Running head: TRANSITION PLAN 1

Transition Plan

Sheila Mahaney

Ferris State University

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Abstract

This paper details the experiences that I have had since receiving my associate degree in nursing.

It will cover the knowledge that I have learned, the skills that I use and the attitudes that I have

experienced during my nursing career. This paper also describes the metaparadigm of nursing,

which includes: person, environment and health. The writer will define the ANA professional

practice standards and how they enhance the role to a professional nurse.

Keywords: SCIP, peri-operative nursing, assessment, planning, communication skills, person,

health, environment, QSEN, ANA professional nursing standards

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Transition Plan

This paper encompasses my nursing experiences over the last 20 years. It will include

the areas I worked with antidotes from each area. The content of the paper is the knowledge I

have gained, the skills I have used and the attitudes that I have developed in my current position

in outpatient surgery. The paper also talks defines nursing philosophy and the foundations of

nursing, which are person, environment and health. The paper will also reflect on the American

Nurses Association (ANA) professional nursing standards that were learned in the transition to a

professional nursing role.

Current Practice

As I reflect over my nursing career, it is often overwhelming to me. I started working as

a nurse’s aide while going to college. After graduating with an associate degree in nursing, I

accepted a position at Metro Hospital on their pediatric unit. I learned the dynamics of working

with children and their families and how illness and disease can affect a family unit. I then

accepted a position on a medical-surgical unit, which I worked for four years. This was an eye-

opening experience for me. I learned to prioritize and be a patient advocate especially since I

worked the night shift. I then transferred to the Childbirth unit. I learned patience in teaching

new and experience moms the art of breast feeding and caring for their infants. I encountered

many different cultures and language barriers. I learned I needed to “be educated and be aware

and respectful of cultural difference…”(Black, 2014, p. 45). There was often sadness on the

unit, with a fetal demise. This was a difficult time for the parents. I showed compassion and

learned empathy in these situations. I was ready for a change and had the opportunity to work on

the Out-Patient Surgical unit. This is where I currently work. The remainder of this paper will

focus on the knowledge, skills and attitudes needed to work in outpatient surgery.

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Knowledge

Working in the outpatient surgical unit over the last six years has been a great learning

experience for me. Entering this department, it was evident that the cultural of safety played a

very important role. Safety is one of the core competencies of the Quality and Safety Education

for nurses (as cited in Black, 2014). The goal, in providing safe care, is to “minimizes the risk

of harm to patients and providers through both system effectiveness and individual performance”

(Cronewell, etl. 2007). One way we achieve this goal is by identifying the correct patient with

the correct surgery being performed (The Joint Commission, on Accreditation of Healthcare

Organizations [JACHO] 2013). JACHO endorses and safeguards that specific standards are

maintained in hospitals and other health care facilities.

We also use the safety measure guidelines of Surgical Care Perioperative Project (SCIP)

(JACHO, 2013). Health care personnel use SCIP to help reduce the number of preventable

surgical complications. There are many protocols associated with SCIP. One of the measures

utilized is antibiotic prophylactic therapy. This is to decrease the risk of infection at the surgical

site (JACHO, 2013). My responsibility as a nurse is to make sure the antibiotics are ready for the

operating nurse to hang. If Vancomycin is ordered, this needs to be given within two hours and I

need to start the infusion. (Metro Health, 2013)

Prophylactic Venus thromboembolism is another measure we use. This is done to reduce

and alleviate blood clots. These are primarily used for orthopedic surgeries because of the

immobility (Rothrock, 2012). My responsibility is to have the patient wear compression

stockings and wear intermittent pneumonic compression devices and to educate them the reason

for implementing this measure.( JACHO, 2013)

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In accordance with SCIP, the beta-blocker protocol was initiated. (JACHO, 2013)

Patients are directed to take their medication prior to coming in. This is used to decrease the

incidence of myocardial infarctions and decrease the incidence of cardiac events. If our patients

don’t take the beta-blocker we need to inform the physician.

