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My Final Blog… The Reward and Challenge

It has been a month since I marched the stage with the inaugural batch for Regis’ DNP Program as we were conferred the distinguished Doctor of Nursing Practice degree on May 5, 2012 at the Boettcher Commons in the Lowell Campus. Classmates from different corners of the country came to celebrate an important milestone in our professional and personal lives. But before the Commencement Ceremony, a luncheon reception was held where we, the students finally got to meet and mingle with the nursing faculties, our capstone chairs, and each other. It was a memorable occasion that affirmed the bonds we have formed throughout the five semesters of the program. That day, we had the honor of receiving a sash with the embroidered statement “Doctor of Nursing Practice, Inaugural Batch 2012.” After we picked up our gowns and regalia, we had a class pictorial. In spite of our beat-up brains and tired bodies, we had the widest smiles on our faces that clearly said, “Yes, we did it!”

The afternoon of May 4, 2012, a Convocation Ceremony was held at the Ranger Dome when DNP candidates received the hoods from capstone chairs together with Doctor of Physical Therapy candidates. Still can’t believe this moment was real. I and a few other classmates had to pinch ourselves to believe that the moment was indeed real. On the morning of May 5, 2012, people started to trickle in at the Boettcher Commons. Under the clear blue sky, a few white clouds, and the heat of the Colorado morning sun, the stage and thousands of chairs were set for graduate candidates and guests to settle in as we awaited for the final moment. I knew it was going to be a hot day, but I didn’t mind. I wanted to savor every moment of it as I recollected and reflected on my DNP journey, which I refer to as a race. As I sat waiting for the ceremony to start, scenes began flashing quickly in my mind from the start of the program to that moment and I can’t help but utter silent words of gratitude to God who has been my strength and fortress. It was a surreal moment that we will never forget.

The ceremony was long, the heat was intense… as candidates from different programs talked about their journeys, I realized all the more I was never alone in my struggles of sleepless nights, anxiety, confusion, meeting deadlines, and overdosing with caffeine to complete weekly assignments/discussions, research, and seemingly endless writings. But after receiving our diplomas and our solo pictures taken, reality sank in and I could not help but once again run through my to-do list. My family and I flew back to Texas and right away, I got back completing my final paper for grading and for publishing. At the same time, I had to start working on the blood stream infection prevention project I began at work; prepare to present findings of my study to the health center; and begin working on the promotion requirements at work. Once again, I find myself going through the DNP Project Process by Zaccagnini and White (2011)… and I thought I’ll be able to clear out my desk after graduation.

My mind, body, and spirit are crying out for a BREAK. As a full time student, mother of three boys, and working at a very busy surgical unit of a teaching hospital, I can’t help but ask God if this was the price of higher education and leadership. I knew the answer, but I was waiting to hear a different answer such as, “you deserve a vacation” or “get a week of good sleep.” As if God answered me, I came across Saint Ignatius Loyola’s prayer:

O my God, teach me to be generous: to serve you as you deserve to be served; to give without counting the cost; to fight without fear of being wounded; to work without seeking rest; and to spend myself without expecting any reward, but the knowledge that I am doing your holy will.

I have presented my project findings and recommendations to the internal stakeholders of Fort Bend Family Health Center where I helped implement a dietitian-led child and adolescent overweight and obesity program through my DNP Capstone Project. I am also closely working with my capstone chair for the publication of my final paper. I will also do a poster presentation of this project at the Philippine Nurses Association of America national convention in San Antonio, Texas this July, and the University of the University of the Philippines Alumni Association International homecoming in Virginia on August. I am also transitioning into a new role of RN IV that I will embark on at my institution… a role I am prepared and ready to take as a clinical expert and scholar.

I feel physically and mentally drained and exhausted, but as I pray the prayer of St. Loyola, I am inspired to work without seeking rest, knowing I am doing God’s holy will. Truly, there is no motivation worth more than to do the holy will of God, the source of all knowledge and wisdom. As I reached the pinnacle of Nursing Education, I begin a new chapter of my life as a DNP-prepared nurse. I will continue to run the race… with gratitude and thanksgiving, I will persevere and endure to the end. If we made it, so can you! So hang in there and keep your eyes focused on the prize. It’s just around the corner.

