1

Wayne Trader

Delaware Technical Community College

Nur 460-601Nursing Capstone

Dr. Mary-Ellen Mcknight

April 17, 2023

My experiences in the BSN program have had a profound effect on my nursing

practice in many ways. They have shaped my values, changed my ideals and philosophies,

and helped fortify my strengths and improve my weaknesses. My thoughts on Strengths,

Weakness, Opportunities and Threats (SWOT) is that it is a useful tool in evaluating not only

the organization you work for but also for you on a personal level. I learned my strength is

that I am patient, communicate with my coworkers well, and can maintain my composure

during stressful situations. My weakness to improve on would be asking for help when I need

it. I do ask for help when I do not know how to do something but I don’t ask for help when it's

something I can do but may end up being overwhelmed had I ask for help instead. For

example, if I had three call bells go for all of my patients and the nurse I am working with

within the same district is not bust they may ask if I need help. In the past, I have not asked

for help saying I could do it all by myself. Someone once pointed out that anything could be

happening when a patient uses the call bell as they have trouble breathing or chest pain or had

a fall to the ground. This is valid since nursing is a team-oriented profession where we all

work together for the needs and safety of the patient. The threat to me making progress would

be my home life as it is something that is out of my control. According to Penn State (2023),

threats are usually considered external which one has little control over but may be offset by

strengths or opportunities. I have personal family issues that might affect my personal life

which that makes me try to control the situation even more. I realize that there are things that

you can't control as you have to do your best to control your actions and your response to the

best of your ability. I try to take every opportunity at work when I think I could use the help

that I ask for it. I try to see the bigger picture of how I can promote patient safety and

strengthen my professional relationship with my coworkers at the same time. Sometimes one
 3

must recognize weakness just means an area to approve in. I think this is a gap in my PGC #6

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

collaboration, and delegation”. I should be working on my ability to delegate to other nurses

and patient care technicians to help keep my patient’s safe rather than try to do everything

myself. My experiences in the program have helped me broaden this weakness as I was able

to recognize this during practicum. I was doing rounds with my preceptors and when I saw a

patient out of bed who was a fall risk rather than get to bed by myself I immediately yelled

out for assistance. Although minor to many people this was a big for me as I later realized that

by trying to train my mind I was able to unconsciously work on my weakness without

thinking about it. I was able to figure this out not only through that experience but through

conversations with my preceptor but also with my co-workers and my manager. It is best to

self-reflect on things you are good at and what to self-improve but also to get an unbiased

point of view from someone else.

During my practicum for Nur 460, I had an experience where my preceptor who is a

nursing coordinator had to show her leadership skills against an uncooperative nurse. My

preceptor is a nursing coordinator whose job is to handle difficult situations when

management is unavailable, bed management, and delegate tasks to charge nurses regarding

admissions, discharges, and transfers to name a few. There was an issue where a nurse was

refusing to take care of a patient because for them it was essentially inconvenient since they

were in the middle of a shift change report and a patient had arrived on the unit. They got mad

and decided to refuse the patient trying to say they had to go back to where they came from

because they were in the middle of shift report. When the charge nurse got involved the nurse

still refused saying it wasn’t safe and fair to the other patients that she had to stop what she
 4

was doing and that the patient should have been transferred before or after shift change. I saw

my preceptor use her leadership skills to talk the nurse down as she was yelling and convinced

her to take the patient. First, she acknowledged and validated the nurse's feelings who was

frustrated and upset. By doing this, my preceptor was seeing her point of view and not

discounting her feelings. Second, she stated her side of the argument in that she had to accept

this patient because this was considered a delay of care. This means that in theory she could

cause harm to the patient or future patients by not allowing transport to drop off the patient so

they could help other patients who may need critical imaging or surgery. She asked what the

nurse wanted and she wanted to finish a report and just to be heard. The nursing coordinator

said why don’t you delegate to a patient care technician, charge nurse, or your district buddy

to help get them set up. Have them do a quick set of vitals, put the bed alarm on, and make

sure their call bell is within reach. That way the patient is safe and set up for you to assess

them and you can finish shift report. The nurse was happy with the compromise and everyone

got what they wanted. This could have easily gone in the wrong direction which could have

caused harm for the patient. I believe this exemplifies PGC# 8 Practice Professional nursing

within an ethical framework and PGC #2 Demonstrate leadership skills to promote patient

safety and delivery of high-quality healthcare. This is evident as my preceptor made it clear

that the nurse's actions were not acceptable because the delay of care is considered unethical

as it has the possibility of causing patient harm if they do not receive the care they need and

utilized her leadership skills to delegate to the nurse what should be done.

