Running Head: PRACTICE TRANSITION

Practice Transition Plan

Brandie Zimmerman
Ferris State University















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Practice Transition Plan
Nursing is an ever evolving profession. It is a vast field, offering many areas of focus,
each with a set of criteria that must be met and maintained in order to practice. Nursing as a
profession is shaped by a standard scope of practice. Nursing students graduate from various
programs and then disperse into many different areas of nursing (Ferris State University [FSU],
2014). An associate degree [ADN] nurse has a different scope of practice in comparison to a
baccalaureate degree [BSN] nurse. It is important for us to critically think about the difference in
the scope of practice of an ADN nurse as we transition into a BSN prepared role (FSU, 2014).
The purpose of this paper is to discuss nursing as a profession, my current scope of nursing
practice, standards of practice and the significance of higher education in the nursing field.
Professional Identity
Nursing is a profession as defined by the criteria set forth by Abraham Flexnar (as cited
in Chitty & Black, 2011). Nursing requires continued education and therefore is intellectual in
nature. Nursing also requires individual responsibility of the nurse as he or she cares for patients
and directs assistive personnel in providing care. Nursing is based on theory and researched to
provide the best practices through evidence. Nursing is taught at institutes of higher education
and motivated by altruism (Chitty & Black, 2011). All of these characteristics prove that
nursing is a profession as described by Flexnars criteria (as cited in Chitty & Black, 2011).
I personally was drawn to nursing because of my altruistic personality. I have always
wanted to be a nurse and care for others. To me, nursing is more than just giving medications and
completing tasks. It is a respectable profession obtained through higher education. I, like most
nurses, consider my degree to be one of the most valued and revered things I have ever worked
toward. Obtaining my BSN degree will not only set me above, but will open opportunities that
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are not available to nurses at the ADN level. ADN nurses and BSN nurses learn the same basic
set of knowledge and skills, but the difference is leadership. BSN nurses are taught to be leaders
and more than just technical nurses.
It can be argued that nursing as a profession is lacking in its own definition (Chitty &
Black, 2011). This is due to the fact that most professions are baccalaureate prepared and
nursing, although, heading in that direction, is still a mix of ADN and BSN nurses (Chitty &
Black, 2011). Chitty & Black (2011) state that, professional status and power increase with
education. This statement supports the fact that ADN nurses are not typically nurse managers or
in leadership roles, but rather more technical in practice. I can personally attest to this idea
through a recent experience that I had. I was encouraged by my co-workers and unit manager to
apply for a permanent position as a patient care coordinator, which is a full time charge nurse
position on my unit. My unit manager contacted me a few days later to sadly inform me that
although I was a great fit for the position, it was only being offered to BSN prepared nurses.
Although, leadership is practiced at all nursing levels and in every nursing practice, a higher
level of education and degree is required to move into a more permanent supervisor type role at
my facility. The policy changed last October and no longer allowed ADN nurses, even if they are
working toward a BSN degree, to be in the coordinator position. I am still a fill in charge nurse
on my unit and I am gaining leadership experience through this role, but not eligible to move into
a permanent charge nurse role until I have a BSN degree. It was a very surreal moment to finally
understand that a difference between ADN and BSN status is literally more than just initials and
extra classes. It is a difference in opportunity, education and scope of practice.


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Scope of Practice
The frame work of nursing practice is the nursing process. This process illustrates the
scope of nursing practice and is defined by sixteen standards. The nursing process begins with a
nursing diagnosis, identifications of expected outcomes, planning, implementation and
evaluation (White & OSulllivan, 2012). Nurses are taught this process at both an ADN and BSN
level in nursing school. We utilize this feedback loop in our everyday practice. Although, nurse
practice acts vary by state, the nursing process is utilized by every nurse, in every field of
nursing (White & OSullivan, 2012).
