Embedded Files
Summary of Clinical Experience
Summary of Clinical Experience
Bayhealth Primary Care/Total Care - (Harrington, DE)
For Practicum IV, I returned to Bayhealth Primary Care in Harrington, DE, under the supervision of Michelle Devern, DNP. During this rotation, I continued to refine my skills as a graduate NP student and practiced with increasing independence and comfort in managing my patient encounters. This rotation provided me a broad exposure to patients aged 15 and older with acute and chronic healthcare needs.
Throughout the semester, I saw an average of 8-10 patients per day and documented these encounters in the electronic medical record. The conditions I managed represented a wide spectrum of common primary care concerns, including diabetes, hypertension, hyperlipidemia, asthma, obesity, anxiety and depression, and acute musculoskeletal and dermatologic issues. Finally, I completed many annual wellness visits for my preceptor's patient panel.
Additional tasks that I completed included sexual health counseling and testing, respiratory swabs and cultures, EKG interpretation, intramuscular injections, PAP smears, and ear irrigation.
This practicum experience strengthened my clinical reasoning, diagnostic proficiency, communication skills, and efficiency with managing a busy patient schedule. My experience at Bayhealth Primary Care was extremely positive; the staff were consistently supportive of my academic and professional development and made every effort to help advance my education and clinical training. This facility helped to shape me into a competent, safe, and compassionate novice nurse practitioner.
Scientific Foundation
Scientific Foundation
Evidence of Achievement:
Translates research and other forms of knowledge to improve practice processes and outcomes.
Develops new practice approaches based on the integration of research, theory, and practice knowledge.
I conducted a follow up visit with a 47-year-old female patient for multiple chronic conditions. I reviewed her outstanding care gaps and inquired if she had a Pap smear recently. The patient told me that she knew she was overdue but was looking for a new gynecologist to perform this screening. After referencing the USPSTF guidelines for cervical cancer screenings, I offered to complete her Pap smear during the visit. After obtaining the sample, I explained to the patient that depending on her results, we would potentially need to schedule a repeat Pao smear sooner than the standard three-year0interval (U.S. Preventative Services Task Force [USPSTF], 2018).
I met with a 50-year-old female patient with type 2 diabetes to discuss weight-loss interventions, as she was struggling to manage both her weight and glycemic goals. Her most recent A1C was 7.0%, and she was already taking metformin and making dietary modifications. I introduced the option of GLP-1 receptor agonist therapy to support both weight reduction and improved glycemic control. The patient expressed concern about medication cost, so I explained that her insurance would likely require a prior authorization to document medical necessity.
Using evidence-based recommendations from the American Diabetes Association, I tailored her diabetes management plan to align with her clinical needs and personal goals. I also obtained a sample GLP-1 pen from my preceptor to review the medication with her in detail. We discussed dosing schedules, injection sites, potential side effects, and possible adverse reactions. The patient was ultimately approved for the medication and subsequently experienced modest improvements in both her weight and A1C levels.
I frequently reference the flowchart below when prescribing diabetes medications:
(ElSayed et al., 2024)
Practice Inquiry
Practice Inquiry
Evidence of Achievement:
Analyzes clinical guidelines to determine treatment pathway
1. I consistently engage in practice inquiry by using evidence-based resources to guide my diagnostic reasoning and treatment decisions. For a 66-year-old female patient presenting with dizziness, I consulted literature from UpToDate to review evidence-based approaches for evaluating a symptom with a broad differential. The clinical pathway outlined systematic strategies for ruling out various potential causes. Based on the patient’s history and her significant family history of cardiomyopathy and pacemaker placement, I was particularly concerned about a possible cardiogenic etiology.
To narrow the differential, I ordered a CBC to assess for anemia, a CMP to evaluate for electrolyte abnormalities and renal impairment, a urinalysis to rule out acute cystitis, and an EKG to assess for underlying dysrhythmias (Barton, 2025). Although her EKG was normal, the patient reported intermittent palpitations accompanying her dizziness episodes. Given these symptoms and her risk factors, I referred her to cardiology for Holter monitoring to further evaluate for occult arrhythmias.
2. I evaluated a 47-year-old male patient for his annual physical during my rotation. Upon reviewing his recent laboratory results, I noted that he had gained 10 pounds since his last visit and that his LDL remained persistently elevated across multiple prior lab draws. After discussing his dietary habits, I referenced the ACC/AHA guidelines for statin initiation. His LDL level was elevated above 70 mg/dL but below 190 mg/dL, prompting me to calculate his ASCVD 10-year cardiovascular risk, which indicated an intermediate risk.
I presented this information to the patient and engaged him in shared decision-making regarding strategies to reduce his cardiovascular risk. Based on guideline recommendations, we agreed to initiate a moderate-intensity statin (Arnett et al., 2019). I prescribed atorvastatin 10 mg daily and ordered a repeat lipid panel with follow-up in three months to evaluate treatment response.
