N708 Weekly Reflective Journal by Amy Nelson

Week 2: In person class

no1219fh — 2025-05-16 00:37:23 UTC

During the in-person class this week, what stood out to me was the reference to The Little Engine That Could acknowledging a common theme of concern or anxiety around being able to balance responsibilities of personal and professional life with additional responsibilities of graduate school, which is my top concern as I begin this journey.

Butts and Rich (2022) list Henderson’s 14 Components of Nursing Care, which resonated with me most during the class exercise on nursing theory. In 20 years of nursing experience, I have honed assessment skills and often remind myself to use fundamental nursing skills. Going forward, I will consciously apply this theory to my graduate education, providing for my basic needs in order to provide for myself as a whole person who can then provide for others.

Reference:

Butts, J.B., Rich, K.L. (2022). Philosophies and theories for advanced nursing practice (4^th ed.). Jones & Bartlett Learning.

Week 3 Professional Identity

no1219fh — 2025-05-28 15:36:56 UTC

After reading Professional Identity Formation: A Concept Analysis by Halvorson et al. (2022), I realized that professional identity is a far more complex concept than I initially thought. Previously, I understood professional identity simply as belonging to the nursing profession and adhering to the standards and expectations set by nursing education and public needs. However, the discussion of model, borderline, and contrary cases was eye-opening. It helped me understand that professional identity exists on a broad spectrum, particularly in terms of the personal responsibility required to develop it. In the United States cultural differences and variables in scope of practice from state to state add layers of complexity to solidifying the professional identity of nursing.

Reference:

Halvorson, K., Tregunno, D., Vidjen, I (2022). Professional identity formation: a concept analysis. Quality Advancement in Nursing Education, 8 (4). https://doi.org/10.17483/2368-6669.1328

Week 1: Values

no1219fh — 2025-05-31 16:34:32 UTC

Scenario: A patient living in a rural area experiences heart failure exacerbation, evidenced by weight gain and shortness of breath. The nearest healthcare facility is two hours away, and the patient lacks reliable internet access, limiting their ability to use telehealth services. In response, a Nurse Practitioner organizes a group of Advanced Practice Registered Nurses (APRNs) to advocate for policy change at the state level. Their goal is to increase funding for broadband infrastructure in underserved areas, ensuring patients like this one can access essential telehealth services. The APRNs present personal testimonies at a state legislative hearing to garner bipartisan support for the initiative.

Nurse Practitioners who deliver telehealth services play a vital role in bridging this gap, especially in rural communities. As healthcare leaders, they must also remain informed about state and federal policies that impact care delivery and advocate for patient needs. Kapu (2022) describes Nurse Practitioners as excellent advocates for health equity knowing the impact that social determinants of health have on a patient’s ability to access and engage in their health care.

Reference:

Kapu, A.N. (2022). Advocacy advances in access to equitable health care. The Journal for Nurse Practitioners, 18(6), 595. https://doi.org/10.1016/j.nurpra.2022.05.005

week 4 DEI

no1219fh — 2025-06-02 18:38:23 UTC

After reading Nikpour et al. (2022), the most important concepts for me are that lifelong learning and self-reflection are essential to becoming an inclusive leader. Nikpour emphasizes that authentic leadership requires a deep understanding of oneself—recognizing personal strengths, areas for growth, and how one's leadership has been shaped by others. This process is more complex than it may seem, as many of our beliefs and behaviors are shaped early in life by external influences and often operate unconsciously. Criticism regarding a lack of awareness of influence of social context, and culture is warranted. In my career, I have witnessed significant progress in my organization toward cultural competence, particularly in supporting BIPOC employees and promoting women into leadership roles. While these efforts are commendable, there is still more work to be done.

