Most of my life I have never been entirely sure what direction I have wanted to

pursue for a career. I have always been a happy person and a driven person. However, I
have constantly been scared to commit to a profession, until I found nursing or rather,
nursing found me.
I graduated from Michigan State University in 2004 with a degree in Human
Biology. With my new degree, I still could not find a job in Michigan. Since I could not
find a job, I decided to take some time off after graduation and travel to Hawaii with my
best friend. It was peaceful, relaxing, and an eye opener into my future. Most of my life
I had been selfish and uninterested in trying to better myself for the greater good. Being
with my best friend, who loves to save, well, really anything, I realized that I needed to
be a better person. She encouraged me to move to Denver, as I had always wanted to
move out West. I moved to Colorado in September of 2004 not knowing a soul. This
was liberating, scary, lonely, and amazing all at the same time. In a way I had a second
chance to figure out who I was and what I wanted to become.
I had a series of jobs and finally settled on a job working with Developmentally
Delayed Adults, which is where I finally figured out that I wanted to become a nurse. I
came to this epiphany more by luck than self-reflection. Somehow, I was a good listener
and helping my clients with medical appointments and medical terminology was
something I really enjoyed. Nursing seemed to be a logical and exciting next step. On
my nursing application my reason for applying was that I wanted to help people. In
January of 2009 I was lucky enough to have been accepted into nursing school and
graduated in May of 2011 with my BSN from The University of Colorado.
Wanting to help people is a very generalized phrase and a phrase I would
assume most people in the nursing profession use frequently. My definition of helping
people has changed dramatically over my three years as a nurse. According to Benner, I
began my nursing career in Stage 2, or as an advanced Beginner. An Advanced beginner
demonstrates marginally acceptable performance because the nurse has had prior
experience. As an Advanced Beginner my clinical practice objective was to help
people by making sure that I did not have a med error or that I did not cause them a
traumatic injury from how many times I stabbed them attempting phlebotomies and IV
starts.
My second year I was in Stage 3: Competent. I had been in similar situation for
two years and could demonstrate efficiency in my actions most of the time. This is when
I began feeling like a well-rounded nurse and not a task-oriented nurse. I could assess a
patient not just physically but also emotionally. Being a BMT/Oncology nurse the
emotional assessment is often times more important than the physical part, especially in
our End of Life Patients.
By year three, I have entered into Stage 4: Proficient. I can cluster care, multi-
task, and guide different levels of nurses toward answers. I have a weird sixth sense and
often times recommend transferring patients off of our unit to step down or ICU, just
because the situation does not feel right to me. Whereas before when I would transfer
patients to a higher level of care I would know that this was necessary because my charge
nurse recommended this to me. Now, I can perceive the patient as a whole rather than an
abnormal lab or vital sign. Not only do I understand the situation but can prepare for the
future care of the patient. I feel that I am now making recommendations to doctors and
my peers about patient situations rather than asking for recommendations.
So, what is my Philosophy of nursing? My husband once told me that people
dont start out making large unethical errors, they start by making a series of small ones
that turn into larger ones. The first unethical mistake you make and how you handle it
will determine your overall character in your profession. So, my nursing philosophy is
integrity. Nobody really knows how you talk to your patients or how you care for them
but you. Integrity is what defines nurses especially in their everyday practice.
Working in a large teaching hospital things are really, really, really busy. A
thirteen-hour day feels like an hour and often times you cannot remember what you did
except survive the day. As I remind my patients that they need to pee every four hours, I
know that I in fact have drank approximately 0 mls of water and gone to the bathroom
one time during my shift. There are always more things that you can do for your patient
and more ways you can help them. You can educate them more, give them a bath, or just
sit with and talk them. I wish I had more time to talk with my patients and help them
navigate through scary life changing situations, but I always try. The first time that you
do not look up a med before giving it or do not report an error that you have made, then
you have compromised your integrity. I promised myself that no matter the cost or how
much I do not want to do something, I would not cut corners and would make sure to
hold myself to the highest standards in health care. Nurses are intelligent, trustworthy,
and must have integrity.
My philosophies and values have changed dramatically over my past three years
as a nurse. No longer do I get angry when I have to wait for my Starbucks coffee or that I
cant go outside because its raining. Now I try to just appreciate the fact that I am
allowed such a luxury as Starbucks and notice that rain is relaxing, not an inconvenience.
My nursing philosophy has evolved from a scared entitled nurse to that of a much more
accepting and tolerant one. I have realized that most of the time when patients are angry
or rude, it is because they are scared. If they are demanding and yell a lot, it is because
they are scared. If they joke and seem detached, it is because they are scared. People
process in very different ways and as a nurse it is our job not only to care for them
medically but also emotionally. Patients do not need to know or should not have to know
how bad your day is, they need you to be present and take care of them. I have learned
that in the hospital my patients come first and that being present is the best thing you can
give to a patient.
While it is important to put your patients first at work, it is also important to
ensure that you take care of yourself outside of work. You need to be balanced and
healthy yourself. If you dont take good care of yourself, then you may not be able to
care for other people well. I feel I learned this the hard way. In December of 2012 I had
my second baby. After maternity leave, I thought that it would be a great idea to come
back to work on a night contract as I would have more time with my kids. I quickly
realized that not sleeping was both unsafe for my ability to care for my patients and also
for my well-being. I became irritated and angry at life. My husband, parents, managers,
and friends all pointed out to me that I wasnt myself. I thought about my life and what
kind of a nurse I wanted to be and realized that I wanted to be a well-balanced nurse. I
wasnt exercising, eating well, or doing anything fun. I was simply surviving and in turn
I was becoming increasingly unavailable for my patients. So, I changed my schedule and
started doing something that I wanted to do at least once a week. I started learning to
knit, seeing my kids for who they are not what I wanted them to be (and loving this even
more), I started hiking again, reading at night instead of watching TV, date nights with
my husband, connecting with friends, being outside every chance I could, and just trying
to notice the all of the wonderful things in life like sunshine and actually tasting coffee,
not drinking it to stay awake. Once I started doing these things for myself, I noticed a
huge difference in my mood at work. I could be present for my patients and I wanted
to not because I had to. I believe in order to be a great Oncology nurse you have to
care about you too and take the time to care for yourself.