(Barton, 2025)
Technology & Information Literacy
Technology & Information Literacy
Evidence of Achievement
Uses technology systems that capture data to provide care and assist in decision-making
Translates technical and scientific health information appropriate for various users' needs
I conducted a follow-up visit with a 65-year-old female patient whose A1C and lipid panel had worsened since her last appointment. She expressed frustration with feeling unable to keep track of her health information. I discussed the benefits of MyChart, including the ability to review medical records, view lab results, monitor trends, and communicate directly with her healthcare providers. I asked her to take out her cellphone, and I guided her step-by-step through creating her MyChart account. The patient was very pleased to learn she could follow her health information more easily and felt newly motivated to make positive lifestyle changes after seeing her results in real time.
I evaluated a 21-year-old male presenting with new-onset anxiety and initiated treatment with Lexapro. Using the electronic medical record, I attached condition-specific and medication-specific patient education so he could review the information at home if he forgot any details about his new SSRI. Through the documentation I completed in EPIC, the patient was able to clearly see where his prescription was sent, the purpose of his visit, his vital signs, weight, and an updated medication list that included his new prescription and dosing. I strive to consistently document thoroughly to promote transparency, enhance patient understanding, and prevent miscommunication that could lead to patient harm.
Ethics
Ethics
Evidence of Achievement:
Involves system-based resources to guide ethical decision-making.
Integrates ethical principles in decision-making.
Applies ethically sound solutions to complex issues related to individuals, populations, and systems of care.
Informed Consent and Autonomy:
I completed an annual physical for a 70-year-old male patient with a 50-year pack history of cigarette smoking. As I reviewed his health maintenance care gaps, I educated him on the USPSTF recommendations for abdominal aortic aneurysm screening. The patient initially stated that he wanted “no more pointless tests,” so I used motivational interviewing to explore his concerns. He explained that he feared the screening might reveal something serious and that he would worry about being sick.
While I respected his autonomy, I provided additional education about the purpose and benefits of the exam, emphasizing that early detection could prevent life-threatening complications. I encouraged him to contact the office if he decided to proceed with an abdominal ultrasound in the future. By ensuring the patient was fully informed and supporting his decision-making process, I upheld Provision 3 of the ANA Code of Ethics (Haddad & Geiger, 2023). I honored his right to self-determination while advocating for evidence-based screening to reduce his risk of future health complications.
Code of ethics.pdf2. Life-Long Learner:
I exemplified Provision 5 of the ANA Code of Ethics by maintaining my competence as a nurse practitioner student and actively participating in opportunities that supported both personal and professional growth. During this semester, I attended the Practicum IV Journal Club, which focused on the role of allergy testing in primary care. This session was highly beneficial, as I learned about the clinical implications of allergy testing and how improper ordering of certain exams can lead to unnecessary costs, patient confusion, and potential harm. I completed a written review of the assigned article along with a summary of the journal club discussion. Moving forward, I will be more hesitant in ordering allergy testing and will instead refer patients to an allergist when evaluating possible food sensitivities.
Practicum IV Journal Club.docxPolicy
Policy
Evidence of Achievement:
Analyzes the implications of health policy across disciplines
Demonstrates an understanding of the interdependence of policy and practice
I evaluated a 45-year-old female patient who presented with chronic back pain for which she follows with pain management. She arrived at the office reporting unrelenting pain and stated that she was out of her medication and needed a refill. After discussing the case with my preceptor, I accessed the Delaware Prescription Monitoring Program to review her narcotic fill history. Her profile indicated that she should have had approximately one week remaining of her prescribed oxycodone. Additionally, because she was actively being managed by a pain specialist, the only treatment I offered during the visit was lidocaine patches until she was able to follow up with her prescribing provider.
According to Del. Code Ann. tit. 16, § 4798 (2010), the Prescription Drug Monitoring Program was established to reduce misuse of controlled substances among patients and clinicians in Delaware. Although the patient was dissatisfied with the treatment plan, my actions aligned with state regulations and potentially prevented misuse or inappropriate duplication of controlled medications.
2. I adhered to Bayhealth policy and CMS guidelines during the government shutdown that occurred while I was completing my clinical rotation. For example, I evaluated a 67-year-old Medicare beneficiary in person for an acute visit because telehealth appointments were temporarily suspended during the shutdown. Although the patient was upset about the change, I took time to explain how the federal policy shift affected the practice’s ability to conduct virtual visits. By the end of the encounter, the patient was more understanding and receptive.
