Running head: PROFESSIONAL PROGRESS SUMMARY

Professional Progress Summary

Victoria Grigorita
Old Dominion University

PROFESSIONAL PROGRESS SUMMARY

Professional Progress Summary

At some point of life, it is very important to take a moment to look back on your
accomplishments, analyze them, and set plans for the future. For the past three years that I have
spent in the School of Nursing (SON) at Old Dominion University (ODU), significant changes took place.
I have grown personally and professionally. As nursing students, we are expected to gain proficiency in
eight core competences that are very important to nursing: critical thinking, nursing practice,

communication, teaching, research, leadership, professionalism, and cultural awareness. The

purpose of this paper is to reflect on my path of growth as a nursing student. I will analyze attainment
of knowledge and skills associated with each of the great eight competencies throughout different periods
of the program, including sophomore, junior, and senior years.

Critical Thinking
Critical thinking is defined as purposeful activity to facilitate nursing practice based on
evidence, scientific method, questioning attitude, and problem solving (Toole, 2013). Upon
entering the program, I was not familiar with the principal of critical thinking because my prior
education experience was focused primarily on memorization of the material. Therefore, in my
sophomore year, my main challenge was an attainment of understanding of the principle of
critical thinking and its importance. Before I learned to apply it in my nursing practice during
clinical rotations, I was taught about it during lectures. During the first semester, we were
introduced to the various types of the National Council Licensure Examination (NCLEX) format
questions where not just knowledge of the material but its application was required to be
successful. In addition, we learned about different nursing theories, which helped us establishing
framework for providing patient care. For example, in one of my clinical experiences during
sophomore year, I applied Levins theory where she described nursing responsibility in helping
patients to conserve energy (Johnson & Webber, 2010). My patient was a 45 year old male who

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was weak and lethargic. Therefore, I tried to cluster my care so I wouldnt wake him up very
often and worsen his condition. By doing this, I was hoping to help him save his energy
necessary to recover.
Throughout my junior year, my critical thinking skills improved. During this time, we
were given more responsibilities in our clinical rotations. This included giving medications,
which required preparation and critical thinking. We had to know indication, mechanism of
action, side effects, and nursing implications for each medication. I began to realize that
individualized approach for patient care is of tremendous importance. For example, my patient
was on several medications for controlling his elevated blood pressure. When it was time to
administer them, under my clinical instructors guidance, I took patients blood pressure, which
was 102/78. Based on this data, we had to hold the medications; otherwise, patients blood
pressure could drop to critically low levels.
During my senior year, I was fortunate to practice my skills in critical care environment.
This was the time when I realized the tremendous importance of critical thinking secondary to
high acuity of patients health status. I was able to strengthen my skills and apply my knowledge
for successful patient outcomes. For example, one of the patients had multiple myeloma which
caused increased production of certain proteins. When these proteins are in excess, they can clog
kidney causing renal failure. Therefore, the patient had to get plasmapheresis to rid his plasma of
the proteins. However, during the procedure, his blood pressure started dropping. We decided to
call a doctor to obtain an order for albumin. Albumin is a protein that is supposed to increase
oncotic pressure by drawing liquids from the third space into blood vessels, which was relevant
for this patient as he was edematous secondary to third spacing. An intended result of its action is
an increase in blood volume and, therefore, an increase in blood pressure. For some reason, it did