Since deciding to credential I feel I have found a new purpose at work. I feel
invigorated and challenged at work in a way I had not felt before. Before deciding to
credential I felt I always worked hard while at work but was not really invested in the
unit and I did not feel very engaged. I still loved going to work and loved my patients,
but found myself wondering why leadership was pushing so many different things on
their staff. Why should I specifically ask patients if they needed to use the bathroom?
Isnt it good enough that I have asked them if they need anything else? before Ive left
the room. I did not understand that performing AIDET, hourly rounding, LOOK report,
and assessing patient satisfaction scores DO matter to patients and make a difference in
their overall outcomes and care. I now find myself asking patients before leaving the
room very specific questions like; Do you need to go to the bathroom? Do you need
help positioning? Do you have any pain? or Do you need help reaching any personal
items? This was all the training I learned so long ago but was unaware of how much
these specific questions matter to patient outcomes. For me credentialing has forced me
to research why we do certain things and it has helped me to find the value and
importance in these things. I now encourage my peers to become engaged with patient
care and have started holding them accountable when I dont see them rounding on
patients, doing LOOK report, or AIDET.
Credentialing has also unveiled all of the behind the scenes things that my
leadership team had been doing without much of the rest of the staff knowing how hard
they all work for our unit. It has been exciting and enlightening to know how much work
is done daily by the leadership team and the leaders on the unit to make UCH so great. It
takes an army to make something great and the more leaders that the unit has, the better it
becomes and the happier the staff becomes too. I have found a new respect for my peers
who have decided to credential or already have credentialed and now know what an
honor and privilege it is to be able to make such a big difference at UCH. A lot of the
credentialing projects have not just changed units but have also changed patient outcomes
hospital wide. It is exciting to have the chance to really change things from the inside out
to directly effect patient care. Since taking this project on in October of last year, I have
caught myself thinking up new ways to make my unit better and have taken on more
projects. I encourage taking the work on instead of thinking who would want to do all
that work? Yes, it is an amazing amount of work, but it has been so rewarding. I am
proud of the work I do for the unit and am excited to present it and change things for the
better.
In April of this year, I had the honor of being promoted to a Permanent Charge
Nurse. With this comes the responsibility of rounding on patients. One patient in
particular really influenced me and gave me a lot of insight into my own clinical practice.
R.S. was a brilliant man who happened to have been diagnosed with cancer in 2013.
However, he learned to cope with his cancer in a very positive way and took his 100 days
on our unit in stride. He decided that since he was stuck here, he was going to help
understand what it was like to be a patient on the Bone Marrow Unit. I was inspired and
amazed by his compassion to help me gain insight into our unit so that other cancer
patients may get an even better experience. He said that sometimes he felt isolated and
alone because staff was always in such a hurry. While he understood that we worked
on a busy unit and that at times we needed to rush off, there was many times that if we
had just sat down and talked with him, he might not have felt like such a number or just
another patient. People want to be heard and want to know that their care is important to
you. Patients, not just cancer patients, are many times thrown into life changing
situations quickly and have little time to digest these feelings until they are sitting alone
in their hospital rooms. R.S. helped me to realize that sitting and talking with your
patients even for five minutes and just listening helps them to digest what is happening to
them and makes them feel like you care. Patients remember that you listened to them and
THEIR story. It does make a difference and helps them through some dark times.
Giving them respect, some dignity, and remembering that they are a person and not just a
patient matters while they are in the hospital. They have lives, families, jobs, and
hobbies just like the rest of us and they are not their diagnosis.
R.S. also helped me to learn that listening to what your patient is saying and NOT
saying with their body language makes a huge impact. Patients are often times
embarrassed to ask for help or do not want to inconvenience the staff. A patient may
not remember if you administered a medication on time, but they will remember if you
helped them understand why they were taking it. A patient may not remember that you
asked them if they want to take a shower, but they will remember if you make the time to
help make sure they take one daily. A patient may not remember that you asked them if
they had any pain, but they will remember if you assessed their pain well and helped
them come up with a pain management plan. A patient may not remember that they felt
nauseous but they will remember if you stay with them and rub their back while they
vomit in an emesis bag. Nursing is not about doing a job, it is about caring for people
when they are many times at one of the lowest points in their lives and helping them
figure out what they need when they dont know what that need might be. I have
changed my clinical practice to dig deeper within patients and myself to make sure that I
know that I dont view them only as a patient but as a person. They deserve respect and
compassion to help them through these difficult times. Thanks to R.S. I now treat all of
my patients like I would want to be treated or my close family and friends to be treated in
a hospital. I try to remember that what may seem intuitive and natural when building
relationships in a personal environment is often lost in a high stress and busy
environment like the hospital. I am always amazed and honored to be involved in some
of the most intimate and difficult moments in my patients lives. I used to be scared
when people would say, Im afraid to die and quietly wish that my phone would ring so
I could rush out the door. Now I welcome these conversations and feel privileged to be
able to help them through these situations. I have become more reflective in my practice
and within myself and now know that treating people with respect and dignity certainly
does not go unnoticed by our patients.




Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing
Practice. Menlo Park: Addison-Wesley, pp. 13-34.