pathway have mortality rates about 25% lower than hospitals with 30% of their nurses with BSN
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qualifications” (Porat-Dahlerbruch & Aiken, 2022). The study completed provided the evidence

needed to show that BSN-educated nurses correlate to better patient outcomes. This study also

showed that although more 4-year colleges and universities are growing slowly, trends suggest

that nurses will find alternate pathways to their BSN degree which will play an important role in

achieving the National Academy of Medicine (NAM) goal that there will be 80% of BSN nurses

within the next decade (Porat-Dahlerbruch & Aiken, 2022).

Conclusion

After completing my ADN at Delaware Tech Stanton, I knew that I wanted to continue

my education for my BSN there as well. Now that I am completing my BSN, I am telling nursing

students who come to my floor that they should continue their BSN at Delaware Tech because to

complete their whole program really makes you the best nurse that you can be. I achieved all my

goals for this course, and I even learned more about myself as a nurse and what I see for my

future in nursing. I think it’s important to take the time to reflect on your nursing career and to

think about where you see yourself in five years. Setting foals for yourself not only in your

career, but for also your education, is extremely valuable. Medicine is constantly changing and

being able to continue your educational journey as a nurse in many other fields is empowering. I

want to continue to achieve my goals that I have set for myself, both short term and long term.

This BSN program was everything I had hoped it to be and more. I really enjoyed my clinical

experience and felt that it was eye-opening for me and my future in nursing. I enjoyed how this

course challenged you to push yourself to analyze your career and goals and find out ways to

achieve those goals and more! I am forever thankful for my nursing journey at Delaware Tech,

and I cannot wait to continue my education in nursing and wherever it takes me.
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Resources

Porat-Dahlerbruch, J., & Aiken, L. H. (2022, January 13). Hospital Nurses and Patient

Outcomes: A Matter of Degree? Penn LDI. Retrieved April 17, 2023, from

https://ldi.upenn.edu/our-work/research-updates/hospital-nurses-and-patient-outcomes-a-

matter-of-degree/