Nikpour, J., Hickman, R.L., Clayton-Jones, D., Gonzalez-Guarda, R.M., & Broome, M.E.
(2022). Inclusive leadership to guide nursing’s response to improving health equity. Nurse Outlook, 70(6S1) S10-S19. https://doi.org/10.1016/j.outlook.2022.02.006

Week 5: Reflection on Panel Discussion

no1219fh — 2025-06-09 17:57:02 UTC

Emphasizing the evolution of the Quadruple Aim was deeply important to me, especially the professional duty to include the fourth aim of improving the work life of healthcare providers, which is overlooked even though as an APRN it is essential for sustainable, high-quality care to be provided. My ICU was a COVID unit, as we provide care with ECMO. Dr. Ben Hickox's statement about the term resilience turning the problem towards workers deeply resonated with me. "Be resilient" is now an unfortunate phrase that is common and intentionally used to be dismissive. I feel inspired to grow as a professional and dive deep using professionalism, ethics, and mentorship to make changes for nurses and providers. The American Nurse (2022) article mentioned in today's discussion notes a key takeaway as, "fostering professional identity in nursing can improve nurse well-being, work retention and job satisfaction, and promote safe quality patient care." This is timely and vital.

Reference:

Owens, R.A., Godfrey, N. (2022, September 7). Fostering professional identity in nursing. American Nurse Journal. https://www.myamericannurse.com/fostering-professional-identity-in-nursing/onal identity in nursing

Week 6: ANA Code of Ethics

no1219fh — 2025-06-19 20:39:30 UTC

According to Provision 3 of the ANA Code of Ethics (2025), nurses are responsible for establishing trusting relationships and advocating for the rights, health, and safety of those in their care. This provision emphasizes the nurse’s duty to protect patient privacy, act as an advocate, and foster a culture of safety while upholding high standards of professional practice. Specifically, Provision 3.2 highlights the nurse’s role as a collaborative member of the interprofessional team, working within their scope of practice to ensure ethical and informed consent.

In cardiothoracic surgical practice, APRNs frequently play a key role in obtaining informed consent. I encountered an ethical dilemma when a patient was listed for a procedure without documented consent in the electronic health record. Upon informing the patient of the day's plan, she expressed surprise, indicating she had not been informed. Although she had a tracheostomy, she was capable of using a speaking valve and asking questions. Additionally, there were concerns about her literacy level, which could have impacted her understanding of the procedure. The procedure was appropriately delayed ensuring informed consent was obtained. However, the proceduralist expressed resistance to the delay, citing the need to maintain the day's surgical schedule. This situation underscored the critical role of the NP in advocating for patient autonomy and ethical care, even in the face of systemic pressures.

According to the Centers for Disease Control (2024), nine out of ten adults struggle to understand health information when it includes unfamiliar terminology. Limited health literacy is associated with increased morbidity and mortality. In alignment with Provision 3 of the ANA Code of Ethics, nurses have an ethical obligation to consider each patient’s unique needs—including social determinants of health, literacy level, and the ability to navigate a complex healthcare system. This includes ensuring that patients have adequate time during consultations to ask questions and receive clear, comprehensible information.

In this context, the APRN plays a critical role in building trust by thoroughly explaining the purpose, risks, benefits, alternatives, and expected outcomes of a procedure. In a recent case I witnessed, a patient was listed for a procedure without documented informed consent. Although she had a tracheostomy, she was capable of communicating using a speaking valve. Concerns about her literacy level further emphasized the need for a careful, patient-centered approach. The procedure was delayed obtaining proper consent, which led to tension with the surgical team due to scheduling concerns. However, ensuring the patient’s informed participation in her care was ethically and professionally the correct course of action.

Failure to act could have resulted in a loss of trust and potential harm.

References:

American Nurses Association. (2025). Provision 3: The nurse establishes a trusting relationship and advocates for the rights, health, and safety of recipients of nursing care. https://codeofethics.ana.org/provision-3

Centers for Disease Control and Prevention. (2024, October 16). Talking points about health literacy. U.S. Department of Health and Human Services. https://www.cdc.gov/health-literacy/php/about/tell-others.html

Week 6: Part II Learning Reflection

no1219fh — 2025-06-19 20:49:18 UTC

In the experience that I shared regarding informed consent, I understood that standing up for the rights of the patient to be informed and my responsibility as a nurse to be her advocate. Unfortunately, I also understood that I would potentially be reprimanded by the surgical team as advocating for my patient's rights would pose as an inconvenience to them. I appreciated the response on my post from Rory and how they could connect provision 3 to utilitarianism: promoting the greatest good while inflicting the least amount of harm. There is too often a war on nurses with a pressure to comply with what we know is wrong in order to increase productivity. Finding the right language to be effective advocates for patients is needed in our education.

