| Course | NU651 AGACNP Introduction to Acute Care Management Clinical I |
|---|---|
| Unit | Unit 8 |
| Paper type | Preceptor feedback reflection |
| Length | About 790 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU651 Unit 8
Ordering to Be Complete: A Preceptor Feedback Reflection Built on an Audit of Thirty-One Lab Orders
[Student Name]
Purdue University Global
NU651: AGACNP Introduction to Acute Care Management Clinical I
Unit 8 Preceptor Feedback Reflection
[Instructor Name]
[Date]
The preceptor, patients and orders are composite; counts and values are bracketed.
Relationship
I had worked beside Dr. [S.] for [four] days on the hospitalist service, and we had settled into a routine: I pre-rounded on [six] patients, presented them and wrote the day's orders for her to review. She had been direct and generous with teaching, which made the feedback on day four easier to hear, though not at first. The R2C2 model of facilitated feedback begins with the relationship because feedback is accepted more readily from someone the learner trusts (Sargeant et al., 2015).
Reaction
Her words were, "You're ordering labs to be complete, not to answer a question." My first thought, which I did not say, was that missing an abnormal value would be worse than drawing an unnecessary one. I had spent [twelve] years as a nurse on a unit where a missed potassium had once led to a rapid response, and a morning panel on every patient felt like safety. I also felt a flash of embarrassment, because I had thought of my thoroughness as a strength.
I also noticed that I wanted to explain myself before I had checked whether she was right. That impulse is worth naming, because a learner who defends a habit in the moment rarely goes back to test it later, and I did not want the conversation to end with my explanation instead of an answer. I am recording this reaction because it explains the habit. Ordering everything felt safe because the cost of an unnecessary test was invisible to me and the cost of a missed result was one I had seen.
Content
Instead of accepting or contesting the feedback, I audited my own orders. Over [four] days I had placed [31] lab orders for [six] patients. For each one I asked a single question: would any result have changed management that day?
1. Daily complete blood counts on [four] stable patients without bleeding, infection or chemotherapy: [11] orders, [nine] of which informed no decision; the other [two] followed a hemoglobin drop in one patient.
2. Daily basic metabolic panels: [12] orders. [Seven] informed no decision; [five] did, including potassium on a patient on diuretics and creatinine on a patient receiving vancomycin.
3. Magnesium and phosphate added to every panel: [5] orders, [four] of which informed nothing.
4. A lipid panel on an admitted patient with pneumonia, and a repeat troponin on a patient whose chest pain had a clear musculoskeletal cause: [2] orders, neither informative.
5. One lactate on a patient whose pressure had fallen: informative.
In total, [22] of [31] orders informed no decision that day. Among the five hospital medicine recommendations in the Choosing Wisely campaign is to stop repeating blood counts and chemistries when the patient and the results are stable (Bulger et al., 2013), and evidence-based guidance on repetitive inpatient testing reaches the same conclusion, with the reminder that each draw has a cost to the patient in blood, sleep and discomfort (Eaton et al., 2017).
The audit also showed where the feedback did not hold. Three repeated potassium levels in a patient receiving intravenous furosemide each changed a replacement dose, and the vancomycin creatinine checks guided dosing. Those were questions, even if I had not framed them that way. I told Dr. [S.] this when we met again, and she agreed; her point was about the other [22], not about every order.
Coaching
We agreed on a plan for the rest of the rotation, which is the coaching phase of the model:
1. Before placing any lab order, I will write down the question it answers and the result that would change what I do.
2. Stable patients get labs every [48 to 72] hours unless a specific question requires more.
3. Magnesium and phosphate are ordered only for patients with a reason: refeeding risk, diuretics, arrhythmia or replacement already under way.
4. At the end of each week I will repeat the audit on my own orders and bring the numbers to our meeting.
By the end of the rotation, my second audit showed [18] orders across [six] patients over [four] days, with [four] that informed no decision.
What I take from this is not that labs are bad or that I was careless. It is that a habit built on one vivid bad outcome needs to be tested against numbers, and that feedback is most useful when I check it against my own data before deciding what to keep.
