Transitioning from LPN/VN to RN

Introduction

• 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

• 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

• 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 under-standing 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, supplement-als, 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, organ-izational 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 fre-quently 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, true-false, 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.)• 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 communi-cates 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 co-workers, 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 respect2. cooperative, two-way learning environ-

ment essential3. builds on the education of participant4. encourages critical contemplative thinking

Adult Learner, (Cont.)

5. presents situational problems and encourages problem-solving6. adult education is pertinent and applicable7. active, give and take process 8. gives power and immeasurable oppor-

tunity to learner9. 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, expecta-tions, 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 forceExternal: 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 motiva-

tion 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, responsibil-ities, 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: factsComprehension: understanding of factsApplication: putting facts to useAnalysis: (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/non-verbal 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, develop-mental, 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 individual-ized 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.