I will strive to embody the Nursing and Midwifery Board of Australia’s (NMBA) Registered Nurse Standards for Practice in my everyday practice with the knowledge that I am responsible and accountable to the NMBA, my patients, and also to myself and my personal values (NMBA, 2016). I look forward to bringing my learning and experiences from my placements to my role. These experiences have taught me that critical thinking, communication skills, and clinical reasoning are critical in adapting to the everchanging circumstances of clinical settings, and the pressure of busy nursing environments.

My SMART goal for my graduate program is to provide the highest quality of care, ensuring that I advocate for my patients, while working collaboratively with the multidisciplinary team to ensure positive health outcomes are prioritised. I will focus on building strong networks with senior nurses and Clinical Development Nurses to ensure I am fully supported and can foster open dialogues to ensure continuous improvement, beginning my lifelong learning journey as a nurse.

My patient was a 35 year old female who was 30 weeks gestation, admitted for multiple fractures of the radius, ulna, and humerus. The patient had a medical history of obesity, gestational diabetes, anxiety, and depression, with a severe allergy to NSAIDs (non-steroidal-anti-inflammatories). Her surgery involved open reduction and internal fixation (Bounds et al., 2023). Following her surgery she was experiencing significant pain for a prolonged period of 24 hours, and establishing a medication dosage that would be safe for her was challenging.

Twelve months prior, the patient had experienced a late term miscarriage, due to genetic conditions including an abnormality of the infants chromosomes.

Her husband and her sister were providing her support at the hospital. All had been impacted by the traumatic experience of her previous pregnancy.

During her 14 day stay, she experienced abdominal cramping, but reported no vaginal bleeding. She was very worried about her baby’s health and reported her symptoms felt similar to her miscarriage symptoms and she felt like ‘something might be wrong’. I escalated her concerns to the medical team on duty and liaised with Midwifery and the patient’s obstetrician who reviewed her that morning. An ultrasound and general A-G assessment, confirmed that what she was experiencing Braxton Hicks – often explained as false labor (Raines & Cooper, 2023).

Post-operative pain management included nurse advocacy. With the supervision of my buddy nurse, I spoke to the medical team and liaised with the pain management team and helped to deliver a trial using two higher dosage slow-release tablets of Endone (oxycodone) one in the morning and once in the evening (TRWH, 2021).

Standard for Practice 2 discusses advocacy and recognises patient’s experiences. This patient’s complex medical and psychological history, previous traumatic experience and history of anxiety and depression meant that engaging therapeutically was vital in this case.

When she experienced the Braxton Hicks and became distressed for her own health and her baby’s health, I was already aware of her background and I knew how important it was to implement and practice trauma-informed approaches (Benton et al., 2024). I was able to influence the multidisciplinary team, who escalated her care to ensure she was provided with reassurance. My advocacy included seeking guidance from my buddy RN on how to contact obstetrics and midwifery for a review. After the review the patient and her husband were more at ease and she was very thankful that she’d been assessed and knew what was going on.

Post-operatively the patient required clexane subcutaneous injections, and these injections would need to continue after her discharge at home. Standard for Practice 3 discusses patient education. In discussions with the patient and her husband, a decision was made that he would administer the injections. I worked with her husband and the patient to ensure that they were both able to administer the injections. Before her discharge I also discussed concerns around handling her ADLs (assisted daily livings) at home with the help of physiotherapists, and referred to our diabetic education nurse for concerns regarding her diabetes. These actions helped build trust with the patient, which at this point in her pregnancy will also help to ensure she feels comfortable when managing future health appointments, treatments and the delivery of her baby.

In all future practice, I remain committed to the NMBA standards, particularly Standard for Practice 1, focusing on patient centred care and evidence based frameworks.

In relation to Standard for Practice 2, providing a respectful therapeutic environment for a patient with complex history is critical. It ensures that patient autonomy and dignity is respected.

As a student nurse in this scenario, Standard for Practice 3, the experiences I have had help to build my capacity for practice.

While most strategies I implemented were effective, this experience highlighted the need for further development of my knowledge in pain management strategies, particularly for patients with complex needs, such as pregnancy and drug allergies. Furthermore, this experience identified the importance of tailoring care to their individual requirements. As a student nurse, I found it challenging to advocate earlier, in future I will continue to develop my confidence in my advocacy skills while still maintaining professional boundaries.

Deborah A. Raines; Danielle B Cooper. (2023). Braxton Hicks Contractions. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470546/ 

Emily J. Bounds; Nicholas Frane; Lawrence Jajou; Luke J. Weishuhn; Stephanie J. Kok. (2023). Humeral Shaft Fractures. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK448074/#:~:text=However%2C%20rather%20than%20splitting%20the,lamellar%20bone%20and%20Haversian%20canals. 

NSW Health. (2025). What is a holistic approach?. NSW Government. https://www.health.nsw.gov.au/mentalhealth/psychosocial/principles/Pages/holistic.aspx 

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Australian Health Practitioner Regulation Agency. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx 

TWRH [The Women’s Royal Hospital]. (2021). Using prescription opioids

during pregnancy and breastfeeding. TWRH. https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Prescription_opioids.pdf