According to White & OSullivan (2012), the scope of nursing practice is defined by the
sixteen standards of nursing practice set forth by the American Nurses Association (ANA). The
standards of practice set forth by the ANA, are authoritative statements by which the nursing
profession describes the responsibilities for which its practitioners are accountable (White &
OSullivan, 2012). According to White & OSullivan (2012), these standards provide direction
for nursing practice and a process for evaluating nursing as a profession. The sixteen standards
of nursing practice, according to the ANA (as cited in White & OSullivan, 2012), include the
nursing process in addition to the following: assessment, diagnosis, outcomes identification,
planning, implementation, evaluation, ethics, education, evidence-based research, quality of
practice, communication, leadership, collaboration, professional practice evaluation, resource
utilization, and environmental health.
Nurses are taught the standard scope of practice in nursing school at both an ADN
and a BSN level. We all learn the basic guidelines that nursing is built upon. The scope of
practice can vary from one area to another within the nursing profession depending on
policies and education. An example of this can be made when considering the varying
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areas of nursing. I am a critical care nurse, so my scope of practice is different than a nurse who
only works on a medical surgical unit. I have training with equipment and medications that
medical surgical nurses do not have. In this way, the nursing scope of practice can vary from one
area of specialty to the next, but is fundamentally the same across the continuum. This difference
in scope of practice can be illustrated when considering ANAs standards of practice.
Standard number 8: Education
The educational standard of nursing practice, as cited in White & OSullivan (2012),
states, the registered nurse attains knowledge and competence that reflects current practice (pg.
123). As stated previously, nursing is an ever evolving profession. It changes and expands to
meet the needs of the people we serve. As nurses, we are continual learners. Our education never
ends. This is accomplished through many different areas such as through continuing education
credits (CEUs), nursing conferences, evidence-based practice and higher education to name a
few areas of education. Education is needed to maintain a current level of practice based on
research, theory and the ever changing population (White & OSullivan, 2012).
I personally continue to meet this standard by completing CEUs, obtaining a CCRN
certification, and continuing my education to become a BSN prepared nurse. A BSN prepared
nurse is held to a higher standard than an ADN nurse. BSN nurses can become clinical
instructors and educate other nurses, they can step into supervisor or manager roles and
potentially earn a higher pay than an ADN nurse. The opportunities available to a nurse will
increase with higher education (Chitty & Black, 2011).
Standard number 12: Leadership
The ANA states, The registered nurse demonstrates leadership in the professional
practice setting and the profession (as cited in White & OSullivan, 2012, pg. 163). Leadership
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is practiced by all nurses, at all levels of nursing and in all areas of nursing practice. It is not
necessarily a management only type of practice (White & OSullivan, 2012). Leadership is
provided through mentorship, supervision, and to provide direction and guidance to fellow co-
workers (White & OSullivan, 2012). In my nursing practice I practice leadership every day. I
am a resource for fellow nurses and assistive personnel. I also practice leadership when I am the
shift charge nurse. As the charge nurse on my unit, my responsibilities include: being the code
team leader, managing the unit and staffing, assisting co-workers as needed and being a resource
person for my peers. This role is something that I enjoy. I like to help and educate my peers
when I can.
Transition
The BSN degree may seem like just a few more classes to take, however, studies show
that nurses who are BSN prepared are safer practitioners who present with a deeper level of
professionalism (Orsolini-Hain, n.d.). As stated previously, nursing is a profession and requires a
higher level of education. An argument exists among some professionals concerning the
differences in educational levels among nursing as a whole (Chitty & Black, 2011). The ANA is
one such group that calls for BSN prepared nurses as an entry level and the exclusion of an ADN
degree altogether (Orsolini-Hain, n.d.). Many employers are moving toward the preference of a
BSN prepared nurse compared to an ADN nurse. My employer is an example of an institution
that is requiring nurses to return to school and obtain a BSN degree within 10 years of their hire
date. The reason my employer is moving in this direction is to improve patient safety,
satisfaction, to maintain magnet status and meet complex patient needs.
