Running head: RN-TO-BSN PROGRAM GRADUATE COMPETENCIES 1

RN-to-BSN Program Graduate Competencies

Miranda Jennings

Delaware Technical Community College

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RN-to-BSN Program Graduate Competencies

An associate degree in nursing (ADN) provides the skillset necessary to be a floor nurse.

After graduation, students are prepared to perform basic nursing skills, interact with providers

and other healthcare team members, and educate patients (Nurse Journal, 2018). However, with

an ADN your career options are limited. A bachelor of science in nursing (BSN) is required to

expand beyond bedside nursing. With a BSN, nurses are able to take on different roles including

nurse educator, public health nursing, or other nursing specialties (Nurse Journal, 2018). A BSN

degree also allows nurses to apply to further advanced nursing schools including nurse

practitioner, nurse anesthetist, nurse midwife, or clinical nurse leader, which are all master of

science in nursing (MSN) programs (Nurse Journal, 2018). A recent study by the Bureau of

Labor Statistics showed that of 187,000 nursing job ads posted in a 90-day period, only 51

percent were available to ADN nurses, while 88 percent were available to BSN nurses (Nurse

Journal, 2018).

Besides increasing the available career options, BSN degrees allow nurses to earn more

money. While nurses with ADN and BSN degrees typically start out at the same salary just after

graduation, BSN nurses’ salaries increase within the first few years (Nurse Journal, 2018).

According to payscale.com the median salary for entry level nursing with either an ADN or BSN

degree is $58,721 (Nurse Journal, 2018). With one to four years’ experience, the median ADN

salary is $61,360 while the median BSN salary is $69,697 (Nurse Journal, 2018). With more

years of experience, the pay difference between ADN and BSN prepared nurses becomes more

apparent.

Another reason to advance from an ADN to a BSN is that many employers are making

the degree a requirement. The Institute of Medicine (IOM) recommends that the number of BSN
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nurses increase from 50 percent to 80 percent by 2020 (Nurse Journal, 2018). This drive for

higher educated nurses is due to studies that show higher educated nurses lead to better patient

outcomes. A ten-year study by the American Association of Colleges of Nursing has found that

BSN nurses have better patient outcomes, lower rates of mortality, and are more proficient at

making diagnoses and evaluating the results of interventions than ADN nurses (Nurse Journal,

2018).

At Delaware Technical Community College each program measures the degree specific

competencies needed for graduation. These are called program graduate competencies (PGC).

For the ADN to BSN program, there are nine PGCs that must be met before graduation. This

paper will analyze these competencies.

PGC 1. Integrate general education, knowledge, skills, and aptitudes to advance

nursing education and growth in professional practice.

Throughout the RN-to-BSN program, we expanded upon the ADN education to improve

nursing practice. During the ADN program, we learned the basics of nursing education. In the

ADN program, we learned how to care for a variety of populations including adults, pediatrics,

maternity, infants, mental health, and community health. We learned about a variety of disease

processes and how to properly perform physical assessments in order to identify conditions

outside of the “normal” healthy patient. We also learned how to administer medications, follow

orders, and educate patients on their disease processes. In the BSN program, we expanded upon

this knowledge to include nurse advocacy, ethical issues and dilemmas, global health, and

population and community health. We also improved upon our health assessment, learned about

nursing research, nursing leadership, informatics, and healthcare policy. The purpose of the BSN
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program was to broaden our scope of practice and set graduates up for more opportunity for

enhanced professional development.

Since entering the BSN program and going through the courses, I have definitely seen a

change in my nursing practice. I am now a more confident provider that is able to better educate

my patients and more willing to voice my opinions and concerns about patient care to the

providers. I frequently act as a patient advocate. In the nursing policy course, I focused my

studies on the opioid epidemic. Since the completion of the course, I have been talking with a

representative from Brandywine Counseling who works with us at night to get patients into

either inpatient or outpatient drug and alcohol treatment. During the community course, I worked

at an elementary school with the school nurse. That course brought me out of my comfort zone

and I am now better able to communicate with my pediatric patients. During the capstone course,

I shadowed a nurse leader at my hospital. I now understand barriers to getting patients admitted

and I better understand the hospital politics.

