Novice Nurses

Hi, I'm hijacking from Space nurse about Pat Brenner's idea of from novice to expert. So many of you have such high expectations of yourself and are so down on yourself for being incompetent and not knowing it all, I thought you'd like to read this so you won't feel so bad.

Confidence and expertise takes time, and your first year in nursing isn't enough.

Many of you probably studied it in nursing school.

The book - http://www.powells.com/biblio/72-0130325228-0

Just a sample:
Novice, Advanced Beginner, Competent, Proficient and Expert.
1. Novice: no background understanding of situation exists. Context free rules & attributes are required for safe performance at this level. Example is a first year nursing student.

2. Advanced Beginner: has enough experience to grasp aspects of (but not attributes) and recurrent meaningful components of the situation. Demonstrates marginally acceptable performance. Example is a newly graduated nursing student.

3. Competent: Able to determine which aspects of situations are important and which can be ignored. Demonstrates conscious and deliberate planning with an increased level of efficiency. An expert judge is needed to ascribe this level.

4. Proficient: Qualitative leap beyond competent. Able to perceive the situation as a whole, performance is guided by principals and rules of conduct. Nurse recognizes salient conditions and has an intuitive grasp of situation based on understanding.
An expert judge is needed to ascribe this level.

5. Expert: Nurse no longer relies on analytic rules, guidelines or principles. Able to focus on the accurate region of the problem of the situation because judgment is based on understanding of paradigms. Effectiveness of practice not hindered by any wasted regard of alternative diagnosis or solutions. An expert judge is needed to ascribe this level.
· “Performance level can be determined only by consensual validation of expert judges and an assessment of the outcomes of the situation” (Benner, 1984).

A Competent or an Expert nurse may fall back into the lower category temporally when placed in a new clinical situation (Benner 1984). This phenomena is also true in Advanced Practice Nursing (Harper, 2001).
Major areas of change with increasing performance skills (Walsh & Bernhard, 1998).

A. Increased reliance on past concrete experiences as paradigms rather than on abstract principles.
B. Perceive events more and more as a complete whole; previously seen as compilation of equally relevant pieces of information.
C. People become engaged and involved performers. In lower levels of skill development nurses have a detached observer position.

The study identified 31 interpretively defined skills that were grouped into seven domains of nursing (Alligood, 2002):
1. Helping role
2. Teaching coaching role
3. Diagnostic and patient-monitoring role
4. Effective management of rapidly changing situations
5. Administering and monitoring therapeutic interventions and regimens
6. Monitoring and ensuring the quality of health care practices
7. Organizational and work-role competencies

Benner believes that it is important for nurses to share critical reasoning and caring practices through narratives. A rich detailed explanation of nursing practice allows for greater understanding. First a nurse will identify with another nurse telling the story, an emotional response will be generated, which causes the receiving nurse to internalize the message (Benner, 1984).
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