CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES DISCUSSION POST

CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES DISCUSSION POST
Main Post
Expectations
      Education is shifting toward competency-based education, and ensuring that preceptors are up to date on what clinical skills and student outcomes must be met is integral to success for the advanced practice student (Roberts et al., 2020). I am excited to start this aspect of the program. I have been working towards this week since March 2021, and my expectations could be clearer, even to me. I want to enter this rotation with an open mind and a thirst for knowledge. I am nervous about changing from a nursing role to a provider role because the nursing role has been part of my life for more than 16 years. I expect to learn how to conduct myself professionally in the provider role and learn the proper way to formulate a diagnosis, dictate and document in a way that maximizes reimbursement and positive patient outcomes.
Strengths & Challenges
My experience in nursing is a strength in itself. I have been fortunate to work with knowledgeable and experienced healthcare staff throughout my career. This has allowed me to see and do things that many others may not have done. I am inquisitive and enjoy research and learning. I take criticism well and try to use mistakes as learning opportunities. I have a good background in primary patient care from cradle to grave through my work in the Emergency Department. I have been fortunate to work with MDs and mid-level Nurse Practitioners and observe their methods of assessment and determination of interventions to implement Career goals: strengths and challenges related to nursing practice competencies discussion post.
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My challenges lie within myself. I have confidence in my skills once they are learned, but I often doubt my ability to tackle new tasks that appear overwhelming from the onset. Learning through simulation is often challenging because it feels impersonal and cold. Simulated learning is shared in both undergraduate and graduate programs. Simulated learning is seen as an effective method of learning despite being used as an adjunct to clinical hours and not as a replacement or addition (Nye et al., 2019).
Career Goals
I chose to start the FNP program solely because of the monetary benefit. I was a single mother of an eight-year-old girl and wanted to ensure that her childhood was better than mine and that she had access to any opportunity that came along. That reason has since changed. I am now engaged and have three additional children to add to the mix. I can focus on the program in front of me as the educational opportunity that it is and not only for the monetary benefit.
I have found throughout the RN to MSN program, I look forward to the research and classes. I have found myself applying what I have learned in my courses to assessing my patients in the ED. I have a renewed interest in teaching individuals about health promotion and illness prevention. I am in my mid-forties, and my career goals are not as lofty as they were in my twenties. Dreams of flight nursing or first assisting in the operating room have been replaced by the aspiration to work in primary care with an excellent mentor. Mentorship, increased autonomy, opportunities for growth and learning, and work-life balance were factors that influenced the transition and preparation of new nurse practitioners in the provider role (Faraz, 2019) Career goals: strengths and challenges related to nursing practice competencies discussion post.
I look forward to the next chapter in my story.
References
Faraz, A. (2019). Facilitators and barriers to the novice nurse practitioner workforce transition in primary care. Journal of the American Association of Nurse Practitioners, 31(6), 364–370. https://doi.org/10.1097/jxx.0000000000000158
Nye, C., Campbell, S. H., Hebert, S. H., Short, C., & Thomas, M. (2019). Simulation in advanced practice nursing programs: A North-American survey. Clinical Simulation in Nursing, pp. 26, 3–10. https://doi.org/10.1016/j.ecns.2018.09.005
Roberts, L. R., Champlin, A., Saunders, J. S. D., Pueschel, R. D., & Huerta, G. M. (2020). Meeting preceptor expectations to facilitate optimal nurse practitioner student clinical rotations. Journal of the American Association of Nurse Practitioners, 32(5), 400–407. https://doi.org/10.1097/jxx.0000000000000304
 

RESPONSE 1

The nurse practitioner-patient relationship is an integral role for us as nurse practitioners as we tend to practice from a more holistic and patient centered focus versus purely medical.  Meaning we are not only interested in the medical focus but the psychosocial, emotional, and spiritual health of our patients (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013).  It is important to remember that we all come from different backgrounds, even if people are from similar groups such as ethnic groups or socioeconomic groups each person is an individual, and each person has individual experiences that are unique to them.  In addition to holistic patient-centered care, another key component to the nurse practitioner-patient relationship is the opportunity we have with each of our patients regarding health promotion.  During every patient encounter, we have the ability to empower and educate our patients on ways they can improve and take control of their own health (World Health Organization, 2016).  What are your thoughts? Career goals: strengths and challenges related to nursing practice competencies discussion post
References
Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
World Health Organization. (2016). Health topics: Health promotion. Retrieved from: http://www.who.int/topics/health_promotion/en/Links to an external site.

