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Running head: TRANSITIONING INTO THE BSN ROLE

Transitioning into the Bachelor of Science in Nursing Role

Jennifer Housel

Ferris State University

1

TRANSITIONING INTO THE BSN ROLE 2

Abstract

This paper identifies the scope of practice for the Associate degree-nurse and is a reflection of

everyday nursing experiences. Identification of the characteristics of a profession provides a

definition for professional identity. After identifying the characteristics of a profession, the

importance of professional status for nurses is examined. The following sections detail how the

scope of practice ties with professional characteristics. Several examples from practice are used

to discuss specific standards of practice, including evidence-based practice and research, and

quality of practice. The challenge of transitioning to a new level of nursing practice is addressed.

These challenges include the many changes that are made in practice due to the experience of

new knowledge, skills, and attitudes. In conclusion, lifelong learning is significant because it

enables nurses to become leaders, which improves quality and safety in healthcare.


Transitioning into the Bachelor of Science in Nursing Role

The purpose of this paper is to identify the Associate degree-nurses’ current scope of

practice. Since new graduate nurses come from many different educational backgrounds, and

work in various areas of healthcare, their experiences are unique. It is important for nurses to

look back on everyday experiences in order to reflect critically on current practice. Critical

reflection helps the nurse grow intellectually while education is continued in pursuit of a higher

degree. As the nurse transitions into the Bachelor of Science in Nursing (BSN) role, this paper

may serve as a practice transition plan.

Professional Identity

A nurse that has just graduated from a community college is eager to gain employment

and start their career as a professional. Personally, gaining employment as a graduate nurse in a

labor and delivery position was very exciting. New graduate nurses spend the majority of the

first year learning how to fit into the profession. Professional status is something that can be

continuously improved upon. After graduating and gaining experience, nurses start to expand

their knowledge, skills, and attitudes in order to form a professional identity. Knowledge is an

important characteristic of a profession and will be described first.

Before practicing in a clinical setting, nurses first spend a large amount of time forming

a foundation of knowledge. “Nurses expect to develop and maintain current knowledge, skill,

and abilities through formal academic programs and professional development programs” (White

& O’Sullivan, 2012, p.7). Flexner has recognized the importance of formal academic programs.

Flexner was a sociologist that published a list of professional criteria. According to Flexner’s

profession characteristics, the professional status of a nurse largely depends on the education

required of the occupation. Flexner states that a profession “can be taught through a process of


highly specialized professional education” (Black, 2014, p. 53). Since nurses receive highly

specialized training, their knowledge is very unique to the nursing profession. One example

would be the specific knowledge gained through the Neonatal Resuscitation Program (NRP).

This is knowledge that a lawyer, for example, would not have in his or her profession.

Continuing to learn new skills throughout a career is vital to a nurses’ professional status. Skills

are a key characteristic of a profession and will be described next.

Obtaining a specific set of skills is the second important characteristic of a professional

nurse. “Direct care includes the use of cognitive skills (critical thinking, reflection, clinical

judgment, creativity); interpersonal skills (caring, communication, comforting, advocacy,

counseling); and technical or psychomotor skills (lifting, giving injections, repositioning)”

(White & O’Sullivan, 2012, p. 88). Staying up to date with skills that are required for

employment benefits both patients and nurses. The Quality and Safety Education for Nurses

(QSEN) pays special attention to these benefits. The purpose of QSEN is to address the

challenge of preparing future nurses with the knowledge, skills, and attitudes necessary to

continuously improve the quality and safety of the health care systems in which they work (Ohio

University, 2013). Many labor and delivery nurses are required to take specialty-training courses

in fetal monitoring, which enables better care for patients. These specialty-training courses help

nurses to advance in their professional status by making them more valuable assets to employers.

After completing the intermediate fetal monitoring course, nurses are able to place internal

monitors, such as fetal scalp electrodes and intrauterine pressure catheters. The last

characteristic of a profession, attitude, will be evaluated next.