Infection control is another measure that our department has instituted. Antiseptic wipes

are used to clean the operative area prior to the surgery. Our pre-surgical testing nurse also

instructs the patient to clean the area with dial soap two days prior to their surgery. This is done

to prevent any unwanted infections during the operation (Metro Health, 2013).

Change is occurring almost everyday in the surgical unit. New doctors coming, new

protocols, each bring a sense of learning new concepts. It is my responsibility as a surgical nurse

to stay current with the changes and embrace them to so our quality of care to our patients

remains the best.

Identifying resources and specific needs of patients becomes an opportunity for teaching

and learning. A patient has a need for home care. It is my responsibility to encourage and

empower my patient and give them resources and information that they can be readily used.

Informing my patients where to get free or reduced medication is also a great way to utilize the

resources that are available.

My responsibilities as a nurse are to know what the scope of nursing include and stay

within those guidelines. I will be a patient advocate and evaluate the effectiveness of the care

that I provide for my patients.

Skills

The skills that I have acquired in this job are great. I need to start intravenous therapy

(IV) on our patients, this is often a challenge because our patients are dehydrated from not

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having anything to eat and drink. Our anesthesiologists prefer IV’s started in the hand or wrist;

this is the most stable position during the surgery. My prior experience was minimal in this area;

it took lots of practice to master this skill. When starting IV’s we may also need to obtain blood

for labs. We have surgical protocols that establish if we need a complete blood count or a basal

metabolic rate or a type and screen this is also a skill that I have mastered after much practice. I

have learned that patience is needed for this skill.

One clinical skill, I use daily is administration of medications by using the six rules (right

drug, dose, patient, time, route and reason). Assessing patient allergies is part of this process to

decrease any harm to the patient. Interdepartmental communication, education, and teaching

patients are also a part of the critical skills that I use. Communication and teaching allows me to

listen to my patients and gain their respect and trust.

Attitude

When I first went into nursing, I wanted to make sure that I was honest and ethical in my

approach to nursing, and the care that I deliver to my patients. I wanted to act and look

professional. I believe that teamwork and working to resolve conflict and conflict resolution is a

part of my nursing care (Black, 2014). Establishing the best quality of care to the patients is very

important. I want to be able to provide a trusting and respectful relationship with my patients

and co-workers. Having a shared vision for the department is valuable to the quality care that we

give to our patients. I also want to remain current to what nursing will be doing in the future. I

can do this through joining an organization and continuing my education. Obtaining continuing

education every two years is allowing me to maintain my current license (as cited in White and

O’Sullivan, 2012).

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Philosophy

Merrier-Webster’s dictionary defines philosophy as “a particular set of ideas about

knowledge, truth and the meaning of life” (Merrier-Webster on line (n.d). What then defines a

nursing philosophy? Black describes it as “statements of beliefs about nursing and expressions

of values in nursing” (Black, 2014. p. 262). Philosophies are based on the foundations of the

nurses’ beliefs and values.

My nursing philosophy is one of compassion and empathy. As a nurse I want to deliver

and provide optimal care to the patient. I achieve this by respecting, listening, and being an

advocate for my patient. Empowering, the patient by providing education and resources to help

meet their needs and goals are vital to the care that is provided. These are part of the concepts

or foundations of nursing: person, environment and health (Black, 2014.). Each of these will be

detailed in the following sections.

Person

“The term person is used to describe each individual man, woman and child” (Black,

2014, p 242). This is one of the foundations of nursing. The person is made up of many

components. They each have individual human needs and how they fulfill them are each

different and unique to their particular situation. Their needs may include physical, cultural, and

spiritual components. Each of these combined makes them a whole person and how they adapt

to their situation is unique. Maslow developed the concept of hierarchy of needs, “the most basic

level of needs consist of those necessary for physiological survival: food, oxygen, rest, activity,

and shelter. are common to all human beings.” (as cited in Black, 2014. p.243). “When a

person’s needs are not met, homeostasis is threatened” (Black, 2014, p.244). There needs to be a

healthy balance or stability in the life of an individual.

