Running head: TRANSITION TO PRACTICE 1

Transition to Practice

Romee A. Johnson

NURS 4700

Dixie State University

TRANSITION TO PRACTICE 2

Transition to Practice

The transition from being a nursing student to becoming a licensed nurse is a big step.

Not only do technical skills need to be mastered, but student nurses need to develop various soft

skills as well. Due to this, Dixie State University’s Nursing Program set out five learning

outcomes to help its student nurses become knowledgeable, efficient, and reliable workers. These

learning outcomes include communication, clinical judgement, patient-centered care,

professional behavior, and caring. Although I still have to further develop these skills through

career experience, Dixie State University’s Nursing Program helped me to understand and

achieve these learning outcomes through lecture courses, extracurricular events, labs,

simulations, and clinical experience.

Communication

Communication is a critical aspect of nursing that not only, if performed right, enables

efficiency, clarity, trust, and safety, but also greatly improves the quality of care for the patient.

According to Anita Davis Boykins, “effective communication is the creation of meaning in

communication in which patients and health care providers exchange information so that patients

are able to actively participate in their care” (2014, p. 40). In other words, effective

communication allows patients to make informed decisions regarding their health and refer to the

nurses and healthcare providers for support in those decisions. When considering communication

in the nursing profession, it is important to understand and be able to utilize therapeutic

communication to provide the highest quality of care to patients.

Throughout Dixie State University’s BSN program, I have sharpened my communication

skills and learned how to use therapeutic communication, which is “the face-to-face process of

interacting that focuses on advancing the physical and emotional well-being of a patient” (Laffan
TRANSITION TO PRACTICE 3

& Schoenly, 2011). I developed therapeutic communication techniques throughout this program

that will provide a strong foundation for me as a professional nurse. A few techniques that

promote therapeutic communication include active listening, acknowledgement, clarity, silence,

reflecting, and offering of self (Burke, 2020). My clinicals helped me practice this skill and these

techniques through performing assessments, discussing interventions, discussing medications,

education and discharge teaching, reporting to physicians and other nurses, and conversing with

my patients to develop a therapeutic and trusting relationship as well as increase patient safety. I

understood the differences in communication between other healthcare professionals and

patients, which helped me strengthen my relationships with both by knowing which aspects of

communication with the specific party were important and which aspects or topics that did not

need to be addressed. By developing this skill and being able to utilize the techniques for

therapeutic communication, I am confident about providing high quality care to my patients and

being a useful asset to my coworkers when I enter into the professional field.

When reflecting back on the program and assessing this learning outcome for any needed

improvements, I noticed that I did not identify communication barriers very well. I feel that this

was because I never had to deal with these barriers firsthand, as it was my nurse preceptor who

was responsible for any discrepancies. Communication barriers with patients include “language,

developmental level, medical condition/disabilities, learning styles, psychosocial, literacy,

financial and cultural factors” (Boykins, 2014, p. 41). Being able to identify these language

barriers is the first step toward finding a solution and allows for the continuation of high quality

care to the patient by the nurse, so it is crucial to be able to identify these barriers and know how

to act accordingly. Alongside this, a nurse must be able to identify and solve communication

barriers with other healthcare professionals. In some instances, this may require a nurse to
TRANSITION TO PRACTICE 4

understand different types of communication and be able to adjust himself/herself accordingly to

allow for the most effective communication. Although this area of my personal nursing practice

may still need improvement, I feel entering into the professional field will help me develop the

skill to identify and address communication barriers.

Clinical Judgement

I feel that clinical judgement is the area where I most need improvement. I know,

however, that this skill is best developed with experience. Clinical judgement is the process of

gathering and evaluating data, implementing the correct interventions, and effectively assessing

patient outcomes (Lin, Hsu, & Tasy, 2003, p. 160). Implementing this process repeatedly

throughout nursing practice helps a nurse to better understand the rationales and conditions for

interventions as well as to gain an “intuition” for choosing the correct interventions to provide

better patient outcomes. This can be seen with experienced ICU or ED nurses who are calm

under pressure and know the correct interventions to take in emergency situations. Clinical

judgement is a continuous learning process that becomes a valuable skill with experience.

Dixie State has greatly developed my clinical judgement skills. Since the first semester,

the program has provided me with labs, simulations, and clinical experience to help develop this

skill by putting me in real-time situations where judgement calls needed to be made. The labs

helped improve my assessment and technical skills. The simulations helped me reflect upon my

clinical judgement by reviewing my decisions and the following outcomes after the simulation

was over. The clinical experiences allowed me to observe different professional nurses’ use of

clinical judgement through their decision-making processes, chosen interventions, and outcome

assessments. Alongside these hands-on experiences, lectures and tests have pushed me to stop

and take the time to think critically about my nursing decisions and use clinical judgement to
TRANSITION TO PRACTICE 5

choose the best interventions. I have noticed my improvement in clinical judgement through the

several NCLEX-style exams and my improved scores.