I have been more prepared to address the current issues relevant to nursing through my

experiences working pre-and post-COVID-19. One of the issues the nursing profession has

caused has been nursing shortages causing an imbalance in the nursing-to-patient ratios. A
 5

survey showed that 28% of nursing facilities reported at least one nursing shortage which

represents 3,900 out of 14,000 facilities that were affected (Chidambaram, & Ochieng, 2022).

I think this issue is prevalent throughout the world where burnout, stress, and people naturally

retiring due to old age has all been contributing factors. A report (as cited in Nurse burn out,

2022) showed that 62% of nurse’s experience burnout with that number being much higher at

69% in nurses under the age of 25 reporting burnout. Some of these issues would be related to

the natural inherent nature of the nursing profession which includes long hours, increased

physical workload, and increased difficulty in the level of acuity of patient care. The

pandemic caused many nurses to retire and quit the nursing profession altogether. According

to CNN (Russell, 2023), a survey published by the National Council of State Boards of

Nursing cited that approximately 100,000 nurses left the nursing profession due to COVID-

19. The same report also cited that another 610,000 nurses with 10 years or more and an

average of 57 were also planning to leave the profession by 2027 to retire or burn out

(Russell, 2023). This is relevant because it ties into PGC #7 “Integrate health promotion and

disease prevention practices to positively impact the delivery of healthcare to diverse

populations. COVID-19 was difficult for caregivers who may not have had access to the

necessary PPE such as N95, face shield, goggles, gloves, or an isolation gown per CDC

recommendations(Use personal, 2023). Many nurses would have to rescue the same PPE such

as dirty facemasks for weeks to months due to PPE shortage. They did their best to promote

optimal health and prevent disease by maintaining isolation during the pandemic. I also have

abided by these best practices but it has been difficult to answer the call bell and constantly

gown up, seat, and feel uncomfortable or worse of all see my patient die of complications of

COVID. I worked as a nurse before and during the pandemic so I know what it was like
 6

before things changed and it the stress level is just on another level with the lack of resources

and staffing and the increase in the patient assignment than I have felt the stress that many

others nurses have experienced. I have learned the importance of teamwork and collaboration

during the pandemic because you don’t feel alone and can achieve more together. I have been

better prepared through my work and school experiences and by talking to other nurses,

family, and my managers expressing my frustration and concern which has been a great help.

Knowing there are not only people who feel the same way I do but having support from my

friends and family has allowed me to maintain a sound mound and also learn better-coping

mechanisms so my mental well-being remains positive so that I can continue to provide

compassionate patient care.

Ethical principles guide a nurse's professional behavior and I think it has helped me.

During my Nur 460 practicum, I was able to see my preceptor use her computer and other

software which applied to PGC #4 Integrate information management technology to improve

patient outcomes. As a nursing coordinator she was in charge of bed management and making

sure patients were transferred promptly. She might anticipate 80 discharges for the day but

only have 30 written orders from the doctors. My preceptor would call the charge nurse to

contact the attending physician and see if any of their patient's statuses needed to be upgraded

or downgraded. For example, an ICU unit may have stable patients to be downgraded to a

step-down unit which would help open up beds for triage patients who may be trauma and

need an ICU bed. She used software known as Capacity Management which would allow her

to see patient, age, gender, transfer status, and isolation status in rooms that were being

cleaned or dirty. This is so important to use information technology as a tool to keep an

organization as big as CCHS moving efficiently with good communication among the staff to
 7

ensure high-quality patient care is delivered. This is significant because the allocation of care

and resources is always an ethical challenge as everyone will want their family to receive

treatment. This requires careful renouncement management which starts from the minute they

come through the door and my experiences in the BSN program have helped enhance my

professional practice.

The knowledge I have gained has helped me improve my role as a BSN nurse in a

couple of ways. First, I have learned that there are several leadership styles in nursing and

there are two that fit me in particular. I believe that I am best suited to the autocratic and

democratic leadership style. Autocratic is when a nurse can make decisions without input

from others utilizing delegation that is best used in an emergent situation (Leadership, 2023).

This is evident as I have been part of several codes where quick thinking, delegation, and

maintaining a calm composure were important in saving the patient's life. A leader must be

able to step in and make the right decision in a quick, efficient, and safe manner to save a

patient’s life in an emergent situation. I have had the opportunity to do this several times and

think autocratic leadership was very effective. These types of situations do not occur often so

the day-to-day leadership style I would say that I use the most would be democratic where I

work in a collaborative manner helping and working together with my coworkers as a team.

