OCNE Competencies- new

#1: A competent nurse bases personal and professional actions on a set of shared core
nursing values:
I maintain a professional demeanor when in my clinical setting. I practice giving
compassion, respect, and justice for all individuals; coworkers, patient, families, etc. The patient
is my priority, advocating for their safety, health, and rights. I collaborate with members of my
nursing team to help provide the patient with optimal care.
February, 28th, 2016 I had my 85-year-old male patient up to a chair who needed their bed
changed and a 95-year-old woman who needed medicated for nausea. I politely delegated the
task of changing the male patients bed while he was up to the chair to a certified nursing
assistant. After medicating my patient for nausea, I checked on my other patient who was still
sitting up to the chair. I asked another nursing staff member to help ambulate the patient back to
bed. When he sat up from the chair I provide peri-care, apply Sensi-care to his coccyx and
change his brief.

#2: A competent nurse uses reflection, self-analysis and self-care to develop insight.
I am an individual whom reflects on events and use my resources to find a way to better
improve or learn from situation. When assessing my patients environment on 01/27/2017 of an
intubated patient in the intensive care unit I observed three IV bags hanging with no change date
times. One IV-bags was not connected to the patient and the other line was being administered
through a peripheral intravenous line, and the other through a central venous access device.
Reflecting to first year, Winter term handing my first IV bag my instructor said I was missing a
step. I collected the correct medication for the right patient at the right time, I collected a new
secondary tubing, spiked the bag correctly, and scanned the med room to see what I was missing.
Hanging off the med cart were changed date labels, this is what I was missing. From that
learning experience, I thus far havent forgotten a change date label on my IV tubing. When this
ICU patient had Levoflox (Levaquin) due I checked Micromedex and Davis drug guide to see if
it was compatible with D5/0.9% NS. When hanging a new bag of medication I put a change date
on the new IV tubing, and I took down the unlabeled change date bag.

#3: A competent nurse engages in intentional learning

During my clinical rotation in labor and delivery unit on October 20th, 2016 I participated
in a practice code of a new born. I was assigned the task of being the scribe, and was handed a
clip board. When the practice code was initiated I wrote down when compressions and breaths
via a bag valve mask were started, intubation time, when the umbilical vein cord was placed,
times and types of medications administered and repeated the meds given back to the team.
After the practice code was complete I asked how a umbilical vein cord was placed. The nurses
informed me that they use a razor to cut the cord, and to not use scissors because it will compress
the cord and you wont be able to see the arterys and vein. They use the AVA pneumonic to
remember where to place the catheter. There are two small openings, the arterys (A), and one
larger opening, the vein (V). These nurses are specially trained with a class and are certified to
place this catheter. During post-clinical I shared my learning experience with my peers so they
could benefit from my experience, as we had not learned this when covering OB, and this is a
special certification within LDRP.
#4: A competent nurse demonstrates leadership in nursing and healthcare
I demonstrate leadership by honoring my commitments and taking responsibility for my
mistakes. Managing my time wisely so I have time to listening to my patients, their families, and
express empathy for those around me. On January, 31, 2017 I assumed care for an intubated
patient in the intensive care unit, admitted with acute respiratory failure secondary to pneumonia
and sepsis. During my head to toe assessment I observed that the patient had a large loose stool.
This patient is at risk for impaired skin integrity related to physical immobilization as evidence
by being intubated, sedated, and a low hemoglobin of 8.5. With assistance of another nursing
staff member I was able to change, turn, and apply a barrier cream to protect his skin.

#5: A competent nurse collaborates as part of a health care team.

On January, 24th, 2017 I assumed care for a 54-day old female with respiratory syncytial
virus infection (RSV). I performed and charted an hourly respiratory assessment. When the baby
had coughing fits and oxygen saturations decreased from 98% on room air to 95% I
collaborated with respiratory therapy to see if they were going to give the Albuterol NEB
treatment, or if I could. The father of the child was in the room during my shift, and had several
questions throughout my shift. I answered his questions to my best ability, and explained what
interventions I was performing and why.

#6: A competent nurse practices within, utilizes and contributes to the broader health-care
system.
Before performing a nursing skill I review the policy on the procedure. February, 14th,
2017 I got the opportunity to do a clinical rotation in out-patient infusion. A twenty-one-year-old
was admitted to outpatient infusion for two units of leucocyte-depleted red blood cells. She has a
diagnosis of lymphoma, fatigue, anemia, and low hemoglobin. Laboratory lab values were as
follows: hemoglobin 6.2, hematocrit 18, platelets 121, and absolute neutrophil count of 0.39. All
lab values are below defined range due to lymphoma. Before administering a unit of blood I
reviewed the hospitals policy on transfusing blood. I assessed her vitals and monitored her
closely for any blood transfusion reaction.

# 7: A competent nurse practices relationship-centered care

February, 28th, 2017 I was administering morning medications to an 86-year-old male
patient. This patient was hard of hearing, so explaining the dose, and action of each medication
took extra time, but allowed this patient to maintain their autonomy. This patient had protonic
orders IV push, and I told him I have to push this medication slowly over two minutes, so Im
going to sit here with you and talk. The patient looked at me, smiled and stated you are a really
good nurse.