A third characteristic of a profession is a positive attitude. “The art of nursing is based on

caring and respect for human dignity” (White & O’Sullivan, 2012, p. 89). One of the driving


forces that lead many nurses to enter the profession is the satisfaction received from helping

others. Reviewing Flexner’s characteristics of a profession, it is obvious that his beliefs were

similar. The first one of the Flexner’s criteria was that a profession “has practitioners who are

motivated by altruism (the desire to help others) and who are responsive to public interest”

(Black, 2014, p. 53). Staying positive is crucial for being a successful nurse. Making a

conscious effort to come to work with a welcoming attitude that is uplifting and pleasant is

essential to having a professional attitude. Staying positive is not easy, and it is a skill that needs

to be practiced in order to be maintained. Too often negative people cause an entire work force

to lose morale. This relates to the final core competency from QSEN about teamwork and

collaboration. The purpose of this competency is to prepare future nurses to “function

effectively within nursing and inter-professional teams, fostering open communication, mutual

respect, and shared decision-making to achieve quality patient care” (Cronenwett et al., 2007, p.

125). Teamwork is something that is personally found to be very enjoyable.

Staying positive in difficult situations can cause fellow employees and patients to have a

more uplifting attitude as well. When encountering patients and staff members who are negative,

the professional nurse tries being even more kind and caring. There is an understanding that not

everyone can be positive all the time. Becoming aware of personal attitude, especially in the

nursing profession, is vital to creating caring healing environment. A fellow student provided a

good example on the nursing 324-discussion board about keeping a positive attitude. “The

nursing profession is only as positive and upbeat as we appear, and honestly, the profession

cannot be sustained without interest from the next generations. Who would want to be a nurse if

it is all negativity all the time?” (S. Smith, January 28, 2014). The following section will detail

how the nursing scope of practice ties with these professional characteristics.


Scope of Practice

The previously discussed knowledge, skills, and attitudes of professionals all relate to the

nursing scope of practice. “Standards are important because they outline what is expected of a

professional” (White & O’Sullivan, 2012, p. 24). The purpose of scope of practice is to create

expectations of professionals, such as nurses. White and O’Sullivan (2012) further describe the

nursing scope of practice:

Nurses are accountable for their knowledge; skills; and behavior to self, to institution, to

regulatory and legal entities, to the profession, to the healthcare consumer, and to society.

They have autonomy to act independently and to make appropriate decisions as they

relate to control over their own practice. This accountability and autonomy for practice

are governed by nursing’s scope and standards of practice. (p. 24)

Nurses use knowledge and personal experiences to assess, diagnose, identify outcomes, plan,

implement, and evaluate care. This is known as the nursing process, and is utilized everyday.

The first part of the nursing process is assessment. Students learn basic assessment skills

while earning an Associate degree. “Assessment knowledge and skill requirements will change

in relation to the demands of society, the need to translate new research into practice, and the

changes in the dynamics of the healthcare system” (White & O’Sullivan, 2012, p. 37).

Therefore, additional assessment skills must be learned after graduating. For example, in the

labor and delivery unit, all newborns are screened for congenital heart disease. A simple pulse

oximetry reading from the right wrist and either foot can help to identify newborns at risk for

congenital heart disease. Newborns with readings lower than 95% are possible candidates for

referral for cardiac consultation. This is a simple assessment skill to learn, but was not part of

routine newborn care before this year. This is just one example of how assessment knowledge


will change with time; therefore it is important for nurses to stay up to date with their

institution’s policies. In addition, nurses should strive to intergrade evidence-based practice and

research into daily practice.

Evidence-Based Practice and Research

Evidence-based practice (EBP) is the 9th standard recognized by the American Nurses

Association (ANA) and is the incorporation of latest research into the professional work

environment (White & O’Sullivan, 2012, p. 133). Similarly, QSEN’s definition of evidenced-

based practice is to “integrate best current evidence within clinical expertise and patient/family

preferences and values for delivery of optimal health care” (Cronenwett et al., 2007, p. 126).

The ANA and QSEN both have the common standard that nurses should improve their practice

by using the most current and up-to-date knowledge available.

Unfortunately, “many nurses continue to rely on outdated knowledge and traditions” and

frequently seek “information from a colleague instead of a reference text” (White & O’Sullivan,

2012, p. 134). Sadly, the practice of seeking guidance from senior nurses has been personally

committed more than once in the workplace. On the other hand, positive facilitators of EBP are

often nurses and nurse managers “who read journals that publish original research” (White &

O’Sullivan, 2012, p. 134). Many topics related to pregnancy and birth are under review in order

to improve EBP. One of the topics that is especially interesting that is currently being reviewed

in the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) is about the restriction

of food intake during labor. Spending more time reading peer-reviewed articles is a new

personal goal for this year. Nurses who use EBP to guide their professional practice may also

find themselves participating in quality improvement initiatives.