The Quality and Safety Education for Nurses [QSEN] was developed to prepare nurses
with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality
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and safety of the healthcare systems in which they work (QSEN, 2014). QSEN (2014), states
that KSAs can be defined through concepts such as: patient-centered care, teamwork and
collaboration, evidence based practice, quality improvement, safety and informatics. According
to QSEN (2014), the definition of patient-centered care is to Recognize the patient or designee
as the source of control and full partner in providing compassionate and coordinated care based
on respect for patients preferences, values, and needs. Teamwork and Collaboration means that
nurses, function effectively within nursing and inter-professional teams, fostering open
communication, mutual respect, and shared decision-making to achieve quality patient care
(QSEN, 2014). Evidence based practice helps the BSN prepared nurse Integrate best current
evidence with clinical expertise and patient/family preferences and values for delivery of optimal
health care (QSEN, 2014). QSEN (2014) states that quality improvement helps the nurse, Use
data to monitor the outcomes of care processes and use improvement methods to design and test
changes to continuously improve the quality and safety of health care systems. According to
QSEN (2014), a BSN prepared nurse improves patient safety and minimizes risk of harm to
patients and providers through both system effectiveness and individual performance and BSN
prepared nurses, use information and technology to communicate, manage knowledge, mitigate
error, and support decision making (QSEN, 2014). All of these components define knowledge,
skills and attitude developments that improve the quality and safety of the healthcare system
(QSEN, 2014). The BSN prepared nurse has refined knowledge, skills and attitudes and growth
in these areas can be tracked throughout the BSN program.
Knowledge: Standard 8 (Education)
I graduated with honors in 2011 from Baker College of Cadillac. I graduated with an
ADN in nursing. I started my pre-requisite classes in the fall of 2008 and was accepted into the
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nursing program in the spring of 2010. Entry into this program is based on a combination of pre-
requisite grades and an admission examination that tests general knowledge. Bakers nursing
program is a rigorous, intensive and accelerated 50 week program. This program not only taught
me how to be a nurse, but general nursing skills and knowledge needed to be a safe and
competent nurse upon graduation. I personally feel that I had excellent nursing instruction and
experiences in my ADN program, but my nursing education was really built upon during my first
few years of actual nursing practice.
Since graduation from my ADN program I have continued to expand my nursing
knowledge through education. I have completed a program called The Essential of Critical Care
Orientation [ECCO]. This program is offered by employers through the American Association of
Critical Care Nurses [AACN] and teaches the basics of critical care nursing. It also helps prepare
nurses for the Critical Care Registered Nurse [CCRN] exam that certifies nurses in critical care.
This certification is also an AACN initiative. My knowledge base has and continues to grow
everyday through continued education, experience and skills acquisition.
Skills: Standard 5 (Implementation)
I started my nursing career working at Mercy Hospital of Cadillac in the Critical Care
Services unit. This unit consists of a six bed Intensive Care Unit [ICU] and fifteen ICU step
down beds. I learned a lot about nursing and the care of critically ill adults both in the ICU and
the step down unit. I learned how to manage multiple patients, ventilators, medication drips, and
basic electrocardiogram interpretation [EKG or ECG]. This hospital gave me an excellent
foundation to my nursing career, but I decided to expand my knowledge base further and gain
more experience by moving to Nashville TN. There I took a job working in the Critical Care
Unit (CCU). This unit was a sixteen bed ICU that encompassed a variety of critical care patients.
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The illnesses and services provided were vaster than I had previously experienced. In addition to
my previous experience I learned more about cardiac patients and interventional cardiology. I
gained more experience with managing ventilated patients, surgical ICU patients, medical ICU
patients, and cardiac patients. I began to move from a novice ADN prepared nurse toward being
a proficient ADN nurse. I wanted to continue to expand my knowledge and experience so I took
my current job at Munson Medical Center in the Coronary Critical Care Unit (CCU). My scope
of practice changed again, and I added more skills and knowledge. Here, I have learned how to
manage therapeutic hypothermia patients, more intensive cardiac interventional cases,
management of balloon pumps, left ventricular assist devices, management of Swan Ganz
catheters and more intensive hemodynamic monitoring.
