Transitioning from LPN/VN to
RN
Introduction
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Moving ahead in your career
Smooth transition to RN role
Explore anticipated changes
Organizing study skills, life responsibilities
Integration and application of nsg process
Gordon’s Functional Health Patterns
Explore current thoughts RN vs LVN roles
Internalization of RN role
Rethink present views and reflect on new
concepts
Role Transition
• Reviewing basic study skills and strategies
• Individual learning styles
• Time management skills
Nurse As A Caregiver
• Preparation for expanded roles and
responsibilities in clinical judgment:
• Problem Solving
• Decision Making
• Client Teaching
• Communication skills with colleagues,
clients, crisis situations
Nurse As A Manager
• Roles as leader and manager defined and
explored:
• Delegation
• Accountability
• Time Management
• Conflict Management
• Decision Making
• Resource Management
Professional Considerations
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Review of “Nurse Practice Act”
Scope of Practice
Legal and Ethical Issues
Personal Value Development
Ethical Decision Making
Major Nursing Concepts
Nursing Theories
Chapter 1
• Returning to School
• Study (Green, 1996)
• LVN to RN’s received excellent work
reviews for nursing competence and
critical thinking
• Students successful in completing
degrees, passing state boards, and
obtaining jobs
Developing A Positive Attitude
• Returning to School Syndrome: (Donna
Shane, 1983)
• Described emotional ups and downs
students experienced for Associate
Degrees
Honeymoon Phase
• Fascinated with school
• Increased awareness of purpose and
confidence
• Lasts until first challenging class
• Causes anxiety
Conflict Phase
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New and different nsg concepts introduced
Causes conflict with roles and faculty
Previous knowledge challenges new knowledge
Uncertainty and self-doubt
Causes anger, overwhelming, fatigue
Blaming others for lack of perceived success
Disintegration: anxiety turned inward,
depression, and withdrawal
• Reintegration: frustration, hostility especially
toward faculty and program
Resolution Phase
• Chronic Conflict: always angry, hostile,
aggressive, educational process failing
• False Acceptance: no longer values or
embraces educational opportunity but
pretends to accept it
• Biculturalism: meshing of school, work,
personal life, understands demands,
adjusts with new coping skills
Coping Skills
• Choosing a new way to solve a problem
• You have a choice in your response to the educational
experience
• Using some of the study and coping methods in this
chapter will help sustain you through these times
• Resolve to learn new coping skills to juggle all your
responsibilities
• Develop a sense of humor, learn not to take life so
seriously and laugh at own mistakes (healthy for immune
system)
• Taking a few minutes each day to distract yourself from
the hectic schedule will provide stress relief
Developing Basic Skills
• Nursing environment constantly changing,
nurses need variety of new skills to be
successful in the work environment:
• Computer Skills
• Basic Math
• English Proficiency
Discovering Your Learning Style
• Scope of learning broadened by understanding how learning occurs
• Why it is easier to learn in some classes
than in others
• Understand the rationale of teaching
methods
• Allows adaptation and helps make
learning more effective
Learning Styles
• (Anthony Gregorc, 1982), one’s learning
style determines preferred study method
• Gives insight into own behavior and
behavior of co-workers: learning styles,
decision-making, social styles
Concrete Sequential
• Practical, organized, structured, orderly
presentation, calm, collected, precise, strives for
perfection
• Works step-by-step, follows specific instructions,
makes time for hands-on experience,
memorizes, drills, workbooks, manuals,
programmed instruction, computer-aided, field
trips, demonstrations, assembly kits
• Does not tolerate environmental distractions
Concrete Random
• Creative, independent, curious, competitive,
quick, impulsive, intuitive decisions
• Idea people in workplace, free to express
themselves, rarely accept another’s word, trial
and error, independent study, computer games,
open-ended problem-solving, simulations,
supplemental reading assignments, short
lectures
• Prefers autonomy, does not respond well to
instructor’s assistance
• Welcomes opportunity to try new methods
Abstract Sequential
• Prefers abstract ideas and pictures
• Flighty, absent-minded, loves to gather
facts and find answers, debates issues
• Often respected for intellectual ability
• Long-term plans lead to higher education
• Prefers lectures, textbooks, supplementals, audiotapes and slides
• Prefers few environmental distractions
Abstract Random
• Sensitive and flexible, intuitive, emotional, gut
feelings, daydreams,
• Experiences learning through emotions
• Receives unstructured information and reflects
on it
• Wants to belong to a group, works well with
others, noncompetitive, prefers group