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not help as much as we expected. After quickly analyzing the situation, we obtained an order for
norepinephrine. Sure enough, blood pressure rose from 80s/60s to 120s/80s within minutes.
Nursing Practice
Nursing practice is defined as a promotion, maintenance or restoration of health
throughout the lifespan by implementation of dependent, independent, and interdependent
therapeutic nursing interventions within accepted standards of care for clients, families, groups,
and communities (Toole, 2013). During my sophomore year, we were first introduced to the
nursing process and nursing diagnosis. I practiced this competency by collecting information
from patients chart and creating care plans the day before the clinical. During the clinical day, I
mostly concentrated on performing head-to-toe assessment. I was not confident with my skills
and preferred to observe interventions done by other nurses. My biggest challenge was to
overcome my fear of hurting patients secondary to lack of experience.
During my junior year, we had clinical rotations in more specific fields, including
psychiatric care and maternity nursing. During this time, I learned to perform focused assessment
relevant to specialty. For example, during my rotation in nursery, I implemented newborn
physical assessment and assigned APGAR scores. During my rotation in mother and baby unit, I
practiced postpartum assessment using BUBBLE HE technique. Finally, during psychiatric
rotation, I used Mental Status Examination tool. Implementation of focused assessment tools and
techniques allowed me to collect information concentrating on specific concerns of these
populations, which was necessary for providing individualized care.
It was not until senior year, when I realized the importance of evaluation as a part of a
nursing process. It not only helps to determine whether nursing interventions are successful or
not but also encourages revision of the plan in a timley manner. In order to conduct evaluation,

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individualized, realistic, and measurable outcomes need to be established. For example, primary
nursing diagnosis for my patient was decreased cardiac output related to a decreased systemic
vascular resistance and increased capillary permeability secondary to systemic inflammatory
response as evidenced by change in level of consciousness, hypotension (78/61), tachycardia
(103), decreased urine output, concentrated urine, and generalized weakness. Patients expected
outcomes were the following: patient would maintain adequate cardiac output by the end of
hospitalization as evidenced by successful wean from vasopressors, urine output greater than
30mL/hr., heart rate within normal limits (60-100), systolic blood pressure greater than 90, warm
and dry skin, and return of level of consciousness to patents baseline. The time frame, by the
end of hospitalization, was chosen because of the complexity of treatments. Blood pressure
remained an issue for my patient until sepsis was resolved. By the end of the shift, patients
cardiac output was adequate with urine output greater than 150mL/hr., heart rate within normal
limits (83), systolic blood pressure 102, warm and dry skin, and return of level of consciousness
to patents baseline.. The outcomes were only partially met because the patient remained on
vasopressors. However, based on patients progress, outcomes were expected to be met by the
end of hospitalizations as it was planned.
Communication
Communication is defined as a process of utilization of verbal, non-verbal, and written
messages in order to establish therapeutic relationships with clients and colleagues (Toole, 2013).
During my sophomore year, I was very hesitant communicating with patients, families, and
professionals. I remember that I was terrified of going into patients room and introducing
myself. I was also hesitant communicating with the nursing staff. Most of my communication
was in non-verbal and written forms, such as daily documentation and clinical logs. However,

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this was the time when I learned about the importance of active listening, which I applied a lot
during my sophomore year.
During my junior year, I was introduced to the principles of therapeutic communication
in a greater detail. Its importance was especially evident during my psychiatric rotation where
communication is crucial for providing patient care. In addition, I realized that facilitation of
communication between family members is important to improve patient outcomes. For
example, during one of my clinical days, I spent a long time communicating with a 17 year old
female admitted for suicidal ideations. I mainly implemented active listening and reflection
techniques to collect information. In addition, I asked open-ended questions to gain more
information. As a result of our conversation, I learned that she felt lonely and, by verbalizing
suicidal threats, she tried to attract attention of her parents. During the family session, I was able
to report these findings, which, eventually, helped the session to take a different turn and improve
patients outcomes.
During my senior year, my communication skills improved significantly. This was due to my
experience in Intensive Care Unit (ICU) where I had an opportunity for professional healthcare
interactions. I openly communicated with the nursing staff and some physicians. In addition, during my
rotation in ICU, I was exposed to several patients in unconscious state. One of my patients didnt
demonstrate any brain activity during my shift. Despite this, I still talked to her hoping that she could hear
me. I oriented her to the place and time. In addition, before I performed any procedure, I informed her
about what I was going to do. When her family came, they asked me if she could hear me. I told them that
I was not sure but I always assume that the patient can hear us. After that, I observed family doing the
same thing.

