Running head: TRANSITIONING INTO THE BSN ROLE
Transitioning into the Bachelor of Science in Nursing Role
Jennifer Housel
Ferris State University
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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.
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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
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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
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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.
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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
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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 evidencedbased 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.
TRANSITIONING INTO THE BSN ROLE
Quality of Practice
Nurses contribute “to quality nursing practice by assuring that patients receive evidencebased 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
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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
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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 selfevaluation 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
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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).
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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
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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 problemsolving 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
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abilities. While expectations may increase for the BSN prepared nurse, so will self-confidence
and professional status.
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References
American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice (2nd
ed.). Silver Spring, MD: Nursesbooks.org.
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). (2013). Women’s
health and perinatal nursing care quality draft measures specifications. Washington, DC:
Author.
Black, B. P. (2014). Professional nursing: Concepts & challenges (7th ed.). Maryland Heights,
MO: Saunders.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson J., Mitchell, P., … Warren, J.
(2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131.
Retrieved from http://www.unc.edu/courses/2009fall/nurs/379/960/%20M10%20
Safety%20and%20Quality%2009/cronenwett%20Quality%20and%20Safety%20Educ%2
0for%20Nurses.pdf
Institute of Medicine (IOM). (2001). Crossing the quality chasm: A new health system for the
21st century. Washington, DC: National Academies Press.
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research.
New York, NY.: Springer Publishing.
Merriam-Webster. (2014). Online dictionary. Retrieved from http://www.merriamwebster.com/dictionary/quality
Ohio University (2013). Subject and course guides: Nursing QSEN competencies. Retrieved
from http://libguides.libray.ohiou.edu/content.php?pid=63132&sid=1733880
Ritter, B. J., Geiger, D. C. (2011). The future of health care: Are you prepared? Retrieved from
http://canpweb.org/chapters/north-bay-chapter/news/the-future-of-health-care-are-you-
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prepared/
Smith, S. (2014, January 28). Re: Housel week 2 initial post [Online forum comment]. Retrieved
from https://fsulearn.ferris.edu/webapps/portal/frameset.jsp?
tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3F
type%3DCourse%26id%3D_10213_1%26url%3D
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.
QSEN Institute. (2014). Graduate KSAs. In QSEN Institute. Retrieved 2014, from
http://qsen.org/competencies/graduate-ksas/