This is the last semester of the program. What have I accomplished so far and what do I need to complete before graduation? This could very well be the most important and crucial last month for me as I finalize my DNP Capstone Project Report. But for Regis University, this month marked an important milestone for the Loretto Heights School of Nursing (LHSON) as the CCNE (Commission on Collegiate Nursing Education) visiting team came to campus as the first part of the DNP accreditation process. CCNE is an autonomous accrediting agency that ensures the quality and integrity of nursing baccalaureate, graduate, and residency programs (AACN, 2012) across the nation.

I have the privilege of participating in this process on March 4, 2012, as the visiting team dialogued with a cohort of DNP student representatives to discuss the DNP program at Regis University. The visiting team consisted of a team leader, an academic representative, and a practice representative dialogued with the students through a conference call and spontaneously asked questions to the group about the mission, program outcomes, processes and procedures of communication with faculty/classmates, and how student or curriculum issues are handled and resolved.  This was a great opportunity for me to give back to the school by sparing a few hours of my time to honestly provide feedback for this important stage of the accreditation process. Not to my surprise, the visiting team concluded that the LHSON is in compliance with all accreditation standards and key elements set forth by the CCNE. Their report will then be submitted to the CCNE Accreditation Review Committee in July 2012 and a decision with recommendations will be determined in October 2012 (Weber, C. J., 2012, March 15, electronic mail). I, along with the inaugural and subsequent class am hopeful that the LHSON will get the DNP accreditation, which will be retroactive from the time of the site visit.

But where am I with my DNP Capstone Project? These are the final weeks of the program. As most of my classmates are finalizing their written report and perhaps preparing for the final defense presentation, I have just completed my post-intervention data collection two days ago. Now I’m feeling the rush – the rush to tabulate all my data, run the stats, analyze and write my findings, polish my paper, practice for my defense presentation, present findings to the agency, formalize a written policy and procedure for the program I have implemented, and the list goes on. I could have started on the other components of the paper months ahead of time. But it seems like I didn’t have the push I needed.

As I read an article by Tornquist (2009) on Introduction to Scholarly Writing, I realized I am a writer that needs a “long block of time” (p. 440) before the thoughts start to flow to begin writing. I need to warm-up by doing all the less important work before being able to really sit down and begin writing. As I read this portion of the article, I saw myself clearly as if in a mirror. I had to clean the house, tend to the garden, listen to music, watch the news, play the piano, run and exercise, and do all sorts of things I enjoy but have not been able to do for the past years because of school. But this is it… this is the final moment. I have all the data I need and there’s no more excuse. I have to run forward, or must I say sprint forward to the finish line.

For those contemplating on going back to school for their graduate or doctorate degrees, practice your writing skills by journaling or writing down thoughts and experiences, as if you intend others to read it through a professional journal or book. Then go back and re-read it to edit and refine your written work. This will enhance your scholarly writing skills, which is a major skill in information dissemination as an advanced practicing or nurse leader.

It has truly been a pleasure to write as a blogger for the Regis University DNP Program. I have until next month to share with you my journey. I hope that I have enlightened or inspired at least one of you to continue on the lifelong journey of learning.

A few quotes on learning and knowledge –

“Education’s purpose is to replace an empty mind with an open one.” Malcolm S. Forbes

 “Continuous learning prepares you to take advantage of opportunities.” Catherine Pulsifer

“Knowledge is of no power, until you put it into practice.” Anton Chekov

References:

AACN. (2012). CCNE accreditation. Retrieved March 29, 2012 from the AACN Website http://www.aacn.nche.edu/ccne-accreditation.

Tornquist, E. (2009). Introduction to scholarly writing. In J. M. Philipps and C. R. King (Eds.). Advancing oncology in nursing. [Electronic Version]. Retrieved from http://www.ons.org/publications/cjon/media/ons/docs/publications/science_chpt20.pdf.

Had another mini-reunion with nursing batchmates from the University of the Philippines College of Nursing Class 1987 as one classmate dropped by TX after a nursing conference. Will be the silver jubilarians this year... time flies!

 

Enjoying a nice and beautiful day at the park with family and friends during Spring Break.

