Introduction

My name is Tameeka Williams. I am currently in the bachelors degree program of NYCCT due to graduate this December. I graduated with my associates degree from city tech as well. I am currently working as a registered nurse in home care (specifically with pediatrics). I have been doing this for about a year and a half to date.
I was born and raised in Brooklyn,New York. My father on the other hand Was born and raised in Kingston, Jamaica. Although my mother was also born and raised in Brooklyn, New York her parents are from the south. My current hobbies are enjoying a good television series, my favorite is Sci-Fi. I’m also really into YouTube, I am currently considering making my own channel. Lastly, I’m trying to make going to the gym a hobby. As this will aid in my journey to over all wellness.
My short term goals are to finish this program and move on to a hospital setting. I have learned a lot being within the home with children who have multiple medical conditions and I believe I can further this knowledge in a pediatric hospital setting. My goals do not stop there. I plan to further my education and get my masters and DNP. As far as long term goals, I’m still contemplating working as a NP Or growing further withIn the hospital into management. When it’s all said and done the number of ways to live in one lifetime is limitless. So why limit yourself?
Welcome to my e-portfolio.

Individual strengths statement/ Self reflection

Introduction
My clinical experience has opened my eyes to a new view on older adulthood. This experience took place at The Stein Senior Center located in the Gramercy Park area of lower Manhattan. The Stein center is a place where seniors can go to not only form new friendly relationships, but get help with safe guarding their health and wellness. After participating in a clinical rotation at the center, I now know what life can be as an older adult. All too often as nurses we see one side of older adulthood and that is when they are sick and hospitalized; however, there is more to aging. Becoming a senior doesn’t mean you will be fragile and sick. If you take care of yourself, and remain active you too can be as young as the seniors at the Stein Center. This self- reflection is written with the purpose of recognizing my abilities, strengths and things I needed to improve to provide quality care to the seniors of the Stein Center.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance
Throughout my clinical experience, I maintained the client’s confidentiality by providing data privacy as per HIPPA regulations. A perfect example is when a patient blood pressure was too high and needed to be referred to the hospital. I Pulled the patient aside into a private room and asked all necessary questions before informing them about my concerns and referral. I assumed responsibility for my own learning by coming to the facility on time and prepared with needed equipment such as my blood pressure cuff and stethoscope. I maintained a good line of communication with my professor as well as my peers for guidance if I should need it. All my assignments were handed in upon due date. I also made a point to participate actively during pre-and post-clinical conferences. Every day of clinical I came dressed professionally in accordance with NYCCT attendance policy.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
During client interviews, I maintained an open-ended dialogue between myself and the client to gain a therapeutic relationship. This new-found relationship then allowed me to collect necessary client information. After taking the patients’ blood pressure, I utilized that time to answer any questions the client may have had. Whenever I got a high blood pressure reading on the clients, I would then inquire about their medications and medical history. Next, I would inform my professor about what I know about the client and the blood pressure results I had received. After enough information gained sometimes it would be imperative that we referred them to see their primary physician or the emergency room for further screenings. Although I did not administer medications to the clients, I reinforced patient education to aid in medication management and adherence.
Objective 3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting.
One key concept to providing quality care for a client is maintaining a therapeutic relationship. I made sure to do so as much as possible with the seniors at the Stein Center. I created lines of communication with all team members including the clients, that were respectful, reassuring, patient-centered and goal oriented to meet the needs of the clients. As a nurse in this day in age, I am aware of my cultural beliefs and I am empathic to the values of others. I utilize this skill to effectively communicate with the diverse group of seniors at the stein center.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
My peers and I conducted a survey in the beginning of the semester to find out what topic the seniors wanted to learn about. The options given to them where four morbidity’s that their community particularly sufferers from. From that survey, the main topic of cancer was chosen. Throughout the next few weeks I constructed and conducted presentations on cancer awareness, nutrition to aid in preventing cancer, cancer prevention, and resources. The presentations were presented in the form of jeopardy games. The seniors really enjoyed each game. These games not only educated them on cancer but it allowed them to get active through dancing. The games even had pop culture sections that had information about music, and iconic people form the 50’s. We gave out nutritious items and pamphlets to the seniors. They not only loved the fact that they had fun, but that they left with prizes and reading material they could take home. The seniors were very appreciative for everything we had done for them throughout the semester. This made me fulfilled and it also helped validate my reasons for being a nurse and a patient advocate.
Objective 5: Utilize informational technology when managing individual and families in the community
Managing information and communication technologies to promote the health of a community is becoming vital in nursing today. My peers and I researched online using reliable data bases and sources, such as the use of community health profiles from the NYSDOH website. My peers and I broke up into two small groups and conducted windshield surveys of the community. Our purpose was to see the community for ourselves and identify any issues that the community may have. We considered everything from safety of the community to access of resources. We even spoke to people outside as well as the seniors at the stein Center to help gather information. Confidentiality was maintained as per HIPAA regulation throughout this whole experience.