PGC 2. Demonstrate leadership skills to promote patient safety and the delivery of

high quality healthcare.

During the BSN program, nursing leadership was included in almost every course.

However, the nursing leadership course NUR 400 and the nursing capstone course NUR 460

really focused on leadership skills in nursing practice. During NUR 400, we learned about the

different leadership styles and conflicts that arise between leaders and employees. During NUR

460, I shadowed the nursing supervisor for the clinical hours where I saw how she interacted

with all members of the healthcare team and we attended meetings with other members of

management.
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Nurse leaders come in many different forms. At work, I act as a nurse leader when I am a

preceptor to new nurses, when I participate in unit council, and when I educate my patients.

Nursing leaders represent the hospital and their department in their actions. Their goal should be

to achieve both patient and staff satisfactions (Guyton, 2012). When staff are involved in

decision making, they are more satisfied with their job. Unit based councils are a great way to

improve staff involvement and increase satisfaction (Guyton, 2012). I enjoy working on the unit

council in my department because I am able to work with a group of my peers to improve

departmental policies and resolve issues that occur at work. The most rewarding leadership role I

have at work is acting as a preceptor to new nurses. I have been working in the emergency

department (ED) for three and a half years, during that time I have gained a lot of unit specific

knowledge and skills that I am able to share with new nursing when I act as their preceptor.

PGC 3. Apply skills of inquiry, analysis, and information literacy to support

evidence-based professional nursing practice.

Every course in the BSN program provided information that was evidence-based to

improve upon our nursing practice. The nursing research NUR 340 and the health assessment

NUR 320 focused on using research, assessment, analysis, and inquiry to support evidence-based

practice. Evidence-based practice is the act of using nursing knowledge and research to make

decisions that improve care processes and patient outcomes (Stevens, 2013). The goal of using

evidence-based practice is to provide the highest quality healthcare. The IOM definition of

quality healthcare is the “degree to which health services for individuals and populations

increase the likelihood of desired health outcomes and are consistent with current professional

knowledge” (Stevens, 2013). Evidence-based practice using clinical expertise and knowledge to

provide quality healthcare to patients (Stevens, 2013).

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I constantly used evidence-based practice at work. During every patient interaction, I am

using my experience during nursing school and during my career to drive my practice. I am

constantly learning and evolving as a nurse, so my patient care is constantly improving. While

assessing a patient, I am thinking of their symptoms and their physical assessment to come up

with a diagnosis. I then use my previous experience to discuss with the provider and come up

with the best plan of care. When doing this, I am using all of my previous experience to provide

the best quality care to my patients.

PGC 4. Integrate information management technology to improve patient outcomes.

Since the RN-to-BSN program was online, we used technology throughout the program.

During the nursing informatics course, NUR 410, we focused on how this technology can

improve patient outcomes. Technological development is the current trend in healthcare and will

continue to play a major role for years to come (Cassano, 2014). The American Nurses

Association (ANA) defines nursing informatics as “a specialty that integrates nursing science

and computer science to manage and communicate data, information and knowledge in nursing

practice” (Cassano, 2014). Informatics has greatly improved my nursing practice. With the use of

nursing informatics, our nursing managers are able to pull statistics to see how we are doing with

patient care and identify any barriers to care we may encounter. They are then able to make

recommendations on how to improve these barriers to care.

When I began work in the ED, we were still using a paper charting system. In 2016, my

hospital converted from paper charting to computer charting. I was heavily involved in the

project. I was the ED educator for the computer system. I went to classes to learn the system and

I then taught the system to all the ED and ICU nurses. After the computer “go-live” I acted as a

computer “super user” on the floor to answer all computer questions and resolve issues my
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coworkers had. In November 2017, I went to out sister hospital in Iowa and helped with their “go

live”. I still act as a source of reference for my coworkers and am asked computer questions

daily.