discussions, television, movies, short lectures
with questions and answers
• Enjoys studying with background music, guided
imagery, contemplative assignments
Learning Style Adjustments
• Adapting to styles that are not preferred
• Obtaining aids that will make learning
easier: workbooks, computers, groups,
videos, asking questions in class
Communicating Learning Style To
Faculty
• Share and discuss learning style with
professor
• Develop a mutually effective learning
environment
• Ask instructor where concepts can be
found in different medias: on-line,
distance-learning methods
Impact To Learning Environment
• Faculty member assists in the students’
learning by utilizing learning style concepts
• Student takes personal responsibility for
learning
• Will hurtle many learning obstacles
Time Management
• Effectively prioritizing and organizing
responsibilities and activities within a set time
frame
• We all have the same amount of time but
some people use time more effectively and
accomplish more than others
• Time can either control us or we can control time
by leaning to manage activities within an allotted
time frame
As a returning student, time is
considered a precious commodity:
• The juggling of all your roles and responsibilities may
seem overwhelming
• Committing your plans to a written schedule provides
direction and a visual reminder
• Monthly: long-term view, early start on assignments
decreases stress
• Weekly: short-term view, opportunity for adjustments
• Daily: effectively manage time (15, 30, 60 minute
intervals), experiment with times of day and outlines,
combined with to-do list,
• Prioritize items, marking off gives satisfaction at end of
day, starts next day with purpose
Study Strategies
• Time-Saving Tips: lessens stress, organizational skills pay dividends as a nurse
• Daily Planner: record all assignments, test
dates, due dates, study times, all life events
• Specific place at home to study, triggers
concentration
• Keep area neat and organized, file old papers,
separate classes to quickly find specific papers,
use 5 minute segments for phone calls
• Multi-task!!! (while waiting in an office, fold
clothes while on phone or feed a pet, etc.
Study Strategies, (Cont.)
• Class participation: prepare before class
to glean more information and participate
• Advanced preparation will allow review for
exams and not study for first time just
before exam
• Prevents last minute rush to complete
assignments at end of semester
Study Strategies, (Cont.)
• Effective Note Taking: learn to take good
notes
• Devise personal abbreviations for frequently used words
• Write phrases, not complete sentences
• Outline reading assignments and fill in
during lectures
• Review while material fresh to complete
fragments in notes
Study Strategies, (Cont.)
• Study Time: set time aside and inform friends
and family to prevent interruptions
• Let answering machine take messages
• Do not allow other activities to creep into time
• General Rule: 2-3 hours study for every hour in
classroom; will vary depending on previous
knowledge base of class content
• Schedule breaks to prevent sluggishness, stand
up and move, munch, short power nap
Study Strategies, (Cont.)
• Paper Writing: learn specific expectations from
professor
• Copy guidelines for home use
• APA, formatting supplement in an electronic
version
• Start work early enough to obtain articles,
computer information and books to be ready
when you need them
• Complete paper early, set aside 24 hours,
review; reduces stress, feeling of security
Study Strategies, (Cont.)
• Exam Preparation: find out type (multiple choice, truefalse, matching, essay), length, items needed, makes
study time more effective because preparation different
for each type
• Study groups effective to review; quizzing classmates,
discussions
• Do not substitute personal study time for group study
• Prepare for participation in group to benefit more
• Cramming leads to insecurity when taking exams
• Adequate preparation increases comprehension
• Positive, self-confident attitude decreases test anxiety;
leads to test-taking success
Study Strategies, (Cont.)
• Examination: Caffeine overdose impedes
concentration
• Before beginning exam jot down on
answer sheet or exam paper rhymes or
information that will assist recall
• Ask for clarification of questions when
necessary
• Pace yourself throughout exam to
complete on time
Study Strategies, (Cont.)
• Grades: intense concern and competition
for grades in students
• Leads to a mental battle for self-esteem,
allows grades to determine identity and
self worth
• Focus is on grades rather than acquiring
meaningful information
Balancing Home, Work, And School
• Study (Scala, 1996), students stopped attending
classes because of health problems and lack of
time for school (health fails, grades suffer)
• “Superman Complex”: think nurses are
invincible, can do all things and be all things to
all people
• Failure to review and revise personal schedules
and work
• Adequate planning decreases number of
conflicts encountered in educational odyssey
Balancing, (Cont.)
