Running head: Transition Plan 1

Practice Transition Plan

Diana VanRhee

Ferris State University

Transition Plan 2

Abstract

This paper is a summary of my professional nursing experience. It details the areas of the

hospital I have worked in, length of time spent in each department and the Knowledge, Skills and

Attitudes that I have achieved during my nursing career. A description of where I current work

and examples of care I provide are included. Philosophy and the paradigms of nursing (person,

health and environment) are defined in relation to my current nursing practices, along with my

nursing philosophy. You will find transitioning from the Associate Degree of Nursing into the

Bachelors of Science in Nursing in relation to Knowledge, Skills and Attitude, Evidence Based

Practice, theory and research.

Key words or phrases: Attitude, Code of Ethics for Nurses, concepts, environment, Evidence

Based Practice, paradigms, health, homeostasis, Knowledge, person, Philosophy, Surgical Care

Improvement Project, Skills, Standards of Nursing Practice and Transition.

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Practice and Transition Plan

The purpose of the paper is to reflect on my professional nursing career and current

nursing practice in relation to the Knowledge, Skills and Attitude (KSA) that I have learned

throughout the years. It demonstrates the skills I currently use and how they are performed based

on the scope of nursing practice and how they will assist me in transitioning into the Bachelors

of Science in Nursing (BSN) role. It also encompasses my transitioning into the BSN role in

relation to the KSA’s that I have learned from the Standards of Nursing Practice. Included are

the paradigms of nursing, which are health, person, environment and nursing, along with my own

personal nursing philosophy.

Current Practice

I have been a registered nurse for 15 years. My career began in the Childbirth Center

immediately after graduating with my Associates Degree in Nursing (ADN). The Childbirth

Center included Triage, Labor and Delivery, Post-Partum and Newborn Nursery. After nine

wonderful, memory making and skill learning years, I began the next chapter of my career,

Surgery Prep and Recovery. Working in the Surgery Prep and Recovery unit allows me to

prepare a patient for surgery, take care of them in phase two recovery and also be a charge nurse

of those two areas. We take second on-call to Post Anesthesia Care Unit one to two weekends a

year and also care for surgical patients that are “direct backs”, meaning they have not had a

general anesthesia, but perhaps intravenous conscious sedation. In the next section, you will find

the Knowledge, Skills and Attitude that I currently use in the Surgery Prep and Recovery unit.

Knowledge

Knowledge is essential and ongoing in nursing, keeping educated on current evidence

based practices, maintaining continuing education, adhering to The Code of Ethics for Nurses

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and abiding by the Standards of Nursing Practice are all unique to the nursing profession (Black,

2014; White & O’Sullivan, 2012).

Prior to beginning care of a pre-operative patient, I educate myself regarding their health

history, surgical history, current medications, laboratory results, and any diagnostic testing they

have received, along with complete history and physical done by the primary care physician.

This allows me to be more confident in their care and gives the patient confidence in me. For

example, a patient is scheduled for a lumpectomy with sentinel node biopsy, there are labs that

should be done prior to surgery based on her medical history, such as a basic metabolic panel if

the history is hypertension. If one was not done, I will order one based on anesthesia protocol

(Information & Quality Healthcare, 2011). The standards of care for the nursing practice gives

me the autonomy to assess, plan, implement, evaluate communicate and collaborate care for this

patient (White & O’Sullivan, 2012). Sometimes the medication prescribed is a beta-blocker for

the high blood pressure and per the Surgical Care Improvement Project, a beta-blocker that

routinely is taken on a daily basis needs to be taken on the day of surgery. The Surgical Care

Improvement Project is a publicly reported national quality initiative and if the institution is

receiving reimbursement from a federally funded program, they must participate in order to get

reimbursement (Information & Quality Healthcare, 2011). If the patient has not taken their

medication, then a new order needs to be received after collaboration with the surgeon and

anesthesiologist.