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Environment

Environment “includes all the circumstances, influences and conditions that surround and

affect individuals, families and groups”(Black, 2014, p. 245). Environment includes the place

where a person lives and works. Some communities or environments may not be conducive to

learning or the ability to receive adequate health care that individuals need. The place where a

person lives may be in a high crime neighborhood and therefore, safety can be a concern. Lack

of transportation and financing may also be a determent to ones’ environment. Individuals are

not able to make scheduled doctor visits if they have limited access to transportation. This may

cause, a decline in their health.

Families are a huge component of the environment. Is there family support? What

defines a family is often the question. Black states that it may not “necessarily involve ‘blood

relatives’. The way the family functions with and within the environment and the dynamic

between various members of the family constitute the family system”(Black, 2014, p. 245).

Cultural plays a very important role in the environment. Understanding the diversity in

cultures is needed. “Effective nurses learn to be aware of and to respect cultural influences on

patients”(Black, 2014, p. 246). As nurses we need to acknowledge their culture and therefore

collaborate with them for the best outcomes that will fit their personal needs.

Health

The World Health Organization (WHO) defined health, as “a state of complete physical,

mental and social well-being and not merely the absence of disease or infirmity”(Black, 2014, p.

250).

Health is a holistic concept; it involves the entire person and the environment that they

exist in (as cited in Black, 2014, p.250). It is can also be seen in the lifestyles that each

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individual has. Maintaining a balance of physical as well as mental and spiritual needs is

important in the over all health of an individual. Individuals need to feel empowered to make the

choices that best fit their life style. “ When individuals are empowered, they have the self-

efficacy, knowledge, and competence to take proactive actions to reach their health promotion

goals”(Pender, Murdaugh, & Parsons, 2011, p. 275).

Nursing Theory

What is a nursing theory? A theory is formed from thoughts, ideas and is based on

knowledge from clinical and scientific research. There are many theories on nursing. Florence

Nightingale originated the first nursing theory and many have followed in her footsteps. The

theory that I identify with the most is the Orlando theory. This theory focuses on meeting the

individual needs of the patient and collaborating with them to find the best outcome for that

individual. This is accomplished by using evidence-based research to provide the best quality

interventions that are consistent with the persons immediate needs.

Transition

In continuing my education to receive a Bachelors degree in nursing, I have gained

knowledge and information related to the nurses’ code of ethics and ANA professional standards

of nursing (White & O’Sullivan. 2012). I have learned how to apply the standards to better

understand my role and how they can be applied to my nursing practice. Transitioning to the

role as a professional nurse has been an empowering experience. Since transitioning to the role

of a professional nurse, I recognize the importance of understanding the reasons behind the care

that I give to my patients.

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Knowledge.

Ethics is professional standard from ANA (White & O’Sullivan, 2012). I realized that my

thoughts and values reflect my critical thinking and judgment skills. Ethical situations occur on

a daily basis. As a competent nurse I need be cognizant and respect the values that my patients

have and not allow personal thoughts conflict with the care that I deliver. The nurses’ code of

ethics states “the nurse practices with compassion and respect for the inherent dignity, worth and

uniqueness of every individual…” (Black, 2014, p. 96). As a bachelor prepared nurse, I need to

portray ethical principles of generosity, autonomy, nonmaleficence, fairness, loyalty, and

authenticity (as cited in Black, 2014, p.96).

Nurses are constantly learning and engaging in opportunities for continued growth and

development to provide quality care to patients. Understanding current, safe and effective

practices in nursing requires a unique body of knowledge (as cited in White & Sullivan,

2012.p.123). Knowledge is obtained from formal and informal learning. Opportunities for

growth can be acquired in the clinical setting or by attending educational seminars. The ANA

states that education is a professional standard and is vital to the nursing profession and makes a

great impact to its practice (as cited in White & Sullivan, p.128).