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Family support essential
Others may not realize demands and pressures of school
Communication can help understanding new stressors
Role reversals and delegation of house-hold chores (show
appreciation)
Perfection is not the name of the game!!
Simplify your life, pay people to help
Accept assistance, gives others sense of contribution to degree
Discuss schedule with supervisor to accommodate times
Student tuition reimbursements
Working only on weekends, sometimes more pay, gives freedom to
study more, also leisure time,
Makes you a better student and happier person
Maintain A Positive Attitude
• Do not neglect yourself
• Isolation leads to boredom and depression
• Remember to get physical exercise 3-4
times a week (family or friends)
• Well-balanced, low-fat diet
• Regular spiritual renewal
• Enjoyable activities are healthy and
necessary to succeed!!
Chapter 2
• Role transition and socialization process needed in
making change to RN
• Role conflicts may be encountered in transition
• Role: set of expectations society assumes a person in a
certain position or occupation will perform
• Role transition in personal identity and role function
• Performance of same clinical skills with improved and
refined critical thinking: analyze diagnostic test results,
pt’s overall condition, etc.
• Accept responsibility for own decisions
• Refinement and application of critical thinking is part of
transition
Role Components
• Competent worker, organized care provider,
knowledgeable caregiver, caring person, hard
worker
• Advocate: speaks for and acts on behalf of
another, speaks to doctor, pt’s rights,
representative, patient is never alone
• Counselor: listens to pt, counsels, therapeutic
communication, explains, defines, reviews
options, assists with choices that determine
health outcome; identifies pt’s emotional status
Role Components, (Cont.)
• Researcher: goal is to improve quality of nursing care,
develops questions about procedures and medications;
collects data daily, values research, applies findings to
practice
• Mentor: (Webster’s Dictionary), wise and loyal adviser;
nurse is wise adviser to new nurse or employee, loyal by
assisting with unit policy and procedures, explaining
equipment, easing adjustment
• Nurse preceptor assignment of new nurse to another
nurse, assists transition, confident, safe, supportive
environment, smooth adaptation to nurse role, enhances
recruitment and retention
Role Components, (Cont.)
• Collaborator: coordination of patient’s
care, skillfully schedules and communicates pt’s needs to departments, meets
with multidisciplinary personnel to achieve
pt’s goal, meets with family to plan care
management, delegates responsibilities to
other nurses and follows up on delegated
tasks
Role Components, (Cont.)
• Change Agent: daily changes occur in present
health care delivery system, often consequences
of nursing input
• Creative, communication skills to persuade
change as smoothly as possible
• Writes proposals, shares ideas with
administrators, staff and committee meetings
• Influences public policy, politicians, legislators,
(staffing, medication issues)
• Professional nursing organizations
Role Components, (Cont.)
• Educator: daily: explaining procedures, lab
results, disease processes, care interventions,
meeting emotional needs. Staff educator:
current literature, shares know-ledge with coworkers, applies to pt care
• Entrepreneur: venturing into health care
business challenges, filling gaps in health care
system, expanding scope of nursing and health
care (aromatherapy, case management,
counseling services). Nurse Practitioner: mng.
health clinics, adult day care centers
Role Components, (Cont.)
• Role Model: professional example for student
nurses and new grads, during interaction with
pts, team members, co-workers, positive,
encouraging, supportive work environment
• Leader: manages pt care, units, clinics, accepts
decision making, autonomy, responsibility,
accountability in providing competent care;
encourages other nurses to also become
leaders; interpersonal communication is
perfected
Role Socialization
• Internalization of a new personal identity
• Chosen to move to different level in education
and professional status
• Personal identity meshes with professional
identity
• Developing internal attitude toward a profession
• Learning new skills, new way of thinking
• Developing new values toward the nursing
profession
Adult Learner
• Special expectations/goals for educational
process
• Principles of adult learning (Lawler, 1991):
1. requires atmosphere of respect
2. cooperative, two-way learning environment essential
3. builds on the education of participant
4. encourages critical contemplative
thinking
Adult Learner, (Cont.)
5. presents situational problems and
encourages problem-solving
6. adult education is pertinent and
applicable
7. active, give and take process
8. gives power and immeasurable opportunity to learner
9. stimulates learner to be self-directed
and independent
Adult Learner, (Cont.)