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Teaching
Teaching is defined as an interactive, multidirectional, culturally sensitive transmission of
information based on a scientific data and strategies implemented to maximize patient health and
enhance professional development (Toole, 2013). During my sophomore year, I was very
hesitant of teaching my patients because I thought that they wouldnt listen to me. In my clinical
logs I could easily identify teaching needs; however, rarely, I implemented the teaching. Towards
the end of the year, as I attempted to teach my patients, I was taken by a surprise how receptive
they were. For example, one of my patients was diagnosed with coronary artery disease. From
my knowledge, I knew that diet can be a huge risk factor. I asked my patient if her diet was
healthy; however, she had no idea what it meant. This was the first time when I realized how
powerful the knowledge is and how beneficial it is to teach our patients.
During my junior year, I became more comfortable with my teaching skills primarily due
to the realization of the importance of teaching. In comparison to sophomore year, I implemented
teaching with each patient encounter. I implemented teaching in preparation for and following
medical interventions. For example, my patient had an abdominal laparotomy scheduled during
my clinical day. Firstly, I focused on teaching the patient about the upcoming procedure. I
specifically concentrated on explaining the steps in preparation for the surgery. Secondly, I
taught the patient about the activities necessary to implement after the procedure, including using
incentive spirometer and deep breathing and coughing techniques in order to prevent
complications after the procedure. The patient was very receptive to my teachings. Also, I
noticed that it helped reducing patients anxiety level.
During my senior year, I realized the importance of teaching as a way of illness
prevention and health promotion. I was able to come to this idea as a result of my experience in

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community health settings. Firstly, we conducted an assessment on current knowledge of the

aggregate. Secondly, we identified areas where our aggregate lacked knowledge. For example,
according to the results of the surveys, our aggregate was not familiar with healthy nutrition.
Therefore, we contributed the most amount of time for nutritional education. We implemented
teaching in a form of lectures, games, and healthy meal preparation. In addition, we invited a
guest speaker who had professional knowledge in nutrition to reinforce what was taught.
Research
Research is defined as a systematic and diligent process of inquiry to gain new
knowledge. It is a foundation for evidence-based practice and therapeutic nursing interventions
(Toole, 2013). During my sophomore year, my view of understanding and importance of nursing
research was very limited. I had to include nursing research articles in my clinical logs; however,
I lacked knowledge of the ways of finding articles and applying them. I was interested in
descriptive nursing literature thinking that published nursing reports were of a little value.
During my junior year, we actually had a nursing research class. This was the time when I
not only learned different ways to locate reliable research articles but I also realized how
important research is. Nursing research is a foundation for evidence-based practice, which leads
to a safe patient care and improved patient and staff satisfaction. During the class, we learned
how write a research proposal. As a result of my new knowledge about nursing research, I started
planning on becoming involved in a research committee in my future place of employment.
During my senior year, I became a very active user of nursing research. For my papers
and projects, I conducted a very extensive research of available published reports. This way, I
was able to support my opinion and position on the issues I had to solve. For example, for my
leadership class, I had to write a paper supporting the diversity in nursing. I was able to find at

