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CAREER PATHWAY ASSESSMENT

Career Pathway Assessment

Courtney Kaelin
Old Dominion University

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CAREER PATHWAY ASSESSMENT

Career Pathway Assessment

Introduction- what led me to nursing?
After graduating high school, I felt like I was officially an adult. I decided at the ripe old
age of 18 that I was done with school and I didnt need to further my education. Years later I
found myself as a single mom living paycheck to paycheck. I was building engines for yard
trimmers in a giant factory that wreaked of gasoline, I ended my days covered in grease. It was a
monotonous, dead end job. My boyfriend at the time was a great, positive influence on me. He
pushed me to be the best version of me I could be. One day he told me, Courtney, youre too
smart for this job. You have so much potential. Youre young, smart, and capable of anything
you put your mind to. You have the potential to be so much more. Those words really resonated
with me. I thought to myself, hes right, what am I doing with my life?
Shortly after, I decided I was going to go back to college and do something with my life.
The question now was, what was I going to go to school for? I thought about it for days. Ive
always loved teaching, maybe I should be a teacher? Should I go back to retail and customer
service as management or business? Then I thought about nursing. Nursing nursing
hmmm I would get to educate people which would fulfill my teaching desire. I would get to
service people which would curb my desire for retail. I would be able to take care of people, help
them get better, and be that rock that they need during an uncertain time. Nursing would be so
rewarding and it truly fits my personality. I knew I didnt want to sit at a desk job day after day
and do the same thing. Nursing is fast paced, different, and full of new experiences. It was the
perfect fit for me. I decided I wanted to be a nurse and from that day forward I worked my butt

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off to make that happen. I had no idea the path it would take me down but I buckled up and
started the ride.
Implementing- Going to College
After deciding I wanted to go back to school to become a nurse I took a trip to Tidewater
Community College to find out how to do so. I spoke with many guidance counselors over the
next few semesters to verify I was on the right track and doing what needed to be done so I could
be considered for a place in their Beasley School of Nursing program. After several semesters of
studying and hard work I submitted my application to the nursing program and waited and
waited and waited some more. After five long months I finally received my answer- I was
accepted! I was so excited and could not wait to begin my journey to becoming a registered
nurse!
As I started nursing school, I felt honored to be one of the 125 nursing students TCC
accepted to the nursing program out of hundreds of applicants. I remember how hard I studied in
anatomy and physiology and I knew how hard I worked to get an A. I told myself I am going to
study my hardest because I want to learn everything I can and be the best nurse I can be, I
wanted to continued getting straight As. I studied and worked extremely hard, my grades,
however, did not seem to reflect that. I did not get one single A in nursing school which
frustrated me. I worked so hard and I felt like my grades never reflected that. But we had a
saying in nursing school, A C is a RN and I learned to accept that my perfect GPA would no
longer be perfect. I learned to stop focusing on my letter grade and focus more on the substance
of the lectures and clinicals.
Several semesters went by and I continued to learn and my critical thinking skills got
stronger and stronger. Before I knew it, I found myself in the mother and baby semester about

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half way through the nursing program. I really looked forward to this class considering one of
the areas of nursing I was interested in was labor and delivery. By the end of the semester I
realized I would not want to be a labor and deliver nurse after the experiences I had during my
clinicals. But in the same hand, I did have a very special and unique day that I will remember
forever. I consider it to be a turning point in my schooling and future career. An experience that
proved to me I was meant to be a nurse.
The day that had a huge impact is the day I worked on the post-partum unit. I got my
assignment and I went in and greeted my patient just as I did hundreds of times before. She was a
very sweet lady who had just given birth the night before. Her family was very nice and
welcoming but asked for some privacy that morning because they were exhausted from the night
before. I came out of the room and thought, well shucks, what am I going to do today then? My
one patient just wants to sleep. I reported to the staff nurse that my patient just wanted to rest
and she asked me if I wanted to shadow her for the day and see what the rest of her patients were
like. I was over the moon with excitement, Absolutely! I replied. This was an amazing
experience because before this point I had not gotten to see what a full day was like for any
nurse. My nurse, Jessica, showed me around the medication room, showed me how to
reconstitute medications, and gave me report on her other patients. She told me unfortunately one
of her other patients had a baby that did not make it. She was in a room down the hall and had
been very upset and emotional, as one would expect. This woman had one child who was 8 years
old at the time and has tried several times to have another child. Twice before she had
spontaneous abortions and this time she was able to carry the baby to full term but lost it. Jessica
was a resource nurse and didnt work on this unit often. She told me, Ill be honest, Im a little
uncomfortable because she has had the baby in the room with her all morning, and the baby has

