Running head: CLINICAL EXEMPLAR

Being a Patient Advocate

Kailey Gay
University of South Florida College of Nursing

CLINICAL EXEMPLAR
Being a Patient Advocate
A clinical exemplar is best described as a reflection of a clinical experience that
demonstrates the importance of nursing on the patient, the nurse, patient care, and society as a

whole (Black, 1997). There was one particular clinical day that stood out the most to me and had
the biggest impact on me as a student nurse. Instances such as these can be used as a tool to
convey something memorable that leaves an impact and shapes the course of your career.
On my second to last shift of my precept in the Neonatal ICU, I had a difficult patient
assignment. My preceptor and I were assigned to four babies, so we decided to split the
assignment to provide the highest quality of care to our patients. My preceptor allowed me to be
very hands on, I educated new parents who were scared, I communicated with physicians and
Nurse Practitioners who were busy, and I provided all care to the babies I was assigned to. On
this particular day, one of my patients was a 34-week gestational age baby who was having
difficulty feeding. I received a normal report on this specific baby with no abnormalities noted.
Upon assessment of this baby, I noticed a strange odor. At first I thought the baby just needed to
be cleaned up, so I gave him a bath. After bathing him, the off smell was still there. I knew
something was off, but I had no idea where it was coming from. I inspected the babys diaper and
the output was normal and did not smell foul. Then I assessed his abdomen. His umbilicus had
almost completely fallen off, there was dry blood around the remains of the cord, but it was
moist and there was a small amount of drainage from the umbilicus. I knew infections could
occur in the umbilicus although I had never seen one firsthand before, so I assumed that was
what it was. My preceptor and I notified the practitioner who was assigned to the patient. The
practitioner came in and assessed the baby and said that it wasnt infected and it was probably
just the smell of old cord blood. I was familiar was with what cord blood smelled like, and it was

CLINICAL EXEMPLAR

not what this baby smelled like. My preceptor agreed that something was off and so we contacted
a different practitioner who was coming on for night shift. This practitioner came and assessed
the baby and immediately ordered an ultrasound. The next day, I had the same patient
assignment. The babys ultrasound came back abnormal and showed a patent urachus, where the
urachus remains patent from the bladder to the umbilicus. Because of this, the baby was leaking
urine through his umbilicus.
This situation taught me multiple things. First and foremost, I am a student nurse. I am
bound to make mistakes and not always be right. However, if I have a gut feeling that something
is off, it is my job and duty to those in my care to always speak up and advocate for my patient.
This situation more than proved the importance of doing so. If I would have taken the
practitioners word for it and let it go, the babys serious abnormality would have gone
undiagnosed and unrepaired. Speaking up isnt always enough, though. To me, advocating means
following through until there is an answer to the suspected problem. From now on, I will always
ensure that if I dont know the answer, I will seek assistance from others until I find the answer
to maintain my patients safety and quality of care.

CLINICAL EXEMPLAR
References
Black, P.J. (1997). Use of the clinical exemplar in performance appraisals. Neonatal
Network: The Journal of Neonatal Nursing, 16. Retrieved from:
http://www.ncbi.nlm.nih.gov/pubmed/9325873