If I do now know how to perform a task or answer a patient’s question, I am able to

collaborate with my co-workers and interdepartmentally per the Standards of Nursing Practice

(Black, 2014). The hospital maintains current policies and protocols which are derived from

Evidence Based Practices, they allow for quality care to be given based on research, theories and

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past proven techniques (White & O’Sullivan, 2012). At times, I will tell a patient, “I do not know

the answer to that, but it is a very good question to ask your doctor when she comes in this

morning. Together we will sit down and make sure your questions are all answered”,

collaboration is a standard of nursing practice in which I act under at times like this (White &

O’Sullivan, 2012). Practical knowledge and experience with the skills I have acquired, allow me

to provide safe, quality care.

Skills

Nursing can be physically, mentally and emotionally demanding. There are many skills

which I have learned over the years that I use on a daily basis. Some clinical skills include

starting intravenous fluids, drawing blood, assessing lung sounds and basic electrocardiogram

interpreting. Having my ADN provides me with the knowledge and skills needed in assessing

my patients on a daily bases (White & O’Sullivan, 2012). When a patient has abnormal lung

sounds, I will assess the sound I hear, call the anesthesiologist and request a respiratory treatment

if needed. After a breathing treatment is done, reassessing the lung sounds is needed. I performed

these duties based on the Standards of Nursing Practice (White & O’Sullivan, 2012).

Identifying the patient’s communication needs and addressing those needs in a way the

patient understands is a standard of The Joint Commission (The Joint Commission, 2013) and

also a Standard of Nursing Practice (White & O’Sullivan, 2012). Effective communication is

essential during every day nursing care, but especially when I am in charge. Along with patient

care, I will need to manage staffing assignments, communicate with patients and family

members regarding surgery delays or accelerations and expect the unexpected. Emergency

surgeries, inpatient and endoscopy add on surgeries or current patient medical need can easily

disrupt the flow of care in the preoperative area, operating room assignment as well as the trickle

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effect to Post Anesthesia Care Unit and phase two recovery room. How I handle myself is

defined by attitude.

Attitude

As I reflect on attitude, many descriptive words come to mind, professionalism,

compassion, empathy, calm, reassuring, respectful, friendly, knowledgeable, trustful, gentle and

helpful are first and foremost. Many of those attributes are included in The Code of Ethics for

Nurses (Black, 2014). Generally a smile and a positive attitude will go a long way when dealing

with patients and coworkers alike. If someone were asked to describe me, I would want them to

say that I have a little bit of all those qualities above rolled into one. One of my best attributes

would be that I have compassion, I treat each patient as I would want myself or family member

to be treated, which is part of my nursing philosophy.

Philosophy

Philosophy is a collection of principles about how something works (Black, 2014).

Establishing a philosophy about your profession is important because it provides the foundation

or core beliefs about it and expresses your values towards that profession. My nursing

philosophy is caring for an individual as a whole, mind, body and spirit, without discrimination

of any kind. I treat each person with dignity, care, respect and compassion. I would have to say

that my philosophy is most similar to Jean Watson, whose nursing philosophy is a concept of

caring and focuses on human-to-human relationships (as cited in Black, 2014). I also base my

nursing philosophy on the metaparadigms of nursing, which include person, health, environment

and nursing (Black, 2014 p. 240). In the following sections, I will outline what I comprehend

each concept to be, starting with person.

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Person

The term person describes an individual that is an open system which contains other

subsystems to make that exclusive individual a whole (Black, 2014). A person is comprised of

physical, emotional and spiritual needs that seeks out homeostasis, can be influenced by the

environment and shows motivation based on their needs. An individual can be a man, woman or

a child. Each person has human needs that have to be met in order for their subsystems to

function together and establish a sense of well-being (Black, 2014 p. 242).