RESPONSE 2

Great post! We share many similar strengths and weaknesses. While simulations have pros, I have found them impersonal, unrealistic, and hard to learn from. I would instead get out there head first and get hands-on with patients in situations. Furthermore, like you, I need help with confidence when it comes to problems I need to familiarize myself with. Choosing an excellent, competent preceptor with a positive attitude that provides a good judgment-free working environment can help conquer this weakness. Makarem et al. (2019) say, “An environment that provides opportunities for professional practice and improvement in clinical skills, and teaching and assessment strategies that increase students’ confidence, can enhance the professional confidence.” Another strategy is to learn to have more trust in oneself. It took some time, but once I could look within myself and realize that I had the skills, competence, and mindset, I could do whatever I wanted to do, no matter how unfamiliar I was with it. Building trust within yourself can build confidence and improve self-development (Goodyear, 2021). More nurse practitioners are needed in healthcare due to the shortage of primary care providers and the increasing aging population (Poghosyan, 2017). I am glad that individuals like yourself and I are attempting to become a part of the solution.
 
References
Goodyear, C. (2021). Overcoming the overwhelming. Nursing Management, 52(2), 56–56. Retrieved November 30, 2022, from https://journals.lww.com/nursingmanagement/fulltext/2021/02000/overcoming_the_overwhelming.11.aspx.
Makarem, A., Heshmati-Nabavi, F., Afshar , L., Yazdani, S., Pouresmail , Z., & Hoseinpour, Z. (2019). The Comparison of Professional Confidence in Nursing Students and Clinical Nurses: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research , 24(4). Retrieved November 30, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6621497/.
Poghosyan, L., Liu, J., & Norful, A. A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. International Journal of Nursing Studies, 74, 1–7. Retrieved November 30, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342506/.

 
Discussion Post Response #1
Hello XX, I enjoyed reading your post. I agree with your point regarding having different nursing experiences and the difference you will see in your daily nursing practice from the knowledge you obtain from your current FNP program Career goals: strengths and challenges related to nursing practice competencies discussion post.
As you mentioned, your Ed experience as a nurse always makes you confident and exposes you to all types of case scenarios, and we can list what is happening to all age groups from birth to the end of life. As an Emergency and critical care nurse, I witnessed the possible cases and problems occurring to human beings during my ten + years . During my journey with this program, having those exposures has been a blessing to me. I agree the transition will not be easy for all of us to take care of patients independently, as APRNs need more knowledge and skills. Having emergency room experience as a nurse will help the FNP who will work in urgent care settings after graduation. Urgent care centers offer services and resources to meet the needs of patients with immediate medical concerns and acute minor illnesses that are not life-threatening (Memmel & Spalsbury, 2017). As you mentioned in your post, competency-based education is a vital tool while caring for the patient, the competencies should include the skill and knowledge of how to obtain the history and perform a physical examination, and in addition, cultural competencies are essential for the provider duet to cultural differences around the globe Career goals: strengths and challenges related to nursing practice competencies discussion post. The study by (Shepherd et al., 2019) indicated that the cultural competence training should be regular, mandatory and it is preferable to have speakers from different cultural backgrounds during the training.
References
Memmel, J., & Spalsbury, M. (2017). Urgent care medicine and the role of the APP within this specialty. Disease-a-Month, 63(5), 105–114. https://doi.org/10.1016/j.disamonth.2017.03.001Links to an external site.
Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Services Research, 19(1), 1–11. Springer. https://doi.org/10.1186/s12913-019-3959-7Links to an external site.
 

CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES DISCUSSION POST RESPONSE 4

XX, I am sure this documentation is necessary for reimbursement and payment. The documentation must state how acute or chronic a patient is and how urgent and compelling the services needed are.
The way the Nurse practitioner communicates can allow the client to receive care or reject care.
 