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least six research articles that served as a strong evidence for my position. All the articles were
recently published reports taken from reliable sources. In addition, I shared the research findings
with my colleagues during oral presentation on the importance of implementation of
communication with people with aphasia. It was a very important thing to do because the
students, to whom the research was presented, may apply the knowledge in their future nursing
practice by participating in conversations with stroke survivors experiencing aphasia. This way,
according to the research findings, my colleagues will ensure the continuity of care, which will
not only aid in language training but it will also promote psychosocial well-being of stroke
survivors.
Leadership
Leadership is defined as self-direction and professional accountability to constructively,
legally, and ethically influence others within ones scope of practice as a designer, manager, and
coordinator of health care (Toole, 2013). During my sophomore year, I was far from being a
leader in the field of nursing. I felt more comfortable observing and following other people who I
thought were more competent than me, including my classmates, faculty, and nursing staff. My
understanding of what I can do as a leader in my clinical practice was very limited. My first
attempts included going into patients room to introduce myself and making myself available to
the staff.
During my junior year, I became more self-directed. I didnt wait until somebody told me
what needed to be done. Instead, I learned the routine and was able to manage my patients care
efficiently. First thing that I did in the morning was introducing myself to the nursing staff and
letting them know my scope of practice as a nursing student. In addition, I started seeking
learning opportunities. For example, some of my patients didnt require much care. Instead of

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staying around and waiting until somebody asks for help, I took initiative and offered my help to
the nursing staff. As a result, throughout my clinical rotation, I was always occupied with
learning new skills. The nursing staff was very appreciative, which made me feel as a very
effective team player.
During my senior year, my leadership skills strengthened as I became more confident in
my abilities as a future nurse. My biggest achievement was realization of the importance of
delegation in nursing practice. Prior to this time, I felt more comfortable to do everything by
myself rather than delegating tasks. However, during my rotation in ICU, I realized that asking
for help when needed, helps saving time and reducing workload, which allows for a care of
higher quality. For example, one of the nurses on the floor got double admission. She was very
busy. When I offered her my help, she readily accepted it. Furthermore, I involved a technician,
who happened to be on the floor, to help us performing some tasks within her scope of practice.
In addition, when some of our patients needed assistance to use bathroom or needed a bath while
others required more skilled care, I felt very comfortable asking nursing aids to help with basic
care.
Professionalism
Professionalism is defined as accountability, advocacy, self-direction, autonomy, and
adherence to standards of practice and legal and ethical principles (Toole, 2013). This is
accomplished by differentiating between general, institutional, and specialty-specific standards
of practice to guide nursing care. During my sophomore year, professionalism was more about
presenting myself as a responsible student. I was always prepared for my clinical days. I came to
clinical rotation on-time and followed the dress code. I primarily adhered to ODU SON
guidelines. At that point, I was not familiar with hospital policies.

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During my junior year, I came to a better understanding of the legal standards in nursing.
For example, I adhered to legal standards when I made sure I took care of a right patient by
checking patients wristband using two identifiers. In addition, before medication administration,
I ensured adherence to six rights, including right patient, right medication, right dose, right route,
right time, and right documentation. Lastly, I made sure that interventions, which I implemented,
were within my scope of practice. For example, I was not allowed to administer intravenous (IV)
push medications. Therefore, when I was offered to practice this skill by the nurses, I explained
to them that it was not within my scope of practice as a nursing student.
During my senior year, I was able to concentrate on polices specific to the specialty of
nursing in which I was practicing. For example, during my role transition in ICU, I adhered to
specific standards of practice for critically ill patients with bundle protocols. I took care of many
patients who had central venous lines (CVLs). Per Sentara policy, CVLs can only be inserted by
physicians and/or their assistants (Sentara Healthcare, 2013). However, removal of non-tunneled
CVLs can be performed by nurses per physicians order. In addition, nurses are responsible for
maintaining the site, including dressing changes. At the time of catheter insertion, a
chlorhexidine (CHG) impregnated transparent semipermeable membrane dressing is applied to
the insertion site. It should be changed at least every seven days and whenever the dressing
integrity is compromised. The dressing integrity is considered compromised when the dressing is
no longer intact, wet, soiled, or contaminated. During my clinical rotation, we followed these
guidelines when assisted patients with CVLs.
Culture
Culture is defined as learned, shared, and transmitted values, beliefs, norms, and specific
lifeways of clients, families, groups, and communities that guides thinking, decisions and actions