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been dead for hours. She doesnt want to let it go. Its an unusual situation and Im not sure how
to help her. We have a bereavement nurse coming by this morning sometime to talk to her and
help her work through it. I didnt know how to digest this information myself either. I told
Jessica I still would want to shadow her in that patients room as well even though she had told
me I didnt have to. I went with the nurse into this patients room shortly after. It was very
emotional, I felt for the mother and her loss.
Later that day Jessica got rather busy and I noticed the call bell on for this room with the
baby that didnt make it. I popped my head in the room and asked the patient if she needed
anything. Her baby was in the portable crib and she asked if she could hold it again. I said sure, I
got my gloves on to hand her the baby and in my head I was thinking Oh my gosh, Jessica,
where are you right now?! I picked up the lifeless baby and passed it to the mother. She cried, I
got teary eyed myself. I asked if she needed anything and she said no, I had done enough for her.
She smiled through her tears at me and I told her Id be back to check on her.
I left that day and on the way home I burst into tears. I was so full of emotions. It was
such a sad and unique clinical that day. It showed me that nursing isnt always going to be smiles
and making everyone better. People arent going to make it, babies and children wont always
make it. But I get to be there for that family involved. I get to be their rock. My job does mean
something to people and so does my presence. Patients come in and out of the hospital all the
time and dont remember anything about their nurses, but that patient will remember me.
Work Experiences
After completion of Tidewater Community Colleges nursing program in July of 2013, I
studied for a few months to take my licensing exam, the dreaded N-CLEX. Finally, in October, I
worked up enough nerve to take the test. I passed! I was so excited and I immediately began

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putting in applications. A few days later I heard back from the unit manager of the oncology unit
at Virginia Beach General Hospital. I went for an interview and was offered the job via
telephone as soon as I left the building. I couldnt believe it! My first nursing job as a med-surg
oncology nurse. Then reality hit me. Do I really want to do oncology? This has got to be one of
the saddest units in the hospital to work for. People will be dying more often on this floor than
anywhere else in the hospital. I didnt get into nursing to watch my patients die. And then I
remembered my patient from labor and delivery. I remembered the impact I made on her and
how amazing it felt to be able to support my patient through such a difficult time. I decided to
take the job and give it a try.
In the beginning of my journey I struggled a lot with our comfort care patients, those who
are actively dying. No one with morals and emotions are eager to deal with death and the passing
of people. As I gained more experience I realized that my struggles and internal conflicts were
normal. Being uncomfortable is natural in the beginning. Everyone has different viewpoints and
feelings on comfort patients and I shouldnt be ashamed or embarrassed that I had some
reservations. In the beginning of my journey, the thought of giving a comfort care patient an IV
medication of morphine or Ativan scared me into tears. I would cry to my boss, Im afraid Im
going to kill them! Through education and experience I learned this is not at all the case. The
facts are, the patient is dying, nothing Im doing is causing that, its their time. I will not be
pushing medications that are going to cause my patient to stop breathing and die instantly. I had
a long talk with a palliative care nurse practitioner. She told me 1mg of morphine IV has the
same effect/power as half of a tablet of Percocet. She said I look at my patients and the dose of
morphine and think, could that person tolerate a Percocet? So, if they are in pain and groaning
and moaning, they will be able to tolerate that pain medicine, there is no need to be scared to