When a client visits the clinic with a concern, the Nurse Practitioner must be a great advocate to observe the needs. client’s
We are assessing conditions and finding solutions such as services for  ADLs, bathing, grooming, ambulation, and even the need for transportation of services. Having access to care is essential to maintain the continuity of services. This improves the outcome of the client. Indeed we want positive results every time.
The article discusses that understanding correct coding strategies is an essential skill that affects billing and reimbursement for value-based cancer care. It mentions that billing and coding requirements vary across states and individual practices because of federal laws, state regulations, payor contracts, and institutional policies. It also says that coding for an established patient visit requires key components or evaluation and management service.Sacharian, K., & Rapsilber, L. (2020) Career goals: strengths and challenges related to nursing practice competencies discussion post.
 
The article discusses the role of coding and documentation. I am creating a Quality Payment Program (QPP) under the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act.
(MACRA).DeVault, K., Easterling, S., & Huey, K. (2017)
 
As the need for more access to remote care is escalated, knowledge and use of these new codes could provide more significant revenue for your practice to the extent your payers cover these services.MOORE, K., MULLINS, A., SOLIS, E., & HUGHES, C. (2020).
 
DeVault, K., Easterling, S., & Huey, K. (2017). The Role of Coding and Documentation in the Quality Payment Program. Journal of AHIMA, 88(1), 52–55.
 
Sacharian, K., & Rapsilber, L. (2020). Billing and Coding Breakdown Helps Nurses Recognize the Realities of Reimbursement. ONS Voice, 35(9), 30–31.
 
MOORE, K., MULLINS, A., SOLIS, E., & HUGHES, C. (2020). The 2020 Medicare Documentation, Coding, and Payment Update. Family Practice Management, 27(1), 8–13.

RESPONSE 5
I enjoyed reading your discussion post and find a lot of myself in your story. I am also in my forties and started nursing school as a single mother. I no longer have the aspirations to work in a face-paced stressful environment as it is time to leave that to the “baby nurses”. Even though I have worked in health care for 20 years, I still find doubt in my abilities. I find simulation laboratories to be extremely helpful in removing anxiety. Simulation labs have improved tremendously overtime. Simulation labs were once looked at as a waste of time and that it wouldn’t give students a proper framework to treat patients. However, with input made by facility, simulation labs became fluid and providing opportunity to move clinical hours between the laboratory, simulation, and clinical setting establishing a total of the hours needed per semester (Ardern, 2022).
My current company has changed the way we treat patients to focus more on patient centered care. Patient centered care is a care based on a partnership between the patient and health care provider that is focused on the patient’s values, preferences, and needs (The National Organization of Nurse Practitioner Faculties, 2012). Just from reading your discussion and your many years of experience in the emergency department, you will excel beyond measure.
Arden, R. (2022). The co-creation of an innovative curriculum model: Balancing lab,
simulation, and clinic. Teaching and Learning in Nursing, 17(3), 318-322.
https://doi.org/10.1016/j.teln.2022.03.008
The National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core
competencies. Download Nurse practitioner core competencies. https://www.pncb.org/sites/default/files/2017-02/NONPF_Core_Competencies.pdf

RESPONSE 6

Hello XX, great post. Nursing is a practice-based discipline with clinical practice being the core to nursing education and the improvement of patient care. Clinical practice provides opportunities for the development of confidence and competence, focusing on students’ learning needs rather than services needed by the health facility (Phuma-Ngaiyaye, 2017). I hope this rotation will help you improve your strengths and weaknesses. Changing from a nursing role to a provider role has been challenging this week but I know we will soon adjust. What are some ways that has helped you adjust this week?
References
Phuma-Ngaiyaye, E., Bvumbwe, T., & Chipeta, M. C. (2017, March 6). Using preceptors to improve nursing students’ clinical learning outcomes: A Malawian students’ perspective. International journal of nursing sciences. Retrieved December 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626121/

