NR 500NP Week 8 NP Role Transition Reflection Paper Example

Reflection: Two Nights in the Emergency Department I Now Read Differently, and the One Thing That Has Not Changed

Student Name

College of Nursing, Chamberlain University

NR 500NP: Foundational Concepts and Advanced Practice Roles

Instructor Name

Month Day, Year

Reflection: Two Nights in the Emergency Department I Now Read Differently, and the One Thing That Has Not Changed

The Claim

My claim at the end of this course is narrow: I now read decisions I watched for eight years as decisions someone had to own, and that change has made me both more respectful of the people who made them and more cautious about the ones I will make. Two nights in the emergency department show the change more clearly than any summary of the term.

Barnes (2015) described nurse practitioner role transition as including a move from giving care others ordered to ordering it, and a stretch of living between two professional identities. I am at the very start of that shift, before I have prescribed anything, and the straddling is already visible in how I look back on my own work.

Occasion One: The Woman Triaged as Anxiety

In my competency mapping paper, I described a 41-year-old woman triaged as having a panic attack whom I suspected had a clot in her lung. I told the physician, the scan was ordered, and it showed a clot. At the time, I read that night as a story about good nursing: I noticed, I spoke up, I was right. I now read it differently. The physician who ordered the scan made a decision that had costs I never saw: radiation, contrast dye, time in a busy department and the chance of a false positive leading to treatment she did not need. If the scan had been normal, the same physician would have owned the decision to scan a young woman with a history of anxiety. I only ever carried the upside of being right.

As a nurse practitioner, I will carry both. That night now reads to me as a decision with two possible outcomes, one of which I was never going to be responsible for.

Occasion Two: The Man With the Red Leg

In my Week 1 post, I described a 58-year-old man discharged at 0200 with cellulitis, without an ultrasound to rule out a clot. At the time, I thought the physician assistant had been efficient. I now think the decision was probably reasonable, and also that I would not make it the same way in my first years of practice. The one I would now pass on is the decision to skip the ultrasound when a clot is plausible, on a busy night, to save time. I would order it, or keep him until it could be done, and I would accept the cost in time and in the department's patience. That is not because the physician assistant was wrong; it is because I will not yet have the experience to judge that risk well, and I would rather pay in time than in a missed clot.

Occasion Three: A Conversation With a Classmate

A third occasion came from the discussion board rather than the emergency department. In Week 1, a classmate who works in intensive care argued that she already made most of the decisions a nurse practitioner makes, because she titrates drips and adjusts ventilator settings within protocols. I replied that the difference lay in who wrote the protocol. She pushed back hard, and by the end of the thread I had to concede that her judgment within those limits is real clinical judgment, not just following orders. What we agreed on was narrower than either of our first posts: the skill of deciding is shared, but the ownership of the decision is not.

That exchange changed how I read my own two nights. I had been treating my noticing as the whole of the skill. The classmate showed me that the skill is continuous from bedside nurse to nurse practitioner, and that what changes is the weight attached to it. It also made me less dismissive of what I will bring from the emergency department. Eight years of noticing is not nothing; it is the foundation the new responsibility will stand on.

What Stayed the Same

Most things have not changed, and that is worth saying. I still think the most important moment in caring for a patient is the first look, before any test, when experience tells you whether someone is sick. Eight years in an emergency department built that sense, and nothing in this course replaced it. I still believe that listening to a patient's own account catches things that no protocol does; the woman with the clot told me about her flight home, and no triage screen asked. And I still believe the nurse at the bedside often notices first. What has changed is not what I value but what I will be responsible for doing with what I notice.

What the Course Added

The course added three things I did not have before. The first is a structure for my own role: the Consensus Model's pairing of role and population focus, which made clear that my license will cover family practice across all ages and nothing beyond it. The second is a list, written in my identity paper, of what I will not sign for yet and where those patients will go, which I would not have thought to write before this course. The third is a practice entry plan that builds my patient load in steps, names who will back me up, and arranges coverage for evenings and weekends. None of these will prevent me from making mistakes, but each makes it less likely that a mistake will come from overreaching, from having nowhere to send a patient or from a weekend with no plan.

Forward, as a Question

I end with a question rather than a resolution. The question is how I will know, in my first year of practice, when I am being appropriately cautious and when I am being so cautious that patients wait longer or travel farther than they should. The list of things I will not sign for protects patients from my inexperience, but in a rural county, every referral has a cost for the patient: a drive, a wait, a missed day of work. Weighing those costs well is something I cannot yet do, and I suspect only practice, with a colleague to check my thinking, will teach me. I intend to bring that question to the daily reviews in my first month and to revisit my not-yet list with it in mind at the end of the first year.

References

Barnes, H. (2015). Nurse practitioner role transition: A concept analysis. Nursing Forum, 50(3), 137-146. https://doi.org/10.1111/nuf.12078