• LVN comes to learning environment with foundation of knowledge
and experience to be refine and advanced to next educational level
• Must have a voice and be involved in learning process
• Interact with staff/faculty, examine/analyze clinical situations, find
solutions to clinical and patient problems
• Experience provides confidence, comfort, independence in clinical
environment
• Seek feedback to improve critical thinking skills and performance
• Opportunity to blossom and reach full potential
• Value past education, meet challenges of accepting new ideas and
nursing techniques
• Time of tremendous growth and change!!
Resocialization Tool
• Throwe and Fought, 1987
• Assessment tool/table using Erickson’s
developmental stages to identify changes
during role transition
• pp 34-40, Transitioning from LPN/VN to
RN, Duncan, DePew.
Role Transition
• Change in role requirements, expectations, work responsibilities
• Requires internal change in thinking about
or viewing new role
• May think performing same responsibilities
but now more knowledgeable
• Using critical thinking skills and nursing
judgment
• Not an overnight change
Role Transition, (Cont.)
• Phases (Nicholson and West, 1998)
stages relating to life transitions
• Preparation: psychological preparedness
for transition, psychological desire to make
the change, examines personal qualities
and decides whether possesses mental,
emotional abilities needed to become RN,
closely watching RN’s for comparison of
own abilities
Role Transitions, (Cont.)
• Encounter: first few days/weeks after initial decision,
necessary contacts for college enrollment, financial
arrangements, personal schedule revisions, feeling of
loss and disconnectedness
• Adjustment: focus, establishes new set of priorities,
previous co-worker relationships change during school
and after RN, feels pulled between two worlds, LVN vs
RN roles
• Stabilization: LVN takes on values of RN role,
adjustments/changes as needed, enjoys successes of
new role, viewing transition as a challenging opportunity,
will help emotionally/mentally, prepares for growth
process
Role Conflict
• Person’s role has two or more conflicting,
incompatible expectations
• Dilemma in trying to assume both roles
Intrapersonal: guilt over not spending enough
time with significant others, struggling to meet
school and social obligations
Interpersonal: physician requests procedure
contrary to facility policy, conflict between
doctor’s/employer’s expectations
Role Conflict, (Cont.)
Emotional: content as LVN, pressure from
employer to become RN, thought knew
procedures but now relearning to pass
classes, knows RN procedures but still
working as LVN
Physical: as conflicts build, development
of HTN, ulcer, psychosomatic illnesses
Avoidance of Conflicts
• Prioritizing tasks
• Using effective communication skills
• Appropriately delegating responsibilities
Change Process
• Response to pressures during various life
experiences that cause modifications in behavior
• Change can occur because of an external or
internal force
External: brought about by situation outside
Ourselves or something we cannot control
Internal: arises within ourselves, stems from
Personal desire for something different
Usually adapt more easily to internal because motivation for change starts within us and is not done to us
Change Theory
• Kurt Lewin, 1951, based on restraining
and driving forces
Restraining: issues in life/society that
resist change (fears, perceived threats,
values, relationships)
Driving: motivators to change (desire for
different clinical arena)
Change Theory, (Cont.)
• Phases:
Unfreezing: uncomfortable, restless,
senses change about to occur, less
uneasiness if change desired, struggle
between restraining/driving forces to
change status quo (decision to return to
school)
Change Theory, (Cont.)
Moving: change accepted and goals set to
determine direction, involvement of others,
easier if their input valued (goals, plans to
accomplish degree)
Refreezing: equilibrium established, change is
status quo, benefits of change emphasized
(adaptation to student life)
Once graduated, change process reoccurs as
adaptation to new work environment takes
place!
Chapter 3
• LVN and RN knowledge and roles
• Compare and contrast roles, responsibilities, knowledge levels, similarities and
differences
• Definitions of LVN/PN and RN based on
data, research, councils
National Nursing Organizations’
Definitions of Nursing Roles
• Chornick, Yocom, Jacobson, 1993, job analysis study to
establish entry-level practices for RNs
• National Council Licensure Examination for RNs
(NCLEX-RN) designed from study
• Emphasizes:
Knowledge: facts
Comprehension: understanding of facts
Application: putting facts to use
Analysis: (not in LPN exam) ability to break down facts,
give rationale for using and applying facts, higher level of
cognitive/critical thinking to make a judgment
Definitions Of Nursing Roles,
(Cont.)
• National Council of State Boards of
Nursing, 2000
• NCLEX-PN/RN Testing Content
Comparison table
• p 54, Transitioning from LPN/VN to RN,
Duncan, DePew.
Definitions Of Nursing Roles,
(Cont.)