RESPONSE 7

Amber, congratulations on your expanded family and I must say your career goals are valid and on point. I agree with you that the transition from RN to FNP can be scary and we RNs often suffer from imposter syndrome; a false internal experience of low confidence, intelligence, or ability that is associated with anxiety, depression, psychological distress, and burnout (Haney et al., 2018). The imposter syndrome creates feelings of self-doubt in individuals, which can result in emotional paralysis preventing them from achieving their fullest potential (Peng et al., 2022) Career goals: strengths and challenges related to nursing practice competencies discussion post. Some of the recommended strategies to beat impostorism in nursing practice include changing your mindset by acknowledging your achievements and exercising awareness empowering thoughts instead of disabling thoughts, surrounding yourself with experienced FNPs and mentors, and sharing your feelings with trusted colleagues or mentors. I believe the purpose of the two practicum courses is to empower us with the requisite confidence, which serves a pertinent role in tackling possible feelings of impostor syndrome.
References
Haney, T. S., Birkholz, L., & Rutledge, C. (2018). A workshop for addressing the impact of the imposter syndrome on clinical nurse specialists. Clinical Nurse Specialist CNS, 32(4), 189–194. https://doi.org/10.1097/NUR.0000000000000386
Peng, Y., Xiao, S.-W., Tu, H., Xiong, X.-Y., Ma, Z.-J., Xu, W.-J., & Cheng, T. (2022). The impostor phenomenon among nursing students and nurses: A scoping review. Frontiers in Psychology, 13. https://www.frontiersin.org/articles/10.3389/fpsyg.2022.809031 Career goals: strengths and challenges related to nursing practice competencies discussion post

RESPONSE 7
Hi XX
Thank you for your very informative and inspirational post. I truly enjoyed reading it. I share your values and goals. I am a father of five. I first entered the field of nursing for the financial benefits.  However, as I continued my journey as a bedside nurse, the fulfillment and joy I felt when my patients did well were very satisfying.  When they overcame their physical and or mental ailments it brought many smiles to my face.   I don’t show it at work, but at home, my children say they see the joy my choice of career has brought to me.  As a result, three of my children entered the field of nursing.
Nursing was not my original choice.  Criminal Law was my first pursuit. I don’t regret not going on to law school, because I have found a sense of fulfillment and accomplishment in nursing.  Nursing is a calling, and I truly believe that I am called.  As nurses, we may complain about the long hours, but a sense of compassion and joy in helping others who are sick, and ailing is at the core of our personalities (Galuska et al., 2018).
As future Family Nurse Practitioners, we are broadening our abilities to help those who are sick and ailing at an even greater capacity.  The Family Nurse Practitioner is trending to become the primary care provider in the future (Fraze et al., 2020).  As Walden students, we are on the threshold of that endeavor.  Our skill sets must be nurtured and groomed to be able to provide optimal care and services to our perspective population. The Family Nurse Practitioner will be a major component in providing care for the elderly and those on the cusp of society.  Once again thank you for your very interesting and inspirational post Career goals: strengths and challenges related to nursing practice competencies discussion post.
 
References
Fraze, T. K., Briggs, A. D., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs. Medical care, 58(10), 853. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552908/Links to an external site.
Galuska, L., Hahn, J., Polifroni, E. C., & Crow, G. (2018). A narrative analysis of nurses’ experiences with meaning and joy in nursing practice. Nursing Administration Quarterly, 42(2), 154-163. https://doi.org/10.1097/NAQ.0000000000000280Links to an external site.