PGC 5. Advocate for patient and the nursing profession with regard to healthcare

policy at the local, state, national, and global levels.

The nursing policy course, NUR 420, showed us the impact of nursing practice on

healthcare policy and how nurses can become involved in politics at a local, state, national, and

global level to impact healthcare policies. The healthcare policy I focusing on during this course

was the opioid crisis in Delaware. This policy is especially important to me because we interact

with patients after they overdose multiple times during each shift in the ED. I have seen the

direct impact opioids have on patients and their families. I have been there when our ED doctors

tell the families of young patients that we were not able to bring the patient back after an

overdose. Delaware ranked ninth in the nation for the number of opiate related deaths (Cherry,

2018). A study by Johns Hopkins also showed that more than one percent of Delawareans have

used heroin at some point. This is more than triple the national average (Cherry, 2018).

My involvement in nursing policy is to communicate with a representative from

Brandywine Counseling that works in our ED on the weekend to help facilitate treatment for

drug and alcohol detox for our patients. One of our doctors works with him and Bethany Hall-

Long the Lieutenant Governor to improve Delaware’s policy on opiates and to provide more

resources for patients who face opiate addiction. I am planning on going with them during their

community outreach program. They go to areas of well-documented opiate use and hand out

Narcan and educate the population on how to properly administer the medication.
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PGC 6. Direct patient-centered care through advocacy, interprofessional

communication, collaboration, and delegation.

During the ADN program, we learned the skills of interprofessional communication,

collaboration, and delegation. During the BSN program, we really focused on the skill of

advocacy. I use all of these skills in my daily nursing practice. In the ED, I constantly have to

advocate for my patients and their families during critical situations. I work to explain the ED

process to my patients and ask if they have any concerns. When they voice their needs and

concerns, I go to other members of the healthcare team to come up with resolutions. I feel the ED

is a great environment for interprofessional communication. We have to work as a team with the

nurses, physicians, techs, social workers, respiratory therapists, and admitting team to care for

our patients. I am constantly communicating with the other members of this healthcare team to

meet the common goal of providing high-quality patient care. I also regularly delegate skills to

my patient care techs (PCA) at work. For example, if a patient comes in having chest pain, we

must quickly get their information, get them hooked up to a monitor, obtain an EKG, perform an

assessment, get an IV, draw lab work, and get the patient off to an X-ray. This is too much work

for one person to do within a short period of time, so I often delegate placing the patient on

monitor and obtaining an EKG to my PCAs.

PGC 7. Integrate health promotion and disease prevention practices to positively

impact the delivery of healthcare to diverse populations.

During the ADN program, we focused on health promotion and disease prevention. We

learned about diseases that affect a variety of patient populations and how to manage these

conditions. During the BSN program, we improved upon these skills by including global health,

health policy, and population and community health.

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The World Health Organization (WHO) defines health promotion as “the process of

empowering people to increase control over their health and its determinants through health

literacy efforts and multisectoral action to increase healthy behaviors” (2018). The WHO defines

disease prevention as “population-based and individual-based interventions for primary and

secondary prevention, aiming to minimize the burden of disease and associated risk factors”

(2018). During work, we are constantly practicing both health promotion and disease prevention.

I see patients who have specific health complaints and disease processes and work to restore

them to their highest possible level of functioning. This is sometimes able to occur in the

emergent setting and patient can be discharged. However, if they are not able to be managed in a

short period of time, patients are admitted to the hospital and then either discharged after

admission or sent to a rehabilitation facility. While educating patients at discharge and

throughout their hospital stay, we are practicing health promotion and disease prevention. We

work to educate patients on how to manage their chronic conditions and how to follow a

medication and care regime at home to prevent them from having further complications and

hospital admissions.

PGC 8. Practice professional nursing within an ethical framework.

