NR 573 Week 8 Competency Reflection Example

Competency Reflection: Three Lines From My Own Lab Documents, Each Quoted and Rewritten in Place to Show What Now Gets a Time and What No Longer Gets Smoothed

Student Name

College of Nursing, Chamberlain University

NR 573: Advanced Acute Care Management Lab

Instructor Name

Month Day, Year

Competency Reflection: Three Lines From My Own Lab Documents, Each Quoted and Rewritten in Place to Show What Now Gets a Time and What No Longer Gets Smoothed

What This Reflection Covers

This reflection looks at how my documentation changed over eight weeks of acute care lab. It does not cover logged hours, check-off sheets or competency sign-offs, which belong to the lab faculty and are not mine to describe. It uses three exhibits from my own written work: a line from a procedure note, a row from a debrief timeline and an entry from a decision log. Each is quoted as I wrote it and then rewritten beneath. The framework my section names for reflection is the reaction, analysis and summary sequence in the debriefing standard (Decker et al., 2021), and I use its summary phase, what I will do differently, to close each exhibit.

How the Exhibits Were Chosen

I chose the three lines that faculty marked in red on my first drafts, because they show the same habit in three different documents. I did not choose the best lines from my later work, because a reflection built only on improvements would not show what changed. Each exhibit is quoted exactly from the draft I submitted, including its wording problems, and the rewrite is the version I would now submit.

Exhibit 1: From My First Procedure Note

As written in lab session 2, first draft: "Line placed under ultrasound guidance without complication."

Rewritten: "10:26 wire inside the right IJ, transverse and longitudinal planes, checked before dilating. 10:34 venous trace on transducer. 10:52 film: tip at cavoatrial junction, lungs fully up."

What changed: the first version recorded that a probe was used. The second records what was seen, when, and which checks confirmed the result. The central access guideline recommends confirming venous placement before dilation (American Society of Anesthesiologists Task Force on Central Venous Access, 2020), and the second version is the only one that shows it was done. What now gets a time: every confirmation step, not only the start and end.

Exhibit 2: From My First Debrief Timeline

As written in lab session 4, first draft: "06:35 Team recognized LAST and initiated treatment."

Rewritten: "06:35 Leader (me) names toxicity aloud and asks the room, not a person, for lipid. 07:50 Kit at bedside. 08:05 Bolus running."

What changed: the first version compressed 90 seconds into one entry and gave credit to "the team." The rewrite separates the words from the action, shows that the instruction had no receiver and puts a number on the gap. The original was smoother and less useful. What no longer gets smoothed: the interval between saying something and doing it.

Exhibit 3: From My Decision Log

As written in lab session 5, first draft of entry 2: "00:50 Breath sounds decreased on left."

Rewritten: "00:48 Nurse raises quieter left-sided breath sounds, phrased as a question. 00:50 I carry on suctioning. 01:10 I auscultate: left side silent."

What changed: the first version moved the nurse's observation to me and placed it at the moment I acted on it, which hid 22 seconds and the fact that someone else had noticed first. The rewrite keeps the source and the delay. A log that credits the writer with every observation tells a reader nothing about how the team worked (Härgestam et al., 2013).

What the Three Exhibits Show Together

In all three first drafts, the same thing happened: a sequence of events became a single smooth sentence, and the sentence made the work look more competent than it was. The rewrites are longer, less flattering and more accurate. The change across the term is not that I became more careful in general. It is a specific practice: I now write the time of each confirming step and each spoken instruction, and I keep the gap between noticing and acting on the page.

A Line I Have Not Yet Fixed

One habit is still visible in my most recent work. In the complication write-up, I wrote down a ten-minute hold timed on the room clock, but I did not record who checked the clock or whether the timing started when pressure began or when the needle came out. The difference is a few seconds and does not matter in a lab, but in a real event with a hematoma it could. I have left that line as it is, as a reminder that the habit is improving rather than finished.

The Weakness I Still Have

When I write from memory rather than from a recording, I still round times to the nearest half minute and still drift toward "the team" when one person acted. This happens under one condition: when the lab has no video and I write the note more than an hour later. My fix for now is to write times on my glove or a card during the scenario and to draft within 15 minutes. That fix is partial, and I am recording it as such. The faculty have suggested that when no video exists, the recorder's role should include writing the time beside every instruction, which would give me a source other than my memory; I plan to ask for that in the next scenario.

What the Faculty Feedback Added

The written feedback on my first procedure note asked one question in the margin: "How would a reviewer know you checked?" That question shaped every rewrite in this reflection. It moved my attention from whether I had done a step to whether the record could prove it. The feedback on my debrief asked who, specifically, had acted at 06:35, and it led to the change in Exhibit 2. Neither comment told me what to write; both asked what the document could establish, which is the question I now ask myself before submitting anything. The answer is often a time, a source or a named person that the first draft left out.

What I Will Do in the Next Setting

In clinical practice the records are real and the stakes are different, but the habits carry over: confirmation steps get times, instructions get receivers, and observations keep their source. Debriefing that asks what a person was thinking, instead of scoring what they did, helped me see these habits in my own writing (Rudolph et al., 2006).

References

American Society of Anesthesiologists Task Force on Central Venous Access. (2020). Practice guidelines for central venous access 2020: An updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology, 132(1), 8-43. https://doi.org/10.1097/ALN.0000000000002864

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best Practice: The debriefing process. Clinical Simulation in Nursing, 58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011

Härgestam, M., Lindkvist, M., Brulin, C., Jacobsson, M., & Hultin, M. (2013). Communication in interdisciplinary teams: Exploring closed-loop communication during in situ trauma team training. BMJ Open, 3(10), Article e003525. https://doi.org/10.1136/bmjopen-2013-003525

Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There's no such thing as "nonjudgmental" debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55. https://doi.org/10.1097/01266021-200600110-00006