 
CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES DISCUSSION POST SAMPLE POST 2
CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES
Nurse practitioners must possess many characteristics to adequately care for the wide range of patients they will be responsible for. Some NPs may be competent in multiple areas, while others may be met with more challenges that need improvement. The National Organization of Nurse Practitioner Faculties (2012) outlines nine core competencies that a nurse practitioner should possess: scientific foundation, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice. After reviewing each of these core competencies, I am confident that some are my strengths, but a couple remain challenging for me.
Strengths
     The first competency that I would identify as a strength is ethics. Ethical competency is what guides us in decision-making and is formed through knowledge and our own practices (Hemberg & Hemberg, 2020). Being ethically competent is the foundation of good patient care and demonstrates the respect that every patient deserves. Operating on morals and viewing each patient as an individual, who may have opposite views to my own, is key to building a strong rapport and trust. I attempt to always do what is best for the patient and when their beliefs or desires may not align with my own, I remain aware of the ethical decisions that I must make.
Another strength for myself would be independent practice. As a hospice nurse who is out in the field alone with patients daily, I have become accustomed to practicing independently. Assessment of patients and identifying abnormal findings are left up to me to determine what warrants treatment or what does not need to be treated. I believe this experience will benefit me as an NP in the future. Operating independently holds more accountability, but through the practicum portion of this FNP program, I feel this strength will benefit and only add to the knowledge I obtained throughout my time at Walden.
Weaknesses
Scientific foundation competency would be one of my greatest weaknesses. Analyzing data and interpreting it is an important component of evidence-based practice (Curtis et al., 2017). With that being said, it also requires a change in thinking and routine. Change is often hard for me as I am routine-oriented and sometimes find it difficult to adapt to change. I have relied on data and research to be interpreted by others. I realize as an NP I will be responsible for translating new research and implementing it independently into my practice. Career goals: strengths and challenges related to nursing practice competencies discussion post This is a weakness that I will need to focus on the most throughout my education and as I enter my role as an NP.
A second weakness that I will be working on is quality competency. As I care for patients, I always think about what would be best for them but tend not to think about the cost or financial aspect. Quality competency is also based on research which is not a strength of mine at this time. Being mindful of the entire organization and how simple changes to practice can impact the patient and the organization is crucial, but it can be difficult to keep these things in mind.
Conclusion
As I have identified a few of my strengths and weaknesses, I know that through this course and practicum, I will be given the opportunity to improve on the areas in which I am deficient. Providers today face limited resources, patients with multiple chronic conditions, and limited time available for each patient, which adds to the stress on practitioners  (Buttaro et al., 2021). Familiarizing myself with areas that need improvement will benefit my patients and help me to provide a higher quality of care.
References
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier.
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to clinical nursing practice. Journal of clinical nursing, 26(5-6), 862–872. https://doi.org/10.1111/jocn.13586
Hemberg, J., & Hemberg, H. (2020). Ethical competence in a profession: Healthcare professionals’ views. Nursing open, 7(4), 1249–1259. https://doi.org/10.1002/nop2.501Links to an external site.
The National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. Retrieved November 28, 2022, from https://www.pncb.org/sites/default/files/2017-02/NONPF_Core_Competencies.pdfLinks to an external site.
 
CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES DISCUSSION POST SAMPLE RESPONSE
Thank you for sharing. I really enjoyed reading your discussion and I applaud your dedication as a hospice nurse. I understand adapting to change may be difficult however, changing your routine can help identify areas needed for improvement. My company recently started patient centered care. Patient-centered care refers to respecting patients and focusing on their physical, psychological, social, and spiritual needs (Yang, 2022). Initially I found this to be difficult. As a dialysis nurse my focus is getting them here for treatment, getting the fluid off that is needed, and making sure that they remain stable throughout dialysis. If the patient had any other needs, I would refer them to the person that they needed to speak with. However, after patient centered care was started at my clinic, I see that I was only addressing one problem instead of looking at the patient Career goals: strengths and challenges related to nursing practice competencies discussion post.
Scientific foundation competency can be very difficult, but we must look at the pros. The world we live in is advancing so quickly. Which means we as health care providers must advance even faster. Having scientific foundation competency will allow us to make changes while still making sure our patients will be taken care of safely. An example of change is Dr. Kopf. Dr Kopf decided to pursue his doctoral education to help enhance patient care through the utilization of process improvement and gain the skills to conduct quality improvement projects (Hickman, 2018). Dr. Kopf notice that novice nurse practitioners felt inadequately prepared for practice and many of the nurse practitioners did not receive structured learning or activities to enhance their new roll. Because of his dedication, new structures were developed so that when we become novice nurse practitioners, we will feel prepared. All of this would not have changed if someone did not notice that there was a problem, research, investigate, and put into practice.
Hickman RL. Evidence-Based Review and Discussion Points. American Journal of Critical
            Care. 2018;27(5):407-408. doi:10.4037/ajcc2018724
Yang, Y. (2022). Effects of health literacy competencies on patient-centered care among nurses.
BMC Health Services Research, 22(1), 1172.
https://doi.org/10.1186/s12913-022-08550-w Career goals: strengths and challenges related to nursing practice competencies discussion post