Quality of Practice

Nurses contribute “to quality nursing practice by assuring that patients receive evidence-

based care that is patient-centered, safe, effective, timely, efficient, and equitable” (IOM, 2001,

p. 40). Nurses hold the key to positive patient outcomes since they are the ones at the bedside

everyday. Witnessed from personal experience, simple acts from quality improvement

initiatives, such as routine hand hygiene, can have a huge impact on the overall well being of

patients.

Quality of practice is not an idea unique only to the ANA. Organizations such as the

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) also develops

measures for improving the quality of care provided by nurses. AWHONN is specifically

interested in the quality of care provided to women and newborns. Many labor and delivery

nurses enhance themselves professionally by being a member of groups such as AWHONN.

Membership provides access to articles published in JOGNN about “the value and significance

of high quality nursing care for women and newborns” (AWHONN, 2013, p. 5). By reading

articles published in JOGNN, nurses stay up to date with EBP and improve the quality of their

clinical practice. Another way for nurses to improve themselves professionally is by pursing a

higher degree.

Transition

The transition to a new level of nursing practice is known to be challenging. “Having a

written philosophy can help guide nurses in the daily decisions they must make in nursing

practice” (Black, 2014, p. 262). Many nurses choose to enter the profession because nursing is

about helping people. A personal belief is that the essence of nursing is altruism. In addition,

the central core of nursing is the commitment to providing quality care. QSEN has a positive


influence on the quality and safety of patient care. Competent professional performance may be

achieved by maintaining the necessary knowledge, skills, and attitudes for the profession as

defined by QSEN. Furthermore, as the transition is made towards becoming a professional

nurse, many changes are made in practice due to the experience of new knowledge, skills, and

attitudes. First, the importance of advanced knowledge will be described.

Knowledge

Taking time to reflect on personal nursing practice is helpful during the transition from

the ADN role to the BSN role. A vast amount of knowledge is gained on the importance of

communication, teamwork, and collaboration during the time spent in a BSN program.

Examples from current personal practice as a nurse are used to display advances of knowledge.

QSEN defines teamwork and collaboration as the ability of the nurse to “function

effectively within nursing and inter-professional teams, fostering open communication, mutual

respect, and shared decision-making to achieve quality patient care” (Cronenwett et al., 2007, p.

125). QSEN’s higher-level competencies provide clear expectations of the nurse with an

advanced degree. For example, the role of the ADN in teamwork and collaboration may be

limited to describing their own strengths and limitation in functioning as a member of a team. In

contrast, the BSN prepared nurse would be responsible for analyzing their self, as well as other

team members’ strengths and limitations.

Communication is an essential interpersonal skill and is the 11th standard recognized by

the ANA. BSN prepared nurses are expected to communicate in a highly effective manner.

Increased confidence is one of the many benefits of knowledge. New nurses do not speak up as

often as BSN prepared nurses. Continuing education in pursuit of a higher degree gives nurses

the knowledge and ability to communicate in a clearly and concisely. For example, nursing


students routinely practice communicating to families, physicians, and peers on discussion

boards. The discussion board rubric may place limitations on the reading grade level, the

amount of words per sentence, and the total word count. This has proven to be an excellent

exercise for improving communication as a nurse in current practice.

Education is key to supporting continuous improvement in knowledge and professional

development. The ANA recognizes education as the 8th standard of practice. Academic

advancement through from ADN to a BSN degree helps “a nurse acquire and maintain

specialized skills and knowledge” (White & O’Sullivan, 2012, p. 125). While the scope of

practice may be the same for a nurse with a higher degree, the nurse’s ability to practice

effectively is greatly improved due to enhanced knowledge. Foundation knowledge was

previously built while attending a community college, and is now being expanded upon at the

university level. Next, the importance of skill improvement will be described.

Skills

QSEN’s core competency of safety is meant to “minimize risk of harm to patients and

providers through both system effectiveness and individual performance” (Cronenwett et al.,

2007, p. 128). In 2007, the IOM set core competencies for all medical disciplines. These core

competencies were taken, revised, and formed specifically for nurses in the Quality and Safety

Education for Nurses (Ritter & Geiger, 2011). QSEN was created after it was estimated that

98,000 deaths per year were attributed to the quality and safety deficits reported in our health

care industry (Ritter & Geiger, 2011).

Professional practice evaluation is the 14th standard recognized by the ANA and is a self-

evaluation process of personal performance. Similarly, QSEN’s definition of quality

improvement is the “use of 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” (Crowenwett et al., 2007, p. 127). The ANA and QSEN both have the common

standard that nurses should improve their professional performance by using self-evaluation

activities.

