Day one I am in awe of the sheer size, energy and pace of New York. I feel quite overwhelmed and intimidated at being here alone, but at the same time I realise how amazing an experience this is. I visited Ground Zero. The tenth anniversary of the 9/11 terrorist attack on the twin towers has just passed and I wanted to experience the impact this had on the people of America. The memorial was beautiful, peaceful and emotive, especially the flowers left for those killed in the atrocity. The mood in the memorial garden was different to anywhere else in New York. The tranquillity with just the sound of flowing water was the polar opposite to the car horns, loud voices, ringing cell phones of New York.

Day two I visited a hospital in the Bronx today. I was quite apprehensive, expecting it to be unsafe and unfriendly. What I experienced was something quite different. The contact I was meeting was a retired Dean of a college in New York who had some involvement in health education. The main purpose of my visit was to get an insight and orientation into American hospitals and to learn about the innovative nursing practices occurring in this community. I was shown some innovative tele-health systems being trialled in the Bronx. I saw nurses sitting in office booths surrounded by computer screens wearing telephone headsets so they could telephone their patients. They were looking at data being entered by patients in their own homes. For example, a patient suffering with heart failure had to weigh daily at home on a set of scales connected to the phone line, which then transferred to a nurse's screen. If the nurse detected an increase within set limits a call would be made, and a medical intervention offered. I understood from the tour that this was a type of money saving initiative commended by health insurers. This level of monitoring was a preventative measure against a hospital admission. I reflected on how something like this could be used in Notts. I personally felt there would be problems with patient compliance, such a huge responsibility bestowed on the patient. An enormous financial investment would be needed to provide patients with the technology in the first place. I wondered if a chronically-ill patient would really want to be reminded of it in such an intrusive manner? Surely monitoring of that intensity would have an impact on quality of life, or would it be seen as caring? I met several nurses to tour the hospital facility and was asked to present a short session about my scholarship opportunity and nursing in the UK. I soon realised that in a poverty-stricken community like the Bronx, patients use the emergency department (ED) as their main access to healthcare. This puts huge pressure on the facility. What I saw shocked me in terms of the quantity of patients. However, with the challenges that service demand brought, there were also initiatives available to confront it. One that impressed me was the role of an ED navigator, a nurse who flagged up frequent attendees to help prevent further re-attendance. This involved the use of community services such as meals, some levels of social care and scheduled follow up appointments. Some of my most fascinating moments were spent with a nurse manager (the equivalent of a ward Sister) who explained why she implemented hourly rounds. This is a particular focus of my scholarship. My host gave me a tour of the area on the drive back to downtown New York. I saw the Hudson River at close range, beautiful trees that were beginning to turn typical fall shades of yellow and red and the skyline of Manhattan appear before my eyes.

Day three By train from New York to Providence, Rhode Island, to meet my next hosts – Haven Roosevelt, grandson of President Franklin and Eleanor Roosevelt and his wife Bunny. The comfortable four-hour train ride was fascinating, watching the city of New York disappear and change into the beautiful coastline of New England. I arrived to find a very foggy, quiet coastal town, and after settling in and getting acquainted with Haven and Bunny Roosevelt I took a long walk along the beach. I was then witness to a storm of a magnitude I had never seen before. The wind and rain whistled around the building. Windows shook. Haven seemed to find it amusing that I was terrified. To him, this was just a mild breeze and he offered plenty of reassurance that we would be absolutely fine.

Day four Haven, Bunny and I were invited to sail with a group of their friends. The afternoon began sunny and warm as we headed in the direction of Cape Cod. But quickly the sky became grey and we turned around to sail home. In the evening, dinner with childhood friends of Bunny, where I was guest of honour. We spent the evening discussing politics, history and hobbies and I truly experienced American hospitality and generosity at its best.

Day five I spent the day with Eliza, a nurse practitioner and distant relative of Haven and Bunny. She took me for a tour of her hospital and explained her outlook of nursing and the American Healthcare system. Her hospital was incredibly small, only 130 beds and the ED department looked like a ghost town with only a handful of patients. Obviously, a more wealthy community and the mandate for health insurance in Massachusetts contributed to the calm. An evening at the movies; Money Ball, a film about American Baseball, so I loved it.

Day Six Got to appreciate the countryside of Dartmouth, Massachusetts, by joining a "Plant Walk" in a nearby conservation area. Haven is president of a conservation society in Dartmouth, so I was shown his enthusiasm and commitment to protecting the landscape. Haven gave a talk to try and encourage financial donations to further the work of the society. I was impressed by his drive for protecting the beautiful countryside he was surrounded by. I found out more about the Roosevelt legacy that was his family. I wanted to know what it was like to have a President and First Lady as grandparents, and I was not disappointed by the response.

Day Seven A travelling day, so six hours on a train to Baltimore, Maryland to attend the Magnet Nursing Conference to learn more about leadership in nursing and to obtain some skills to better equip me as a nurse leader. Magnet hospitals in America are an elite type, consistently delivering excellent quality in care and outcomes for patients. So a few days of intense learning ahead of me.