BSN625

I am currently a Semester 6 student in the Honours Bachelor of Science in Nursing program at Seneca Polytechnic. From my first rehabilitation placement to more complex medical and surgical settings, my clinical experiences have helped me develop a stronger understanding of what it means to be a nurse and the responsibility that comes with caring for patients. I have become more confident in my clinical skills, communication, and ability to make decisions while recognizing that there is still a lot for me to learn. My goal is to become a knowledgeable, compassionate, and reliable nurse who makes patients feel safe, respected, and supported throughout their care.

Some of the nursing values that are most important to me are patient safety, compassion, respect, advocacy, and accountability. I believe patients deserve to be listened to and included in decisions about their care, even when they may be upset, uncertain, or have difficulty trusting the healthcare system. During one of my acute medicine placements, a patient expressed concerns that he was not receiving fair treatment. I listened to him, documented his concerns, and informed the assigned nurse so that appropriate support could be arranged. This experience reminded me that nursing is not only about completing physical assessments and procedures but also about taking patients’ concerns seriously and helping them feel heard.

My clinical experiences have increased my interest in medical-surgical and acute care nursing. I enjoy learning about different health conditions, understanding the reasons behind treatments, and seeing how nursing interventions affect patient outcomes. I am particularly interested in improving my wound care, medication administration, discharge teaching, and peripheral intravenous therapy skills. I also want to continue developing my leadership abilities and confidence when communicating with the healthcare team.

As I move forward in the nursing program, I am committed to practising within my level of competence, following professional standards, protecting patient confidentiality, and asking for assistance when needed. I understand that safe nursing practice requires continuous learning, reflection, and openness to feedback. I plan to use my remaining clinical experiences to strengthen my clinical judgment and prepare for the responsibilities of becoming a registered nurse.

Throughout nursing school, my clinical placements have included restorative and rehabilitation care, nephrology and stroke care, surgery and medicine, and acute medicine. My first placement was on Southlake’s Restorative Care Unit at the Jane and Finch site, on the 6 West rehabilitation floor. My second placement took place at Oakville Trafalgar Memorial Hospital on 5 Centre, a nephrology and stroke unit. I later gained surgical and medical experience at Oak Valley Health in Markham and cared for patients with complex medical needs at Humber River Hospital. Across these settings, I have worked with adults and older adults who had different mobility limitations, chronic illnesses, rehabilitation needs, and post-operative care requirements. Each placement has helped me build on my earlier learning and take more responsibility for patient care.

During my first placement at Southlake’s Restorative Care Unit, I worked with my clinical instructor, Kelly Minor, and five other nursing students. At the beginning of this placement, I felt nervous about being in a clinical environment and taking responsibility for a patient. I was assigned one patient each day and worked with the nurse to complete care within my student scope of practice. Working on a rehabilitation floor helped me learn the importance of patient comfort, mobility, patience, and helping individuals maintain as much independence as possible. As the placement continued, I became more comfortable providing bedside care and more confident in my role as a nursing student.

My second placement took place at Oakville Trafalgar Memorial Hospital on the 5 Centre nephrology and stroke unit. I worked with clinical instructor Adesola Anjola and five other students in BSN525. At first, I was responsible for one patient, and after midterm I progressed to medication-related care for one patient or total care for two patients, as assigned. We were expected to organize our shifts with an hour-by-hour care plan and document the care we provided. This placement taught me a lot about time management, staying organized, and safe medication administration. Caring for patients with kidney-related conditions and stroke-related needs also helped me understand how complex health conditions can affect mobility, daily functioning, and nursing care.

My later surgical learning experiences at Markham Stouffville Hospital, part of Oak Valley Health, included the 3WH Surgery/Medicine unit in Markham, where I worked alongside my preceptor, Dorothy Hoffman, and four other students. These experiences helped me become more comfortable with patient assessments, post-operative monitoring, medication administration, documentation, and teamwork. During a surgical shift, a patient’s blood pressure dropped to approximately 80/40 mmHg while seated. I repeated the assessment, involved my instructor, and assisted with positioning and follow-up monitoring. This reinforced the importance of recognizing abnormal findings and asking for help promptly.

During my more recent placement on Humber River Hospital’s 8W Acute Medicine unit, I took on greater responsibility for organizing and completing patient care. For example, I cared for an older adult with cellulitis and chronic venous stasis, completing a head-to-toe assessment, scheduled vital signs, personal care, and documentation. I also helped provide wound care for a patient with significant contractures related to a previous stroke. I recognized that repositioning and personal care would be difficult for one person to complete safely, so I asked classmates and the nurse for assistance. These experiences strengthened my ability to prioritize safety and adapt care to the patient’s needs.