There are five levels of human needs. “According to Maslow, the most basic level of

needs consists of those necessary for physiological survival: food, oxygen, rest, activity, shelter,

and sexual expressions” (as cited in Black, 2014, p. 243). Once these basic needs are met, safety,

social, esteem and self-actualization needs can be accomplished. I believe that each individual is

unique and can meet those needs in a variety of ways, and that not everyone will get to the

highest level of self-actualization. In fact if someone did reach self-actualization, a circumstance

could bring them back to needing one of the basic needs again (Black, 2014).

Homeostasis is a balance of the functioning subsystems working together (Black, 2014).

Subsystems are how the body functions together and include breathing, blood circulating, food

digesting and waste elimination. These all need to function as a whole to maintain the

homeostasis state. Next, I will relate how the concept of health relates with the person.

Health

Health is something that is ongoing and can change from day to day and from one

circumstance to another, based on factors such a sleeping habits, nutritional status and stressors

(Black, 2014). An individual may define their health as they perceive it, or as others do, based on

the body working as a whole...mind, body and spirit. I believe when a person views their health

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in a positive light, it empowers them and encourages self-efficacy, which will allow them to

promote their health goals (Pender, Murdaugh, & Parsons, 2011). Environment can directly or

indirectly affect an individual’s health, which leads to the following section.

Environment

The environment, or suprasystem is described as what surrounds the person and affects

them, but also could support or breakdown the homeostatic nature of the individual (Black,

2014). I consider the environment to be lighting, temperature, sound and social support. Creating

an atmosphere this is desired by the individual with provide the person with a sense of peace and

safety.

Families are the single most influential factor on a person (Black, 2014). They provide

love, understanding, support and communication when needed. I believe when families are

involved in the patients care, it fosters closeness and a sense of security, which fosters an

environment conductive to healing. Families are unique to each person and are a major

contributor to how a person learns, deals with conflict and social behavior (Pender, Murdaugh, &

Parsons, 2011).

Culture plays a considerable role in a patient’s environment and “consists of the attitudes,

beliefs, and behaviors of social and ethnic groups that have been perpetuated through

generations.” (Black, 2014, p. 246). A person can be influenced spiritually, emotionally, socially

and physically based on their cultural beliefs. I believe that your culture can define who you are

and should be respected according to The Code of Ethics for Nurses (Black, 2014).

Nursing Theory

Nursing theory is a broad term that I believe encompasses the conceptual models of nursing

(as cited in Black, p.273), theory’s that developed over time based on evidence based practice,

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the knowledge acquired through experience and through current educational curricula.

According to Black, “theories are more concrete descriptions of concepts that are embedded in

propositions” (Black, 2014, p. 267). Using theory in my current nursing practice allows me to

have a sense of identity in transitioning into the role of Bachelors of Science in Nursing (BSN).

Transition

Transitioning from an ADN, to a BSN, is a gradual process to which I welcome and am

excited for. I have felt empowered in this process and as my knowledge grows, so does my

confidence level. Throughout this journey, I have gained understanding and appreciation for the

KSA’s that a BSN nurse must have in regards to the Evidence Based Practice (EBP) and research

which are woven into everyday nursing practice.

Knowledge

I have gained a profound amount of knowledge in the transitioning to the role of BSN.

Reviewing the Standards of Nursing Practice has brought back the fundamentals of nursing for

me. Ethics is a core value in nursing and something I personally view is a reflection of myself in

my professional career. “Having the ability to deal effectively with such everyday ethical issues-

in addition to the more serious life-and-death and end-of-life issues-comprises the competencies

that nurses must possess as part of the professional performance standard that is related to ethics”

(White & O’Sullivan, 2012, p. 116). I can apply ethics to a variety of facets in nursing, such as

education and leadership. When an error is made, demonstrating leadership in an ethical manner

by reporting the error can possibly lead to a learning opportunity and may help prevent future

similar episodes (White & O’Sullivan, 2012).

