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Running head: PRACTICE TRANSITION PLAN

Practice Transition Plan: ADN to BSN

Lindsay Scholten
Ferris State University

PRACTICE TRANSITION PLAN

Practice Transition Plan: ADN to BSN

Transitioning from an Associates degree registered nurse (ADN) to a Bachelors degree
registered nurse (BSN) may seem like only a matter of education, time, and money, but it is
much more than that. A nurse is transformed by new knowledge and grows as a professional.
Before one can advance in a career, there must be reflection on current practice. Identifying the
current scope of practice will help differentiate [it] from future practice as [one] transition[s]
into the BSN role (Ferris State University, 2014, p. 7). Before reflecting on this writers career,
nursing will be identified as a profession and nursings scope of practice will be explored to set
the framework for future professional growth.
Professional Identity
To gain respect and authority, nursing must be defined as a profession. Certain criteria
are required for an occupation to be considered a profession. Scholars and sociologists have
formulated lists of characteristics which all contain similar ideas and themes. Flexners criteria
includes that a profession must be intellectual, practical, and able to be taught through
specialized professional education (Black, 2014, p. 53). The other three characteristics that are
uniquely fitting to nursing, are that professions must be altruistic or service oriented, be based on
a unique body of knowledge, and have professional organizations which direct practice (Black,
2014). While nursing meets all of Flexners requirements, the latter three will be described in
greater detail.
The Merriam-Webster online dictionary defines altruism as feelings and behavior that
show a desire to help other people and a lack of selfishness (Altruism, 2014). Service is an
innate part of nursing. Although some may not enter the profession with an altruistic spirit, the
very essence of nursing is serving others. Virginia Henderson (1939) defines nursing as service

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to an individual that helps him to attain or maintain a healthy state of mind or body (as cited in
Black, 2014, p. 115). The Quality and Safety Education for Nurses (QSEN) further proves
nursing as a service oriented field by their recommendation for competence in patient-centered
care (Black, 2014). Nursing practice is not about the nurse or the physician, it is about the
patient. The American Nurses Association (ANA) lists five tenets of professional nursing
practice, one of them being that caring is central to the practice of the registered nurse (White
& OSullivan, 2012, p. 14).
Nursing is based on unique knowledge backed by research that is taught in nursing school
and continues on in lifelong learning (Black, 2014, p. 146). Today nurses can get a diploma,
an Associates degree, or a Bachelors degree, although there are recommendations to make the
BSN the minimum degree for entry into practice (Black, 2014, p. 136). Nurses can go on to
pursue masters and doctoral degrees as well. Nursing uses evidence-based practice (EBP)
because healthcare is always changing and the practice of nurses must also change (Black, 2014).
EBP is using information that has been researched and proven effective (Black, 2014). Outcome
improvement is the goal of EBP (White & OSullivan, 2012, p. 135). EBP provides nursing
with a unique body of knowledge that is relevant to practice, further strengthening the profession
(Black, 2014).
Professions must have an organization to guide and promote high standards of practice
(Black, 2014, p. 56). The ANA is the primary advocate (Black, 2014, p. 58) for nurses in the
United States. Flexner wrote that a true profession has a strong internal organization (Black,
2014, p. 53) with a well-developed group consciousness (p. 53). The ANA has done that for
nursing by setting high standards and developing a code of ethics for nurses (White &

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OSullivan, 2012). If more nurses became members of the ANA, the profession would be
strengthened and increase its political power (Black, 2014, p. 58).
Scope of Practice
To provide a clear picture of nursing the ANA has developed the scope of practice which
details the scope and standards of nursing practice (White & OSullivan, 2012). Nurses practice
at different levels within that scope depending on their education, experience, role (White &
OSullivan, 2012, p. 11) and the population they serve. The ANA has developed six standards
for nurses to carry out the scope of practice including assessment, diagnosis, outcomes
identification, planning, implementation, and evaluation (White & OSullivan, 2012, p. 12). The
goal of these standards is to improve the health and well-being of all recipients of nursing care
and to establish the responsibilities for which nurses are accountable (Black, 2014, p. 59).
Implementing the six standards requires unique nursing knowledge. Assessment and
implementation will be reflected upon in this writers current scope of practice.
Assessment
Assessment is a crucial part of a nurses practice. The ANA defines assessment as when
the registered nurse collects comprehensive data pertinent to the healthcare consumers health
(White & OSullivan, 2012, p. 35). An accurate assessment can be a matter of life or death for a
patient. In the post-anesthesia care unit (PACU), assessment begins when the patient enters the
door. First, the patients airway is assessed. There are times when a patient has an obstructed
airway and the anesthesiologist or nurse anesthetist has failed to notice it between the operating
room and the PACU. Next, the patients color is observed, along with their position on the cart
for safety. An initial set of vital signs is taken, and a focused physical assessment is done by
auscultating lung sounds, observing incision sites, and palpating any pertinent pulses. The ANA
says systematic and continuous data collection establishes a basis for the clinical reasoning

