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Reflection Paper
Sarah Bricker
Ferris State University










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Reflection Paper
According to Borrello, a practice transition plan documents the goals, required
skill(s) and competencies, along with the objectives a BSN prepared nurse will need to
accomplish in order to support continuous improvement and professional
development(2014). While this is a formidable goal, we will begin by looking at
nursing as a profession, the scope of nursing practice, and several practice standards as
well as highlighting some of the knowledge, skills, and attitudes necessary for nurses at
the Bachelors level. We will conclude with a short discussion on why these things are
significant.
Professional Identity
Many people refer to themselves or others as professionals and we usually do so
without a great deal of thought. We could define the word profession in numerous ways,
both technical and informal, but for our purposes we need a well thought out definition.
Black quoted Flexner who provides such a definition. Flexner described a profession as
having the following six characteristics:
1. Is basically intellectualand is accompanied by a high degree of
individual responsibility
2. Is based on a body of knowledge that can be learned and is developed
and refined through research
3. Is practical, in addition to being theoretical
4. Can be taught through a process of highly specialized professional
education
5. Has a strong internal organization of members and a well-developed
group consciousness
6. Has practitioners who are motivated by altruismand who are
responsive to public interests(2014, p. 53)

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With such specific criteria, many of the jobs or people that we might have otherwise
considered professionals are ruled out. Do we, as nurses, fit into a profession? Let us
examine nursing as a whole against this list that Flexner has suggested.
Nursing requires a broad base of knowledge, requiring very specialized education,
which addresses not only Flexners point about education but also about a profession
being highly intellectual. However, for all of this knowledge, nursing would be nothing
if not practical. Nursing is very hands-on and focused on and motivated by the needs of
others. The care that nurses provide is based on research, which is constantly changing
as we learn more and more. Lastly, nursing has organized itself with a governing body
and many members see themselves as part of a larger group of nurses with a rich
history.
We can see from our discussion that nursing does indeed meet Flexners six
criteria of a profession, but why is this important? Is it necessary to make any distinction
between nursing as a profession versus an occupation? Black (2014) clarified this well
by saying, A profession is different from an occupation in at least two major ways
preparation and commitment.(p. 54). Someone can decide to be a waitress or a janitor
and, after a week or two of training, do the job well. Waitressing, while requiring some
skills, can be done with little preparation and one may move on to another job just as
quickly. Nursing however, does require a high degree of preparation and commitment,
not only during the training process but throughout the course of the career.
Scope of Practice
We have already talked about how nursing fits in to the framework of a
profession. One of the ways it does this is by nurses being individually responsible for
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their actions and also using a professional organization as a primary point of
reference(Black, 2014, p. 53). The professional organization for nurses in this country
is the American Nurses Association (ANA). According to the ANA (2012), 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(p. 11).
The scope of nursing is broad and there are many standards set by the ANA but we will
focus on just two of the standards in the following section.
Evidence-Based Practice
The first standard that we will look at is evidence-based practice (EBP). EBP
seems like it has become somewhat of a catch phrase lately, and yet it is critical to our
practice. The ANA cites evidence-based practice as the use of
a problem-solving approach to clinical decision-making within a
healthcare organization that integrates the best available scientific
evidence with the best available experientialevidence, considers internal
and external influences on practice, and encourages critical thinking in the
judicious application of such evidence to the care of thepatient (2012, p.
133).

In using evidence based practice we do not simply carry out random interventions
because it seems like a good idea or someone told us to. For example, if the
research shows that good hand washing decreases the rate of disease transmission,
then we would seek to increase the rate of hand washing compliance.
EBP ties back into Flexners standard that professions should be based on
a body of knowledge that can be learned and is developed and refined through
research(Black, 2014, p. 53). The more research is done and analyzed, the more
knowledge we have and are able to more adequately care for our patients. It is
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also part of the ANAs standard that EBP be included in nursing education at all
degree levels (ANA, 2012, p. 135).
Quality of Practice
The Institute of Medicine (IOM) has established core competencies for all
healthcare professionals to ensure quality outcomes. The ANA (2012) lists the following
competencies set by the IOM:
Provide patient-centered care that encompasses the uniqueness of each
patient. Work on interdisciplinary teams to integrate care, thereby
ensuring that care is continuous and reliable. Use evidence-based practice
that integrates research evidence with clinical expertise and patient
preference. Apply quality improvement principles and strategies to
change patient care processes and systems of care. Use informatics to
communicate and support decision-making to reduce errors(p. 146).

The QSEN Institute has gone a step further and developed educational standards for the
knowledge, skills, and attitudes necessary for nurses based off of the IOM competencies
(QSEN).
That all of these standards are in place is yet another proof that nursing is
established as a profession. Basing our practice on current research and evidence helps
us to provide the right care. However, we are responsible as nurses not just for
implementing the appropriate interventions but also for doing so in a way that is safe and
provides quality care (ANA, 2012, p. 145).
Transition
Evidence based practice and quality of care are just two of the sixteen
performance standards set forth by the American Nurses Association (ANA). These
standards, as we have already mentioned, help to define the nurses scope of practice. As
the ANA explains,
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Standards are authoritative statements by which the nursing profession
describes the responsibilities for which its practitioners are accountable.
Standards reflect the values and priorities of the profession and provide
both a direction for professional nursing practice and a framework for the
evaluation of this practice (2012, p. 24).

