Practice Transition Plan



Practice Transition PlanMelissa ClarkFerris State UniversityPractice Transition PlanWhen first deciding to become a nurse, the difference between an associate degree nurse (ADN) and a bachelor degree nurse (BSN) was foreign. I chose to go to Grand Rapids Community College and then eventually I would get my BSN at a university. Throughout nursing school I kept hearing about how important it was to continue your education to get your BSN because employers weren’t hiring ADN nurses. I always wondered what the big deal was because didn’t ADN and BSN nurses take the same NCLEX? Doesn’t that mean we are the same? After only one semester at Ferris State University I can see that they are not the same. During my schooling for my ADN we were taught the essentials, and that isn’t necessarily a bad thing, but there is so much more to learn. BSN nurses are more prepared because they are taught to see the big picture and they are taught the theories behind the practices we have today. Professional IdentityWhat does it mean to be a professional? When I think of a professional I think of the high paying professional athletes, and where does nursing come into place? “ Historically, physic (medicine), law, and divinity (clergy) were considered ‘learned professions’” (Black, 2014, p. 52). Black goes on to describe what a profession is and she states that, “a profession is an occupational group with a set of attitudes, behaviors, or both” (Black, 2014, p. 52). What are the set attitudes and behaviors, who decides what these set behaviors will be, and how does this affect nursing?One person who can describe professionalism is a sociologist by the name of Flexner. He made a list of six criteria that describes how he thinks professionals should act. His list includes being competent and responsible, having the proper knowledge to perform your duties, continuing your education, and having a desire to help others learn (Black, 2014, p. 53). Many different professionals use Flexner’s criteria, but Lucie Kelly has a list that is directly influenced by nursing.Kelly’s list includes, getting knowledge through research, continuing our education, know that nurses are important to society, be accountable for our actions, be able to work independently, be able to serve others, follow a code of ethics, and support a high standard of practice (Black, 2014, p. 55-56). As a nurse I want to always think about these characteristics and try to apply them to my everyday practice; obtaining my BSN, making sure I follow the code of ethics for nurses, making sure I stay accountable for my own actions, are a few of the things that I can do to become a professional. Becoming professional is a huge step to decrease negative stereotypes surrounding nurses. I have had many patients question what I do because I am “just a nurse.” Some people think that nurses don’t need to be knowledgeable because we have doctors that tell us what to do. It is very common to see the media portray nurses as sleazy, and it is very common for the media to portray male nurses as girly. I think that it is important for nurses to be seen as professionals, and get rid of these negative images. Scope of PracticeKnowing what our boundaries are in our job is very important, so we are able to know what we can and can’t do. “The profession of nursing has one scope of practice that encompasses the full range of nursing practice. The depth and breadth in which individual registered nurses engage in the total scope of nursing practice depends on their education, experience, role, and the population served” (White & O’Sullivan, 2012, p. 11). Every state determines the specifics of what nurses are allowed and not allowed to do, and it is our responsibility to know what our boundaries are. This responsibility goes back to acting like a professional because we do not have someone that is always watching over us. We need to take the responsibility and accountability of our own actions.Another important part of helping professionals know what is expected of us is by using standards of practice. “Standards reflect the values in priorities of the profession and provide both a direction for professional nursing practice and a framework for the evaluation of this practice. The also define the nursing professions accountability to the public and the outcomes for which registered nurses are responsible” (White & O’Sullivan, 2012, p. 24). Having standards of practice or a good foundation is important when it comes to the difficult situations we are put in as a nurse.Ethics Working with patients who are dying can be very difficult, working with the patient’s families can be even worse. There have been a few times in my practice where the patient wants to sign on with hospice, but the family is refusing. As a nurse I am put in a tough spot because my patient is my number one priority, but the family has the legal right to make the decisions. The first time this happened I was so upset that my boss referred me to an ethics conference in hopes that it would help me better understand my role in these tough situations. Having ethics be a, “foundation of nursing, provides the basis for nurses’ commitment to society to provide and ensure safe and quality patient care” (White & O’Sullivan, 2012, p. 115). I believe that in order to be an ethical nurse we need to know about ethical issues and what our role is as a nurse. We also need to be aware of our laws regarding certain ethical issues. For example, I had a patient who asked me about physician-assisted suicide. Living in Michigan, it is against the law, so I had to explain that it is not an option. Another important factor is that we need to know what we can and can’t do as a nurse. We can’t choose a doctor for the patient or the family, and we can’t decide if the patient should get more treatment or not. It is vital that we keep our own opinions and beliefs to ourselves and give the patient the facts. EducationEducation is one of the most important standard of nursing because without education we would have nothing. It has been said many times, “the health care world is constantly changing,” and if we don’t keep up we can get lost in a hurry. One way that I keep up is going to school to earn my bachelors degree, and I plan to continue my education further by hopefully one day earning my doctorate. Another way I believe that I can keep up is by getting certified in a specialty. Where I currently work I can become an Oncology Certified Nurse (OCN) and/or a Certified Hospice and Palliative