(Leadership, 2023). I have learned that the patient is always the priory in promoting optimal

well-being but one must also consider the feelings of others. As a leader, there will be times

when you do not agree and you must be able to validate their feelings but still be strong to

emphasize your point and compromise when needed. I learned a lot from my general

knowledge courses in English and Communications. I learned how to articulate what I wanted

to say coherently and professionally. It is difficult to be a good leader if you are too able to
 8

communicate with your coworkers efficiently and clearly which I was able to learn in my

general education courses. Also, math was very important as I was able to learn the

fundamentals which have helped me in nursing dosage calculations. I remember a classmate

in nursing school once ask out professor why did we have to learn math when we had

calculators. The professor responded what happens if we had hurricane Katrina or any natural

disaster and there was no electricity to charge your phones, power your computers, and no

batteries for your calculator. She said these were tools to help us to determine the right answer

but at the end of the day, it is something we should know in our heads. If we do not have these

tools available to us we had better know how to manually determine the answer or risk of

dosing or overdosing a patient that could cause death. This is why I believe PGC #1 Integrates

general education, skills, and aptitudes to advance nursing education and growth in

professional practice. There were basic skills I needed to help me build the foundation I

needed to build my nursing skills to what they are today.

My thought on my nursing philosophy has changed throughout the Deltech nursing

program. To be honest I never gave a second thought to nursing philosophy as I never really

knew what it was. I learned in Nur 330 that holistic nursing can help a patient learn to care for

themselves physically, emotionally, spiritually, and mentally which is a philosophy that I

believe most applies to me. An analysis of holistic care found on the National Library of

Medicine database shows holistic care helps patients evaluate their care scientifically and

systematically which in turn provides evidence for application in nursing practice and

research (Jasemi et. all, 2017). PGC# 5 Advocate for patients and the nursing profession

concerning healthcare policy at the local, state, national, and global levels. I believe that

holistic nursing should be applied at all levels for state, national, and global levels. I learned
 9

in Nur 420 how important nursing policy is to the well-being of our patients. I chose to

evaluate the mental wellness of patients affected by the COVID-19 pandemic regarding

healthcare policy changes. Unfortunately, the Consolidated Appropriations Act of 2023 will

end continuous Medicaid coverage which was permitted during the pandemic, and will end on

March 21, 2023. 2023 (HHS reminds, 2023). This will result in thousands of people losing

health insurance coverage. Currently, Delaware Health and Social Services estimate that

13.2% (73,324 Delawareans) of the Delaware population does not have insurance with whites

accounting for 8.7%, Black 9.7%, and Latinos 49.4% (Delaware, T.S., 2023). Steven

Costantino, The Director of Health Care Reform for Delaware Health and Social Services,

Steven Costantino estimates that approximately 5-12% of the United States will lose Medicaid

coverage which is approximately 40,000-60,000 people in Delaware who could lose Medicaid

insurance coverage. (Kirkpatrick, 2023). This is significant because a U.S. Census Bureau

Household Pulse Survey found that 29.3% of people in Delaware experienced both anxiety

and depression which would only get higher as more and more people lose coverage. (Adults

reporting, 2023). Not only will people not have insurance to pay for their physical ailments

but also no therapist, medication management, or behavioral treatment for those with will

mental illness will be affected. I have learned that nursing can advocate for their patients but

to make a change in our world we must lobby for change at the legal level for it to be a law to

help all patients nationwide.

My role as a BSN nurse will help me work toward improvement in the healthcare

system in a significant way. It is said that evidence-based practice has shown nurses with BSN

degrees have fewer, medication errors than nurses who did not. According to a study by Sheu

(as cited in Kerari & Innab, 2021) a teaching hospital reported 328 medication errors where
 10

68.3% were made by associate degree nurses in contrast to 26.2% of errors done by BSN-

prepared nurses. This is important because it shows a correlation that higher education helps

reduce medication errors. This is why many hospitals strive for magnet status where 80% of

their staff has a BSN degree. Christiana Hospital was able to obtain it's their Magnet status

from the American Nurses Credentialing Center (ANCC) which is a high distinction given

that 8% of all U.S. hospitals have this recognition (Bonnett, 2020). I believe that my work as a

BSN nurse working for this hospital will help me improve the healthcare system as a whole as

I learn how to take care of patients using my higher education to keep them patients safe. PGC

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

professional nursing practice. This PGC is important because you have evidence-based

practice dictating how to best improve the nursing profession as a whole. I focus on holistic

nursing and using my critical thinking skills to help solve challenging things that may not be

safe for the patient. I believe the education I received in the BSN program at Deltech has

helped me approach nursing in a whole new way that has been positive and educational.