These nursing standards apply to licensed nurses at all levels, from those with an
Associates Degree level education all the way to those who are advanced practice nurses
or have additional certifications in a particular specialty.
If the standards set forth by the ANA for nursing practice apply to nurses at all
levels, is there any distinction or differentiation between a nurse prepared as an ADN and
one prepared as a BSN? According to Borrello, when you graduate with a Bachelor level
degree you may actually stay in the same position, however, you are changed by the
experience of new knowledge (2014). In the next section we will be looking at how this
new knowledge may impact the thinking and practice of the BSN prepared nurse. First
however, we will briefly review the knowledge, skills, and attitudes set for by QSEN as
this will aid us in our discussion.
In the Quality of Practice section we mentioned the competencies set forth from
the IOM and the educational standards created by the QSEN Institute. According to
QSEN,
The overall goal for the Quality and Safety Education for Nurses (QSEN)
project is to meet the challenge of preparing future nurses who will have
the knowledge, skills and attitudes (KSAs) necessary to continuously
improve the quality and safety of the healthcare systems within which they
work(QSEN).

The focus is in the areas of patient-centered care, teamwork and collaboration, evidence-
based practice, quality improvement, safety, and informatics, with KSAs for each of
these. Many of these areas of educational emphasis overlap with the professional
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practice standards of the ANA. As we go on to give three examples showing areas of
role transition we will be referring to both the practice standards and the KSAs.
Knowledge
As nurses progresses in their education they gain an ever-widening base of
knowledge. The presence of such knowledge is in fact one of Flexners criteria for a
profession as mentioned previously (Black, 2014, p. 53). The ANA states that nursing
students should be introduced to the concept of standards of practice and the role of the
ANA as the professional organization that is for nursing and develops the
standards(2012, p. 27). The knowledge that an ADN student may have of practice
standards and governing bodies is much more cursory and superficial.
BSN students will spend time looking at these topics more closely and will gain
a higher degree of working knowledge about the scope, standards, and governing bodies.
The expectation of the ANA is that there should be a discussion of the application of the
scope of practice, standards, and code of ethics in the major practice areas included in all
nursing education programs(2012, p. 27). Such a discussion is not unlike the topic of
this paper or the subjects of discussion in NURS 324. BSN students should be able to
more clearly articulate the rationale for the practice standards as well as the impact of
those standards on their practice.
Skills
The skill that I have chosen to give an example of is that of assessment.
Assessment is not only the first step of the nursing process but also one of the
professional practice standards established by the ANA (ANA, 2012, p. 35). According
to QSEN all nurses should have the skills necessary to assess the presence and extent of
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pain, physical and emotional comfort, level of decisional conflict, and personal level of
communication skills, among others(QSEN). All nurses should be able to assess specific
patient situations as well as available resources and any ethical concerns (ANA, 2012, p.
41-42). While still able to accomplish all of those areas of assessment, the nurse who has
furthered her education should also be able to identify contextual and etiological
assessment datanecessary to formulate differential diagnosis (ANA, 20120, p. 42).
The assessment should take into account national standards and a broader range of
available information.
Attitudes
As BSN prepared nurses practice availing themselves to a great deal of
information and coupling this with their careful assessment they should do so with an
attitude of life long learning. Such an attitude would serve them well as they increase
their knowledge in reading and critiquing research so they can identify new knowledge
appropriately applicable to the practice setting (ANA, 2012, p. 147). Keeping up on the
latest research and practice will enable the BSN prepared nurse to improve the quality of
their practice. The emphasis on quality is not only an ANA practice standard but is also
an area of education in QSEN, as has already been mentioned. Attitudes that would fit
with this area of quality would include appreciating that continuous quality
improvement is an essential part of the daily work of all health professionals and valuing
own and others contributions to outcomes of care in local care settings (QSEN).
Significance and Conclusion
In this paper so far we have discussed what a profession is and how nursing meets
those criteria, making it more than just an occupation. We have also discussed a
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professional scope of practice, including two of the ANA practice standards. Moreover
we have reviewed the practice standards in relationship to the areas of educational
emphasis set forth by QSEN and how these relate to the BSN prepared nurse in the areas
of knowledge, skills, and attitudes. What then is the significance of all this?
According to Black (2014), Registered Nurses are the largest group of health
care providers in the United States(p.2). As such we are in many ways the face of
healthcare. Nurses are at the bedside and are the last line of defense for the patient. If
nurses are not committed to quality care, excellence, and current standards both our
patients and our profession will suffer.
In the present time, healthcare is changing at an alarming rate. Nursing as a
profession must continually adapt in order to keep current with these changes. Because
of this the ANA has established that nurses have continuing education to maintain the
adequate skills and knowledge to provide quality patient care (ANA, 2012, p. 123). In so
doing we can maintain our professionalism and effectively train up the next generation of
nurses.

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References
American Nurses Association. (2012). The essential guide to nursing practice. Silver
Spring, MD: Nursesbooks.org.
Black, B. P. (2014). Professional nursing (7th ed.). St. Louis, MO: Elsevier.
Borrello, S. (2014). NURS 324: Transition into professional nursing course syllabus.
Unpublished manuscript.
QSEN Institute. (n.d.). Competencies. Retrieved January 24, 2014, from
http://qsen.org/competencies/