Running head: RN TO BSN TRANSITION PLAN

RN to BSN Nursing Practice Transition Plan

Ken McIntyre
Ferris State University

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Abstract

This paper is a summarization of some of the factors come together that define the nursing
profession and how these factors define my current practice as an Associates degree nursing
(ADN) prepared registered nurse (RN), and how these aspects will contribute to my development
into a professional, Bachelor of Science Nursing (BSN) prepared RN. I will discuss some of
my thoughts on how education and ethics plays a role in nursing. I will also examine how a
professional BSN prepared RN can make a significant contribution to the health care system.
This paper concludes with how I will meet the challenges of becoming a BSN prepared RN.
Keywords: Associates Degree, ADN, Bachelor of Science nursing, BSN, education,
ethics, scope and standards of practice, professional identity.

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RN to BSN Nursing Practice Transition Plan

The purpose of this paper is to help me to define my professional identity, my scope of

practice, and outline how I will transition into a BSN role using the standards put in place by the
American Nurses Association (ANA). In this paper I will consider specific standards of nursing
practice as outlined by the ANA, and how these standards apply to reaching my objectives within
the timeframe I established for myself. I will summarize the significance of these standards in
relationship to becoming a professional nurse.
Professional Identity
Black (2014) states the [educational] goal of socialization is the development of
professionalism (p. 118). My interpretation of Blacks statement is that by assembling a group
of people together with the same goals, and by providing that group with the same training,
education, and set of codified ethics or principles, you can assimilate that group of people into an
established profession, or possibly create a new profession. One of sociologist Abraham
Flexners criteria of a profession is that it Has a strong internal organization of members and a
well-developed group consciousness (as cited in Black, 2014, p. 53.). Belonging to a likeminded group helps define an individuals professional identity.
The start of my professional identity as a nurse began in the Fall of 2010 when I began
taking prerequisite courses for the associate of applied science registered nursing [program]
(ADN) at Montcalm Community College (MCC). In addition to the prerequisite courses I took
at MCC, I also took classes that would transfer to Ferris State Universitys (FSU) RN to BSN
program. From the beginning of my education in nursing I knew that I would need a BSN in
order to be more competitive in the job market, and I would need a BSN if I eventually decided
to further my education to become a Nurse Practitioner.

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MCC has a laddered approach to the registered nursing program, therefore after the
first year of the nursing program, I was able to sit for the Licensed Practical Nurse (LPN)
National Council Licensure Examination (NCLEX). I received my LPN license on June 26,
2014 and began my nursing career in the secure dementia unit at Metron of Belding, a skilled
nursing home in Belding, Michigan. Less than a year later, I graduated from the ADN program
from MCC on May 1, 2015, took the RN NCLEX in July 2015, and subsequently received my
RN license on July 23, 2015.
I acknowledged that I needed practical experience and working in long-term care was a
viable option for a new LPN. Working at Metron has given me confidence and a set of skills that
were not taught in the nursing program. Once I was hired as an LPN I was given 15 days of
orientation, and following orientation I was immediately placed in the position of charge nurse.
My position as charge nurse made me responsible for 4 other staff and between 50 to 52
residents. After I obtained my RN license, with the exception of being able to pronounce the
death of a resident, my responsibilities did not change.
To become a professional nurse and pursue my goals, I realized from the beginning of
this endeavor I had to stay in school and acquire my Bachelor of Science in Nursing (BSN). With
my education I am continuing to develop my professional identity, and I anticipate modifying
my identity as my career in nursing progresses.
Scope of Practice
The ANA outlines the measures, actions, and methods that comprehensively describe
nearly every aspect of the practice of nursing (White & OSullivan, 2012, p. 11). In addition,
due to the potential harm of a person that can result from untrained or incompetent nursing, all
states have enacted rules and regulations that govern licensure of nurses. A nurses scope of