#8: A competent nurse communicates effectively.

During each of my clinical rotations I collaborate with the nursing staff I am working
with effectively to provide the optimal care to the patient, using the SBAR report style. On April,
25th, 2016 I was working on the post-surgical unit with a patient with a left femur fracture that
had a hemiarthroplasty completed the previous day. I Collaborate with physical therapy to create
an activity and exercise plan, ambulating patient two to three times daily, including range of
motion exercises, ambulation, and use of assistive devices. In doing this we were able to create a
plan that would be most effective and patient centered for this patient.
#9: A competent nurse makes sound clinical judgments
Upon assessment of a 78-year-old female patient vital signs her heart rate was 43 beats
per minute Reviewing my patients medications she had Metoprolol, 50 milligrams ordered for a
history of hypertension. Metoprolol is a beta blocker, and slows the heart rate. Therefore, I didnt
administer this medication, made a note, and spoke with the physician when he rounded in the
morning. This clinical day was November, 17th, 2016.

#10: A competent nurse, in making practice decisions, locates, evaluates and uses the best
available evidence, coupled with a deep understanding of client experience and preferences.
February, 28th, 2017 my patient reported nausea, states I think it was from all
the medications this morning, I just need something to take this nausea
away. I reviewed her as needed medication and saw she had Ondansetron 8
milligrams, IV push ordered. I reviewed how fast to administer the
medication, checked her IV for patency and administered the PRN anti-
nausea medication per physician order through her IV. I helped the patient
into a comfortable position onto her right side with head of bed elevated.

Original OCNE competencies

A competent nurse personal and professional actions are a set of shared core nursing
values through understanding that, caring, advocacy, protection of patients autonomy and
prevention of harm; respect for self and others, collegiality, and ethical behaviors; and that a
competent nurse embodies these values (November, 01, 2015).

05-26-2016, I collaborated with my patient to identify what nursing interventions were

working to alleviate her pain, and what further interventions were need. Administrating
Tizanidine (Zanaflex) 4MG to help control the muscle spasms in her right shoulder, and
performing hot and cold therapy. She did not want to have a warm blanket on her shoulder
after the ice was off for 15 min, after teaching her that ice helps decrease inflammation, and
the heat helps with relaxing the muscles, she was compliant with the therapy. After fifteen
minutes I went to check on her, she was asleep (November, 01, 2015).
October, 27th, 2016 I was working with a preeclamptic, primigravida, laboring patient with
ineffective thermoregulation due to labor complication of maternal fever. I monitored her
Axillary temperature every hour and rotated ice cold washcloths to the mothers forehead, and
neck every fifteen minutes. I showed the laboring mothers significant other how and where to
apply the cool washcloths so he could participate in the care, while I was assisting and
monitoring. Tylenol was administered at 0400 for a temperature of 102.2 F. Axillary temperature
dropped to 101.1 axillary at 09:00, and the baby was born at 09:19. At 11:59 the mothers
temperature was 98.9 orally (November, 27, 2016).
A competent nurse engages in intentional learning. Developing self-awareness of goals,
processes, and potential actions of this learning and its effects on patient care. Purposely seeking
new, relevant knowledge and skills guides best practice development. Integrated thinking
establishes connections between seemingly disparate information and sources of information that
will be applicable to new situations (November, 01, 2015).
Applying what I learn in class and lab to my clinical has helped identify and handle
patient situations. An example of applying a learned skill includes teaching patients to take
their pulse before taking their cardiac medication, and assess their ability to perform the
task. I am not afraid to ask questions, I would rather ask someone or look up information
before completing a task without understanding and confidence. When researching
medications or information that is given to the patient I find a second source to support my
findings (November, 01, 2015).
I had the opportunity to participate in a neo-natal practice code during clinical on October,
th
27 , 2016. During this simulation, I was the scribe, writing down when medications were
administered, vital signs, umbilical IV was started, CPR was started, along with any other
activity that occurred. I repeated the medications that were administered, and communicated, and
observed what the team was doing. This experience helped me to strengthen and learn effective
communication skills when in a critical situation (November, 27th, 2016).