The ADN program addressed many ethical issues we would encounter as nurses in our

practice. We further addressed nursing ethics during the ethical issues in health care course SOC

213 during the BSN program. During the ethical issues in health care course, we learned about

the seven ethical principles of justice, beneficence, nonmaleficence, accountability, fidelity,

autonomy, and veracity.

All of these ethical principles are important in daily nursing practice. When caring for

patients, I have to use justice to act in a way that is fair for all of my patients. This principle
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focuses on how to distribute the limited resources to all of my patients in a way that is fair

(Ethical Practice, n.d.). My nursing practice must include beneficence which is to do good or to

do the right thing for my patients (Ethical Practice, n.d.). At the nursing pinning ceremony, we

recited the nursing oath, which included the principle of nonmaleficence which is to do no harm

or to work to not cause any intentional or unintentional harm to our patients (Ethical Practice,

n.d.). In my nursing practice, I must be held accountable to my actions and for the nursing care I

provide. This means that I must accept all consequences of my actions as well (Ethical Practice,

n.d.). Fidelity means to keep one’s promises (Ethical Practice, n.d.). I must be faithful to my

patients and keep my professional promises to them. When interacting with patients, I must

uphold their right to autonomy. Patients have a right to make their own medical decisions and,

regardless of my beliefs, as a nurse I must follow through with their decisions (Ethical Practice,

n.d.). The last ethical principle is veracity, which means to be truthful and honest with patients

(Ethical Practice, n.d.). In my nursing practice, I must be upfront and honest with my patients

and work to not deceive them in any way. I do this by keeping my patients updated throughout

their care and explaining the plan of care throughout the process.

PGC 9. Demonstrate lifelong learning that empowers personal and professional

growth.

The RN-to-BSN program has provided me with the groundwork to improve my nursing

practice. It is up to me to continue with my nursing education and professional growth. This

semester, I was asked to create a lifelong learning plan for after graduation. I have decided that

after graduation, I will apply to nurse practitioner (NP) school. Without completing the BSN

program, I would not have the all of the opportunities to advance my nursing practice that I now

have. I would, instead, only be able to work as a bedside nurse. This program gave me the ability
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to expand upon my professional nursing practice. My BSN degree allows me to take on different

roles in the nursing profession including nurse educator, public health nursing, or other nursing

specialties (Nurse Journal, 2018). A BSN degree also gives me the opportunity to apply to

further advanced nursing schools including nurse practitioner, nurse anesthetist, nurse midwife,

or clinical nurse leader, which are all master of science in nursing (MSN) programs (Nurse

Journal, 2018). I will continue to use the skills and knowledge I obtained during this program to

drive my nursing practice.

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References

Cassano, C. (2014). The right balance—technology and patient care. The Online Journal of

Nursing Informatics, 18, 3. Retrieved from https://www.himss.org/right-balance-

technology-and-patient-care

Cherry, A. (2018). ‘Major crisis’: Johns Hopkins tells Delaware to take ‘major action’ to stop

alarming opioid overdose trend. Retrieved from https://www.wdel.com/news/major-

crisis-johns-hopkins-tells-delaware-to-take-major-action/article_2e0ed3b4-91c4-11e8-

90eb-83a79b09ed1e.html

Ethical Practice. (n.d.). Ethical practice: NCLEX-RN. Retrieved from

https://www.registerednursing.org/nclex/ethical-practice/

Guyton, N. (2012). Nine principles of successful nursing leadership. Retrieved from

https://www.americannursetoday.com/nine-principles-of-successful-nursing-leadership/

Nurse Journal. (2018). BSN degree vs RN differences. Retrieved from

https://nursejournal.org/bsn-degree/bsn-degree-rn-differences/

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas.

The Online Journal of Issues in Nursing, 18, 2. doi: 10.3912/OJIN.Vol18No02Man04

World Health Organization. (2018). Health promotion and disease prevention through

population-based interventions, including action to address social determinants and

health inequity. Retrieved from http://www.emro.who.int/about-who/public-health-

functions/health-promotion-disease-prevention.html