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practice is limited by their license as defined by law and includes specific educational
requirements, clinical experience, and specific demonstrated competencies. As a licensed RN in
the State of Michigan, I have met these requirements.
Education
The registered nurse attains knowledge and competence that reflects current nursing
practices (White & OSullivan, 2012, p. 123) is Standard 8 in the American Nurses Association
book The Essential Guide to Nursing Practice. Education in nursing is ever-changing due to
advancements in technology, new discoveries and information as a result of research, and the
changing scope of practice for nurses.
To attain knowledge and competence that reflects current nursing practice, the nurse must
be curious and not only seek out continuing education, but be inquisitive and research
information that may help provide a better outcome for their patient.
One of Abraham Flexners criteria for determining a profession stated that it is practical,
in addition to being theoretical (as cited in Black, 2014, p. 53). Prior to the nursing program,
working in the health care field is a new experience for me. The only preparation I had in the
area of health care was basic cardiopulmonary resuscitation (CPR) and instruction on how to use
an automated external defibrillators (AED). The ADN program gave me a rudimentary set of
nursing skills and a basic education of body systems, disease, and pharmacology that allowed me
to safely practice. In these examples I had the theory, or education, but not the practical
application of that theory that knowledge (awareness, familiarity, and understanding) I believe
Flexner was referring to in this particular statement.

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Adopting and expanding Flexners ideas, the ANA puts forth the concept of education as
an obligatory necessity in what it takes to practice nursing effectively and safely (White &
OSullivan, 2012).
Education, especially current education, is one of the fundamental building blocks of
knowledge and the development of a professional nurse. As I mentioned before, the ADN
program gave me a fundamental set of nursing skills and a basic education of body systems,
disease, and pharmacology. The education provided in the ADN program allows me to practice
safely while I developed my education and an awareness, familiarity, and understanding of this
commendable profession.
In the nursing program basic nursing skills such as obtaining a blood pressure, pulse,
tracheotomy care, and several other skills were taught. My classmates and I had to memorize the
steps and perform the procedure on a manikin to the satisfaction of our instructor. Regrettably,
the skill required to perform a procedure on an emotionless manikin does not always translate
into the skill needed to perform the procedure on a human, and it does not provide the subtle
insights needed to be fully aware of all the intricacies and issues that may occur during the actual
process.
Tangible skills require real-world experience. As I continue my practice with my current
employer and perform the same tasks repeatedly, I become more competent with my skills. It
becomes easier to care for people using my nursing judgement as opposed to caring for people
following a written set of guidelines. As I continue my education and learn new techniques or
procedures, I become more knowledgeable and I am able to build on previous experiences to
become a better nurse.

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With knowledge comes a certain level of maturity and self-confidence that will govern a
persons tactics in any given situation. From working in a prison for 25 years I have developed
an approach that allows me to accomplish a task despite unpleasant outside influences. An
unruly patient or resident using profanity and threats is quickly assessed as to the threat they
actually pose and are approached accordingly.
It is extremely difficult to separate skills, knowledge, and attitude when attempting to
define education because, at its essence, education is simply learning. In my current scope of
practice, I continue to learn and increase my knowledge while I incorporate previous education
and learning experiences. Previous and current classroom education must also be supplemented
with research and a genuine curiosity to increase my understanding beyond what is formally
taught.
Ethics
A moral code of conduct, beliefs, principles, philosophies, and integrity are some of the
pieces that make up the characteristics of ethics. They [written philosophical statements] are
intended to guide the practice of nurses employed in that setting (Black, 2014, p. 262). Despite
an institution having a written philosophical statement, ultimately our beliefs and values our
ethics are what will guide our actions.
Since ethics vary among cultures and people, it is important for a profession to define its
own set of values in order to provide a clear and articulate standard of conduct that represents the
profession as a whole. These ethics must represent societys aspired to norms and be amicable to
those in the profession. Ethics also includes an educational aspect. It would be difficult to
practice ethically knowingly using outdated information and procedures.

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Ethics enhances trust. Practicing ethically within a written guideline communicates to