As my placements progressed, I began taking on more responsibility for my own patients and became more aware of the importance of time management, clear documentation, and collaboration. During a shift as student team lead, I helped organize our group’s responsibilities, checked that important care tasks were being completed, and reminded peers to complete documentation in a timely manner. I found that speaking up and leading a group did not always come naturally to me, but the experience helped me identify leadership as an area I want to continue improving. Across my placements, the most important lessons have been to communicate clearly, notice changes in a patient’s condition, ask for help when necessary, and remain accountable for the care I provide.

Reflection on Clinical Feedback

My clinical experiences and feedback from instructors and preceptors have helped me identify my strengths and areas for improvement. I have grown more confident with each placement. During my first placement on Southlake’s rehabilitation floor, I was initially nervous, but gradually became more comfortable taking responsibility for a patient and providing bedside care. During my second placement at Oakville Trafalgar Memorial Hospital, I learned to use an hour-by-hour care plan to organize my shift and keep my documentation on track. I also received positive feedback about my medication knowledge and preparation during a later surgical placement after reviewing a patient’s medications before supervised administration. These experiences encouraged me to keep preparing carefully and asking questions when I am unsure.

Another strength I have developed is recognizing when patient care requires support from others. During my acute medicine placement, I listened to a patient who felt he was not being treated fairly, documented his concerns, and reported them to the nurse, who helped connect the patient with social work support. I also worked with classmates and the nurse to safely complete care for a patient with severe contractures. These experiences demonstrated that advocating for patients and asking for help are important parts of responsible nursing practice. They also reinforced the importance of professional communication, respecting each patient’s concerns, and working collaboratively rather than trying to manage every situation on my own.

Areas for Development and Actions Taken

One area I have been working to improve is my confidence when taking on a leadership role. During my shift as team lead, I was responsible for helping my peers stay organized and complete their tasks and documentation. At times, I found it difficult to speak up or direct others because I did not want to come across as too demanding. However, I learned that communicating expectations clearly is necessary for patient safety and effective teamwork. I responded by making a greater effort to check in with classmates, communicate priorities, and speak up when tasks needed attention. In future placements, I want to continue practising clear, respectful leadership and become more comfortable raising concerns in a timely manner.

I have also been focusing on improving my efficiency when caring for more than one patient. At Oakville Trafalgar Memorial Hospital, I progressed from caring for one assigned patient to more complex assignments after midterm, including total care for two patients. Creating an hour-by-hour plan showed me how important it is to organize assessments, medications, personal care, and documentation throughout the shift. In later placements, I continued to work on prioritizing tasks, reviewing medication schedules, and grouping care activities when appropriate. My learning goals also include becoming more confident with discharge planning and teaching, complex wound care, and peripheral IV therapy. I plan to keep seeking supervised learning opportunities, using feedback, and reflecting on how I can provide care more safely and efficiently.

These experiences have shown me that professional growth comes from reflecting on what went well and what I could do differently. I am proud of the progress I have made in patient advocacy, communication, and taking responsibility for care, while recognizing that my clinical judgment and leadership will continue to develop with experience. My goal is to remain open to feedback, follow the College of Nurses of Ontario’s professional expectations, and provide care that is safe, ethical, and respectful.

A. Clinical Skills and Competency Record

My clinical skill development has progressed from foundational patient care toward more complex assessment, monitoring, medication-related responsibilities, and team communication. Below is a summary of skills I have described practising or participating in during clinical placements. This narrative does not replace Seneca’s required BSN Skills Tracking List. The completed, up-to-date official tracking list should be attached to this portfolio and should document each skill introduced, practised, and the level of supervision or independence, as applicable.

• Head-to-toe assessments and scheduled vital signs: completed during clinical care; progressing toward greater independence with appropriate supervision.
• Personal care, bed baths, repositioning, and comfort measures: provided directly, including seeking assistance for patients with severe contractures or limited mobility.
• Medication review and supervised medication administration: practised with attention to safe preparation, patient-specific considerations, and documentation.
• Wound care and skin assessment: participated in care of wounds involving the hip and coccyx and identified complex wound care as an ongoing learning goal.
• Post-operative care and monitoring: participated in surgical-unit patient assessments, including recognizing and escalating low blood pressure.
• Documentation, handover, and team communication: practised documenting assessments and care, communicating with nurses, and supporting peers with timely charting.
• Patient advocacy and interprofessional collaboration: communicated concerns to nursing staff and collaborated with team members to support patient needs.
• Discharge education and peripheral IV therapy: identified as learning priorities; actual completed procedures and competence levels must be confirmed in the official tracking list.

