A nursing exemplar is a detailed narrative written in the first person on a real patient to illustrate an RN’s practice/experience. The exemplar showcases clinical experience from a nurse’s perspective. This reflective document highlights how a nurse applied critical thinking, clinical expertise, and compassionate care in a specific patient scenario. For nursing students, understanding how to craft a compelling nursing exemplar example is essential for professional development and academic success.
As you progress through your nursing education, you’ll encounter various opportunities to write a nursing exemplar that demonstrates your growth in the nursing field. These reflective pieces serve as powerful tools for self-assessment and professional advancement.
Nursing Exemplars in nursing practice provide concrete examples of how theoretical knowledge translates into real-world patient care. Every nurse encounters pivotal moments in their career that shape their approach to the profession. By documenting these experiences through a nursing exemplar, you create a valuable record of your clinical reasoning and professional growth.
The process of writing an exemplar encourages nurses to analyze their actions, consider alternative approaches, and identify areas for improvement. This reflective practice is central to developing proficiency in nursing care and advancing your capabilities as a healthcare provider.
Essential Elements of a Nursing Exemplar
Elements of a Nursing Exemplar
Patient Context and Assessment
A strong nursing exemplar begins with a clear description of the patient’s situation. Consider this example: “Lynda was newly diagnosed with laryngeal cancer and admitted for initial treatment and care plan development.” This concise introduction immediately establishes the clinical context.
When writing your nursing exemplar, include relevant assessment findings such as vital signs, physical examination results, and psychosocial factors that influenced your nursing interventions. Remember to maintain patient confidentiality by using pseudonyms and removing identifying information.
Nursing Process Application
The heart of any nursing exemplar is the detailed explanation of how you applied the nursing process to address patient needs. This section should demonstrate your systematic approach to:
Assessment: Document how you gathered and interpreted patient data
Diagnosis: Identify the nursing diagnoses that guided your care
Planning: Outline the goals and expected outcomes
Implementation: Detail the specific nursing interventions you performed
Evaluation: Explain how you determined the effectiveness of your care
For example, in a respiratory case, you might describe: “After noting decreased oxygen saturation and audible wheezing, I implemented nursing interventions including positioning, oxygen therapy, and suctioning to improve airway clearance. This patient-centered approach addressed the immediate respiratory distress while maintaining the patient’s comfort.”
Critical Reflection Component
The reflection section of your nursing exemplar transforms a simple clinical narrative into a powerful learning tool. This is where you demonstrate critical thinking by analyzing:
What went well in the patient encounter
What challenges did you face
How you adapted your nursing care to overcome obstacles
What would you do differently in a future similar situation
How does this experience contribute to your development as a nurse
How to write an exemplar in Nursing: Step-by-Step Guide
1. Select a Meaningful Clinical Situation:
Choose a patient encounter that had a significant impact on your nursing practice. The best nursing exemplar example often comes from challenging situations where you grew professionally. Consider instances where:
You applied evidence-based practice to improve patient outcomes
2. Gather Relevant Information
Before writing, collect the key details about the patient encounter, including:
Chief complaint and medical diagnosis
Relevant assessment findings
Nursing interventions performed
Patient responses to care
Communication with healthcare team members
Resources utilized
For example, if your nursing exemplar focuses on caring for a patient with a newly diagnosed chronic condition, document how you provided initial education and emotional support during this critical period.
3. Write a Detailed account in First-person perspective
Structure your nursing exemplar in a logical flow that guides the reader through the experience. A common organizational approach includes:
Introduction to the patient and clinical situation
Detailed description of your nursing assessment findings
Discussion of patient outcomes and response to care
Reflection on the experience and lessons learned
4. Incorporate Nursing Theory and Evidence
Strengthen your nursing exemplar by connecting your actions to nursing theories, evidence-based guidelines, or best practices. This demonstrates your ability to integrate theoretical knowledge with clinical practice.
Example: “My approach to pain management in this case was informed by McCaffery’s definition of pain as ‘whatever the experiencing person says it is.’ This patient-centered perspective guided my assessment and nursing interventions, leading to more effective pain control and improved patient satisfaction.”
5. Reflect Deeply on the Experience
The reflective component elevates a simple case study to a true nursing exemplar. Consider questions such as:
What emotions did you experience during this patient encounter?
What went well? What could have been improved?
How did this experience change your approach to nursing care?
What did you learn about yourself as a nurse?
How will this experience inform your future nursing practice?
Sample Nursing Exemplar with Examples
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:
N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.
Or
P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.
Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.
General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)
Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.
Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.
Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:
Where patient was born, who raised the patient
Number of brothers/sisters (what order is the patient within siblings)
Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?
Educational Level
Hobbies:
Work History: currently working/profession, disabled, unemployed, retired?
Legal history: past hx, any current issues?
Trauma history: Any childhood or adult history of trauma?
Violence Hx:Concern or issues about safety (personal, home, community, sexual (current & historical)
Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.
Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.
Allergies:Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.
Reproductive Hx:Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!
You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).
Assessment
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses:You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
References (move to begin on next page) You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting
Nursing Exemplar Template
When crafting your first nursing exemplar, a template can provide helpful structure. Here’s a basic nursing exemplar template to guide your writing:
Title: Brief description of the clinical focus (e.g., “Nursing Care for a Patient Following Stroke”)
Patient Introduction: Age, gender, relevant medical history, and presenting condition
Setting: Hospital unit, clinic, or community setting where care was provided
Initial Assessment: Key findings from your nursing assessment
Coordinating care for a patient with multiple comorbidities
Advocating for a vulnerable patient’s needs
Educating a patient newly diagnosed with a chronic condition
Implementing fall prevention strategies for an at-risk patient
Managing pain for a post-surgical patient
Providing culturally sensitive care to diverse populations
Supporting a patient through a difficult diagnostic process
Frequently Asked Questions
What is the difference between a nursing care plan and a nursing exemplar?
A nursing care plan is a structured document outlining specific interventions for a patient’s identified problems, while a nursing exemplar is a reflective narrative describing a significant clinical experience from the nurse’s perspective. Care plans focus on planning patient care, whereas exemplars emphasize reflection, critical thinking, and professional growth through clinical experiences.
How can I effectively incorporate suctioning procedures into my nursing exemplar?
When including suctioning in your nursing exemplar, describe your assessment findings that indicated the need for this intervention, detail your preparation and technique, and discuss how you maintained patient comfort and dignity throughout the procedure. Explain how you evaluated the effectiveness of suctioning and any adjustments you made based on the patient’s response.
What are some strategies for showcasing my clinical expertise in a nursing exemplar?
To highlight clinical expertise in your exemplar, include detailed descriptions of your assessment techniques, explain your clinical reasoning behind intervention choices, describe how you adapted standard procedures to meet individual patient needs, and reflect on how your specialized knowledge influenced patient outcomes. Use specific examples that demonstrate advanced skills rather than general statements about your abilities.
How should I address case management involved in complex patient situations?
When discussing case management in your nursing exemplar, describe the coordination of services across disciplines, explain your role in facilitating communication between team members, detail how you advocated for appropriate resources, and reflect on how effective case management impacted the patient’s overall care experience and outcomes. Include specific examples of collaboration with social workers, discharge planners, and other case management professionals.
As a passionate educator, Rachel DNP contributes to nursingwritershq.com, where she writes and edits guides helping nurses with Nursing APA papers and capstone projects. Drawing from her experience as both a DNP and a seasoned nurse, she bridges the gap between academic theory and clinical practice.