• National League of Nursing, 1989, 1990
• Established roles and responsibilities for
practical and associate degree nursing
programs
• LPN/VN roles: provider of care supervised
by RN, member of the discipline
• RN roles: provider of care, manager of
care, member of the profession
Definitions Of Nursing Roles,
(Cont.)
• K. Claytor, 1993
• LPN and RN Roles and Responsibilities
Comparison table
• pp 56-57, Transiioning from LPN/VN to
RN, Duncan, DePew.
• Differences between two roles are the
professional changes that you will
experience during next few semesters of
your educational experience!!
Definitions Of Nursing Roles,
(Cont.)
• 2000, Council of Associate Degree Nursing
Competencies Task Force, National League of Nursing,
and National Organization of Associate Degree Nursing
wrote Educational Competencies for Graduates of
Associate Degree Nursing Programs
• Defines competency expectations of ADN programs,
main functions, expected abilities, skills, expertise of an
ADN graduate, delineates core components and
competencies as professional behaviors,
communication, assessment, clinical decision making,
caring interventions, teaching and learning,
collaboration, and nursing care
Professional Behaviors
• Nurse adheres to standards of professional
practice
• Nurse is accountable for own actions and
behaviors
• Nurse practices nursing within legal, ethical, and
regulatory framework including concern for
others as demonstrated by caring, valuing the
profession of nursing, and participating in
ongoing professional development
Professional Behaviors, (Cont.)
• Evaluates personal learning needs and assumes
responsibility for continued education and
personal development
• Has opportunities to contribute to profession by
gathering research data, facilitating change in
organizational structure and analyzing and
evaluating quality control measures
• Research done individually or as a team by
distributing, collecting, and analyzing surveys or
conducting interviews
Communication
• Interactive process, exchange of
information, verbally, non-verbally, writing,
information technology
• Therapeutic communication: verbal/nonverbal between nurse and patient,
assesses pt’s ability to cope with change,
develop more satisfying interpersonal
relationships, and ability to integrate new
knowledge and skills
Communication, (Cont.)
• Ability to assess and analyze verbal and
non-verbal communication between pts,
families, health care members
• Assists pts with coping and solving
problems
• Coordinates communication and activities
with pts, families, health care members
Assessment
• Collection, analysis, synthesis of relvevent
data, appraising pt’s health status
• Holistic view of pt, physical, developmental, emotional, psychosocial, cultural,
spiritual and functional status and how
influences and affects patient
• In-depth assessment utilizing nursing
process steps of goal setting, planning,
interventions to address patient’s needs
Clinical Decision Making
• Performance of accurate assessments,
use of multiple methods to access
information, analysis and integration of
knowledge and information to formulate
clinical judgments
• Performs more comprehensive, in-depth
assessment obtained from multiple
sources and applies critical thinking to
determine best patient care approach
Caring Interventions
• Nursing behaviors and actions that assist
clients in meeting their needs
• Based on knowledge and understanding of
natural sciences, behavioral sciences,
nursing theory, research, and past nursing
experiences
• Nurturing, protective, compassionate,
person-centered
Teaching And Learning
• Encompasses health education to promote and
facilitate informed decision making, achieve
positive outcomes, support self-care activities
• Transmission of information, evaluation of
response to teaching, modification of teaching
based on responses
• Learning involves assimilation of information to
expand knowledge and change behavior by
assessing needs of pt and developing individualized client teaching plan
Teaching And Learning, (Cont.)
• Outcomes set for client, RN evaluates
progress toward learning
• Modifies plan according to progress in
knowledge and observed changed
behaviors
• Depth of teaching increases as nurse
obtains more education
Collaboration
• Initiates shared planning, decision making,
problem solving, goal setting, assumption
of responsibilities by those who work
together cooperatively with open,
professional communication
Managing Care
• Efficient, effective use of human, physical,
financial and technological resources to meet
client needs and support organizational
outcomes
• Initiates and completes nursing assessment,
client interview, and history
• Initiates, evaluates and revises written nursing
care plans
• Initiates discharge planning according to
physical, psychosocial, and financial needs
Managing Care, (Cont.)
• Completes client care assignments,
orients, supervises, evaluates staff
performance
• In charge of patient care, coordinates care
for a group of patients
• Includes safety and cost-effective factors
in patient care plans
• Leads individualized client conferences
Epilogue
• The rationale for performing a
procedure in a certain way is based on
knowledge and critical thinking skills
gained through the educational
experience of the Registered Nurse.