B. Practice Settings and Client Population Summary

My first clinical placement was at Southlake’s Restorative Care Unit at the Jane and Finch site, on the 6 West rehabilitation floor, during my third semester. I worked under the guidance of clinical instructor Kelly Minor alongside five other nursing students. I was assigned one patient each clinical day and provided care within my student scope while working closely with the patient’s nurse. The restorative and rehabilitation population included patients who needed support with mobility, recovery, and activities of daily living. This placement helped me build a foundation in bedside nursing care, patient communication, and the importance of promoting independence. Although I was very nervous at first, I gradually gained confidence as I became more familiar with the clinical environment and my responsibilities.

My second clinical placement took place at Oakville Trafalgar Memorial Hospital on 5 Centre, a nephrology and stroke unit, for BSN525. I worked with clinical instructor Adesola Anjola and five other students. The unit exposed me to patients with kidney-related illnesses and stroke-related needs, including patients who required close monitoring, assistance with daily care, and support with complex health conditions. At the beginning of this placement, I was assigned one patient. After midterm, my responsibilities increased to medication-related care for one patient or total care for two patients. We completed hour-by-hour plans for each shift and documented the care we provided. This experience helped me improve my time management, medication administration knowledge, and ability to organize patient care while maintaining accountability for my documentation.

My later clinical experiences included surgical and combined surgery/medicine practice at Oak Valley Health in Markham, including the 3WH Surgery/Medicine unit, where I worked alongside preceptor Dorothy Hoffman and four other students. These placements exposed me to patients recovering from surgery and patients managing multiple medical conditions. I practised assessments, supervised medication administration, post-operative monitoring, and documentation, and learned to respond promptly when a patient developed low blood pressure. At Humber River Hospital on 8W Acute Medicine, I cared for adult and older adult patients with complex needs, including cellulitis, chronic venous changes, stroke-related contractures, and wounds. I also learned the importance of patient advocacy after listening to and reporting a patient’s concerns about his care.

Looking across my placements, I can see how my responsibilities have increased over time. I started by providing care for one patient in a rehabilitation setting and gradually progressed to organizing care for two patients, reviewing medications, recognizing changes in patient condition, and supporting classmates during a team-lead shift. Working with rehabilitation, nephrology, stroke, surgical, and acute medicine populations has shown me that nursing care needs to be adapted to each patient’s needs. These experiences have strengthened my confidence, time management, communication, and commitment to safe and respectful patient care. I will continue developing these skills as I prepare for practice as a registered nurse.

A. Professional Competencies

Clinician 1.24: "Uses effective strategies to prevent, de-escalate and manage disruptive, aggressive or violent behaviour" (College of Nurses of Ontario [CNO], 2019, p. 5).

Advocate 7.11: "Demonstrates cultural humility and sensitivity to diversity in nursing practice" (CNO, 2019)

CNO Practice Standard – Professional Boundaries and Nurse-Client Relationships: (CNO, 2026).

B. Evidence from Professional Practice

Clinician 1.24 requires that nurses have the ability to mitigate aggressive or violent behaviours by managing the situation through deescalation in a calm and safe way that will ensure that the client and staff are safe from harm. I was caring for an older client admitted to the unit for acute infection and showing signs of delirium. He became increasingly agitated, getting angry and wanting to climb out of bed without help. I stayed calm and validated the client’s fears and confusion by asking short simple questions, actively listening to him and reorienting him to his situation. I closed his door to lessen the noise and lowered the lights in his room. I then provided him a warm blanket and offered him a glass of water. The client calmed down and settled down. By de-escalating the situation, I avoided using restrains, a potential fall and it allowed me to complete my safety checks for the client.

Advocate 7.11: states that nurses are required to critically reflect on their assumptions and biases and be sensitive to client’s cultural diversities and beliefs. Cultural humility is realizing that we do not have all the answers in clients life. Nurses need to respect client’s perspectives and empower them in their care decisions. While caring for an older adult, I noticed that she was tearful, withdrawn and did not want to engage much. I quickly realized that English was not her first language and she was dependent on family members translating for her. I realized that the client did not want to discuss her mental health openly due to stigma. I immediately advocated for an interpreter and asked open ended questions in a non-judgmental way and the client started opening up more. I learned about her extreme anxiety around the hospital setting and the unfamiliar routines while being separated from her cultural practices. I learned about her preferred coping strategies, communication preferences and I was able to include these into her care plan. This created a more inclusive, safe and trusting culturally responsive care.

CNO Practice Standard – Professional Boundaries and Nurse-Client Relationships: This requires nurses to maintain clear therapeutic boundaries while constantly being aware of the power imbalance between client and nurse. As well as avoid dual relationships and making sure that care is solely based on the client’s needs. A young client in my care was in hospital for a long period. She had very limited family support and because I was providing compassionate care, she started asking me personal questions about my life and wanted to connect with me on social media after she is discharged so that we can stay in touch. I realized the vulnerability that the client was in and that I needed to maintain my professional boundaries with her. I politely explained to the client that I am not able to share any personal information with her and that our relationship can only be focused on her wellness and recovery. I advocated on her behalf with my supervisor and the social worker to connect her with peer community support prior to her discharge.

