NSGD 2147 RPN to BScN Role Transition Midterm Review

Professional identity

A nurse’s sense of self and relationship to others as shaped by nursing’s characteristics, norms, and values. It influences how a nurse thinks, acts, and feels in the professional role.

How professional identity develops

Through nursing education, clinical experiences, professional values, expectations, relationships, responsibilities, and ongoing learning.

Why professional identity matters?

A stronger professional identity supports accountability, ethical practice, and confidence in the nursing role.

Personal identity vs. professional identity?

Personal identity is the broader sense of who a person is. Professional identity is the part connected to nursing. The two interact rather than existing completely separately.

Professionalism?

How professional values are demonstrated in behaviour. It includes ethical behaviour, integrity, respect, responsibility, and commitment to nursing values.

Integrity?

Act consistently with ethical principles and professional standards, including when doing so is difficult.

Honesty

Be truthful and transparent in professional interactions and practice.

Accountability

Accept responsibility for professional decisions and actions, recognize limits, and seek support when needed.

Professional socialization

The materials describe learning nursing norms and values through education, experience, relationships, and professional expectations.

Academic transition

The student adapts to an academic environment that places greater emphasis on theory, research, critical thinking, leadership, and evidence-informed practice.

Connecting experience with theory?

Clinical experience is valuable, but it should be examined alongside research, theory, professional standards, and the individual client’s situation.

Growing responsibilities

The transition develops inquiry, advocacy, collaboration, and professional accountability while the learner continues to recognize limits and seek guidance.

Avoiding a simplistic role comparison

The supplied materials caution against assuming RN automatically means complex care and RPN automatically means simple care. Client complexity and predictability, setting, resources, knowledge, and individual competence matter.

Critical thinking

Careful consideration and analysis of information before reaching a conclusion or choosing an action.

Critical inquiry

Systematically question and evaluate information, evidence, assumptions, beliefs, theories, principles, and actions instead of accepting a practice just because it is familiar.

Reflective practice

Review experiences and one’s performance to gain insight, identify learning needs, and improve future practice.

Clinical judgment

Interpret a client’s needs or concerns and decide whether to act, modify a usual approach, or respond differently to the person’s situation.

Professional judgment

Apply clinical knowledge, experience, ethical principles, and evidence-informed practice to assess needs and choose appropriate actions.

Tacit knowledge

Knowledge developed through experience and often used intuitively.

Explicit knowledge

Formal, teachable knowledge that can be stated, explained, or documented.

A practical reflection sequence: Describe

What happened and what did you notice?

A practical reflection sequence: Consider

What do evidence, professional standards, client preferences, and context suggest?

A practical reflection sequence: Learn

What did you learn, what would you change, and what learning goal follows?

A practical reflection sequence: Apply

Use the learning in future practice and evaluate whether it improves care.

Confidentiality and privacy

Do not share client information or identifying details online.

Professional boundaries

Maintain appropriate boundaries in online communication as well as in person.

Digital presence and public trust

Online communication can affect trust in the nurse and the reputation of the profession; think carefully before posting.

How evidence, reflection, and knowledge translation work together

Evidence-informed practice (EIP) supports decisions by integrating research, clinical judgment/experience, client values/preferences, and context. Reflective practice helps nurses look back at clinical experiences, analyze what happened, identify learning needs, and improve. Knowledge translation moves research-based knowledge into clinical practice so it can be communicated and implemented. Together, these support professional development, quality assurance, and improved care.

Critical inquiry and reflective practice are related but different?

Critical inquiry questions and evaluates assumptions, information, and evidence; reflective practice examines experiences and performance to learn and improve.

Client values and preferences

Part of evidence-informed and ethical decision-making. Emphasize considering the person’s story, circumstances, rights, choices, and values—not treating the client only as a diagnosis or clinical problem.

How to apply client values and preferences

Consider what matters to the client, listen to their perspective, and include their preferences alongside evidence, clinical judgment, and the context of care.

Client values and preferences: why it matters?

The same clinical question may need to be approached differently depending on the person’s situation, preferences, and circumstances.

Client values and preferences: Connection to autonomy?

Respecting client choice and informed decision-making is closely connected to the ethical principle of autonomy.

Nursing roles listed in the CNO competency material

clinician, professional, communicator, collaborator, coordinator, leader, advocate, educator, and scholar. These roles overlap in everyday nursing practice.

Clinician

Provides safe, competent, ethical, compassionate, evidence-informed care and responds to the client’s needs.

Professional

Demonstrates accountability, integrity, respect, responsibility, and adherence to professional expectations.