My transition to a professional nurse will include becoming a leader, an ANA

professional standard. Leaders are role models that exhibit qualities of purpose, values and self –

discipline. The quantum theory of leadership examines the changes in the healthcare

environment and how they can be better understood. Leaders need to address and resolve

conflict effectively. This leadership style encourages identification of common goals,

opportunities for growth and empowerment to make decisions (as cited in White & O’Sullivan,

2012, p. 165). “ Leadership in nursing is demonstrated when registered nurses’ commit to

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ongoing learning, seek competency-based education, and track their professional contributions”

(White & O’Sullivan, 2012, p. 166). Leaders are constantly learning and use EBP to support

their practice.

I have learned the importance of providing a culture of safety in nursing, which is an

ANA professional standard (White & O’Sullivan. 2012). In 2003 an organization defined this

and QSEN or quality and safety in education of nurses was established (as cited in Black, 2014,

p.148). One of the core competences of QSEN is providing patient centered care. I can improve

the quality of care by communicating with other disciplines and by using evidence based

research. The opportunities for identifying areas of improvement are a daily occurrence (as cited

in Black, 2104, p 146). Nursing has the responsibility and the accountability for the quality care

that they provide for their patients (as cited in White & O’Sullivan, 2012, p.146). “Through

quality improvements efforts, nurses – as the key caregivers in hospitals significantly influence

the quality of care provided and ultimately the effectiveness of treatment and patient

outcomes”(White & O’Sullivan, 2012, p. 147).

Skills

During this journey of continued learning, I have learned the importance of research and

how that relates to evidence based practice (EBP). Research is an ANA professional standard

that is expected in the nursing profession (White & O’Sullivan. 2012). The connection between

scientific research and clinical experiences are vital to understanding new concepts and benefits

the care that I provide for my patient. Research enhances my critical thinking and judgment

skills as a competent nurse (as cited in Black, 2014. p.227). The professional nurse needs to

have resources about clinical practices readily available to them either from a hospital library or

in the department that they work on, so they can remain current and effective in their specialized

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practice. In the unit I work on, we use Medscape nursing. I have also reviewed research from

databases such as PubMed and CINAHL; these are both reliable and scholarly resources.

Communication and Collaboration, which are ANA professional standards, are skills that

I will need as I transition into the role as a professional nurse. I need to be conscious of the way

I communicate with patients and colleagues. “Effective interpersonal communication is

necessary to perform an assessment and to make an accurate diagnosis…”(White & O’Sullivan,

2012, p. 153). Effective communication involves the ability to listen and acknowledge what is

said and then to form a mutual plan of action. Communication takes many forms from verbal,

non-verbal, written and spoken. “Nurses must be proficient in communication as they are in

clinical skills”(White & O’Sullivan, 2012, p. 157). Collaboration with other disciplines is vital

to problem solving and making decisions that will achieve the best outcome for the patient.

QSEN reaffirms that nurses must “function effectively within nursing and interprofessional

teams, fostering open communication, mutual respect and shared decision making to achieve

quality patient care”(White & O’Sullivan, 2012, p.177).

Evaluation is a skill that I have developed in the transition to this professional role. In

my current job we have yearly evaluations. My performance is based on my clinical skills,

leadership skills, patient satisfaction, and attendance. I need to adhere to a code of standards that

apply to my job description. I need to be responsible and accountable to myself, but also to the

unit as a whole. I need to continue to foster professional growth and development (as cited in

White & O’Sullivan, 2012, p.187). I accomplish this by accepting constructive feedback from

my managers and my peers.

Another ANA professional skill I have achieved and continue to pursue is the utilization

of the resources on the unit that I work on. I use my critical judgment skills and knowledge of

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the patient and their needs to provide safe and effective care. Safe and effective care is achieved

by being fiscally responsible with the services that are provided. Being aware of quality

improvement and cost effective measures are ways of maintaining quality in the healthcare

environment (as cited in White & O’Sullivan, 2012, p.193).