C. Mental Health–Informed Analysis

Integrating mental health nursing concepts into my clinical helped me to safely meet Clinician 1.24, Advocate 7.11, and the CNO Practice Standard on Professional Boundaries and Nurse-Client Relationships. Through therapeutic communication using actively listening, open-ended questions and validation I was able to de-escalate the client’s agitation quickly and also create a non-judgemental safe space for clients to be able to express themselves better and ask for what they need. I was also able to set clear boundaries in a kind and compassionate way when clients were asking for personal connections. In addition, psychosocial and emotional assessment made it possible for me to see beyond obvious signs and allowed me to recognize underlying agitation, fear, anxiety, loneliness, cultural communication barriers, and emotional distress. This allowed me to prevent escalations and reliance on restrains by ensuring both physical as well as emotional safety. I was also able to set clear boundaries with clients.

Trauma-informed and recovery-oriented approaches allow me to not only look at the symptoms but the client as a whole. By empowering client choice and cultural safety, it aided in making clients more resilient. Recognizing trauma responses and digging deeper allows clients to feel more heard and understood. Maintaining self-awareness helped me remain calm during escalations and holding clear boundaries with clients assisted me in staying professional. These help in maintaining compassionate, culturally safe, ethical, professional and client centred care.

D. Reflective Synthesis

I have learned that competence in mental health nursing is essential for competent client care. Physical and psychological issues in clients are inseparable. At clinical unfamiliar settings, discomfort, pain, loss of independence can become triggers for underlying psychological conditions such as anxiety, social withdrawals, isolations and depression. Learning de-escalation, practicing trauma informed care and having cultural humility allowed me to treat the whole person rather than just looking at diagnosis and symptoms. Earlier, it was harder for me to set firm boundaries but now through reflection and feedback it has become easier. I am now able to see anger as pain or fear and recognize boundaries as essential for safe client care.

As I transition toward entry-level Registered Nurse practice, I feel better prepared to advocate for holistic, trauma-informed care for my clients.

Key professional strengths

Throughout my clinical settings, I have provided client centred care. In semester 6, I managed to increase my ability to look at the client holistically and recognize that psychosocial and emotional assessments are just as important as physical care. Early intervention on signs of anxiety, delirium, and distress is crucial in providing the best care to our clients. I improved my active listening skills, de-escalation techniques and learned to respect diverse cultural and communication needs. I developed self-awareness in keeping and maintaining clear therapeutic boundaries and navigating power imbalances in alignment with the CNO Practice Standard on Professional Boundaries and Nurse-Client Relationships.

Areas for continued development

As I transition toward consolidation, I want to further work on time-management and prioritization skills when caring for full patient duties with both physical and emotional needs. While I was able to use verbal de-escalation strategies, I want to gain more confidence in managing higher crisis situations. I want to familiarize with community mental health resources, different types of mental health assessments, and discharge planning for clients with psychosocial needs.

Learning goals moving toward consolidation and entry to practice

Goal 1 – I will independently manage an entry-level RN patient assignment while consistently prioritizing client centred approaches and building therapeutic alliances. Incorporating psychosocial assessments into daily care plans that will be verified through weekly supervisor/peer feedback.

Goal 2 – Prior to completing consolidation, I will participate in three interprofessional care conferences with the interdisciplinary team or discharge planning meetings and advocate for culturally safe, trauma-informed community supports for clients experiencing emotional or social vulnerability at discharge.

Goal 3 – Have a reflective journal every two weeks on my clinical decision-making, personal biases, emotional regulation, and professional and ethical boundaries to build habits aligned with the CNO Quality Assurance Program.

Planned portfolio updates at the next program checkpoint

I will continue to add de-identified clinical reflections, clinical evaluations, and simulation artifacts in order to work on my clinical growth during consolidation. I will also update my competencies including care coordination, leadership and care collaboration with others in addition to my mental health and clinical competencies. I will also include an updated resume, NCLEX-RN progress notes, and a CNO learning plan outline to showcase my readiness for registration as a Registered Nurse in Ontario.

References

College of Nurses of Ontario. (2019). Entry-to-practice competencies for registered nurses (Pub. No. 41037). https://www.cno.org/Assets/CNO/Documents/Become-a-Nurse/41037-entry-to-practice-competencies-2020.pdf

College of Nurses of Ontario. (2026). Professional boundaries and nurse-client relationships [Practice standard]. https://cno.org/Assets/CNO/Documents/Standard-and-Learning/Practice-Standards/41033_therapeutic.pdf