NURS 492 Week 8 Reflection Paper Example

Looking Back and Ahead: A Capstone Reflection on the RN-to-BSN Program

Why I Came Back

By the time I started this degree, I had been a registered nurse for thirteen years. I was good at my job and I knew it. I came back partly because my hospital was pushing for more bachelor's-prepared nurses and partly because I wanted to be a charge nurse, and I expected the program to teach me little that I did not already know. This paper reflects on how wrong that expectation was, course by course, and on where I hope to go next.

Pathophysiology: The Reasons Behind the Routine

NURS 215 was the first course that surprised me. For years I had titrated oxygen to 88% to 92% for patients with COPD and given iron to patients with anemia, but I could not have explained the mechanisms beyond a sentence. Writing forum threads on sepsis, COPD and iron deficiency made me trace each finding to its cause. The change was practical: when a patient's carbon dioxide rose after a well-meaning colleague turned up the oxygen, I could explain why, and the explanation changed what the colleague did next time.

Nursing Concepts: Seeing My Own Growth

NURS 325 introduced me to Benner's model of skill acquisition, in which nurses pass through five stages, from novice to expert, as experience teaches them to see situations as wholes rather than lists of rules (Benner, 1984). I recognized myself as proficient, perhaps expert in some situations, and, more importantly, I recognized the new graduates I precept as advanced beginners who need rules and examples, not my intuition. That insight changed how I teach. Instead of saying "you just know," I now explain the cues I am reading. Last month, when a new nurse asked why I had called the rapid response team for a patient whose vital signs looked acceptable, I walked her through what I had noticed: the patient's new restlessness, his refusal of dinner and a respiratory rate that had crept up over four hours. She told me later that no one had ever put intuition into words for her before.

Communication: Conversations I Used to Avoid

NURS 220 asked me to practice the conversations I had spent years avoiding: telling a physician I disagreed with an order, addressing a colleague who left work undone and talking with a family that wanted everything done for a dying parent. Role-playing those conversations felt artificial at first, but the structure stayed with me. A few months later, I told a surgeon that I would not give a second dose of a sedative to a patient whose breathing had slowed, explained my reasons calmly and asked him to come and assess the patient. He did, and he changed the order. I had been right before in situations like that, but I had not always said so, and the course taught me that being right does a patient little good if I stay silent.

Community Health: Outside the Hospital Walls

NURS 440 sent me into my own city with a community assessment, and I learned that the patients I readmit for heart failure go home to neighborhoods with high food insecurity and limited transportation. I had blamed some of them for not following instructions. One man I had privately labeled noncompliant turned out to live alone three miles from the nearest pharmacy with no car, and the instructions I had given him assumed resources he did not have. The course taught me that health is shaped by conditions as much as choices, and I now ask every heart failure patient how they will get their medicines and food before I teach them about salt.

Leadership, Management and the Capstone: Finding a Voice

The final courses changed how I see my role. In leadership and management, I interviewed a servant leader, studied delegation in Virginia's regulations and wrote about Nehemiah leading people through change. In this capstone, Buresh and Gordon (2013) challenged me to stop describing nursing only in terms of caring and to explain what nurses know. I changed how I introduce myself to patients, using my full name and title and saying what I will be watching for. It felt awkward for a week and natural after that. Patients now ask me more questions, which tells me they understand that I can answer them.

The Program as a Whole

Looking back, the program did not make me a better bedside nurse in the obvious ways; my skills were already strong. It changed what I can explain, whom I notice and how I speak. Using Benner's stages (Benner, 1984), I was proficient at the bedside, but as a teacher, a writer and a leader I started as a novice and have moved, I think, to competent. The research supports what I experienced. Lasater et al. (2021) found that hospitals that increased their share of BSN nurses between 2006 and 2016 saw lower mortality and readmissions, and Porat-Dahlerbruch et al. (2022) found that the benefit held for nurses who completed RN-to-BSN programs, not only for those who started with a bachelor's degree. I no longer see this degree as a credential I needed; I see it as preparation I lacked.

Looking Ahead

I have three goals for the next five years. First, I will take a permanent charge nurse role within a year, completing my hospital's charge nurse leadership course first. Second, I will keep my progressive care certification and add a cardiac medicine certification within two years. Third, within three years I plan to enroll in graduate study, most likely a master's degree focused on teaching nurses, because precepting has become the part of my work I love most and I want to do it with better preparation. Each goal builds on something the program started: leadership on the unit, deeper clinical knowledge and teaching. I also know the obstacles. Graduate school will compete with my family's needs and with night shifts, so I plan to begin part time and to ask my manager about a day schedule once I take the charge role.

Faith and the Future

My faith was part of my nursing before this program, but it was mostly private. Courses that asked me to write about Scripture alongside research taught me to connect them openly. Doornbos et al. (2005) describe nursing as a calling within a Christian vision of persons and health, and that vision now shapes my goals. Leadership is a way to serve the nurses who serve patients, and teaching is a way to pass on what I have been given. Peter wrote that each one should use whatever gift they have received to serve others, as faithful stewards of God's grace (English Standard Version Bible, 2001/2016, 1 Peter 4:10). The program did not give me a new calling; it gave me better tools to answer the one I had.

Conclusion

I came back to school expecting to learn little and finish quickly. Instead, every course changed something: why I do what I do, how I see new nurses, where my patients go after discharge and how I speak about my profession. I leave the program as the same nurse in many ways, but one who can explain her knowledge, lead others and keep learning, with a faith that now has words to go with it. The doubt I brought with me, that a degree could teach an experienced nurse little, turned out to be the first thing the program corrected.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Buresh, B., & Gordon, S. (2013). From silence to voice: What nurses know and must communicate to the public (3rd ed.). ILR Press.

Doornbos, M. M., Groenhout, R. E., & Hotz, K. G. (2005). Transforming care: A Christian vision of nursing practice. Eerdmans.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Lasater, K. B., Sloane, D. M., McHugh, M. D., Porat-Dahlerbruch, J., & Aiken, L. H. (2021). Changes in proportion of bachelor's nurses associated with improvements in patient outcomes. Research in Nursing & Health, 44(5), 787-795. https://doi.org/10.1002/nur.22163

Porat-Dahlerbruch, J., Aiken, L. H., Lasater, K. B., Sloane, D. M., & McHugh, M. D. (2022). Variations in nursing baccalaureate education and 30-day inpatient surgical mortality. Nursing Outlook, 70(2), 300-308. https://doi.org/10.1016/j.outlook.2021.09.009