There are always educational opportunities to be sought, sometimes an individual just

needs encouragement to seek them out. I have identified my need to further my education by

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enrolling in the AND to BSN program at Ferris State University, this is a personal and

professional career move that will open up additional areas of job opportunities. Throughout my

learning process, I will add to my professional portfolio material that I have collected that reflect

upon my educational competencies. Education, as a standard, is an ongoing process and should

continue throughout my career. According to White, “maintaining continued competence is an

ethical responsibility of professional nurses and an expectation of the society to which nurses are

accountable” (White & O’Sullivan, 2012, p. 115).

While transitioning into the BSN role, I will use EBP and research as standards in my

nursing practice. Whereas EBP “uses explicit methods to critically appraise the rate both the

level (strength) and quality of evidence to answer a practice issue or question” (White &

O’Sullivan, 2012, p. 133), research opportunities arise when the issue is unable to be resolved or

not resolved adequately. Nurses with their BSN degree can be mentors or facilitators to other

staff members in having them participate in research projects that could potentially enhance the

clinical setting they work in.

Research can be done through online sources such as PubMed or Google Scholar. Many

places of employment or schooling have access to written or online nursing articles and journals.

These scholarly resources provide valuable information based on EBP and will enhance the

knowledge, skills and attitude needed in providing high quality nursing care. An RN will grow in

autonomy and be held accountable by using EBP which “stresses the use of protocols and

procedures substantiated by research” (White & O’Sullivan, 2012, p. 168).

Skills

Enhancing my current nursing skills will assist me in providing a higher level of quality

care to my patients, which is also another Standard of Nursing Practice. Excellence care is

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established on Quality Improvement (QI) indicators, education and informatics. All RN’s should

participate in QI activities and have an attitude of inquiry about themselves (White &

O’Sullivan, 2012). One example of a quality indicator is a hospital reducing the rate of

nosocomial infections, such as Urinary Tract Infections (White & O’Sullivan, 2012). Periodic

evaluations of QI should be done to assess the effectiveness of the programs and to make

changes of the goals and outcomes if needed. In fact the evaluation process of all healthcare

workers is crucial in order to ensure the care provided at an institution is of the highest quality.

Where I work, I am given an annual performance evaluation. The managers review peer

input, patient satisfaction surveys, continuing education, attendance, utilization habits,

professional performance and participation in quarterly QI to establish an overall score that is

presented to myself in a one-on-one meeting. The evaluation process, which is a nursing

standard, allows for growth opportunities, accountability and if needed, an action plan can be

made to enhance weaknesses (White & O’Sullivan, 2012).

Using resources wisely and appropriately is the healthcare environment is an ongoing

process and one that should be practiced by all. At times this is not an easy nursing standard to

follow, when you want to provide safe and effective care (White & O’Sullivan, 2012).

Economics should not hinder and compromise the quality of care I give, so I must use critical

decision making skill, sound judgment and my own knowledge to provide the best patient

outcome and experience for the patient without wasting resources. After all, my actions represent

the facility where I work.

Since nursing is a profession that is looked upon with favor and respect, I feel that I have

an opportunity to be an example and role model to others. Nurses can advocate for healthy

working conditions, promote a healthy lifestyle and even participate in a green workplace (White

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& O’Sullivan, 2012). A facility that fosters a positive environment and a healthy campus will

demonstrate their commitment to health to the community. Smoke-free campuses, safe walkable

areas and a healthy work environment for employee’s shows pride and exhibits a caring attitude

for the employees (White & O’Sullivan, 2012, p. 203).

Attitude

As an RN, I am committed to my profession through my behavior and will strive to

display integrity always. Attitude and mannerisms play a key role in how people perceive you.

Leadership is a characteristic trait that develops over time and is a responsibility of all nurses. In

adherence to the Leadership Standard of Nursing Practice, RN’s must demonstrate leadership

characteristics with accountability and a commitment to education (White & O’Sullivan, 2012).

Collaboration and effective communication is demonstrated through leadership and is displayed

best when working together as a team.