In addition to my constant learning and skills acquisition, I have also become certified in
my area of practice by successfully passing the CCRN exam (critical care registered nurse). I
have also become a mentor, preceptor, and a fill in charge nurse for my unit. It is because of this
continued growth and a desire to continue on to graduate school that I decided to return to school
and work toward the BSN degree. It is also required by my employer to become BSN prepared
and recommended if I want to become more than a fill in charge nurse.
Attitude: Standard 13 (Collaboration)
In my practice I collaborate with all the members of the healthcare team. I personally
think everyone has something to offer and that I can learn something from everyone no matter
whom they are or what part of the healthcare team they belong to. Attitude can effect
collaboration among members of the healthcare team. A poor attitude can have a negative impact
on the patient and their safety. Members of the healthcare team collaborate to ensure continuity
of care and patient safety through shared knowledge, skills and attitudes. A BSN prepared nurse
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conducts themselves in a professional manor at all times and respects members of the healthcare
team as a professional. BSN prepared nurses have a deeper understanding of the importance of
collaboration as it pertains to the QSEN principles stated above and integrate these attitudes into
their practice.
Significance and Conclusion
Nursing is a profession held accountable by standards and a nursing scope of practice. An
ADN nurse is held to the same standards of practice as any other nurse: BSN, MSN or advance
practice, however, the scope of practice differs from ADN to BSN nurses. The scope of nursing
practice also differs from one area of nursing to the next; however, the nursing process is utilized
in all areas of nursing. My scope of practice is different from a medical-surgical nurse or an
operating room nurse. My area of nursing is highly specialized in critical care and interventional
cardiology and I strive to continually grow through education.
The BSN degree will enable me to step forward into a higher level of nursing by opening
up opportunities that are not available to ADN nurses. A BSN degree will allow me to provide
quality care that is shown to be safer and follows QSEN initiatives (Chitty & Black, 2011). A
BSN degree is the gateway to graduate school, which is my ultimate goal. I am undecided at this
time what kind of advanced practice nurse I will become, but I know that is the path I am headed
toward. The skills, knowledge and experiences that I have gained and continue to gain through
education will facilitate a transition in the BSN prepared nurses role and eventually will pave the
way toward advanced practice nursing. I will and am becoming a better, safer and more
knowledgeable nurse as I transition into the role of the BSN prepared nurse.
The purpose of this paper was to reflect and discuss my practice transition plan from an
ADN nurse to a BSN prepared nurse. My plan is to continue to develop professionally through
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continued education as I transition from an ADN nurse to a BSN nurse. I will have a deeper
understanding of nursing as a profession and utilize critical thinking to become the best nurse I
can be. I will utilize my education to educate other nurses as the opportunity arises and will have
a deeper understanding of what it means to be a leader through professional development. This
paper discussed nursing as a profession, my current scope of practice, standards of nursing
practice and the significance of higher education in nursing as it pertains to my individual goals
and the profession of nursing as a whole.
















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References
Chitty, K.K., & Black, B. P. (2011). Professional Nursing: Concepts & Challenges. Maryland
Heights: Saunders Elsevier.
Ferris State University. (2014). NURS 324 Transition into professional practice [course
syllabus]. Retrieved from Ferris State University My FSU course page
https://fsulearn.ferris.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2F
webapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_1021
3_1%26url%3D
Graduate KSAs (2014). QSEN: Competencies. Quality and Safety Education for Nurses.
Retrieved April 20, 2014, from http://qsen.org/competencies/graduate-ksas/
Orsolini-Hain, L. (n.d.). Whats all the fuss? Working towards a baccalaureate or graduate
degree in nursing. National Student Nurses Association [NSNA]. Retrieved April 20,
2014, from http://www.nsna.org/careercenter/fuss.aspx
White, K.M., & OSullivan, A. (Eds.). (2012). The Essential Guide to Nursing Practice:
Applying ANAs Scope and Standards in Practice and Education. Silver Spring:
Nursesbooks.org.