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necessary to respond to changes in an effective and timely manner (White & OSullivan, 2012,
p. 35). A thorough baseline assessment is crucial to notice any changes in a patients condition.
The PACU uses an Aldrete scoring system to rate a patients level of sedation from 0-10, using
activity, respiration, circulation, consciousness, and oxygenation as criteria (Metro Health
Hospital [MHH], 2013).
PACU nursing requires vigilance. From monitoring patient airways to protecting patients
from injury while they are waking up, safety is key. The American Society of PeriAnesthesia
Nurses (ASPAN) sets the standards for PACU care (MHH, 2013). ASPAN recommends a
nursing assessment be completed by an RN within ten minutes of arrival to the PACU (MHH,
2013, p. 3). Other APSAN standards include monitoring electrocardiography on anyone 12 years
and older and documenting vital signs at least every 10 minutes, including pain and sedation
scale (MHH, 2013). Discharge from the PACU depends on assessment findings, sedation level,
vital signs, and pain control (MHH, 2013). While assessment is the most critical part of PACU
nursing, implementation addresses the problems revealed through assessment.
Implementation
Implementation is the response to assessment, it requires thinking and doing, as well as
feeling, sensing, and valuing (White & OSullivan, 2012, p. 88). In the PACU, a plan of care is
implemented for the patient after collecting assessment data. Implementation involves
medication administration, carrying out physician orders, and hands-on patient care (MHH,
2013). The plan of care differs greatly depending on pain, sedation level, and vital signs. Some
patients only require repositioning and ice, while others require a lot of medications, and much
reassurance.

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ASPAN guides how patient care is implemented in the PACU. Clinical guidelines have
been developed using EBP regarding normothermia, pain and comfort, and post-operative nausea
and vomiting (PONV) (ASPAN, 2014). EBP has shown adverse outcomes from hypothermia
and PONV (ASPAN, 2014). In the PACU, temperature is monitored upon arrival and at
discharge. Patients must have a temperature above 36 degrees Celsius, and if they are cooler
warm blankets or Bair huggers are used to increase temperature. Nausea and vomiting can lead
to complications and an increase in length of hospital stays (ASPAN, 2014). To combat PONV,
physician-ordered antiemetic medications are given. The Joint Commission mandates that
patients have the right to proper pain management (ASPAN, 2014). In the PACU multi-modal
pain therapies are used including Ofirmev, Toradol, narcotics, and occasionally benzodiazepines.
Therapeutic interventions are often necessary when the risks of medicating outweigh the
benefits.
Transition
To transition into the BSN role certain knowledge, skills and attitudes are required to
grow as a professional. QSEN developed competencies listing the knowledge, skills, and
attitudes needed to provide safe and quality nursing care (Quality and Safety Education for
Nursing [QSEN], 2014). Knowledge consists of EBP, self-assessment, utilizing others abilities,
and recalling ones education (QSEN, 2014). Skills are the actions one performs to implement
care. Skills range from effective communication to actual hands-on care (QSEN, 2014).
Attitude includes respect, appreciation, and valuing others (QSEN, 2014).
The ANA lists the standards of professional performance including: ethics, education,
evidence-based practice and research, quality of practice, communication, leadership,
collaboration, professional practice evaluation, resource utilization, and environmental health
(White & OSullivan, 2012). These standards along with the scope of nursing practice should

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guide the BSN in his or her practice. To acquire the knowledge and develop the skills and
attitudes needed as one transitions into the BSN role, the ANAs professional performance
standards should be considered. Evidence-based practice, quality of practice, and leadership are
standards that will be used to exemplify the knowledge, skills, and attitudes necessary to
transition into the BSN role.
Knowledge
Evidence-based practice endows nurses with the knowledge essential for providing safe
and quality care. QSEN (2014) defines EBP as integrating the best current evidence with
clinical expertise and patient/family preferences and values for delivery of optimal health care
(Pre-licensure KSAs). Nurses cannot rely on what they learned in school throughout their
careers because information changes and practices change. EBP is used to create the policies,
procedures, and guidelines that nurses use to achieve the best patient outcomes (White &
OSullivan, 2012).
Professional nurses rely on EBP to seek new knowledge and improve their practice.
BSNs must maintain professional standards and continue in their education to set an example for
others. As nurses advance in their careers, they are responsible for lifelong learning and
maintenance of their professional and clinical competence (White & OSullivan, 2012, p. 115).
Patients depend on nurses to provide the most current and safe care, and using EBP is an
essential part of that.
Skills
The Merriam-Webster dictionary defines skill as the ability to do something that comes
from training, experience, or practice (Skill, 2014). Nurses have many skills from technical
skills used in direct patient care, to managerial or administrative skills. Maintaining competence
in ones skills is an ethical obligation of the BSN. Quality of practice is an ANA standard that
requires nurses provide the highest quality care (White & OSullivan, 2012). Nurses are directly