Objective 6. Demonstrate a commitment to professional development
Continuing ones’ education is vital in the field of nursing. To provide quality care and services a nurse must know what is relevant today not yesterday, as the medical field is forever changing. Nurses must think critically and use evidence based practice when providing care. Demonstrating a commitment to professional development, we utilized reliable resources to conduct our research. Our community textbook was used to aid in the implementation of our interventions. In pre-and post-conference we talked about our experiences and even went on to evaluate ourselves. For example, one thing I self-evaluated was how I conducted myself when helping a vision impaired individual eat their lunch. One thing I noticed about myself was that I remembered my nursing basics. Without thinking twice I laid out the clients food and utilized the clock-face method to let them know where each item was on the table. Every clinical experience was an opportunity to adjust to the challenges presented to us as community health nurses.
Objective 7. Incorporate professional nursing standards and accountability into practice
As a nurse, I embody the American Nurses Association standards in clinical practice by providing high standards of nursing care. I promote safety and an ethical work environment while advocating on health care issues that affects the community and my fellow nurses. At clinical I practiced under my professor’s supervision while abiding by the stein centers guidelines. I took accountability for my actions at the clinical site. I was clear about my professional role responsibilities and organizational goals. When constructing the jeopardy games, I provided clear directions about how this should be accomplished and my expectations of the team. I now realize that I helped in building a culture of accountability with my peers and professor.
Objective 8. Collaborate with clients, significant support persons and members of the health care team
Each clinical day we had conferences, with the purpose of collaborating to address the clients care. This helped my peers and I to meet the needs of the seniors. Upon getting high blood pressure result, we took that time to teach the client about nutrition, exercise and the importance of sticking to their medication regime as per their doctor’s orders. Educational material and additional resources was also provided to the seniors to take home, read and hopefully utilize to better their overall well-being.
Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
After conducting a windshield survey and talking to the seniors, we began to recognize the impact finances, social demographics and how it affects their health. Many of the seniors attend the Stein Center to receive a nutritious meal for a very low price. The community in which they live is rather expensive and the stein center provides services for them that they may not have received otherwise. Some of the seniors have lost a loved one or two and uses the stein center to cultivate friendly relationships. Through the center the seniors can get a workout, participate in hobby like activities, referral services and a great meal all under one roof.

Conclusion

In conclusion, my clinical experience has given me a new-found appreciation on aging. This community experience was very fulfilling and opened my eyes to community health nursing. This experience has improved my knowledge on economic, political, social and demographic forces that affect my very own delivery of health care services. This is an experience one cannot receive in the hospital setting. From here on out I will use what I learned and take it into consideration when I am preforming as nurse in all health care settings. I can honestly say that with the help of my peers and instructor, I was able to help the seniors at the Stein Center improve their health and wellness.

 

Resume

Tameeka Williams
(347) 232-4953 ♦ 297 E 38th street ♦ Brooklyn, NY 11203 ♦ T.williams20@yahoo.com

EDUCATION

Jan 16 – Dec 17 NEW YORK CITY COLLEGE OF TECHNOLOGY Brooklyn, NY
Bachelor of Science, B.S.N., expected Dec 2017

Aug 12 – Dec 15 NEW YORK CITY COLLEGE OF TECHNOLOGY Brooklyn, NY
Associate of Applied Science, A.A.S.

HONORS & AWARDS

Dean’s List Award – Fall 2013, Spring 2012
National Society of Collegiate Scholars – Spring 2012

CLINICAL EXPERIENCE

Sept 13 – Present NYCCT Clinical Experience Rotations Brooklyn, NY
Nursing Student
• Leadership & Management of Care at Kings County Hospital (Summer 2017)
• Community Health at The Stein senior center (Spring 16)
• Labor & Delivery and Medical Surgical Unit at Maimonides Hospital (Spring 2015)
• Behavioral Psych unit at Kings County Hospital (Fall 2014)
• Medical Surgical unit at Brooklyn Hospital (Fall 2014)
• Long Term Care unit at shore front Jewish geriatric center (Spring 2013)

RELEVANT EXPERIENCE

Aug 16 – Present PIONEER HOME CARE INC. Bronx, NY
Registered Nurse
• Perform patient assessments and work with physicians and therapist to plan, implement, and
evaluate plans of care for patients of all ages; mostly Pediatric
• Observe patients and actualize nursing interventions to expedite healing and recovery after surgery.
• Work with ventilator patients, tracheotomy care, gastronomy tubes, catheters and wound care
• Educate patients and caregivers on diagnosis, treatment options, and disease process
and self-management.
• Maintain accurate and detailed patient records and charts
• Provide comfort while developing and encouraging independence

