NURS 4200 Leadership

Northbay ICU Preceptorship Reflections

1. Leadership & Management Definitions

"Leadership means acting, not just holding a position, especially in the ICU. One instance that taught me this was when I first gave a report on my own to the morning shift nurse, where I was able to answer their questions about the patient's current regimen, medications, etc., on my own. The experience helped me learn to step up and communicate clearly. The overall fast-paced environment pushed me to build trust, stay adaptable, and advocate for my learning. These moments have helped me begin developing my own leadership style that I can use as I transition into real practice." 

2. Leadership and Management Roles, Theories & Behaviors

"Many of my preceptor shifts allowed me to practice active listening and critical thinking in a high-stakes environment. During one shift, I found that adopting a democratic leadership style was most effective! Collaborating with my preceptor, the respiratory therapist, ER nurse, and lift tech to successfully admit a new patient, take their vitals, and connect them to oxygen helped build trust and confidence in my role. This experience connected directly to several leadership concepts by showing me that effective leadership can be participative, adaptable, but is centered around clear communication."

3. Interprofessional Practice Part 1

"Precepting in the ICU as a student has been an intense yet invaluable learning experience. I strengthened my nursing skills, specifically my critical care skills, as well as improving my critical thinking and confidence in making clinical decisions under pressure.  In one key interaction, I had the chance to report my DKA patients' glucose level and the number of units they were receiving via insulin drip to the physician. Working closely with my preceptor and other healthcare professionals, such as the respiratory therapists, phlebotomists, intensivist physicians, and the lab, highlighted the importance of interprofessional collaboration in achieving the best patient outcomes. 

4. Professional Organizations

"Spending my semester in the ICU, I have come to deeply appreciate the role of professionalism in fostering critical thinking, resilience, and compassionate care in high-stress environments. One experience that emphasized professionalism and mentorship was when another nurse took the time to guide me and teach me how to use a "Vein-finder" to locate a vein and insert an IV. This experience showed me the importance of mentorship because, without guidance, I wouldn't have been able to have that valuable learning experience. This again shows the emphasis on professional identity, collaboration, and engagement through organizations that support growth, especially in units like the ICU." 

5. California BRN and Nursing Practice Act

"In the ICU, I've had the opportunity to see firsthand how critical accountability and adherence to the Nursing Practice Act are in delivering safe, high-quality care. The ICU environment demands collaboration, integrity, and continuous learning—values emphasized in both the Nursing Practice Act and professional organizations that support nursing growth and leadership. One key experience that showed me the value of the Practice Act was when I helped a physician insert a central line. During this experience, he talked to me through the procedure but also about the scope of practice and how essential nurses are to positive patient outcomes. This experience and the rest of my preceptorship have strengthened my professional identity and commitment to upholding nursing standards."

6. Advocacy 

"Advocacy is an essential part of working in the ICU, as my preceptor has taught me. I’ve come to understand the critical role of advocacy in protecting vulnerable patients. In one instance, I helped my nurse best interpret the wishes of a vented patient who could only communicate by blinking their eyes. We asked them yes and no questions and ensured to check their pain levels as well as comfort through warm blankets or dimming the lights in the room. This experience directly showed me that patient advocacy is a core nursing responsibility that enhances the quality and safety of care. Practicing these skills in real-time has strengthened my confidence and reinforced the importance of being a strong patient advocate."

7. Legal & Ethical Issues

"While it has always been in the back of my mind, legal and ethical issues are quite important in the ICU. I’ve come to appreciate how critical it is to uphold both standards in critical care. In one shift, my nurse showed me how to check the compatibility of IV medications running through the same line. She showed me how to input each medication into an online tool that showed if it was safe to have, for example, Cefazolin drip in the same line as Acetaminophen drip. This experience showed me the importance of being vigilant about patient safety, respecting patient autonomy, and other core nursing values such as nonmaleficence and confidentiality.

8. Interprofessional Practice Part 2

"During my ICU preceptorship, I had several opportunities to engage in interdisciplinary collaboration that highlighted the importance of communication in critical care settings. In another interaction, I called the laboratory to report key lab values to my nurse and requested specific blood cultures to be collected. From collaborating with other interdisciplinary team members and observing my preceptor, I learned how clear communication and mutual respect among team members directly impact patient safety and care quality. Overall, this experience has shown me that effective teamwork is as vital as clinical knowledge in the ICU." 

9. Global Health Advocacy to Promote SDGs in Nursing Education

"In the ICU, I witnessed the direct impact of health disparities and the need for culturally competent, equitable care. One time at preceptor, I dealt with a vented patient who was a severe alcoholic whose history reported verbal abuse and physical threats to his family. Despite this, my preceptor and I provided around-the-clock quality care, ensuring to turn him every 2 hours, bathe him twice a shift, and suction his ventilation tube to prevent cough attacks. This specific patient reinforced the importance of Sustainable Development Goal #3, ensuring good health and well-being for all, no matter if their past is good or bad, as nurses, our job is to heal. Overall, it reminded me that in all healthcare settings, nurses are global health advocates with the power to create change."

10. Transition into Practice

"As my time precepting in the ICU has come to a close, I have strengthened my clinical judgment, prioritization, and communication skills while being able to navigate complex patient care. One experience that proved I was ready to truly begin this transition was during my last shift. In my final shift, I cared for a DKA patient mostly independently, checking their blood sugar every hour, doing my neuro checks every four hours, and with supervision, titrating down their insulin drip as their mentation and blood sugar improved. Moreover, I successfully did head-to-toe assessments and was able to report my findings during the shift, independent from my preceptor, not just to the AM shift nurse, but in part to the rounding nurses and the physician. I believe my growth during preceptorship emphasizes the leadership, interprofessional collaboration, and critical thinking skills that I have developed and strengthened, which will allow me to confidently enter professional practice. My time in the ICU has shown me that I am on my way to be both a competent nurse and a compassionate leader."