As mentioned, this learning outcome is where I feel I most need improvement. I need to

develop this skill more because I know that there are situations where I would not know the

interventions to take, when to take them, or how those interventions would affect patient

outcomes. Clinical judgement is a crucial skill not only to become an important asset for a

healthcare facility, but to also greatly improve patient outcomes and patient safety. This skill,

however, is different from the other learning outcome skills in that it involves a great deal of

“personal experience and professional ethical considerations” (Lin, Hsu, & Tasy, 2003, p. 160).

In other words, it is best developed through experience in the professional nursing field that

comes with obtaining and sustaining a nursing job.

Patient-Centered Care

The primary focus of nursing is patient-centered care. Regardless of the patient, every

nursing shift is centered around the patient’s needs and individualized care plan. The goal of

patient-centered care is “to see and treat the patient as a unique person… and to involve the

patient in their care determined by their decisions” (Bachnick, Ausserhofer, Baernholdt, &

Simon, 2018, p. 99). When caring for a patient, the nurse must use holistic care. Due to this,

patient preferences strongly influence the type of care nurses need to give.

I developed this learning outcome through attending clinicals, creating care plans, and

prioritizing patient care. Throughout clinicals, I focused on discussing goals with my patients and

fulfilling requests within reason. At the beginning of my precepting shifts, I prioritized which

patients I would need to assess first, planned medication administration times, and identified any

scheduled tests or interventions that I needed to prepare for. Alongside my nurse, I

TRANSITION TO PRACTICE 6

communicated with my patients throughout the shift to determine if they needed anything or had

any questions. I kept open communication with my patients as well as the other healthcare

professionals included in their care. Creating care plans also helped me develop a better idea of

how to prioritize my patients as well as how to prioritize interventions.

Although I have gained a better sense of patient-centered care, there are a few areas that I

still need to improve. I was able to properly prioritize my patients and nursing interventions, but

I did this with the help of my preceptor. Independently, I still have a hard time prioritizing my

patients. Alongside this, I am still developing my time management skills to appropriately visit

each patient. I still struggle to gauge how much time needs to be spent with each patient

depending on their needs and coordinating my roundings with medication administration. These

skills, however, I know will come with time and experience in the professional nursing field.

Professional Behavior

Because nurses are healthcare professionals, they must hold high ethical and moral values

to maintain a higher standard of professional behavior. Along with maintaining a strong work

ethic, nurses must maintain the nursing ethical principles. These principles guide the nursing

practice and help to keep this profession as trustworthy and safe to others. According to Burke,

“the ethical principles that nurses must adhere to are the principles of justice, beneficence,

nonmaleficence, accountability, fidelity, autonomy, and veracity” (2020). Following these

principles as well as strong work ethic principles, a nurse will maintain a high level of

professional behavior.

As an individual with a strong work ethic, I feel my level of professional behavior was

already well developed. When starting a shift, I would arrive 15 minutes early, organized my

priorities and tasks at the beginning of my shifts, established communication with my coworkers
TRANSITION TO PRACTICE 7

for the shift, asked for help when I needed it, and worked to manage my time efficiently. As an

individual with high morals, I feel my values line up with the nursing ethical principles, which

guides my actions and behavior. Although my work ethic and values were already developed, I

know that attending clinicals and studying cultural diversity throughout the program helped to

minimize my ignorance of other cultures and helped me to become more aware of my actions.

Reflecting back onto my development of professional behavior throughout the program, I

know I have come a long way. However, I know that there are aspects of professionalism that I

do need to continue developing. One aspect of professional behavior that I know I need to focus

on would be addressing my personal experiences and biases regarding certain cultures or social

situations and leaving them at home when treating patients. I noticed this bias during a

precepting shift when my nurse was assigned to take care of a patient whose culture required that

her husband make all the medical decisions for her and that he speak for her. Personally, I had a

hard time accepting that decision due to my personal belief of individual empowerment.

Observing my nurse, she put that bias aside and affirmed and clarified who she needed to discuss

decisions with. Watching this, I understood how important it was to check my beliefs before

addressing patients in order to be professional with my patient’s care. In this instance, I realized

it would take some effort for me to accept this decision, but I understood that it should not affect

the quality of care that I provided. Although I have developed the learning outcome of

professional behavior greatly, there are still areas of this skill that I need to improve.

Caring

Genuine care is a prime characteristic of nursing. Nurses need to act as patient advocates,

respect various cultural and social backgrounds, build trusting relationships with the patients, and

always consider patients’ needs as most important. The area of caring that I most developed
TRANSITION TO PRACTICE 8

throughout DSU’s nursing program was acting as a patient advocate. Starting in the program, I

had never assumed the role of a nurse and cared for a patient. Now, I understand that patient

advocacy is a key characteristic of being a nurse. Nurses are the last line of defense against

contraindicated orders or nonbeneficial decisions made by other healthcare providers, thus it is

crucial to advocate for patients to prevent any harm. As Davoodvand, Abbaszadeh, and Ahmadi

stress, nurses are the “link between the patient and the health care system” (2016, p. 2).

Alongside this, the nurse is the healthcare professional that is most acquainted with the patient

and is more aware of the patient’s rights and requests. This means that the nurse is responsible

for taking on the tasks of “being a patient representative, defending the patient’s rights and

universal rights, protecting the interests of the patient, contributing to decision-making and

supporting the patient’s decisions, ethical-centered skills for the ‘professional self’, and ‘being a

voice for the vulnerable’” (Davoodvand, Abbaszadeh, & Ahmadi, 2016, p. 2). During my

preceptorship and clinicals throughout the program, I observed the important role that patient

advocacy plays into providing patients with high quality care.

When reflecting back onto my clinicals, I am able to clearly identify one instance where I

knew the qualities of the caring learning outcome greatly helped to improve a patient’s quality of

care. In this clinical experience, I cared for a patient who was undergoing diagnostic tests, but no

diagnosis had been made. This patient was disheveled and emotional. Throughout the shift, my

nurse refused to acknowledge the patient’s fears and simply conducted the necessary tasks to

care for this patient. At one point, I went into the patient’s room to refill her water and found her

crying. Considering my role as a nurse, as well as my general concern, I sat down and had a

conversation with the patient about her feelings. She expressed her fears to me, and we talked for

a while. At the end of the talk, the patient was visibly less distressed. She claimed to feel better
TRANSITION TO PRACTICE 9

and said it was nice to have someone to talk to, as her family could not visit. In this situation, I

felt I had practiced the caring learning outcome by sitting with a patient and offering myself. I

built a therapeutic relationship with that patient and made her aware that I genuinely cared for

her well-being.

There are a few areas of caring that I feel I need to improve. I am quite shy, so entering a

patient’s room and having a conversation can sometimes be difficult for me. I know that this is a

necessary skill to build therapeutic relationships with my patients. Alongside this, I feel that I

need to act as a stronger patient advocate. In clinicals, when discussing patient care with my

precepting nurse, I would be afraid to discuss certain interventions or patient requests due to my

lack of experience and expertise. I know now that I cannot be afraid of standing up for my

patient due to my lack of experience. I need to advocate for my patients regardless of the

healthcare professional I am speaking to, or even family members that I may be speaking to, and

always put my patient’s rights and needs first.

Conclusion

In conclusion, Dixie State University’s Nursing Program has greatly prepared me for the

professional nursing field. I have achieved all of the outcomes and developed my skills greatly

since the beginning of the program. Although I have developed these skills, however, I know that

there is still more to learn once I enter the professional nursing field. I know that the professional

experience will help me to work on these skills and develop them more to become an efficient

and reliable nurse.

TRANSITION TO PRACTICE 10

References

Bachnick, S., Ausserhofer, D., Baernholdt, M., & Simon, M. (2018). Patient-centered care, nurse

work environment and implicit rationing of nursing care in Swiss acute care hospitals: A

cross-sectional multi-center study. International Journal of Nursing Studies, 81. 98-106.

https://doi-org.libproxy.dixie.edu/10.1016/j.ijnurstu.2017.11.007

Boykins, A. D. (2014). Core communication competencies in patient-centered care. ABNF

Journal, 25(2), 40-45.

Burke, A. (2020, March 2). Therapeutic communication: NCLEX-RN. Registered Nursing.

https://www.registerednursing.org/nclex/therapeutic-communication/

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical

nurses’ viewpoint: A qualitative study. Journal of Medical Ethics & History of Medicine,

9(5). 1-8. https://www.ncchc.org/cnp-therapeutic-communication

Laffan, S., & Schoenly, L. (2011). Therapeutic communication and behavioral management.

National Commission on Correctional Healthcare.

Lin, P., Hsu, M., & Tasy, S. (2003). Teaching clinical judgement in Taiwan. Journal of Nursing

Research (Taiwan Nurses Association), 11(3), 159-166

16https://doi.org/10.1097/01.JNR.0000347632.64852.c16.