BSN prepared nurses can improve quality and safety in a health system by recognizing

their role to speak up when they observe discrepancies from the standard of practice. Nurses

“must also know how to give feedback to others in constructive ways that are designed to

improve performance and patient safety” (White O’Sullivan, 2012, p. 190). While a BSN

prepared nurse may stay in the same position obtaining an advanced degree, the nurse has still

experienced a change in practice due to an increase in knowledge and leadership ability.

Nurses contribute to the role of leaders in healthcare in the professional practice setting.

The ability to influence others characterizes leadership. For example, a nurse provides guidance,

inspiration, and motivation to co-workers so that patient outcomes may be achieved. Through

the scope and standards of practice, BSN prepared nurses are confident in fulfilling leadership

responsibilities. Finally, the way attitude contributes to the development of the professional

nurse will be evaluated next.

Attitude

Attitude is a key component to ethical nursing practice. Ethics is identified as the 7th

standard recognized by the ANA. Clear differentiation between ADN in comparison to BSN

roles can be made. For example, as the nurse continues to develop professionally, ethical

decision-making becomes less difficult. The ability to deal effectively with everyday ethical

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. 114).


A second professional performance standard that may be used as an example for attitude

relates to how the nurse practices in an environmentally healthy manner. Nurses promote the

healthiness of the environment for their patients. The BSN prepared nurse understands that

environmental health includes more than fall prevention. For example, a respectful attitude

towards diverse cultures can help promote a healthy environment for patients and their families.

Personal philosophies often fit within a nursing theory. “As nurses mature in the

profession, they may find that their philosophies about nursing change, even though underlying

values may not” (Black, 2014, p. 264). Encouraging patient comfort by providing high quality

care improves patient satisfaction. Kolcaba’s Comfort theory believes that comfort is the core of

nursing and is instilled in the foundation. Holistic care is one way to enhance to overall comfort

of the patient.

Significance

BSN prepared nurses can improve quality and safety due to their advanced knowledge in

a health system. White and O’Sullivan (2012) support this view:

Nurses with greater experience and advanced education are expected to be able to

recognize and efficiently correct gaps in information, to recognize salient data and trends,

and to apply theoretical models in ways to enhance their ability to enable rapid and

highly targeted responses to patient, practice, and organizational problems. (p. 38)

Facilities recognized by the Magnet Recognition Program typically employ more BSN

prepared nurses have drastically improved patient care outcomes through increased focus on

quality nursing care (White & O’Sullivan, 2012, p. 80). Most nurses would favor being

employed at a hospital with magnet status dedicated to improving quality and safety. Standard


16 from the ANA points out the importance for nurses to practice in a manner that is

environmentally safe and healthy (White & O’Sullivan, 2012, p. 201).

Nurses take on the leadership role everyday within various health care settings. Specialty

units, such as labor and delivery, often have a daily charge nurse for the unit. The expectations

of the charge nurse can vary widely depending on the shift. For example, night shift nurses are

expected to take on a greater amount of responsibility due to the lack of resources available after

hours. The BSN prepared nurse could better fill the leadership role due to advanced problem-

solving capabilities and increased self-esteem. Standard 12 from the ANA demonstrates the

importance of nurses in leadership roles in the professional practice setting (White & O’Sullivan,

2012, p.163).

The majority of BSN prepared nurses would describe themselves as lifelong learners.

The reason why nurses with advanced degrees are proud of their educational accomplishments is

because of the positive associations that accompany competence in current practice. The

education Standard of Professional Performance describes the importance of nurses attaining

new knowledge through continuing education (White & O’Sullivan, 2012, p. 123). Nurses who

work towards an advanced degree make less clinical mistakes and initiate more positive

improvements in their current workplace. “Formal, informal, and reflective learning experiences

foster development of the requisite knowledge, skills, abilities, and judgment necessary for safe,

high-quality nursing practice” (White & O’Sullivan, 2012, p. 26). Through lifelong learning

nurses continue to strength the profession of nursing.

In conclusion, moving up to the BSN level of nursing practice can be intimidating. The

unique knowledge, skills, and attitudes of nurses with advanced degrees enhance overall


abilities. While expectations may increase for the BSN prepared nurse, so will self-confidence

and professional status.


References

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Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson J., Mitchell, P., … Warren, J.

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