I also researched updates to telehealth policy following the shutdown to better prepare for my future role as a clinician. CMS is implementing significant changes to telehealth coverage; beginning January 31, 2026, Medicare beneficiaries will be required to be located in a medical facility within a rural area to receive Medicare-covered telehealth services. The only exception will be psychiatric services, which will continue to be accessible from any location within the United States (Centers for Medicare & Medicaid Services [CMS], 2025).
Leadership
Leadership
Evidence of Achievement:
Self-reflection of leadership style and identification of personal merits
Inter-professional leadership and collaboration
Demonstrates leadership that uses critical and reflective thinking
Communicates practice knowledge effectively, both orally and in writing
I exemplified leadership by taking initiative to see patients while my preceptor was behind schedule because of a meeting. I track the incoming patient schedule via EPIC and can see when patients have arrived and are roomed. After completing a chart prep on a 45-year-old patient with a complaint of bilateral hip pain, I entered the room, introduced myself, and conducted the entire sick visit. I presented my patient case to my preceptor and explained my treatment plan. My preceptor agreed with my plan and then returned to the patient's room with me to discuss next steps with the patient and place orders in the electronic medical record.
As I am completing a double practicum, I have developed a résumé and cover letter to present to potential employers. During my clinical rotation at this site, I worked with my preceptor to network with the Director of APCs regarding employment opportunities within Bayhealth. Director Seth Nyman, PA-C, met with me during my lunch break at clinical to discuss my experience, education, training, and professional goals. I provided him with the résumé and cover letter I had prepared for Practicum V. At the conclusion of our meeting, he expressed that he was pleased with my progress and stated that he would look for potential positions for me within Bayhealth Primary Care or Endocrinology.
APC Cover Letter.docxProfessional Resume 2025 CCR.pdf
Independent Practice
Independent Practice
Evidence of Achievement:
Clinical decision-making based on evidence and shared decision-making
Functions as a licensed independent practitioner
I completed a sick visit for a 60-year-old patient who presented with acute elbow pain that worsened with activity (flexion and extension). I triaged her symptoms with the Bates' Guide to Physical Examination and History Taking: 13th Edition by Lynn S. Bickley and Peter G. Szilagyi. Based on her chief complaint, I diagnosed her with an overuse injury. I independently created a treatment plan that included a short course of oral corticosteroids, NSAIDs, physical therapy, and conservative treatment with rest, elevation, and ice. I presented my findings to my preceptor and discussed my plan with her and the patient. Finally, I used the electronic medical record to document my assessment, review of systems, diagnosis codes, and a full note that included my treatment plan. I ordered her medications and consults via the electronic medical record under the supervision of my preceptor.
I had a 21-year old female patient who presented with concerns for a sexually transmitted infection due to new lesions that presented around her vaginal area. After assessing the patient and obtaining my review of systems and HPI, I ordered an HSV PCR lab test to confirm my suspected diagnosis of Herpes Simplex Virus. The patient was concerned that she was not to be started on any antibiotic therapy for her lesions. I took the time to explain my suspicions and review the disease process and the indications for treatment. Since she did not reach out sooner during the prodromal phase and some of her lesions started to crust over, then the antiviral would be ineffective. I explained that the antiviral is most effective at reducing symptom length when started as soon as prodromal symptoms arise, typically the first 72 hours of an outbreak (Albrecht, 2024). I reinforced the need to practice safe sex hygiene with condoms and to disclose with future partners her status so that both parties can prevent the spread of HSV.
Health Delivery Systems
Health Delivery Systems
Evidence of Achievement:
Inter-professional collaborative relationships
Evaluates the impact of healthcare delivery systems on patients, providers, stakeholders, and the environment
I completed a sick visit for a 60-year-old woman who was complaining of recurrent dizziness. She had a positive familial cardiac history; two of her family members had cardiomyopathy and required pacemakers at around age 40. I decided to complete an EKG on her which was concerning for ventricular hypertrophy (Benditt, 2024). After referencing UpToDate's dizziness pathway, I collaborated with a known cardiologist to the practice and referred her for management and holter monitoring.
I was following up with a 55-year-old female patient for an annual wellness visit. She mentioned that she was a part of Alcoholics Anonymous but she wanted to talk to someone about mental health. I suggested that she could see a therapist or psychiatry clinician for therapy and medical management. After choosing the latter, I referred her to David Torres, APRN, PHMNP-BC for psychiatric services. I provided her with the website to schedule an appointment with this clinician.
David Torres, APRN, PHMNP-BC
Sozo Wellness Centers
Quality and Safety
Quality and Safety
Evidence of Achievement:
Uses best available evidence to continuously improve clincial practice
Evaluates relationships among access, cost, quality, and safety, and their influence on healthcare
I was completing an annual physical on a 45-year-old patient who was on multiple medications for diabetes, hypertension, and mental health conditions. When the patient is being roomed by the medical assistant, they obtain their vitals and reconcile the medication list for the provider. At each visit with the patient, regardless if medication reconciliation has been completed, I review the patient's medication list with them to ensure that we are following the rights of medication administration: patient, drug, route, time, and dose (Hanson & Haddad, 2023). Medication reconciliation is a safety measure that I use to prevent excessive addition or duplication of drug orders that can lead to polypharmacy. Additionally, I use this time as an assessment of the patient's insight and health literacy by asking them why they take each medication.
