For much of my life, I was not entirely sure what direction I wanted to pursue for

a as my career. I have always been a happycheerful person and a driven person.

However, I found myself scared afraid to commit to a profession, until I found nursing or
rather, nursing it found me.
I graduated from Michigan State University in 2004 with a degree in Human
Biology. I moved to and moved by myself to Colorado later that year not knowing a
soul. This was a liberating, scary, lonely, and amazing experience 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 ofAfter multiple jobs, including a jobone working with
dDevelopmentally dDelayed aAdults, which is where I finally figured out that I wanted to
become a nurse. I came to this epiphany more by chanceluck than self-reflection.
Somehow, I wasI was a good listener , and found that 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 school application, my reason for
applying was that I wanted to help people. In January of 2009, I was honored to be
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 one 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 the manymultiple times I stabbed them attempting ed
phlebotomies and IV starts.
My second year I was advanced toin 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 As 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 advanced to Stage 4: Proficient. I can now
cluster care, multi-task, and guide different levels of nurses toward answers. My practice
and experience has given me almost a sixth sense: where . For example, beforein the
past years I would have transfer ed a patient off of our unit to step down or ICU because
my charge nurse recommended it. Whereas now I should, I now find Ifind that I
recommend transfers just because the situation does not feel right 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, wWhat is my pPhilosophy 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. MSo, my nursing philosophy is
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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 hospitallarge academic institution, things are really,
really,can be really busy at times. A thirteen-hour day sometimes feels like an hour and
often times you cannot remember what you did except survive the day. I find that, even
aAs I remind my patients that they need to pee void every four hours, I know that I
havent drank any liquids or drank approximately 0 mls of water and gone to the
bathroom one timeonce during my entire shift. Even so, 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, from focusing on tasks - and becoming frustrated when difficult patients
prevented me from getting those tasks done - to focusing on my patients overall well-
being. I have become a much more accepting and tolerant nurse. 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 physically but also emotionally. Patients do not
need to know and should not have to know how bad your day is, they need you to be
present and take care of them. There are always more extra 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 to make time.
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 bethis balance to
stayd and healthy yourself. If you dont take good care of yourself, then you may not be
able to care for other s either.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 asso 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 to include the things that :started learning to knit, seeing my kids
for who they are not what I wanted them to be (and loving this even more), sI started
hiking again, reading at night instead of watching TV, having 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 . In addition, I was able to and
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actually taste the ing coffee now , not without just drinking it to stay awake. Once I
started doing these things for myself, I noticed a huge difference in my mood at work and
home. I was present for my patients because I wanted to and just 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 have found a new purpose at work. I feel
invigorated and challenged in a way I had not felt before. Before deciding to credential, I
felt I always worked hard while at work but was not fully engaged and invested in the
unit. I still loved going to work and loved taking care of my patients, but found myself
wondering why leadership was pushing so many different things on the 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 year2014, I had thewas honored with a promotion of being
promoted to a Permanent Charge Nurse. With this comes the responsibility of leadership
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 me understand what it was like to be a patient on the
Bone Marrow Transplant 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 often 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 exactly 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 just about doing a job, it is also 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 and to make sure
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 myself 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.




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