your patient that you have their best interest in mind and promotes a trusting relationship.
Practicing ethically also enhances peer to peer relationships due to promoting trust and
professionalism. In my current practice I always strive to act ethically not only because of deepseated moral values, but to project professionalism to my patients, peers, and supervisors. The
ANA also defines ethics. ANA Standard 7. Ethics. The registered nurse practices ethically
(ANA, 2014, p. 113). The ANA points out that morals and ethics are often used interchangeably
(ANA, 2014, p. 114). I found this is often the case in my current practice.
The implication of education and ethics in nursing is stunning. It is important for the
nurse to understand societies values change over time, and quite possibly the nurses values may
change over time also. In my own practice I have found my core values have not changed, but I
have become more accepting and understanding of others values. It is vital for nurses to
integrate their own values into the profession without impinging on the values of others. It is
also important for the nurse to always act within the guidelines established by the nursing
profession in order to maintain an ongoing trust with patients and colleagues.
Baccalaureate Role
Knowledge
The nursing program that I attended at MCC is an example of the eighth ANA Standard
of Practice, Education. The ANA defines this standard as The registered nurse attains
knowledge and competence that reflects current nursing practice (White & OSullivan, 2012, p.
123). In the ADN program at MCC I learned the basics in order to pass the National Council
Licensure Examination (NCLEX) exam and practice safely while I continued to learn and
develop a knowledge-base that I could draw from while I practice.

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I believe knowledge is much more than education; it is the application of an education

that results in something that is much more than the sum of its parts. Knowledge is the
cumulation of education, learned skills, and the ability to connect effectively with a patient or
resident using education and skills to provide the care needed. This knowledge helps to produce
what nurse theorist Ida Jean Orlando-Pelletier termed good nursing, which she determined
occurred If the nurse stated [to a patient] a perception, thought, or feeling, and asked a question
about the same perception, thought, or feeling, the nurse produced the good nursing (Fitne,
n.d.). Interaction with a patient or resident is key to increasing knowledge.
Standard Nine of the ANA Standards of Practice, Evidence-Based Practice and Research,
is defined as The registered nurse integrates evidence and research findings into practice
(White & OSullivan, 2012, p. 133). One aspect of the education provided in ADN program at
MCC was evidenced-based practice. I am aware and in total agreement that evidence-based
practice based on expert research is vital in producing the best outcomes possible for residents
and patients.
Skills
Sir William Osler once stated, The good physician treats the disease; the great physician
treats the patient who has the disease (Centor, 2007, p. 59). I believe the same concept should
apply to nursing, particularly since nursing better serves the patient when it is practiced as a
holistic profession. The skills that I learned in the nursing program and on-the-job provide better
outcomes for my residents when I treat both the resident and the disease.
Many skills are required of the nurse in order to be effective in providing care. These
skills include assessment of the patient, developing a nursing diagnosis, patient or resident

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education, effective communication, procedural skills, and delegation of duties all of which are
part of the ANAs Scope and Standards of Practice.
Assessment is the first ANAs Standard of Practice and is defined as The registered
nurse collects comprehensive data pertinent to the healthcare consumers health and/or situation
(White & OSullivan, 2012, p. 35). When assessing a resident, the physical data I collect
includes an assessment of their skin, vital signs, any wounds, and in some cases, their blood
glucose level. Non-physical data I collect is their level of cognition, pain level, and their
education needs. With this information, I am better able to address my residents needs and meet
their individual care plans.
The ANAs second Standard of Practice is Diagnosis and is defined as The registered
nurse analyzes the assessment data to determine the diagnosis or issue (White & OSullivan,
2012, p. 45). The ability to recognize a medical issue is vital to the health and safety of a
resident, and it is a skill that is essential for a nurse to have and cultivate.
Outcomes Identification is the ANAs third Standard of Practice which is defined as The
registered nurse identifies expected outcomes for a plan individualized to the healthcare
consumer or situation, and the fourth Standard of Practice is Planning which the ANA defines
as The registered nurse develops a plan that prescribes strategies and alternative to attain
expected outcomes (White & OSullivan, 2012, p. 63 and p. 75). Once the desired or expected
outcome is determined, it is important that the nurse develops primary plans and contingency
plans in order to attain the desired outcomes. In long-term care where I work, care plans have
been developed but are subject to modification as the residents physical and mental health
condition changes.