Attitudes

In the role of becoming a professional nurse, my attitude to environmental health and

how that impacts the health care facility where I work has changed. I have become aware of the

importance of working in a healthy and safe environment. The interventions that we have

implemented in our department is recycling of plastics and disposing of hazardous materials in

the appropriate waste bags. We have a protocol when using therapeutic chemicals and drugs.

Nurses play a vital role in “reducing the ecological footprint of the healthcare industry and in

mitigating the impact of the disposal of medical waste, including pharmaceuticals on

communities and the global environment” (White & O’Sullivan, 2012, p. 202). As a

professional nurse we can impact the environment by promoting a positive working

environment.

The acoustic environment can also have an impact on health care and patient outcomes. I

try to minimize the noise and lighting in our patient’s room to create a safe and positive outcome

for the patient. The hospital where I work takes a positive outlook on environmental health and

innovative ways to protect the planet. The roof on our facility has a green roof. This green roof

provides low maintenance, increases greater insulation and provides a healing and relaxing

environment for families and patients (as cited in Metro Health, 2013). The hospital also

promotes a healthy environment by hosting a farmer’s market that supports the local business

and farmers in the area.

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Reflection

In writing this paper and reviewing the nurses’ code of ethics and the ANA professional

standards, I have developed a new outlook on what it means to be a professional nurse. Over the

last 20 years of nursing, I have utilizing some of these standards without comprehending or

understanding the motives behind the care I provide.

I have developed an appreciation for these ANA standards and how it relates to the care

that I provide for my patients. The ANA standards that I have identified the most with are

evidence based practice, communication and collaboration. I have learned the significance of

researching and how that can improve my daily nursing practice. I have realized the importance

of being a patient advocate and how interdepartmental communication is vital to my

responsibility to my patient in helping them achieve the best outcome for their care.

I have learned the importance of accountability, autonomy and how understanding the

scope of my practice can make me a more effective leader. I have learned that knowledge is

powerful and I can be a role model in empowering my patients to be active participants in the

care that is given to them.

Conclusion

Over the last couple decades of working as a nurse, I have worked in three different

specialty units. I have had many clinical experiences that have helped mature the nurse that I

have become today. I have gained knowledge, developed skills and learned many unique

attitudes related to nursing and the patients that I care for. I have developed an understanding of

the fundamentals of person, environment and health and how they help guide the care that I

provide for my patients.

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In transition to becoming a bachelor prepared nurse, I have continued to nurture my

knowledge in nursing and have welcome the opportunities for growth as I continue my life long

learning. I have become acquainted with the nurses’ code of ethics and the ANA professional

standards and how they can enhance my knowledge of nursing as a whole.

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References

Black, B. P. (2014). Professional nursing: Concepts and challenges (7th ed.). Maryland,

Missouri: Saunders.

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

(2007). Quality safety education for nurses. Nursing Outlook, 55(3), 122-131.

Joint Commission of Accreditation of Health Care [JACHO] (2012). Surgical care

improvement project. Retrieved September 19, 2013 from

http://jointcommission.org/surgical_care_improvement_project

Metro Health, (2013a). Antibiotic pre surgical criteria. Metro Health policy 2013

Metro Health, (2013b). Green roof. Retrieved from http:://www.metrohealth.net

Metro Health, (2013c). Preparing the skin before surgery. Metro Health policy 2013

Philosophy, (n.d.) (2013). Merrier- Webster’s on-line dictionary (11th ed.) Retrieved from

http:://www.m-w.com/dictionary/philosophy

Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice (6th

ed.). Upper Saddle River, New Jersey: Pearson.

Rothrock, J. C. (2012, June 13). What Can Perioperative Nurses do to Prevent DVT? Retrieved

October 13, 2013 from http://medscape.com

White, K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA’s

scope and standards in practice and education. Washington D.C.: American Nurses

Association [ANA].