Week 7 ANA

no1219fh — 2025-06-27 07:21:23 UTC

While reading the provisions of the ANA Code of Ethics for Nurses, I was struck by some of the statements that at first seemed to feel contradictory or even ambiguous. For example, the primary commitment of the nurse is to the patient (Provision 2) and the equal duty to self (Provision 5) feel paradoxical. I then decided to look into interpretive statements to help clarify that these are not competing priorities. Of course, a nurse who neglects their own well-being is likely less capable to provide competent care.

I am not alone in wanting to understand the true effectiveness of the Code's application to the nursing profession. I found an intriguing journal article regarding the use and impact of the ANA Code. Numminen et al (2024) analyzes over 850 publications in a scoping review of scientific publications and non-scientific publications (anecdotal articles). Findings conclude that the Code with widely referenced in discussions of professional ethics and workplace culture. However, there is a significant gap as the Code is underutilized in nursing education, research, and leadership development. Toi truly understand the Code's impact, more empirical research is needed to measure how well nurses apply the Code in real-world settings and how it is used to shape outcomes for patients and policy. With the Week 7/8 Ethical Dilemma assignment, this is crucial in understanding how we as leaders must work to change policy for positive changes in society.

Reference:

Numminen O, Kallio H, Leino-Kilpi H, Stokes L, Turner M, Kangasniemi M.(2024). Use and impact of the ANA Code: a scoping review. Nursing Ethics. 31(8):1389-1412. doi:10.1177/09697330241230522

Week 8: Imposter Syndrome

no1219fh — 2025-06-30 16:51:03 UTC

During the recording for the Ethical Dilemma debate, I felt very uncomfortable. I had researched thoroughly and reviewed my material, but as soon as the recording began, my mind went blank. My mouth was dry, my palms were sweaty, and I felt a wave of anxiety wash over me. Immediately afterward, I was overwhelmed by thoughts of inadequacy.

This wasn’t stage fright—I’ve had a 20-year career as a nurse, participated in committee work, and spoken publicly many times. This was something deeper. I now recognize it as imposter syndrome.

Para et al. (2024) note that imposter syndrome is increasingly recognized in academia, healthcare, and management, often leading to workaholism as individuals try to avoid failure and fear. That description resonates with me deeply.

Going forward, I plan to remind myself that these feelings are not a reflection of reality. I’ve worked extremely hard to get to where I am. I will seek out mentors and counselors for support, and I’ll be intentional about pausing to reframe my thoughts—reminding myself that I am learning and growing. I also plan to track my milestones on my calendar as a visual reminder of my progress.

This experience, while uncomfortable, has helped me better understand myself. I’m not a fraud—I’m a capable, evolving professional who deserves to be here.

Reference:

Para, A., Kaur, H., & Singh, R. (2024). Understanding imposter syndrome: A review of its prevalence, impact, and interventions. Frontiers in Psychology, 15, Article 1360540. https://doi.org/10.3389/fpsyg.2024.1360540

Week 9: Digital Presence

no1219fh — 2025-07-07 16:28:53 UTC

Conducting an analysis of Cleveland Clinic’s digital presence provided valuable insight into how healthcare organizations operationalize professionalism and equity in virtual spaces. The organization’s strategic use of clear, evidence-based communication and patient-centered design reflects a strong alignment with nursing values. However, the evaluation also revealed systemic gaps in digital follow-up and access for underserved populations, underscoring the need for more inclusive digital health strategies. This analysis reinforced the critical role of digital communication in advancing equitable care delivery. This evaluation aligns with Booth et al. (2021), who argue that the nursing profession must adapt to a digital future by embracing ethical, inclusive, and transparent communication practices. Cleveland Clinic’s digital strategy reflects many of these principles, particularly in its use of patient-centered content and evidence-based messaging. However, as Booth and colleagues emphasize, digital professionalism also requires proactive efforts to reduce disparities in access and engagement—an area where Cleveland Clinic’s limited follow-through on digital referrals suggests room for growth.