References
Bulger, J., Nickel, W., Messler, J., Goldstein, J., O'Callaghan, J., Auron, M., & Gulati, M. (2013). Choosing wisely in adult hospital medicine: Five opportunities for improved healthcare value. Journal of Hospital Medicine, 8(9), 486-492. https://doi.org/10.1002/jhm.2063
Eaton, K. P., Levy, K., Soong, C., Pahwa, A. K., Petrilli, C., Ziemba, J. B., Cho, H. J., Alban, R., Blanck, J. F., & Parsons, A. S. (2017). Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Internal Medicine, 177(12), 1833-1839. https://doi.org/10.1001/jamainternmed.2017.5152
Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., Driessen, E., MacLeod, T., Yen, W., Ross, K., & Power, M. (2015). Facilitated reflective performance feedback: Developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706. https://doi.org/10.1097/ACM.0000000000000809
The Purdue Global NU651 Unit 8 instructions
The Unit 8 assignment asks you to reflect on specific feedback from your preceptor. You describe the feedback and its context, examine your reaction to it, test it against evidence from your own practice, and set a plan for change. Many sections name a feedback model, such as R2C2, and expect the reflection to follow its stages. The goal is not to agree or disagree but to examine the feedback honestly. Expect a word count in the high hundreds and two sources or more. The preceptor's formal evaluation should not be reproduced, and patients should be described without identifying details. Where you can, bring a small piece of your own data, since feedback is easier to weigh against numbers.
How the NU 651 Unit 8 example is put together
The example follows R2C2 in order. The relationship section sets four days of working together in a few sentences. The reaction section records the author's first thought and a vivid memory from nursing that made extra labs feel safe, with one highlighted sentence explaining the habit. The content section is an audit: five groups of orders with counts and a single test for each order. Choosing Wisely and guidance on repetitive testing support the finding. The audit also shows where the feedback did not hold. The coaching section gives four numbered changes and the result of a second audit. A closing paragraph says what the author keeps from the old habit and what changes.
Where the points sit in the NU651 Unit 8 rubric
The Unit 8 rubric usually looks at self-awareness, analysis of the feedback, use of evidence, the plan for development and writing. Self-awareness earns full credit when the writer's reaction is recorded candidly, including any defensiveness. Analysis is judged on whether the feedback is tested rather than simply accepted. Evidence counts when it bears directly on the behavior, such as guidance on repetitive laboratory testing. The development plan should be specific and measurable. A reflection that shows the change with numbers from later in the rotation demonstrates growth more convincingly than one that promises it. Clear headings for each phase also make the structure easy to follow. Where the feedback did not fully hold, saying so with evidence is treated as analysis, not defensiveness.
Common NU651 Unit 8 mistakes, and how to avoid them
Many feedback reflections simply agree with the preceptor, which shows little reflection. Others argue with the feedback without testing it. Students often leave out their first reaction because it seems unprofessional, when that reaction is what explains the habit. Audits are sometimes reported as a single percentage with no detail. Some writers overcorrect and treat every lab order as waste, ignoring checks that did answer a question. Plans are often vague. And a reflection that does not follow the named model loses points for structure even when its content is sound. Include the dates of both audits so the change can be seen over time.
Get an NU651 Unit 8 example written to your instructions
The feedback itself can be paraphrased; what the NU651 Unit 8 sample needs is its substance, the rubric and whichever reflective model the section names. A first sample, free, follows within 24-48h, built around a composite preceptor comment, an audit that tests it line by line, a concession where the evidence supports one, and a change measured afterward. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU651 Unit 8 questions, answered
Should the reflection include my preceptor's actual evaluation?
No. Formal evaluations are part of the student's clinical record, completed by the preceptor, and the sample never writes or reproduces one. A reflection can paraphrase feedback the student received. The sample works from an invented comment to show how feedback becomes evidence, and a student's own paper would rest on the feedback actually given.
What if the feedback seems unfair?
Then the reflection tests it, as it would fair feedback. The sample concedes most of the comment and defends one part with evidence, which reads as examination rather than resentment. A paper arguing that feedback is wrong can still earn credit if it shows the data and reasoning, and acknowledges what the preceptor may have seen that the student did not.
Is the R2C2 model required?
Only if the section names it. R2C2 was developed for facilitated feedback conversations, and its order of relationship, reaction, content and coaching suits a written reflection on one comment. Gibbs, Rolfe or Johns would also work, and the sample would be restructured around whichever model the prompt specifies.
Where can I find a free NU651 Unit 8 sample paper?
The full NU651 Unit 8 preceptor feedback reflection is on this page, with the R2C2 stages, the 31-order audit and the coaching plan. A free reflection built around the feedback you received can be written from your notes.
What does R2C2 stand for in NU651 Unit 8?
Relationship, reaction, content and coaching, the four phases of a facilitated feedback model developed by Sargeant and colleagues. The sample uses them as its headings, which places the writer's reaction before the analysis of the feedback itself.