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administer it. She told me that my understanding of how some of the medications react in the
body was not correct. She told me when you are dying your adrenaline is pumping even though
you may not look like it from the outside. That fear and anxiety driving your adrenaline to be
released will not allow someone to pass. The adrenaline keeps them alive and they suffer. The
Ativan and morphine allows them to relax. It still doesnt mean that they are going to pass as
soon as they get the medication into their body, but it will ease their anxiety and adrenaline and
allow it to be a more peaceful process for them.
This conversation drastically changed my views on everything I had thought. I became
more comfortable giving the needed medications to my comfort care patients. I found throughout
my career as an oncology nurse, that not once have I pushed a medication on a comfort care
patient and felt like that is why they died. Not once have I pushed a medication and they have
passed within the hour even. I have found that now that Im not afraid since I know the facts.
The patients family sees my nursing first hand, I explain why I do certain things, why I give
certain medications, why I wont give certain medications. All of my patients have looked
comfortable and have passed peacefully. For this their families are forever grateful to me. I will
hold a special place in so many peoples hearts because I have held their hands and cried with
them and walked them through their most difficult journeys. This foundation to my career
allowed me to impact hundreds of patients lives. I was able to help new nurses experiencing the
same fears I had once had as well. I had even helped several veteran nurses who were scared to
ask the questions I asked. This foundation allowed me to learn how to effectively communicate
with my peers and patients and seek assistance and guidance when I needed it.
Professionally I began to reach all the goals I had set out to reach. I was the best nurse I
could be, I was growing professionally and personally. My weakness in caring for comfort

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patients became a thing of the past. I realized that many nurses admired me for asking the tough
questions that some of them had been afraid to ask. I gained a platform within my unit as
someone to talk to about situations with both personally and professionally. I set my sights on
becoming a manager so I could continue to reach out to fellow nurses young and old, experience
or no experience, and offer my assistance as they navigate through their careers. In order to
become a manager I decided to continue my schooling and get my masters and move out of
oncology as a resource nurse to see what other units were like and how they functioned.
Flash Forward
Flash forward to where I am today. I am a unit manager of the Step Down Unit. My
growth as a nurse took leaps and bounds after I became a resource nurse. I found myself working
on every unit of the hospital and seeing and experiencing things I would have never been a part
of had I stayed in oncology. I soon got certifications in critical care and also worked as a
resource nurse in ICU and CCU. I completed my masters in nursing at ODU two years ago and
have been looking forward to moving into a management position. Last year I was offered the
unit manager position of the step down unit. Im thrilled to be in this position and honored that I
was even considered for it. My experience in oncology and comfort care patients has given me a
unique experience and has allowed me to help families of our patients who struggle with the
decision to pursue treatment or consider palliative/hospice care. Because I have seen so many
cases I can share a unique viewpoint and knowledge base with these families. We see many
cases involving this dilemma as our patients are in step down which is one step below critical
care and a notch above stable med-surg floors. Im also well suited for this floor considering I
spent nearly 6 years as a resource nurse and saw a little bit of everything nursing has to offer.

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My values and beliefs have not changed either. I still hold everything that I feel is
important close to me. My values and beliefs have been unchanged and I continue to strive to be
the best nurse I can be. The same drive pushes me to stay up to date with new and advancing
ideas and equipment in the world of nursing. It pushes me to be the best nurse I can be to support
my staff and our patients. It allows me to stay educated and informed and be an example and
resource to new nurses and the rest of my staff.
Reflection
I actually have learned quite a bit from reflecting on my path. Currently, I am an
Oncology nurse looking towards becoming a resource nurse (my paper reflects what and where
Im hoping to be in 10 years). Management is something that I have considered often but have
not given much in depth thought to until now. The step down unit has always intrigued me and I
can really see myself one day becoming management and aiding new, young nurses.
I do have some advice to new nurses which would be to really think about all aspects of
nursing. And, of course, dont do it for the money. Ethically, there are a lot of challenges in
nursing. The biggest one I have faced so far is how to treat and care for comfort care patients.
The answers arent always so black and white, there is a lot of gray area in nursing. One person
will view a situation completely different than another. That is what makes nursing and the
medical field amazing though. Embrace the differences and challenges, its from those that we
learn and grow. There will be good days and bad days in nursing. There will be days filled with
joy and those that will leave you deeply saddened. You will, however, never come across a more
rewarding profession, and that is what I love.

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I pledge to support the Honor System of Old Dominion University. I will refrain from any form of
academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the
academic community it is responsibility to turn in all suspected violators of the Honor Code. I will report
to a hearing if summoned.

Name: ___Courtney Kaelin_________________________________________

Signature: __Courtney Kaelin_______________________________________
Date: _3/7/2015____________________________________________