Jun 16 –Dec 16 SWEET P. HOME CARE Queens, NY
Registered Nurse
• Perform patient assessments and work with physicians and therapist to plan, implement, and
evaluate plans of care for patients of all ages; mostly Pediatric
• Observe patients and actualize nursing interventions to expedite healing and recovery after surgery.
• Work with ventilator patients, tracheotomy, gastronomy tubes, catheters and wound care
• Educate patients and caregivers on diagnosis, treatment options, and disease process
and self-management.
• Maintain accurate and detailed patient records and charts
• Provide comfort while developing and encouraging independence
Aug 16- Jun 17 WHOLE FOODS MARKET Manhattan, NY
Customer Service
• Help customers with all their needs,
• Assist customers with bagging and finding items to purchase
• Ensure customer satisfaction with our services and their experience.

CERTIFICATIONS
• Registered Nurse in the State of New York
License #715506 May 2016 Present

• American Heart Association Basic Life Support (BLS) for Healthcare providers (CPR and AED) program.
• Crisis Prevention Intervention (CPI) personal training
• Screening, Brief Intervention, Referral toTreatment (SBIRT) training

ORGANIZATIONS

AUG 12- JUN 13 NUTRIX (NYCCT NURSING CLUB)

VOLUNTEER EXPERIENCE

JULY 13 – JULY 14 PARK SLOPE GERIATRICS DAY CENTER BROOKLYN, NY
Volunteer
• Assisted in sharing out lunch to seniors
• Promoted health and wellness via exercising with the clients
• Conducted blood pressure screenings for participating seniors
References– Available upon request.

Self-Learning Analysis

I have learned that progression and productivity are things that I value greatly. After becoming a nurse, I was afraid of not being able to transition from school to the real world; however, I surprised myself and I worked very well as a new nurse. My journey through school wasn’t easy at all. I had to maintain not only my work life but my school and social life as well. Throughout all my classes, I gained better time management and produced better assignments. The bachelor program has allowed me to build upon the fundamentals of nursing and has brought me much insight on controversial health care topics. I am not very confident that I will succeed in a graduate program.

Philosophy
My philosophy of nursing has been greatly influenced by Jean Watson’s “Philosophy and Theory of transpersonal caring”. The way a nurse cares for a patient has a huge impact on the plan of care they provide with regards to
health promotion and wellness, illness prevention and restoration of health. I have learned from experience that the quality of care nurses provide is very different, when they practice with care and when they do not. Nurses who don’t care tend to do the bare minimum to get through the day; however, there are others who go above and beyond to see that their patients are having a better quality of life. Growth for the patient is promoted through care. A caring health care environment not only accepts the patient for who they are but it considers what the patient can become. In order not set high expectation, some nurses set limits on how far they believe their patients will grow and thus limit the care they provide. I would rather try to teach my patient something and fail at them comprehending or understanding, then to not have tried at all due to limited expectations.
There are quite a few ethical values that are pertinent to Nursing. Maintaining patients dignity is very important to their quality of life. Nurses must always provide privacy and advocate for their patients. Autonomy in decision making provides the patient with a sense of control of their care. A transpersonal experience between the nurse and the patient should take place, as this improves patient outcomes. In order to gain trust with the patient a nurse must be honest. Lastly, professional competency is a necessity because patients trust you more when they are confident in your work.
Patient centered care is vital to all aspects of care. This type of care gives regards to the patients values, needs and experiences when planning care and it’s delivery. All of these things can take place through a therapeutic relationship with the interdisciplinary team. Patient centered care leads to better patient outcomes and satisfaction with the quality of care provided.

 