 

February 25, 2012

Two months to go! I almost could not believe that in a few more weeks, I am going to graduate from what almost seemed like a never-ending journey to the DNP degree. I’m telling my kids how excited I am to “living a more normal life.” I look back to when I started with my first two courses NR701 Theoretical Applications and NR 702 Applied Statistics. I remember my anxiety level before even beginning Applied Statistics. How in the world can I fathom such mathematical concepts when I didn’t even know how I passed math courses in high school and college? But that was about 4 semesters ago and here I am…. half a semester away into the finish line.

For this last semester, I honestly feel more relaxed – too relaxed that I am now playing catch-up. But with only the capstone project to work on, I actually have more time for my family and myself, giving me more reason to take it easy and slow. My DNP project is implementing a dietician-led child and adolescent overweight and obesity 3-month program in a federally qualified health center. I have completed collecting my pre-intervention data during January and will be collecting my post-intervention data this March. I am also finalizing my written report as I collate my data. Both are challenging tasks that I need to master. However, most of the written report sections, except for the outcomes data, analysis, and implications are already done from all the previous course works. This makes this semester a good time to really edit and proof my writing – no room for vagueness and uncertainties. It’s really a venue to showcase everything I have learned and accomplished in the DNP program.

At the dietician's office during the pre-intervention data collection phase.

As a future DNP, implementing EBP practice change initiatives and writing to disseminate findings will be the norm. Hence, the ability and skill to write scholarly papers and analyze statistical data is to be behooved. What helped me along the way in learning these skills is reading other studies and literature that discusses scholarly writing basics. The discussion forums in the course are also good venues to learn from the expertise and experiences of the faculties and classmates. A good perspective to have is that no one knows everything and no one’s perfect. There will always be room to know, learn more, and improve. So although this is a terminal nursing degree, I still see myself traversing the journey of lifelong learning, whether it is in the academic or practice arenas or for my own personal growth.

I’d like to share a quote about the value of education to our day-to-day life. It underpins the accountability “to do what ought to be done” as we acquire more knowledge and wisdom.

“Perhaps the most valuable result of all education is the ability to make yourself do the things you have to do, when it ought to be done, whether you like it or not. It is the first lesson that ought to be learned.” -  Thomas H. Hurley

Receiving the Philippine Nurses Association of Metropolitan Houston Scholarship Award on February 25, 2012. With me is Amira, one of the recipients of the Outstanding Filipino Nurses Award.

 

I just can’t believe this is the last semester of the program. It was truly like a roller coaster ride from the beginning until last semester right before the Christmas holiday. There’s really a lot of ways to describe the experience of the DNP Program at Regis University, but one thing for sure, it was very rewarding and fulfilling to have acquired the critical knowledge, skills, and tools I need to be a leader in nursing.

I sure cherished every day during the Winter break. It was a time to look back and reflect, slow down and relax with my family and friends. As the New Year unfolded, I come closer and closer to the finish line. Zaccagnini and White (The Doctor of Nursing Practice: A New Model for Advanced Practice Nursing, 2011) state that the implementation phase is the time to showcase everything that I have learned.

Just right before the Winter break, I presented my DNP project proposal to the family health center’s Peer Review Committee. It was the same week when I also presented it to my DNP course faculties, after which, I became a DNP candidate or DNPc. My DNP project is implementing a child and adolescent overweight and obesity prevention program in a federally qualified health center in Texas. Presenting my project proposal was a very humbling experience as the administrative leaders and providers of the health center paid close attention to every detail of the project, relying on this program to improve healthcare and patient outcomes.

DNP Project Proposal presentation to the health center's Peer Review Committee

This January, I began consenting eligible participants to the program and obtaining the pre-intervention data. This will end on the last day of this month and then I will begin collating and analyzing these data. One of the things I learned is that no matter how much preparation I’ve made, there were still corrections, revisions, and adjustments that needed to be done. I realized that the simpler the questionnaires, the better it is for the participants. Everyday, I learn something new.

DNP Project implementation phase with the Registered Dietician promoting the 5210 Let's Go! message

One of the challenges of implementing an evidence based practice change is letting go of the old ways of doing things. The good thing is that the registered dietician of the health center is very much willing to adopt the approach recommended by the Expert Committee because it is more focused, realistic, and is patient/family-centered. The Stage 1 Prevention Plus approach uses motivational interviewing to assist families to change behaviors and habits that lead to overweight and obesity based on their readiness to change.