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in patterned ways (Toole, 2013). Nurses are required to demonstrate cultural awareness and
sensitivity to diverse clients, families, group, and communities. Since I come from a different
culture, I have always been aware of the significance of diversity. However, my perception of
culture was restricted to race, ethnicity, gender, religion, and age. For example, in one of my
clinical logs I stated that my patient was a 64 year old Caucasian female, which didnt impact my
care. My understanding of impact of culture on health status was very limited at that time.
During my junior year, I came to a better realization of impact of culture on health status.
I began recognizing culture as a lifestyle, diet, socio-economic status, and habits. For example,
my patient was from the Southern state. The diet in that area consists of a lot of fried foods high
in fat. For this patient, consumption of such foods was a normal part of his welling and he didnt
think that it can possibly hurt him. Therefore, I have decided to teach my patient about
disadvantages of this diet without being judgmental and with compassionate attitude offering
him various alternatives.
During my senior year, I had many encounters with patients and families dealing with the
end of life issue. During every interaction, I felt saddened talking to the families about it and,
honestly, had a hard time going through it myself. Nurses always try to think of the ways to save
lives of their patients; however, sometimes patients and their families prefer peaceful death.
Nurses told me that with more experience I will learn to cope with the situations like this. It is
not due to becoming indifferent but rather due to finding the ways to cope with end of life issues.
I tried to be very compassionate with the families and supported them despite my own feelings.
The families were very appreciative to have a person who cares for their loved one and shares
their feelings.

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Conclusion
Reflecting back is a thought-provoking way to see the path of growth. After writing this
paper, I realized how much I have grown as a nursing student. Upon entering the program, I was
not even familiar with many areas specific to nursing. However, by being open-minded and
having a great willingness to learn, I was able to grow tremendously in the eight great
competences that are so important to nursing. Although, I realize that I have areas where
improvements are needed, I take pride and value my achievements. I strongly believe that ODU
SON prepared me well for becoming an efficient nurse for an entry-level position. Throughout
the program, I have acquired many skills, including drawing blood, starting IVs, participating in
admission process, administering medications, titrating drugs, inserting Foley catheters, etc.
However, I feel that I am more prepared in a cognitive domain. I started with not even knowing
what critical thinking is and, now, I use it constantly during my clinical rotations, which allows
me to put the pieces of the puzzle together to see a complete picture.
I believe that my strength is in having a great desire to learn. I always look for new
learning opportunities and readily accept challenges. Nursing truly pushes me out of my
boundaries, which makes me a stronger person and a better specialist. In addition, my strength is
in appreciation of a research. I truly value its importance and take my time to stay up-to-date
with recent findings. Finally, I realize the significance of continuing education and already
planning my next steps in obtaining advanced nursing education. Despite my progress, I realize
that I have a lot more to learn! There are many diseases, medications, and medical and nursing
procedures that I dont have adequate information about. However, I realize that I will have
many opportunities to learn about it throughout my future nursing practice.

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Overall, I am very satisfied with who I am today. I may only be a new grad; however, I
have a strong foundation and eagerness to grow in order to become an effective registered nurse
in the future. I am not focused on the final destination but rather on the process of becoming the
best nurse I could be. I will take one step at a time remembering and valuing my previous
experiences and searching for new opportunities.

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References
Johnson, M., & Webber, P. B. (2010). An introduction to theory and reasoning in nursing (3rd
ed.). Philadelphia, PA: Wolters Kluwer.
Sentara Healthcare. (2013). Central Venous Catheter & Peripherally Inserted Central Catheter
Maintenance and Site Care.
Toole, M. (2013). Mosby's dictionary of medicine, nursing & health professions (9th ed.). St.
Louis, MO: Elsevier/Mosby.

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Honor Code
I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community, it is my responsibility to turn in all suspected violators of
the Honor Code. I will report to a hearing if summoned.
Signature _________Victoria Grigorita 04/08/2015_________________________________