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As a residents physical and mental health changes, it is important to put into practice
ANA standard fifteen, Resource Utilization. The ANA defines Resource Utilization as The
registered nurse utilizes appropriate resources to plan and provide nursing services that are safe,
effective, and financially responsible (White & OSullivan, 2012, p. 193). With long-term care
facilities being mostly funded and highly regulated by the government, documentation is vital to
making use of available and potential resources. Without proper documentation, medications
can be discontinued or a reduction in payments for the resident can be reduced.
Implementation is standard five of the ANA Standard of Practice, and is defined as The
registered nurse implements the identified plan and is divided into four subsections: Standard
5A Coordination of Care, Standard 5B Health Teaching and Health Promotion, Standard 5C
Consultation, and Standard 5D Prescriptive Authority and Treatment (White & OSullivan,
2012, 87). In my current nursing practice as an ADN registered nurse in long-term care, I put
into practice each of these standards to some degree each day.
The sixth ANA Standard of Practice, Evaluation, is defined as The registered nurse
evaluates progress toward attainment of outcomes (White & OSullivan, 2012, p. 105). After
synthesizing the ANA Standards of Assessment, Diagnosis, Outcomes Identification, Planning,
Implementation, and Communication into care for a resident or patient, Evaluation is key to
providing a measureable criterion of the interventions provided.
Attitude
Projecting professionalism, being respectful, considerate, and acting ethically is
extremely important to the manner in which I portray to myself to my residents, co-workers, and
supervisors. ANA Standard Thirteen, Collaboration, is defined as The registered nurse
collaborates with the healthcare consumers, family, and others in the conduct of the nursing

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practice (White & OSullivan, 2012, p. 173). I believe professionalism is not possible without
collaboration with the resident/patient, family members, or other disciplines involved in the care
of the resident or patient.
Attitude is a reflection of the nurses ethics. ANA Standard Seven, Ethics, is defined as
The registered nurse practices ethically (White & OSullivan, 2012, p. 113). The ANA also
has a separate, ethical standard of professional practice known as the Code of Ethics for Nurses.
White & OSullivan further expand on this code of ethics to point out, The Code of Ethics for
Nurses is the professions nonnegotiable standard and framework (2012, p. 119). Using
critical-thinking, assessment, and rational thought, I am able to identify ethical predicaments and
take appropriate action to address the dilemma.
Significance and Conclusion
Archaic regulatory obstacles impede providing health care to the population. The
professional, BSN prepared nurse should take the opportunity to promote substantial changes in
these obstacles by educating policy-makers and the public concerning scope-of-practice
limitations. Advanced practice registered nurses should be able to practice to the full extent of
their education and training (Institute of Medicine (U.S.) & Robert Wood Johnson Foundation,
2011, p. 278). White & OSullivan state that all nurses should practice to the full extent of their
scope of practice (2014, p. 12), however, I believe all nurses should be allowed to practice to
the full extent of their education, skills, and training.
Nurses are an integral part of the American health care system. Medical technology
advances at a rapid pace and nurses are generally the recipients of this new technology. The
professional nurse can play an integral role in evaluating new software by how it impacts patient

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care, evaluating new medical procedures by how it improves patient outcomes, and new medical
equipment by how it improves patients lives.
Continuing education is not only required, but it is necessary for the safety of patients.
New drugs and medical devices are constantly evaluated and new information may come to light
that can significantly affect the health of a patient. For nurses to make a positive, substantial
impact on the lives of our patients every day, and in order to continue to improve our patients
lives, it is clear our education and our involvement needs to be on-going.
As I advance into the BSN role I realize that I will be held to a higher professional
standard and my judgment will be scrutinized much more than when I was an LPN or an ADN
prepared RN. I accept the fact that I will need to be capable to applying my knowledge in a
manner that meets the professional standards of performance, and I will be expected to provide
leadership in many areas of my practice regardless of where I am employed. Continuing my
education, refining my professional identity, and constantly evaluating my performance will help
me meet these expectations.

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References

Black, B. (2014). Nursing's Pathway to Professionalism. In Professional nursing: Concepts &

Challenges (Seventh ed.). St. Louis, Missouri: Elsevier Saunders.
Centor, R. M. (2007). To be a great physician, you must understand the whole story. Medscape
General Medicine, 9(1), 59. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924990/
Fitne (Producer). (n.d.). The Nurse Theorists, Portraits of Excellence, Volume 1 - Ida Orlando
[MP4 Video file]. Available from https://www.fitne.net/products.jsp
Institute of Medicine (U.S.), & Robert Wood Johnson Foundation. (2011). The future of nursing:
Leading change, advancing health. Washington, DC: National Academies Press.
White, K. M., & O'Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA's
scope and standards in practice and education. Silver Spring, MD: American Nurses
Association.