Reference:

Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. BMJ, 373, n1190. https://doi.org/10.1136/bmj.n1190

Week 10: Case Study Reflection

no1219fh — 2025-07-15 23:21:37 UTC

Reflecting on this case through the lens of nursing values of compassion and patient-centered care is essential in this case despite the stress and fear of litigation, the NP must prioritize Eva’s well-being and tailor care to her needs. The NP is torn between clinical judgement and the pressure to conform to defensive practices; they must uphold integrity and be accountable to use assessment skills to gather evidence and then make decisions to advocate for the patient.

The assumption that ordering more tests will protect the providers against litigation is not true and can lead to incorrect diagnosis and increased costs. Practicing in a defensive mindset can erode trust and compromise quality of care. Instead, practitioners require courage and clarity to practice ethically.

The challenges faced include moral distress, burnout, systemic pressure, communication, and team dynamics. Dolan (2017) highlighted that practicing legally ensures practicing ethically. Also, there are few studies on moral distress and moral courage experienced by NPs in controversial practice situations. Applying a decision-making tool for the stakeholders in this case study may encourage evidence-based practice and decrease moral distress felt by the peers of the NP.

I will take into account future clinical or ethical situations a commitment to ethical principles of patient autonomy, non-maleficence, and justice. Relying on evidence-based practice rather than fear-driven decisions will serve to trust in clinical judgement with courage to lead and advocate for patients. This case is a reminder that ethical dilemmas are emotionally taxing and reflecting on experiences builds resilience and strengthens my professional identity. Seeking support and continuing education are essential to sustaining an effective practice.

Reference:

Dolan, C. (2017). Moral, ethical, and legal decision-making in controversial NP practice situations. The Journal for Nurse Practitioners, 13(2), e67–e69. https://doi.org/10.1016/j.nurpra.2016.10.018

Week 11: Professional Organization

no1219fh — 2025-07-22 19:47:43 UTC

The American Association of Nurse Practitioners (AANP) plays a vital role in supporting nurse practitioners. Its mission empowers all nurse practitioners (NPs) to deliver accessible, person-centered, high-quality health care for diverse communities through practice, education, advocacy, research, and leadership (AANP, 2025).

Membership is offered to students enrolled in a NP program, licensed NPs, and affiliate organizations supporting the NP role. Fees vary by category of membership, and members receive benefits including continuing education, networking, and discounts on conferences and events. Multiple opportunities to be involved in leadership and engagement include committees and task forces to influence policy at state and national levels, as well as engagement in education at conferences and events, and mentorships to grow in practice.

The AANP websites notes that involvement in the organization can significantly enhance development as a leader through providing access to research, continuing education, offering roles that build advocacy skills, and networking with other NPs in a national network. These opportunities are relevant to the NP role as tools to influence health policy and improve patient outcomes. Mathews, J. H. (2012) states that professional organizations' ability to communicate quickly with their members is one of the many benefits of involving various organizations in collaborative efforts. Newsletters and bulletin alerts keep members aware of issues and help explain developments that may affect nurses and patient care delivery.

Potential barriers to joining AANP include the cost of membership and potential time commitments required, especially for professionals balancing academic and clinical responsibilities. However, these challenges can be addressed by viewing memberships as a strategic investment in long-term professional development. Setting aside time for engagement and budgeting for membership can open doors to leadership, education, and policy influence that are essential to the NP role.

References:

American Association of Nurse Practitioners. (2025). About the American Association of Nurse Practitioners. https://www.aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp

Matthews, J. H. (2012). Role of professional organizations in advocating for the nursing profession. OJIN: The Online Journal of Issues in Nursing, 17(1). https://ojin.nursingworld.org/table-of-contents/volume-17-2012/number-1-january-2012/professional-organizations-and-advocating/