Communicator

Communicates respectfully and clearly with clients and the healthcare team. Communication supports understanding, safety, and coordinated care.

Collaborator

Works with clients and other healthcare professionals. Collaboration brings different perspectives together to support care.

Coordinator

Helps coordinate care and resources so that care activities and supports are organized around the client’s needs.

Leader

Contributes to direction, improvement, and professional practice. Leadership can be demonstrated through actions and influence, not only through a formal title.

Advocate

Supports the client’s needs, rights, safety, interests, and voice; advocacy can include speaking up when a concern or barrier affects care.

Educator

Supports learning and understanding. In nursing, education may involve helping clients understand care and contributing to the learning of others.

Scholar

Uses knowledge, evidence, inquiry, and ongoing learning to inform and improve practice.

Important CNO entry-to-practice principles

Entry-level RNs are beginning practitioners, not experienced nurses. They are prepared as generalists and are expected to practise safely, competently, compassionately, and ethically across the lifespan and in diverse settings. They practise autonomously within legislation, standards, ethics, and scope, and seek guidance when a situation exceeds their ability. Critical thinking is used throughout practice.

Who counts as the client??

The client is not limited to one individual patient. The supplied CNO study guide includes individuals, families, substitute decision-makers, groups, communities, and populations.

Therapeutic relationships

Uses nursing knowledge, skills, and attitudes to support well-being. Relational practice involves listening, questioning, empathy, reflection, self-observation, and sensitivity to context.

Client-centred care

Treats the client as a whole person and respects autonomy, voice, self-determination, advocacy, empowerment, and participation.

Boundaries

Protect the nurse-client relationship and prevent misuse of the power difference for the nurse’s personal needs.

Cultural humility

Ongoing self-reflection about personal and systemic biases and approaching relationships as a learner.

Cultural safety

Involves addressing power imbalances so clients feel safe from racism and discrimination. Nurses should adapt care respectfully to the client’s culture, values, beliefs, and circumstances.

Communication

Active listening, clear and respectful language, conflict-resolution skills, appropriate use of technology, and accurate, timely documentation and reporting.

Collaboration

Understanding one’s own role and the roles/scopes of other professionals, and working together for safe, continuous care.

Leader

Contributing to direction, improvement, and professional practice.

Ethical reasoning

Examines values, responsibilities, principles, possible actions, and consequences so that a decision can be explained and justified.

Personal beliefs

May influence a nurse, but professional responsibilities, client rights, ethical codes, standards, law, and context must also be considered.

When personal beliefs and ethical reasoning conflict

Conscientious objection: concerns should be identified in advance and referral arranged in non-emergency situations; emergency circumstances or unavailable alternatives may differ.

Research evidence?

Findings from research are one important input, but research alone does not make the whole decision.

Clinical judgment and experience?

The nurse interprets evidence in light of knowledge, experience, assessment, and the particular care situation.

Client values and preferences?

The person’s priorities, choices, circumstances, and story help shape the appropriate decision.

Context

The setting and real circumstances of care affect how evidence and options can be applied.

Knowledge translation

Moves knowledge or research into practice so that it can be communicated and implemented.

Putting EIP together?

Consider research evidence + clinical judgment/experience + client values/preferences + context. Do not rely only on tradition or “how we have always done it.”

Ethical decision making 1. Identify the ethical issue?

State the concern or conflict clearly. Ask what values, responsibilities, or rights may be in tension.

Ethical decision making 2. Identify who is affected?

Consider the client and other people involved, while keeping the client’s needs, rights, and perspective central.

Ethical decision making 3. Consider the client and context?

Explore the client’s values, beliefs, preferences, circumstances, relationships, and story. Ethical practice is contextual and relational.

Ethical decision making 4. Identify relevant ethical principles?

Consider autonomy (respect choice), beneficence (promote good), nonmaleficence (avoid harm), and justice (fairness). More than one principle may apply, and principles can conflict.

Ethical decision making 5. Apply an ethical theory or perspective?

Deontology asks about duties and rules; utilitarianism asks about overall outcomes; virtue ethics asks what a good/virtuous nurse would do; care ethics considers relationships and context; narrative ethics focuses on the client’s story.

Ethical decision making 6. Consider professional responsibilities?

Bring in the CNA Code of Ethics, relevant CNO expectations/competencies, professional accountability, and any applicable legal or practice requirements covered in the course.

Ethical decision making 7. Compare possible actions and effects?

Consider realistic options and their possible effects on the client and others. Identify competing ethical considerations rather than assuming there is always an obvious answer.

Ethical decision making 8. Decide and justify?

Choose the action you can best justify using the client’s situation, ethical principles/theory, and professional responsibilities. Explain why this option is appropriate.

Ethical decision making 9. Reflect on the outcome?

Consider how the decision may affect the client’s experience and outcomes, and what follow-up or learning may be needed.

Ethical decision making framework order

identify the ethical issue; consider the client and context; consider values and principles; use an ethical theory/framework; consider effects of different choices; use professional nursing responsibilities; and justify the reasoning.

What is step 1 of the ethical decision-making framework?

Identify the problem or issue statement — State the ethical concern clearly, then clarify and expand it.

What is step 2 of the ethical decision-making framework?

Decide who should be involved — Determine whether the patient can and wants to participate. Identify relevant team members, such as the primary nurse. When appropriate, consider family, a substitute decision-maker, community Elders, clergy, an ethicist, an ethics committee, patient relations, or risk management.

What is step 3 of the ethical decision-making framework?

Describe the issue in detail — Confirm who raised the concern, clarify the ethical questions, consider whether an ethical or legal violation may exist, and identify care-process gaps such as communication problems.

What is step 4 of the ethical decision-making framework?

Share preliminary perspectives — Listen to participants’ views and identify actual or potential conflicts within the team, family, or between the team and patient/family.

What is step 5 of the ethical decision-making framework?

Share the person’s story and assess the situation — Listen to the patient/family story and their perspectives, emotions, and reactions. Review diagnosis, prognosis, abilities, and decision-making capacity. Consider any substitute decision-maker, power of attorney for personal care, or advance directive. Explore relevant values, culture, religion, important relationships, involved team members, and external stakeholders. Address effects on the patient’s care.

What is step 6 of the ethical decision-making framework?

Explore relevant legal factors — Identify laws and legal duties relevant to the situation, such as rules about confidentiality and disclosure.

What is step 7 of the ethical decision-making framework?

Share values — Clarify the values of the patient, family, and team members and identify significant conflicts.

What is step 8 of the ethical decision-making framework?

Clarify ethical principles — Identify relevant principles, determine whether they conflict, and consider whether one or more should take priority in the circumstances.

What is step 9 of the ethical decision-making framework?

Select applicable ethical theories — Use relevant theories to clarify the issue: deontology (duties/rules), utilitarianism (outcomes), virtue ethics (character), care ethics (relationships/context), and narrative ethics (the person’s story).

What is step 10 of the ethical decision-making framework?

Identify alternatives or options — Summarize available options, determine whether a clear ethical/legal choice exists, and notice emotional reactions even when participants have difficulty explaining them.

What is step 11 of the ethical decision-making framework?

Deliberate about the alternatives — Weigh each option against ethical principles and theories, likely consequences, applicable rules, and any conflicts between them.

What is step 12 of the ethical decision-making framework?

Choose a course of action — Choose the action most consistent with the ethical theories, principles, and rules. Consider how it fits participants’ values, whether consensus exists, emotional reactions, and accountability for the decision.

What is step 13 of the ethical decision-making framework?

Develop an action plan — Decide what will be done and how it will be communicated. Clarify the responsibilities of the patient, family, nurse, and team.

What is step 14 of the ethical decision-making framework?

Evaluate the plan — Review outcomes and modify the plan as needed. Reflect on whether anything should have been done differently, how future processes could improve, whether a guideline could help with similar cases, and whether moral distress remains.

Four ethical principles

Autonomy, beneficence, non-maleficence, justice

Autonomy

Respect the person’s right to make informed choices. It is relevant when discussing options, consent, and a client’s preferences.

Beneficence?

Act to benefit the client and promote their well-being.

Nonmaleficence?

Avoid or minimize harm; consider potential risks as well as benefits.

Justice?

Consider fairness in treatment, resources, and access to care.

Deontology

Focuses on duties, rules, and obligations. A decision is evaluated in relation to the duty, even when outcomes may differ.

Utilitarianism

Focuses on consequences and outcomes, often seeking the greatest overall benefit.

Virtue ethics

Focuses on character and the qualities of a good person or professional.

Care ethics

Emphasizes relationships, empathy, compassion, emotions, caring responsibilities, and the particular context of a client’s situation.

Narrative ethics

Focuses on listening to and understanding the client’s story and lived experience.

Identify the issue?

Clarify what ethical concern exists and who is affected.

Gather perspectives?

Consider client preferences and story, relevant facts, professional values, principles, standards, and context.

Consider options?

Think through possible actions and their likely consequences; seek consultation where appropriate.

Justify the choice?

Explain how the chosen action fits the relevant ethical and professional considerations.