Sample Writing

Safe Staffing Ratios
Nurses play a major role within the health care system. State mandated staff ratios is essential to ensure the safety of patients as well as nurses. Poor nurse patient ratios can greatly impact the health of the nursing staff, examples of this includes high blood pressure, stress, and burn out. Having adequate staffing is vital to patient care and the retention of nurses. Lack of proper staffing leads to higher expenses for for the over all facility. Lack of proper staffing places patients in danger and decreases staff satisfaction. Thus resulting in staffing issues, that will only continue to worsen as the number of people above the age of 65 increases.The demand of quality health care services is increases making safe staffing rations a continued problem.
Having safe staffing rations aids in the maintenance of quality patient care and improves the work environment. In order to improve the quality of care and nurse retention rates, California became the first state to enforce a minimum nurse to patient staffing rationing back in 2004. Studies proved that this reform indeed improved the retention of nurses and patient care. Researchers at the university of Pennsylvania conducted a study in 2010 that showed twenty-nine percent of California nurses experienced High burnout when compared to states that had no minimum staffing rations such as thirty-four percent in New Jersey and thirty-six percent of nurses in Pennsylvania. According to this study twenty percent of California nurses claimed dissatisfaction with their jobs when compared to twenty-six percent and twenty-nice percent in New Jersey and Pennsylvania. With the new nurse staffing ratios in California also came a decrease in inpatient death within 30 days of being admitted to the hospital. Lastly there was even a decrease in death from failing to properly respond to patients symptoms.
Poor nurse to patio ratios places nursing staff in danger. Due to the combination of challenges presented by nursing shortages and decreased nursing budgets, there are fewer nurses working for longer periods of time while caring for sicker clients. This is the kind of environment that drives nurses away from bedside care. Such environments affects the health of nurses and results in back injuries, cardiovascular disease, high blood pressure and depression. Health issues results in increased call outs and paid time off usage. Nursing staff tend to complain about their workload leading to feelings of burnout (chronic fatigue, irritability, depression and more).
The health of the nurses is greatly impacted by working longer shifts and overtime. What is a study conducted in 2010, there is a correlation between incidence of heart disease and high rates of overtime work. Researchers followed a total of 6,014 middle aged individuals for 11 years who worked full time at baseline. The outcome of this study proved that workers who worked 3-4 hours of over time per day were 1.6 times more likely to have a cardiovascular health disorders. This research studies findings suggest that coronary health is adversely affected by over time work.
There are quite a few studies that show that there are correlations between inadequate nurse staffing and poor patient outcomes. This is associated with increased patient infection, medical errors, bedsores, pneumonia, cardiac arrest, and accidental death. According to a study that used administrative data from 1997 from 799 hospitals in 11 different states, to study the correlation between the quantity of nursing care provided and patient outcomes. Results showed that with more hours of nursing care lead to better patient outcomes in hospitals.
Under staffing leads to more expenses for facilities as a whole. Due to poor work environment and work loads nurses are beginning to reconsider their career choices. Some nurses are considering part time or Per diem work,While others are looking into new careers all together. These changes result in high turn over rates and money down the drain for facilities. Facilities are missing money when they train new nurse, who turns around and quits before their one year mark. Employers then have to use temporary nurses to fill the gaps in their staffing. This supplemental nursing can be very costly for hospitals. As facilities have to pay staffing agencies any where between 250,000 to 400,000 for their services.
Better staff ratio can be around to improve the retention of nurses and may even catch the attention of students to the profession. After the nurse to patient ratio reformed place the California board of nursing reported an influx of Registered Nurse location from other states. Also that year there was a 60% increase in nursing licensure application. In the same 2010 study that took place in California, nurse managers and nurses agreed that legislation goal was achieved. There was recruitment and retention of nurses, thus decreasing nurse workloads, and improving the quality of patient care.
Improving staff ratios does place a financial burden upon hospital facilities. Despite the fact that some people claim that better nurse to patient ratios increases cost, research shows that this is actually cost effective. High turn over rates along with supplemental nurse staffing via agencies increases the average cost per discharge and overall operating cost. Adequate staffing improves patient outcomes and nurse performance, decreases the rate of turn over staffing cost, as well as liability. One study in the Journal of Health Care Finance showed that high nurse staffing did increase operational costs for hospitals; but, it did not decrease the hospitals’ overall profitability.
To conclude, Nurses are the key to quality health care systems. State mandated staff ratios are needed to make sure that the safety of patients and nurses is maintained. Improved nurse to patient ratios are associated with better patient outcomes. Since there is an increased focus upon value based care, set staff ratios are vital to the delivery of quality care that is cost effective. The implementation of legislative reform will improve staffing standards. Their should be encouragement of facilities to be transparent through public reporting, and penalties should be set in place for facilities that fail to adhere to minimal standards.

References
Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., . . . Smith, H. L. (2010). Implications of the California Nurse Staffing Mandate for Other States. Health Services Research, 45(4), 904-921. doi:10.1111/j.1475-6773.2010.01114.x

 

Virtanen, M., Ferrie, J. E., Singh-Manoux, A., Shipley, M. J., Vahtera, J., Marmot, M. G., & Kivimaki, M. (2010). Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study. European Heart Journal, 31(14), 1737-1744. doi:10.1093/eurheartj/ehq124

 

Needleman J, et al. Nurse-staffing levels and the quality of care in hospitals
N Engl J Med. 2002.

 

Bae, S., Brewer, C. S., & Kovner, C. T. (2012). State mandatory overtime regulations and newly licensed nurses’ mandatory and voluntary overtime and total work hours. Nursing Outlook, 60(2), 60-71. doi:10.1016/j.outlook.2011.06.006

 

McCue, M., Mark, B. A., & Harless, D. W. (2003). Nurse staffing, quality, and financial performance. Retrieved November 16, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/12908654/