My life-learning plan will start with me getting my master's in nursing (MSN) within

the next year. I wanted to be a nurse practitioner but doe the time required to invest in the

program which would require me to work fewer hours may not be feasible for me and my

family at this time. I have started looking at management or leadership opportunities at my job

and the requirements for them. I have messaged an advisor at Wilmington University to help

me figure out the necessary steps so I can start the next step in my educational journey. Most

nurses will only do the Continuing Education credits that are required by the state to maintain

their license and there nothing wrong with doing the minimum required of you to maintain

your licensure. I cannot speak for other nurses but I know that I would not be able to do that
 11

because I am always trying to learn new things and make sure I stay on top of everything best

I can. I know that the nursing profession is constantly changing with evidence-based practice

always bringing better ways to treat and protect our patients but I think keeping a good habit

to learn as much as you can always help in the long run. I also just enrolled in a CCCN review

course at work to help e prepare for the exam. I am a float nurse and can be assigned to a

variety of units and I think any educational opportunity to expand my knowledge to help me

more successful is always a good option. I think this perspective embodies PGC #9

Demonstrate lifelong learning that empowers personal and professional growth. I was able to

learn a lot in the BSN program which helped me understand the bigger picture and critical

thinking when making nursing assessments. This has transitioned into my professional

practice as I have tried to utilize any opportunity CCHS has to offer to help me improve my

career. They paid for my BSN and I plan to have them pay for my masters when I sign their

contract which is not only worth it financially but more importantly that I can add more

education to build my nursing foundation.

References

Adults reporting symptoms of anxiety or depressive disorder during COVID-19 pandemic. KFF.

(2023, March 1). Retrieved from https://www.kff.org/other/state-indicator/adults-reporting-

symptoms-of-anxiety-or-depressive-disorder-during-covid-19-pandemic/?

currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort

%22%3A%22asc%22%7D

Bonett, J. B. (2020, October 23). Love + excellence = magnet. ChristianaCare News. Retrieved

from https://news.christianacare.org/2020/10/love-excellence-magnet/?

_ga=2.232335004.264326005.1656433012-1330825485.1652193341 

Conducting a SWOT analysis. Penn State Extension. (2023). Retrieved from

https://extension.psu.edu/conducting-a-swot-analysis 

Chidambaram, P., & Ochieng , N. (2022, April 4). Nursing facility staffing shortages during the

COVID-19 pandemic. KFF. Retrieved from

https://www.kff.org/coronavirus-covid-19/issue-brief/nursing-facility-staffing-shortages-

during-the-covid-19-pandemic/ 

Delaware, T. S. of. (2023). Prevalence of health care coverageamong Delaware adults, 2020.

Health Insurance Coverage - Delaware Health and Social Services - State of Delaware.

Retrieved from https://dhss.delaware.gov/dph/dpc/healthinsurance2017.html

Dr. Lorna Breen health care provider protection act. ACEP // Home Page. (2023). Retrieved

from https://www.acep.org/federal-advocacy/mental-health/dr.-lorna-breen-health-care-

provider-protection-act/
 13

HHS reminds states of legal obligations to federal civil rights protections as states transition from

Medicaid continuous coverage changes as the public health emergency ends. HHS.gov.

(2023, April 5). Retrieved from https://www.hhs.gov/about/news/2023/04/05/hhs-reminds-

states-legal-obligations-federal-civil-rights-protections-states-transition-medicaid-

continuous-coverage-changes-public-health-emergency-ends.html

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A concept analysis of holistic

care by hybrid model. Indian journal of palliative care. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294442/ 

Kerari, A., & Innab, A. (2021, June 22). The influence of nurses' characteristics on medication

administration errors: An integrative review. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223601/#:~:text=Nurses%27%20level

%20of%20education%20was,percentage%20of%20sever%20medication%20errors. 

Kirkpatrick, Q. (2023, March 5). Changes are coming to Delawareans enrolled in Medicaid.

Delaware First Media. Retrieved from https://www.delawarepublic.org/delaware-

headlines/2023-03-05/changes-are-coming-to-delawareans-enrolled-in-medicaid

Leadership in nursing: Qualities & why it matters. ANA. (2023, February 23). Retrieved from

https://www.nursingworld.org/practice-policy/nursing-excellence/leadership-in-nursing/ 

Nurse burnout: What is it & how to prevent it. ANA. (2023, February 17). Retrieved from

https://www.nursingworld.org/practice-policy/work-environment/health-safety/nurse-

burnout-and-how-to-prevent-it/ 
 14

Russell, K. (2023, April 14). About 100,000 nurses left the workforce due to pandemic-related

burnout and stress, survey finds. CNN. Retrieved from

https://www.cnn.com/2023/04/13/health/nurse-burnout-post-pandemic/index.html 

Use Personal Protective Equipment (PPE) when caring for patients ... - CDC. (2023). Retrieved

from

https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf