RN TO BSN PGC’S REFLECTION 1

RN to BSN Program Graduate Competency Reflection

Veronica Payne

Delaware Technical Community College

Nursing Capstone – NUR 460

April 26, 2020

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In the fall of 2018, I began the course work for the RN to BSN program at Delaware Technical

Community College. Although required by my current position, earing my Bachelor of Science in

Nursing was always part of my educational goals. Throughout this program, I have built upon the

foundation of my nursing education and skills, gained confidence in my role as an advocate, leader and

communicator, and strengthened my understanding of holistic, evidence-based coordinated care. Each of

the nine program graduate competencies has been met through the course work and clinical hours of the

RN to BSN program. The following is an explanation of how each program graduate competency has

been achieved.

Integrate general education knowledge, skills, and aptitudes to advance nursing education and

growth in professional practice.

The first course in the RN to BSN program, NUR 300, is a transition course that begins to build

on prior nursing education and is the foundation for the baccalaureate prepared nurse. By the end of this

course, I had developed my own nursing philosophy, which I titled Integrity and Leading by Example: A

New Nurses Philosophy. In the readings for the RN to BSN Transition course, I came across a quote by

Carolyn Jarvis, “The character of the nurse is as important as the knowledge she possesses.” This quote,

so short and simple, summed up exactly what I wanted to include in my own nursing philosophy. After

further research, I discovered that, Carolyn M. Jarvis, PhD, APRN, is the author of, Physical Examination

and Health Assessment, a health assessment textbook that was in my possession every single day during

nursing clinical for my associate’s degree. It is this quote that helped me frame my own nursing

philosophy.

My philosophy is that, as a nurse, I will demonstrate integrity in all aspects of my nursing care,

and I will lead by example. I will practice safe, competent and holistic nursing care. I will demonstrate

compassion, kindness and respect. I will be a fierce advocate for my patients and their families. I will

end each shift knowing I have cared for my patients to the best of my ability. I will strive to learn from
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my experiences, to build upon my educational foundation, and to grow professionally as well as

personally. My own personal nursing philosophy can translate to any environment in the healthcare

setting. I have stayed true to my nursing philosophy, most likely because it reflects who I am as a person,

not just who I am as a professional.

Demonstrate leadership skills to promote patient safety and the delivery of high-quality healthcare.

Nursing leadership, NUR 400, examined different leadership theories and styles, and how they

can be applied to our own nursing practice. Throughout the RN to BSN program, I found that confidence

in myself as a leader and communicator improved greatly, and this course was especially important to this

development. I have pulled together different aspects from multiple leadership theories that I identify

with and would most like to emulate as I grow as a nurse and leader.

W. Edward Deming’s theory of management focuses on team work between management and

staff, and I believe the value of staff participation should not be underestimated. Peter Drucker’s theory

of management promotes individual autonomy while also places high value on the nurturing of staff to

become leaders and involved in the decision-making process. This theory is especially important to the

profession of nursing, as nurses are encouraged to become trusted leaders early in their education. The

connective leadership theory promotes teamwork and collaboration across the continuum of care, a very

important aspect of our current population’s health care needs. The knowledge management theory is

especially valid in today’s health care industry. This theory places value on knowledge and learning.

“Critical thinking, clinical reasoning and judgement, and evidence-based practice and management are

important in today’s organizations, focusing on the need for knowledge that can be applied to improve

care” (Finkelmann, 2015). I especially like this theory because it places high value on nurses’ knowledge

and expertise, interprofessional collaboration and evidence-based practice in the age of information

technology.
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Transformational leadership and innovation, is perhaps, the most encompassing and practical

style for today’s ever-changing health care system. Transformational leaders embrace new ideas and seek

improvement, while nurturing staff and supporting a positive work environment. A clear vision for the

future and mission statement is utilized to encourage the individuals of an organization to become

invested in accomplishing goals. “This style is focused on change and how the leader adopts change as

opportunity for improvement. Rather than seeing change as a barrier, the transformational leader is

engaged in the change process and draws staff into the process. Change can lead to opportunities”

(Finkelman, 2015). The ideal qualities of a transformational leader include confidence, autonomy,

integrity, passion, loyalty and dedication. Transformational leaders empower and support their staff,

while developing and executing a vision.

I feel most comfortable with a democratic style of leadership, where participation and input from

fellow coworkers is used in the decision-making process. As a leader, I can help guide the decision-

making process, consider individual input equally, and feel confident that the majority of the group

supports the decisions being made. Incorporating other aspects of leadership styles can be valuable as

well. In a previous nursing position, there have been occurrences that called for the flexibility of a

situational leadership style. In these instances, decisions were made based on the current situation and

what was needed on the unit. They only leadership style that I cannot relate to at all is the authoritarian

style, I believe that best decisions are made when great minds collaborate.

Apply skills of inquiry, analysis, and information literacy to support evidence-based professional

nursing practice.

  Nursing research, NUR 340, emphasizes the importance of information literacy in research as it

applies to the clinical practice. As members of the health care community we need to make sure we are

providing our patients with valid information and our care is guided by best practices. Qualitative and
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quantitative evaluations of my chosen research topic, violence in the healthcare setting, were analyzed

during the course of NUR 340.

The interpretation of themes and ideas, and the examination of case studies and direct

observations, are aspects of qualitative research. I struggled with the concept of qualitative research at

first, but through the course work of NUR 340 I began to understand the importance of utilizing multiple

research methods to explore my chosen research topic and to produce solutions to the problem of violence

in the healthcare setting. The concept of quantitative research was far easier for me to grasp.

Quantitative research is objective, concrete and measurable. This type of research utilizes statistics,

numerical data and scientific experiments to answer research questions and hypotheses. This type of

research is replicable and the relationship between tested variables is proven or disproven by the

information collected. 

The issue of violence directed towards healthcare staff has the potential to be combated by using

both qualitative and quantitative data to identify risk factors.  By identifying risk factors, preventative

measures can be developed and implemented to assist healthcare staff in recognizing the potential for a

violent situation and or how best to deal with violent situations as they arise. As it is in all aspects of

healthcare, prevention is always preferable.

Integrate information management technology to improve patient outcomes.

  Nursing Informatics, NUR 410, is an introductory course to the application and impact of

informatics to the nursing profession. “Nursing informatics (NI) is the specialty that integrates nursing

science with multiple information and analytical sciences to identify, define, manage and communicate

data, information, knowledge and wisdom in nursing practice.  For many people, NI, and health care

informatics in general, are about technology” (Bickford, 2014).  When I started my ADN clinical, nurses

documented on patient care flow sheets, or paper charting, and pagers were used for communication with

one another. Nurses now utilize electronic health records for patient care, and iPhones for quick
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communication. I have always welcome technological advancements and view the changes they bring

with a positivity.  

For NUR 410, I chose to research interpretation services for non-English speaking patients as a

topic for process improvement and to present information on innovative uses of communication

technologies to cost effectively provide interpreter services Through my research, I found that

translation services, whether in-person, on the phone, or video, are not utilized and nurses often make

assumptions or rely on a patient’s English-speaking family members for interpretation. The use of

appropriate nursing informatics has the potential to enhance the process of language interpretation, and

thus improving quality patient care. Telephonic interpretation, like the commercial service Language

Line, is easy to use, quickly accessed and best for simple conversations not requiring visual

communication. Videoconferencing can also be quickly accessed, while allowing for visual

communication, which is especially important for American Sign Language (ASL) interpretation.

High-quality, safe health care requires exceptional communication. Our nation is composed of a

diverse population, the U.S. Census Bureau estimates that 350 different languages are spoken at home in

the United States, with Spanish being the second most common. Specifically, to the State of Delaware

the Spanish speaking population is expected to double by the year 2060. Health care providers need

round-the-clock access to interpretation services to be able to communicate with patients so that they both

can understand and be understood. Research has shown that qualified medical interpreters reduce health

care costs, decrease length of stay for limited English proficiency (LEP) patients and improve patient

satisfaction. By using nursing informatics, the process of providing interpreter services, whether in-

person or by video conference, can be enhanced to increase productivity, promote safety and improve

both patient and employee satisfaction.

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Advocate for patients and the nursing profession with regard to healthcare policy at the local, state,

national, and global levels.

Nursing Policy, NUR 420, examined how policy creation impacts the nursing practice, with

emphasis on the role of the nurse as an advocate in the legislative and regulatory process. For the purpose

of my final project in NUR 420, I researched environmental policy, specifically related to clean water

access and climate change, and offered suggestions for influencing policy creation.

There is no denying that climate change is one of the most serious global public health threats.

For decades now, scientists have been addressing the dangers of climate change, yet governments and

populations have been slow to act. “Although climate change is one of the most serious public health

threats, few people are aware of how it can directly affect them… the greatest public health challenges of

today include air quality; climate change; the safe management of chemicals; and adequate, safe sources

of water, food, and energy” (Mason, Gardner, Outlaw & O’Grady, 2016). International cooperation and

goal setting are critical. Disappointingly so, the United States lags far behind other nations in legislative

efforts to combat climate change. To date, The United States has no comprehensive federal plan for

combating climate change, and the current administration has attempted to roll back previous

administrations environmental rules aimed at reducing emissions to fight climate change.

My suggestion for combating climate change, is a bottom up approach with individuals affecting

policy at the local, community, state and national levels. In the State of Delaware, one of the largest

industries is healthcare. The State of Delaware is notable for Bayhealth, Christiana Care and Nemours.

“Policy choices in local communities, such as those at the state and national levels, are shaped by the

distribution of money, power, and resources. Nurses need to advocate with public health professionals,

environmentalists, and other diverse stakeholders to promote healthy communities where they live”

(Mason et al., 2016). Stakeholders are directly impacted by policy decisions, and therefore it is in their

best interest to be involved in the policymaking process. By appealing to the CEO’s of the health care
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companies previously mentioned; Terry Murphy, Janice E. Nevin, and R. Lawrence Moss, local and state

climate change interest groups can turn policy into action with the support of these stakeholders. On a

national level, appeals can be made to the CEO of the American Nurses Association, Loressa Cole, and

the CEO of the National Coalition on Health Care, Ralph Neas.

In addition to my research for NUR 420, a situation involving policy creation by my preceptor for

my nursing capstone course is worth mentioning and discussing. For our capstone course, I fulfilled

forty-six clinical hours with a preceptor, Angela Lord BSN, at both Kent and Sussex Bayhealth Campus

Hospitals.  Angela fulfilled many roles as a nurse manager.  She is a house supervisor, as well as a

manager for the nursing float pool and a medical surgical unit at the Kent Campus.  During my clinical, I

learned the ins and outs of how difficult the discharge process can be for patients going to long term care

facilities. 

After 1630 on Fridays, long term care facilities are not required to have a scheduled pharmacist

on staff.  Therefore, if a patient is not discharged and transferred to a long-term facility before 1630, their

medication will not be available to them for the weekend, and thus they cannot be discharged.  This keeps

a patient ready for discharge in the hospital unnecessarily because a pharmacist is not available at the

long-term facilities.  Angela was leading a lobbying effort to require Medicare and Medicaid long term

care facilities to employ a pharmacist on the weekends.  Being able to transfer these patients to long term

care facilities increases bed available for patients waiting in the emergency department or overflow units.

While I have not personally been involved with healthcare policy at the local, state, national, or

global level, I recognize the importance of nursing organizations advocating for the profession through

policy creation.  In 2004, the state of California began implementing laws requiring hospitals to adhere to

nurse to patient ratios, depending on the hospital setting.  To date, California is the only state the

stipulates in law and regulations a required minimum nurse to patient ratios be maintained on a unit.  MA

passed a law specific to ICU nurse to patient ratios, while CT, IL, NV, OH, OR, TX and WA have state
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laws requiring hospitals to have staffing committees for policies related to staffing and nurse-driven

ratios.  The states of CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT and WA, have laws or

regulations addressing nurse staffing in hospitals. 

Our nation is currently in the midst of the Coronavirus, or Covid-19, pandemic.  Hospitals across

the country, and around the world, are facing severe challenges in combating this dangerous and deadly

respiratory illness.  The current administration and the Center for Disease Control and Prevention has

seriously mishandled this international crisis.  Across much of the United States, medical professionals do

not have access to adequate personal protective equipment.  Many health care workers have fallen ill after

caring for Covid-19 positive patients, and even succumbed to the virus.  The demand for ventilators in

certain hospitals, like those in New York City, could potentially exceeded availability, thus landing

medical professionals in the difficult spot of making decisions as to who receives lifesaving treatment and

who does not.  The real travesty of this epidemic, is that we could have been better prepared or it could

have been prevented entirely.  Public health officials and national security experts have been warning for

years that a viral pandemic was a matter of “when” and not “if”. 

In 2018, the current administration dissolved the National Security Council Directorate for Global

Health Security and Biodefense, an office responsible for preventing the next disease outbreak from

becoming a pandemic.  I choose to discuss the Covid-19 pandemic because I feel that the message the

current administration has been sending to health care professionals and the citizens of the United States

is that we are expendable.  I feel as though we have been abandoned during a time when support is

needed most.  Nurses across the country have been protesting the lack of preparedness and blatant

disregard for the advice of the scientific community. My hope is that nurses across the country, myself

included, will participate in the creation of health care policies at every level, to ensure we are prepared

for and protected from future pandemics.                   

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Direct patient-centered care through advocacy, inter-professional communication,

collaboration, and delegation.

  Population and Community Health, NUR 330, examined the collaborative effort between

healthcare professionals and the community to plan, implement and evaluate interventions for health

promotion and disease prevention within the community. NUR 330 required forty-five clinical practicum

hours for successful completion of the course, for which, I shadowed registered nurses at Bayhealth’s

Kent Campus Emergency Department.

Bayhealth’s Kent Campus Emergency and Trauma Services Department is a Level III Trauma

Center located in the heart of Dover, Delaware. The emergency room is staffed twenty-four hours a day

with a trauma team that consists of board-certified emergency medicine physicians and specially trained

nurses. This emergency department services 52,000 patients each year, has forty beds, and four trauma

and resuscitation rooms. Bayhealth is a not-for-profit healthcare system, their mission is to strengthen the

health of their community, one life at a time by delivering high-quality and patient centered care. During

my practicum experience, I compiled data on the population serviced by the emergency department,

identified specific needs of this population, and developed a plan of care with interventions for this

population, while also considering an evaluation of my plan.

An aspect of emergency medicine that has always interested me is the frequency and complaints

of individuals who use the emergency department as if it were their primary health care provider.  Like

most emergency departments, Bayhealth had its fair share of non-emergencies waiting to be seen each

day during my practicum experience. Multiple patients, including children, presented each day to the

emergency department complaining of dental issues. I identified three needs of this community, related

to oral health. The first being, the need to increase awareness of the importance of oral health to overall

health. The second being, the need for preventive oral care. And lastly, the need to reduce disparities in

access to dental treatment services. I developed SMART goals to meet the needs of the community.
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SMART goals are designed to provide structure and guidance to improve the success of a project or goal.

SMART stands for specific, measurable, achievable, realistic and time. This concept can be applied to

public health nursing.

Integrate health promotion and disease prevention practices to positively impact the delivery of

healthcare to diverse populations.

  Global Health, NUR 310, explored global healthcare issues for diverse populations with emphasis

on health disparities and the nurse’s role in advocacy and social justice. During the course of NUR 310,

we examined concepts of global health such as; determinants of health, measurements of health status,

importance of culture, global burden of disease, risk factors, demographic and epidemiologic transitions,

and the organization of different health systems. We also examined the United Nations Millennium

Development Goals, and the Sustainable Development Goals. My view is that access to quality health

care is a universal human right and my perspective on global health is that the majority of resources are

currently allocated to a small percentage of the world population. The popular video, “If the World Were

100 People” helps highlight this worldwide disparity. If our world consisted of one-hundred people,

thirty-three would not have access to a safe water supply and sixty-three would have inadequate

sanitation. Fifty individuals would be malnourished, and for every two babies born, one would die. Over

half of the population would live on less than two dollars a day.

For my health impact research paper for NUR 310, I identified health determinants,

measurements and trends related to the HIV/AIDS epidemic, while also discussing the burden of the

HIV/AIDS epidemic in Sub-Saharan Africa; a region that has been severely impacted by the epidemic.

With access to proper health care and medical management, HIV positive individuals may lead long and

healthy lives, the diagnosis is no longer a death sentence. The burden of this disease, however, varies

greatly from wealthy to poor regions around the globe and is still considered an epidemic in specific

regions. Where you are born, should not determine whether you live or die. Governments, non-
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governmental organizations, and healthcare professionals are tasked with the responsibility to combat this

disease on population wide and individual based levels.

Practice professional nursing within an ethical framework.

  Health Assessment, NUR 320, utilized a holistic approach for health promotion and disease

prevention in creating comprehensive health assessments. I have always described holistic as treating the

person as a whole, rather than a part.  I strongly believe in promoting a holistic lifestyle for myself, as

well as my patients.  The concept of treating patients holistically is popular in many nursing theories.  For

example, in discussing Betty Neuman’s nursing theory, the Neuman Systems Model, “patients are cared

for from a holistic perspective in order to ensure they are cared for as people and not simply ailments”

(Petiprin, 2016).  Neuman’s model of care included patients physiological, psychological, sociological,

and developmental aspects.  “A patient is not simply the illness or injury being treated, but an entire

person.  In fact, every aspect of a patient can contribute to how that patient deals with treatment and

recovery” (Petiprin, 2016).

Using a holistic approach, in NUR 320, I created a health history questionnaire and health

assessment for a “patient”, thirty-two-year-old Billy Madison. The health history questionnaire was a

detailed review of Mr. Madison’s health history; including past medical history, current medical history,

family history, current medications, nutritional status and level of activity. This questionnaire also

included a detailed review of body systems, as well as, environmental and psychosocial assessments.

This questionnaire was conducted with therapeutic communication techniques, and per the instructions of

the assignment video recorded. After conducting the detailed health history questionnaire, I developed a

health assessment and individualized plan of care for Mr. Madison to address his most pressing health

concerns.  
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Demonstrate lifelong learning the empowers personal and professional growth.

After earning a bachelor’s degree in a field unrelated to healthcare, I would jokingly say I was a

“student for life”, while I waited to be accepted to the nursing program at Delaware Technical

Community College.  While waiting for acceptance into the program, I completed a phlebotomy

certification course at DTCC and worked as a phlebotomist through nursing school.  Earning my BSN is

required by my current employer, but continuing my education was always part of my plan.  I recently

started a new job as an operating room fellow and will take my Association of Peri-Operative Registered

Nurses (AORN) Peri Op 101 course exam April 2020.  In addition to continuing education hours needed

to maintain my nursing license, CCHS strongly encourages eligible nurses to sit for their certification

exam.  Once I have two years of experience in the OR setting, I’ll be able to sit for the Certified

Perioperative Nurse (CNOR) certification.  Earning the CNOR is a mark of distinction and demonstrates

a commitment to upholding the highest standards in patient safety, it is both a personal and professional

accomplishment.  The certification assesses the knowledge and skills of a perioperative nurse with a

minimum of two years of clinical practice.  Due to the rapid rate of change in the perioperative setting, a

conscious effort is required to maintain competency, recertification is required every five years.

My goal for the next two years is to build a strong foundation of perioperative skills and continue

to build upon them.  One of the best parts of working in the OR is working closely alongside other

disciplines, such as, surgeons, anesthesiologists, perfusionists and numerous medical representatives. 

Each having a vested interest in knowing what is the latest and greatest in our field.  In the best interest of

our patients, we are always striving to use evidence based best practice in our care, seek out new

information and continue to advance our practice.  Part of being successful is surrounding yourself with

successful and intelligent people, and absorbing as much information from them as possible.  I am in that

position right now, surrounded and overwhelmed with the knowledge and experience of my coworkers.   

Conclusion
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In conclusion, I am proud of myself for having completed Delaware Technical Community

College RN to BSN program. By developing these specific nine program graduate competencies, I have

gained confidence in myself as a nurse and leader, become a more efficient communicator and advocate,

and become more aware of my potential for positively influencing my community. As a “student for life”

I am looking forward to what comes next, while positively reflecting on all that I have accomplished.

References
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American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education

for professional nursing practice. Retrieved from aacnnursing.org

Bickford, C.J. (2014). Nursing informatics: scope and standards of practice. The American

Nurses Association. Retrieved on October 21, 2019 from http://www.ncbi.nlm.nih.gov/pubmed/19593018

Finkelman, A. (2015). Leadership and Management for Nurses: Core Competencies for Quality

Care, 3rd Edition. Upper Saddle River, NJ: Pearson Education. ISBN-13: 978-0134056982

Mason, D., Gardner, D., Outlaw, F., & O’Grady, E. (2016). Policy and Politics in Nursing

Healthcare. 7th Edition. St. Louis, MO: Elsevier.ISBN-13: 9780323241441

Petiprin, A. (2016). Betty Neuman- Nursing Theorist. Retrieved September 03, 2018, from

http://www.nursing-theory.org/nursing-theorists/Betty-Neuman.php