Nurse (CHPN). These certificates can give patients comfort in knowing that I have a higher knowledge in these areas. TransitionEarning my BSN will increase my knowledge, but I also believe that it will enhance my skills and my attitude. Quality and Safety Education for Nurses (QSEN) has six competencies that include, patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics; to achieve these competencies you must posses the knowledge, skill, and attitude as defined by QSEN. For example, according to the QSEN website, for the competency of patient centered care, you must, “analyze multiple dimensions of patient centered care, analyze ethical and legal implications of patient centered care, analyze strategies that empower patients or families in all aspects of the health care process, and integrate principles of effective communication with knowledge of quality and safety competencies,” (2014, table 1). This list is only a few of the many things you should have knowledge in with patient centered careContinuing with the competency of patient centered care, the QSEN website defines some of the skills as, “asses and treat pain and suffering, respect the boundaries of therapeutic relationships, engage patients in active partnerships along the health illness continuum, and continuously analyze and improve own level of communication skill in encounters with patients, families, and teams” (2014, table 1).Finally, the QSEN website defines some attitudes with patient centered care as, “honor learning opportunities with patients who represent all aspects of human diversity, value shared decision making with empowered patients and families, respect patient preferences, and value continuous improvement of own communication and conflict resolution skills” (2014, table 1).There are many things that go into defining knowledge, skill, and attitude, and I plan on using the standards of practice and the QSEN competencies to improve my nursing care. KnowledgeQuality of practice is, “assuring that patients receive evidence-based care that is patient-centered, safe, effective, timely, efficient, and equitable” (White & O’Sullivan, 2012, p. 145). Making sure that my patients receive the best care possible is my number one goal, but I believe that my degree only gets me so far. My ADN schooling was all about assessment and implementation, and we spent a lot of time on how to respond to certain situations. My BSN degree, however, will teach me how to find reputable research and evidence based practice, so I don’t just respond, but I will have the evidence to back my actions. I also believe that my BSN will help me to anticipate the needs of my patient by showing me the big picture.SkilsNursing is such an amazing profession because there are no limits. We could be a medical-surgical nurse, and then become a pediatric nurse, after we could decide we want to work in informatics, and finally we could end our career in nursing management. We always have doors open to us and that is what I find the most exciting about this career. Leadership is one of many avenues that you can take along your health care career, but you need to posses certain skills to become a successful leader. “The RN must consistently demonstrate specific competencies in nursing leadership, including both oversight of nursing care given by others while retaining accountability and commitment to continuous, lifelong learning” (White & O’Sullivan, 2012, p. 165). I believe that you must have the skills to advocate for your bedside staff while at the same time you need to back what the executives want you to do. In order for you to be able to have this broad view of the whole system, you need to have a BSN. Leadership is one of the avenues I plan to take, and at the hospital I work at you must have your BSN to even be considered for the job. AttitudeCollaboration is very important, especially in nursing because nurses can’t do it all. We need to work well with our team and our team can include the patient, family, physicians, other nurses, physical therapy, dieticians, social work, care management, nursing aids, and the list could go on. I feel that as a new nurse my attitude was that I didn’t need help and I believe that my patients suffered as a result. I felt that is was a sign of weakness to ask for assistance when in reality we always could use help. During my ADN schooling there was not much time spent on your interdisciplinary team and how important they could be, but in only two semesters I have learned more on reaching out and collaborating with my team. For example, I have learned to work with my team to anticipate my patient’s discharge needs. When it was time for the patient to be discharged, care management and physical therapy had everything taken care of, so my patient didn’t have to wait an extra day to go home. Significance and ConclusionI believe that obtaining my BSN will make me a better nurse because I will be able to see more “big picture.” BSN nurses learn more about the patient as a whole, and we will have better critical thinking skills. I believe that because we see the whole picture rather than a list of symptoms, we can help be a better advocate for them. Nurses are the frontline for the war on sickness because we are at the bedside. Nurses need to be able to know what to advocate for and more importantly we need to know what to teach our patients so they can become advocates for themselves. Learning about theorists who researched on the relationship between the nurse and patient helps me understand how to interact with them and help them understand why I do what I do. I also believe that having my BSN will help me be a better leader because I am learning how to work in groups and work with a team. Finally, having a BSN is only one step in the continuous learning process that must happen in the healthcare world. Working as a nurse can be very difficult and demanding. We are expected to be kind, caring, helpful, compassionate, ethical, educated, and trustworthy, but I wouldn’t change it for the world. I enjoy being able to walk side by side and hold my patient’s hand as they fight their toughest battles. My BSN will not only make me more confident, but will make me a better nurse. ReferencesBlack, B. P., (2014). Professional nursing: Concepts & challenges (7th ed.). : Saunders.Graduate KSAs., (2014). Retrieved from , K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education. Silver Springs, MD: American Nurses Association. ................
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