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involved at the point of care, and therefore need to be accountable for providing quality care
(White & OSullivan, 2012). Quality care is backed up with research through EBP.
In the PACU, quality is ensured through audits by nursing and anesthesia. The care given
in the PACU will impact the patients entire hospital stay. Adverse outcomes can easily be
tracked back to post-operative care. To ensure the best care is being provided, ongoing
evaluation of care and improvement is necessary. BSNs play an important role in providing high
quality care. Better outcomes have been reported in patients cared for by Bachelors prepared
nurses, and having that higher degree makes a difference in high-quality health care (White &
OSullivan, 2012, p. 128).
Attitude
Transitioning from the ADN to BSN role requires a transformation in ones thinking and
attitude. Ones job may not actually change, but the knowledge gained through school empowers
BSNs to become leaders. Leadership is an important role of all nurses. Leadership can be
learned, and is not dependent upon ones rung on the ladder (White & OSullivan, 2012).
Leadership is not about being the boss; leaders inspire, motivate and encourage others to change
(White & OSullivan, 2012).
QSEN (2014) uses words like respect, acknowledge, value and appreciate to describe the
attitudes necessary to meet their competencies. Leadership requires one to have a positive
attitude to encourage and influence others. Assertiveness and confidence are other vital traits of
a leader. In the PACU one can assume the leadership role by being the charge nurse, clinical
coordinator, or manager, but rank is not necessary to be an inspiring and motivating presence.
Setting an example by following policies, providing the best patient care, and communicating
effectively is the best way to lead. Joining committees and councils is another way to become a
leader for ones department. BSNs should set an example for others by adhering to standards

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and policies, demonstrating accountability, and committing to lifelong learning (White &
OSullivan, 2012).
Significance and Conclusion
BSNs are vital to the improvement in quality and safety in healthcare. QSEN is one way
nursing education is ensuring competent nurses (Black, 2014). EBP and lifelong learning
address the educational needs of nurses in practice (Black, 2014). The scope of nursing and its
standards provides a key framework for nursing (White & OSullivan, 2012, p.12), ensuring
nurses practice safely within set boundaries. A few ways BSNs can improve safety and quality is
by effective communication, vigilance in practice, and continuing education.
Nurses are not only an important part of the healthcare team, but at times are leading the
team. For effective leading, collaboration is important since nurses work with physicians,
therapists, and technicians to implement a plan of care (Black, 2014). Collegiality or
supporting, assisting, and counseling (Black, 2014, p. 60) other nurses is an equally important
trait of a leader. Leadership is also demonstrated through adhering to the professional and the
legal aspects of nursing (White & OSullivan, 2012, p. 165). One barrier to nurses as
professionals and leaders is the lack of uniformity in education (Black, 2014). Requiring a BSN
for entry into practice would strengthen the profession since professional status and power
increase with education (Black, 2014, p. 60). Bachelors prepared nurses are equipped to
provide, coordinate, and manage care, and to be an active member of the profession (Black,
2014, p. 137).
Nurses maintain expertise (Black, 2014, p. 146) through lifelong learning and
continuing education. Healthcare is always changing and so must a nurses practice. Pursuing a
BSN is part of that lifelong learning. Preparing this practice transition plan has helped identify
the goals, required skill(s) and competencies (Ferris State University, 2014, p. 7) that must be
accomplished to enter practice as a BSN.

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References

Altruism. (2014). In Merriam-Websters online dictionary. Retrieved from http://www.merriamwebster.com/dictionary/altruism

American Society of PeriAnesthesia Nurses. (2014). Clinical practice guidelines. Retrieved from
http://www.aspan.org/Clinical-Practice/Clinical-Guidelines
Black, B.P. (2014). Professional nursing: Concepts and challenges (7th ed.) Maryland Heights,
MO: Saunders
Ferris State University. (2014). Syllabus for NURS 324: Transition into professional nursing.
[Word Document]. Retrieved from https://fsulearn.ferris.edu/webapps/portal/frameset.
Jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher
%3Ftype%3DCourse%26id%3D_9600_1%26url%3D
Metro Health Hospital. (2013). Post anesthesia care unit (PACU) structure standards. Wyoming,
MI: Author
Skill. (2014). In Merriam-Websters online dictionary. Retrieved from http://www.merriamwebster.com/dictionary/skill
White, K.M., & OSullivan, A. (2012). The essential guide to nursing practice. Washington D.C:
Author
Quality and Safety Education for Nurses. (2014). Pre-licensure KSAs- QSEN. Retrieved from
http://qsen.org/competencies/pre-licensure-ksas/