The next challenge ahead is ensuring that the participants for the program come during the second and third visits with the registered dietician. Another challenge is the statistical analysis of the findings and writing a scholarly report for dissemination. In either case, I can only be hopeful that all things will turn out for good.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

                                                                                                                      – Aristotle –

This year’s Thanksgiving Day is truly a day of giving thanks. Looking back from August of 2010, I could not imagine how I could have made it this far without the support of my family, classmates, friends, and faculty. But most of all, it is a day of giving thanks to God who has given me the wisdom, strength, and perseverance to get to where I am now. I truly believe that He paves the way for me… for us. As the song goes, “God will make a way when there seems to be no way. He works in ways we cannot see, He will make a way for me.” When I was close to quitting the program while working full time as a charge nurse, God prompted me to go look for a part time job. I applied at a sister hospital where I used to work not really knowing what department I’ll end up in, but sure enough, He lead me to the unit where the nursing director was my preceptor during my MSN practicum with Regis. This is another blessing to be thankful for. The nursing leadership on that unit is so supportive of me that I could not ask for a better place to work at this time. The hospital also supports and encourages nurses to pursue higher educational degree, so it’s a great place to be.

On November 12, my family and I went to Austin, Texas to meet with my husband’s high school classmates. I was sick at that time and thought I’ll go and lock myself in one of the rooms to finish schoolwork and recuperate. But my body was so sick I could not even get my brain to think. Well recuperate means to “recover from illness or exertion.” I don’t think I could if I will keep working while recuperating. So I took one of my nursing director/friend’s advice to take time to enjoy and relax… something I could not do when I think of all that I need to accomplish.

With the family on my birthday at The Oasis overlooking Lake Travis of Austin Texas, the sunset capital of Texas.

Another blessing is a picture frame I saw in the store while searching for a gift for my friend. On the frame it says “Too blessed to be stressed.” It’s as if God once again spoke to me. Those were just powerful words that added another dimension and depth into my understanding of God’s divine providence and omnipotence. I hope and pray that God will allow this to linger on in my consciousness for it sure makes my burdens light.

This weekend, I am preparing for two big presentations. I will present my Capstone Project to the medical staff and executive leaders of the community health center where I’m doing my project. The next day is my defense presentation to Regis faculty. I also have yet to complete my Project Proposal for NR706. I know I’m in a time crunch (as always), but I spent the whole day yesterday cleaning up my garden – moving and dividing plants… something I have not done as often since I went back to school. The good thing about living in Texas compared to New Jersey is that I can garden on November wearing my pj and a tank shirt!

November in Texas... feels like spring!

This semester ends in three weeks time. Sounds like a short time but there sure is a lot of work that needs to be done. In the mean time, I am trying to live up to my new mantra “Too blessed to be stressed.” I plan to put up my Christmas tree and decorations just before Christmas. Till then, I wish everyone safety and peace during this Christmas shopping season. Remember all, it’s the Reason for giving that counts!

For important updates about the DNP Program, visit the American Association of Colleges of Nursing at http://www.aacn.nche.edu/media-relations/fact-sheets/dnp and the Doctor of Nursing Practice, LLC website at http://www.doctorsofnursingpractice.org/.

Sorry, I missed posting last October. Time is just passing by so quickly; I could not believe I have one more course to finish. After NR 708, the last semester will be solely devoted to the capstone project: finishing the report for the project and disseminating the information.

NR 708 is Health Policy Analysis and Development. One of the main activities in the course is developing a policy in relation to the capstone project. For this activity, I plan to develop a policy on the treatment and prevention of child and adolescent obesity for Fort Bend Family Health Center (FBFHC). Currently, FBFHC does not have a prevention program for overweight and obesity among children ages 2 to 19 years. After piloting a dietician-led Stage I Prevention Plus approach recommended by The Expert Committee, I will present the results of the study to FBFHC and collaborate with them in formalizing a policy that will improve and standardize the care and treatment of overweight and obese children and teens at the health center.