A competent nurse demonstrates leadership in nursing and health care through the
understanding that an effective nurse takes a leadership role to meet patient needs, improve
the health care system and facilitate community problem solving. A competent nurse
effectively uses management principles, strategies and tools. An effective nurse is skilled in
working with assistive nursing personnel including the delegation of responsibilities and
supervision (November, 01, 2015).
November, 17, 2016, I was working with a patient admitted for hypernatremia related to
dehydration. My nursing goal was for the patient to maintain adequate hydration as evidenced by
urine output at least 30 ml/hr. I noticed that the patient hasnt urinated during my shift. I asked
the patient if she felt like she needed to use the restroom, she state, no I dont need to pee. I
bladder scanned her for 526 ccs. Another nurse stated, you can do an I and O catheter, she has
them ordered. This patients urinary analysis showed evidence of a urinary tract infection, and
the physician that morning prescribed intravenous antibiotics. To prevent patient harm, and
promote circulation I requested assistance of another staff member to ambulate this patient to the
bedside commode. She was able to urinate 500 ccs of concentrated, foul smelling, slightly
cloudy urine.
Nurses are teachers, and have a role in helping the client understand why and how they
can better their health. With each nursing action, I understand why and what I am doing. I
take the opportunity to educate the patient where they can carry out the interventions
independently when they return home. May, 19, 2016 I provided discharge instructions to
my patient who was going home after having a laminectomy. After reading the patient
instruction of monitoring temperature two times a day, and reporting a temperature of 101 or
greater, I asked the patient why this was important, he shrugged his shoulders. I educated
the patient that the purpose of monitoring his temperature was to monitor for signs of
infection. An elevated temperature can indicate infection. With his discharge instructions, a
thermometer was provided in his folder (November, 01, 2015).
October, 6th, 2015 at 07:10 I assessed a patients ileostomy stoma. The dressing had dark
black shadowing around stoma appliance. I called supply for ileostomy appliance, and gathered
supplied to apply a new dressing. I reassess the stoma site at 09:10, removed the appliance.
Around the stoma there was excoriation 5 by 9 cm, stoma measures 2.5 by 3 cm. I applied the
new appliance with no difficulty. Patient educated throughout procedure, patient stated, Im
going to need help doing this at home. Patient also expresses acceptance with new stoma stating,
at least its not cancer. Post total colectomy, partial ileectomy, and ileostomy, a biopsy was
taken from the ilium. Biopsy results showed benign tumor (November, 27th, 2016).

A competent nurse collaborates as part of a health care team through the understanding
that the patient is an essential member of the healthcare team. Successful health care
depends on a team effort, and collaboration with others in a collegial team is essential for
success in serving patients. Learning and growth depend on receiving and using constructive
feedback; effective team members must be both open to feedback and able to give useful
feedback in a constructive manner (November, 01, 2015).
On 2-15-2016 my patient had several night time medications, and reported feeling
nauseated. We had our IV push lab check off October, 11 th, 2016. Being unable to administer
this patient anti-nausea medication intravenously, I collaborated with a nurse. The nurse
administered Zofran through the patients IV. Thirty minutes after the IV administration, the
patient stated I feel better, and can take my night time medications. I talked with the
patient about her night time medications, and she said that the hospital was missing one of
her night time medications. I had never heard of the medication she mentioned before, so me
and another nurse investigating her home medication list. We discovered that she had been
taking a chemo drug orally, last medication administration was three days previous to
hospital admission. The physician was called, and we received an order for her chemo-
medication, placed her on chemo-precautions, and notified the CAN (November, 27 th, 2016).

A competent nurse practices relationship-centered care through the understanding that;

effective care is centered around a relationship with the patient that is based on: empathy and
caring, patient preferences, a deep understanding of the care experience, developing mutual trust
and respect for the autonomy of the patient. The effectiveness of nursing interventions and
treatment plans depends, in part, on the attitudes, beliefs and values of patients and these are
influenced both by how professionals interact with patients and by the intervention itself.
Patients reflect the culture and history of their community and their broader population, and that
these must be considered in developing nursing interventions (November, 01, 2015).
I have demonstrated patient centered care through understanding that a competent nurse
practices effective relationship-centered care based on empathy and caring, patient
preferences, a deep understanding of the care experience, developing mutual trust and
respect for the autonomy of the patient. Involving the patient and incorporating their values
and beliefs when making nursing interventions and making treatment plans, while keeping
in mind cultural beliefs and practices. 02-23-2016 I answered a call light of a PT with
COPD, she was anxious, and reported that she couldnt breathe. I collected her vital signs
and reported to the primary nurse. Her oxygen saturation was 92% on 3L nasal cannula,
doctors order was to maintain oxygen saturations of 92% or greater. Patient stated that she
was anxious, and the RN informed her that she already received her Ativan. The Bi-pap was
offered, PT refused. I took extra time to set the patient up to a chair, talk with her, educating
her on purse lip breathing, while changing her bed and making her feel more comfortable.
When I was done, she returned to bed, stated she felt better, and went to sleep. Taking extra
time to do small things can have positive results, and even save you more time in the long
run. More importantly, focusing on the patient and their needs, and not worrying about how
quickly a task can be completed (November, 01, 2015).
November, 17, 2016, I was working with a patient admitted for hypernatremia related to
dehydration. One of my nursing goals was for the patient to maintain a blood pressure below 120
systolic, and below 90 diastolic, upon assessment of blood pressure. During my morning
assessment her blood pressure was 107/62, heart rate 43. Amlodipine was not administered
because of low blood pressure and bradycardia. Amlodipine causes vasodilation resulting in
lowered BP. Inotropic effect (increases myocardial contraction stroke volume), Chronotropic
(Decreases heart rate), Dromotropic (decreases conduction of the heart cells). The patients heart
rate began to slowly increase to defined limits after two hours of increasing oral intake of fluids
and food. At 07:30 her heart rate was 43 beats per minute, her heart rate increased to 55
beats per minute at 13:30 when I left for the day (November, 27 th, 2016).