Transitioning from LPN/VN to RN

1
Transitioning from LPN/VN to RN
2
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
• Gordons Functional Health Patterns
• Explore current thoughts RN vs LVN roles
• Internalization of RN role
• Rethink present views and reflect on new concepts

3
Role Transition

• Reviewing basic study skills and strategies
• Individual learning styles
• Time management skills

4
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

5
Nurse As A Manager

• Roles as leader and manager defined and explored
• Delegation
• Accountability
• Time Management
• Conflict Management
• Decision Making
• Resource Management

6
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

7
Chapter 1

• Returning to School
• Study (Green, 1996)
• LVN to RNs received excellent work reviews for
  nursing competence and critical thinking
• Students successful in completing degrees,
  passing state boards, and obtaining jobs

8
Developing A Positive Attitude

• Returning to School Syndrome (Donna Shane,
  1983)
• Described emotional ups and downs students
  experienced for Associate Degrees

9
Honeymoon Phase

• Fascinated with school
• Increased awareness of purpose and confidence
• Lasts until first challenging class
• Causes anxiety

10
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

11
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

12
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

13
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

14
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

15
Learning Styles

• (Anthony Gregorc, 1982), ones learning style
  determines preferred study method
• Gives insight into own behavior and behavior of
  co-workers learning styles, decision-making,
  social styles

16
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

17
Concrete Random

• Creative, independent, curious, competitive,
  quick, impulsive, intuitive decisions
• Idea people in workplace, free to express
  themselves, rarely accept anothers 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
  instructors assistance
• Welcomes opportunity to try new methods

18
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

19
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

20
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

21
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

22
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

23
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

24
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

25
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.

26
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

27
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

28
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

29
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

30
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

31
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

32
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

33
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

34
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

35
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!!

36
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, pts overall condition,
  etc.
• Accept responsibility for own decisions
• Refinement and application of critical thinking
  is part of transition

37
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, pts 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 pts emotional status

38
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 (Websters 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

39
Role Components, (Cont.)

• Collaborator coordination of patients care,
  skillfully schedules and communi-cates pts needs
  to departments, meets with multidisciplinary
  personnel to achieve pts goal, meets with family
  to plan care management, delegates
  responsibilities to other nurses and follows up
  on delegated tasks

40
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

41
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

42
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

43
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

44
Adult Learner

• Special expectations/goals for educational
  process
• Principles of adult learning (Lawler, 1991)
• 1. requires atmosphere of respect
• 2. cooperative, two-way learning environ- ment
  essential
• 3. builds on the education of participant
• 4. encourages critical contemplative thinking

45
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 oppor- tunity
  to learner
• 9. stimulates learner to be self-directed and
  independent

46
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!!

47
Resocialization Tool

• Throwe and Fought, 1987
• Assessment tool/table using Ericksons
  developmental stages to identify changes during
  role transition
• pp 34-40, Transitioning from LPN/VN to RN,
  Duncan, DePew.

48
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

49
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 RNs for
  comparison of own abilities

50
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

51
Role Conflict

• Persons 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
  doctors/employers expectations

52
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

53
Avoidance of Conflicts

• Prioritizing tasks
• Using effective communication skills
• Appropriately delegating responsibilities

54
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
  motiva-
• tion for change starts within us and is not done
  to us

55
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)

56
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)

57
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!

58
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

59
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

60
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.

61
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

62
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!!

63
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

64
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

65
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

66
Communication

• Interactive process, exchange of information,
  verbally, non-verbally, writing, information
  technology
• Therapeutic communication verbal/non-verbal
  between nurse and patient, assesses pts ability
  to cope with change, develop more satisfying
  interpersonal relationships, and ability to
  integrate new knowledge and skills

67
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

68
Assessment

• Collection, analysis, synthesis of relvevent
  data, appraising pts 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 patients needs

69
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

70
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

71
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

72
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

73
Collaboration

• Initiates shared planning, decision making,
  problem solving, goal setting, assumption of
  responsibilities by those who work together
  cooperatively with open, professional
  communication

74
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

75
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

76
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.