Communication is vital in all aspects of patient care. When clear, concise communication

is used interpersonally, interprofessionally, interdepartmentally and with the patient, a reduction

in errors is evident, patient satisfaction increases and there are improved health outcomes (White

& O’Sullivan, 2012). Individuals can be empowered when their communication skills are strong

and it reflects upon who they are which allows them to understand others points of view (Gerson

& Gerson, 2007). I strive to be an effective communicator, especially when giving a hand-off

report. The SBAR reporting format which stands for situation, background, assessment and

recommendation, provides patient report in a pertinent verbal format (The Joint Commission,

2013). When SBAR is used appropriately, teamwork and collaboration standards are evident.

Collaboration helps to share the responsibility in finding solutions and execute the plans of care

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for the patient (White & O’Sullivan, 2012). The patient is reassured that the care given is

provided in a safe, efficient manner and of high quality.

Using the Standard of Nursing Practice, my attitude will reflect in the professional care I

provide my patients. I understand that by making ethical, critical decision making skills while

communicating and collaborating with other healthcare workers, I will be able to provide a

higher quality of care that I can be proud of.

Reflection

So many thought have gone through my head these last few days while I contemplated

the reflection portion of this paper. One word in particular stands out and that is growth. I have

grown so much in my behavior, critical thinking skills, knowledge, skills and attitude. Most of

that growth can be attributed to the 16 Standards of Nursing Practice. While some had more

significance to me than others, I can say that I am grateful for the opportunity to further my

education in to the role of BSN. Reflecting back to 18 months age when I began this journey, I

can say that my attitude did not embrace this journey so much. I recall discussing this with my

husband and letting him know that I will begrudgingly begin the classes, but I did have a

resentful attitude. The facility I work for strongly encourages all ADN nurses to make the

transition over to BSN, although at this time it is not a requirement to stay employed in my

current department. Working alongside both BSN and ADN nurses, our clinical skills paralleled

one another and I did know who possessed what degree. Now, I can say that I have come to

realize the importance and relevance that EBP and research has on our everyday nursing

practice. Using the critical thinking skills, collaboration and communication enhances the

professional care I current provide and enable it to be a higher quality. Reviewing ethics and

leadership has empowered me to seek out career opportunities that were previously unavailable

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to me as an ADN nurse. At my annual evaluation, I felt pride when my manager said she has

seen me grow in professional development, leadership skills and participation with unit

activities. I currently facilitate peer interviews and am on unit committees, I also seek out

educational opportunities where prior to taking the BSN classes, I did not. I was very

comfortable in providing routine bedside care as an ADN, whereas now I question the evident

and research behind the methods and apply theory where I did not before. I am excited at this

new transition phase for me and welcome it! With pride and empowerment, I will become a BSN

nurse and may further my education with a Master’s degree.

Conclusion

In conclusion, I view my role as an Associate Degree Nurse as an important professional

team member. Using the Standards of Nursing Practice, adhering to the Code of Ethics for

Nurses and using Evidence Based Practice allows me to act in my scope of practice while

providing safe and competent patient care. The foundations of nursing, person, health and

environment act together to assist me in defining nursing and develop my own philosophy of

nursing. My current practice, along with the education I am receiving, will allow my transition

into a Bachelor’s of Science in Nursing to be a smooth one. The transitioning to the BSN role is

a crucial element for my education and professional development. I am looking forward to what

the future holds for my nursing career and I believe it will be a very rewarding experience.

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References

Black, B. P. (2014). Professional Nursing Concepts & Challenges (7th Ed.). St. Louis, Missouri:

Elsevier Saunders.

Gerson, S. J., & Gerson, S. M. (2007). Workplace Communication: Process and Product. Upper

Saddle River, New Jersey: Pearson.

Information & Quality Healthcare. (2011). Surgical Care Improvement Project, retrieved from

www.iqh.org

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice

(6th Ed.). Upper Saddle River, New Jersey: Pearson.

The Joint Commission. (2013). Standards of Nursing Care, retrieved from

www.jointcommission.org

White, K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice. Washington

D.C.: American Nurses Association