In NR 706 DNP Capstone Project, we are to start writing our project paper and present it at the end of November to the faculty. After this presentation, we are considered DNP candidates. Thinking about it, I almost feel at a limbo… I want to be excited about the fact that I am about to finish this race, but then again… I am also asking myself what I am going to do in the future. I would love to be involved in clinical prevention or preventive health, yet I don’t know where and how. I have a lot of opportunity at my place of work to be involved in evidence-based practice initiatives or be in the nursing leadership… but I want to be able to find my niche; where I can flourish, make use, and share the bountiful knowledge and skills I’ve garnered through this DNP program and all the wisdom I’ve gained through my years of working in the frontline.

I know the answers will come in time, for indeed, there is a time for everything. To end, I would like to share this excerpt from the book of Ecclesiastes chapter 3.

There
is an appointed time for everything, and a time for every affair under the
heavens.

A time
to be born, and a time to die; a time to plant, and a time to heal; a time to
tear down, and a time to build.

A time
to weep, and a time to laugh; a time to mourn, and a time to dance.

A time
to scatter stones, and a time to gather them; a time to embrace, and a time to
be far from embraces.

A time
to seek, and a time to lose; a time to keep, and a time to cast away.

A time
to read and a time to sew; a time to be silent, and a time to speak.

A time
to love, and a time to hate; a time of war, and a time of peace.

This has been my permanent place in the house for the past 15 months - my study table... finishing the Business Plan Paper for NR 722.

 

Enjoying the hot summer days with the kids in the community pool.

I am half way through the course NR722 Health Care Systems Finance and Marketing. After completing a strategic plan in NR721, I am now charged with completing a business plan for the fictitious consulting enterprise I’ve been working around with since the last course. The business I created is a health care consulting enterprise providing expert advice and assistance to community health centers and clinics in the implementation of evidence-based pediatric overweight and obesity prevention program.

I was not too interested in learning about the finance, marketing, and business side of health care. I have never been too much of a business-minded individual to begin with. I was contented being in the front line doing the hard work. But as a future DNP, it is inevitable to be mindful of this end of the health care spectrum. Fiscal responsibility and accountability are essential in the roles of a DNP in quality, policy, practice, and safety. And I can honestly say I am enjoying this course as I continue to evolve into a more holistic nurse leader.

However, the emerging roles of a DNP are not confined within systems or organizations. A DNP can be a leader in the community or be an entrepreneur; providing products and services urgently needed in the ever-evolving health care system. A DNP is better prepared to venture into the health care market as an all-around nurse entrepreneur. With preparation in strategic planning, finance, marketing, as well knowledge about the health care regulatory climate, a DNP is equipped with the knowledge and skills necessary in managing or starting up a business that can satisfy the many needs in the health care industry.

Aside from developing a business plan for my fictitious health care consulting, I am also in the Implementation phase of Zaccagnini’s (2011) DNP Project Process Model. This is the model adopted by Regis University for the DNP’s Capstone Project. After a couple of revisions as advised by my capstone chair, I have submitted my proposal to the Regis IRB. I am waiting for the decision before I could actually start implementing the pediatric overweight and obesity prevention program at a community health center in my neighborhood. The IRB process does not seem to be so taxing once the project proposal is completed; but there are details that address the ethical principles in human subject research and the IRB needs to ensure that these principles are upheld. The safety and protection of the human subjects are at the very core of the IRB process.

"Those who make great strides take chances and plan past the challenges of life. Go out on a limb... that's where the fruit is." - John Mason

I’ve always talked about this DNP journey as a race with several uphill climbs and at times, very steep ascents… and at times, small plateaus, as if… just to give the contenders a moment to catch their breath, savor the beauty of being at the top. I would say that this implementation phase of the process is a much-needed plateau before the final descent. One more semester and we can all proudly say, “We have won the race and earned the price of being a DNP!”

"The real voyage of discovery consists not in seeking new lands but seeing with new eyes." - Marcel Proust

Reference:

Zaccagnini, M. E. (2011). The doctor of nursing practice essentials: A new model for advanced
practice nursing
. In M. E. Zaccagnini & K. W. White (Eds.). Sudbury, MA: Jones and Bartlett Publishers.

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