I used the American Heart Association's Prevent calculator to review a 50-year-old male's risk for a cardioembolic event within the next 10 years during his follow up visit. On review of his lab work, he had an elevated LDL count that kept increasing as well as comorbid diabetes and hypertension. Based on his individualized risk factors, his ASCVD risk percentage was 13.6%. Therefore, I counseled him on diet and intiated him on a low-intensity statin and scheduled a 3-month follow up visit to reassess his risk.
(American Heart Association [AHA], 2025)
References
Albrecht, M. A. (2024). Treatment of genital herpes simplex virus infection (M. S. Hirsch, J. Mitty, & K. Law, Eds.). UpToDate. Retrieved November 23, 2025, from https://www.uptodate.com/contents/treatment-of-genital-herpes-simplex-virus-infection?search=genital%20herpes%20diagnosis%26source=search_result&selectedTitle=4~121&usage_type=default&display_rank=4
American Heart Association. (2025). The american heart association prevent™ online calculator. Retrieved November 23, 2025, from https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
Arnett, D., Blumenthal, R., & Albert, M. (2019, March 17). 2019 acc/aha guideline on the primary prevention of cardiovascular disease - american college of cardiology. American College of Cardiology. Retrieved November 25, 2025, from https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2019/03/07/16/00/2019-ACC-AHA-Guideline-on-Primary-Prevention-gl-prevention
Barton, J. J. (2025). Approach to the patient with dizziness (M. J. Aminoff, D. G. Deschler, & J. L. Wilterdink, Eds.). UpToDate. Retrieved November 25, 2025, from https://www.uptodate.com/contents/approach-to-the-patient-with-dizziness?search=dizziness%26source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H6
Benditt, D. (2024). Syncope in adults: Clinical manifestations and initial diagnostic evaluation (P. Kowey, K. S. Zachrison, & S. B. Yeon, Eds.). UpToDate. Retrieved November 23, 2025, from https://www.uptodate.com/contents/syncope-in-adults-clinical-manifestations-and-initial-diagnostic-evaluation?search=dizziness%20workup%26topicRef=5099&source=see_link#H4075452314
Benditt, D. (2024). Syncope in adults: Clinical manifestations and initial diagnostic evaluation (P. Kowey, K. S. Zachrison, & S. B. Yeon, Eds.). UpToDate. Retrieved November 23, 2025, fromhttps://www.uptodate.com/contents/syncope-in-adults-clinical-manifestations-and-initial-diagnostic-evaluation?search=dizziness%20workup%26topicRef=5099&source=see_link#H4075452314
Center for Medicare & Medicaid Services. (2025, November 14). Telehealth faq calendar year 2026 [PDF]. Centers for Medicare & Medicaid Services. Retrieved November 24, 2025, from https://www.cms.gov/files/document/telehealth-faq-updated-11-20-2025.pdf
Delaware Code Annotated. (2010). Title 16: Health and Safety, Chapter 47 – Uniform Controlled Substances Act, Subchapter VII – Miscellaneous § 4798. https://delcode.delaware.gov/title16/c047/sc07/index.shtml#4798
ElSayed, N. A., McCoy, R. G., Aleppo, G., Bajaj, M., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Gaglia, J. L., Garg, R., Girotra, M., Khunti, K., Lal, R., Lingvay, I., Matfin, G., Neumiller, J. J., Pandya, N.,...Bannuru, R. R. (2024). 9. pharmacologic approaches to glycemic treatment: Standards of care in diabetes—2025. Diabetes Care, 48(Supplement_1), S181–S206. Retrieved November 25, 2025, from https://doi.org/10.2337/dc25-s009
Haddad, L. M., & Geiger, R. A. (2023). Nursing ethical considerations. StatPearls [Internet]. Retrieved November 21, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK526054/
Hanson, A., & Haddad, L. M. (2023, September 4). Statpearls [internet]. StatPearls Publishing. Retrieved November 23, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK560654/
Lynn S. Bickley MD FACP, Peter G. Szilagyi MD MPH, Richard M. Hoffman MD MPH FACP, & Rainier P. Soriano MD. (2023). Bates' guide to physical examination and history taking 13e with videos lippincott connect print book and digital access card package (Thirteenth ed.). LWW.
U.S. Preventative Services Task Force. (2018, August 21). Cervical cancer: Screening. Retrieved November 25, 2025, from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening
Page updated
Google Sites
Report abuse