Expert nurse

[shodobe]

It is hard to try to tell sometimes if certain people are sincere or not. If this guy is on the level then he will have to find out on his own how hard certain specialities can be. If not, then we answered the question for others who found it hard for them to ask. I have always been a firm believer that there are no stupid questions only stupid, wrong answers. I don't have the time to try to decide who is a troll and who isn't. All of us out here with the experience should just answer questions to our best ability. What they do with it afterwards is their problem. Mike

[nursemike, ASN, RN]

On the other hand, as I transition from a fairly proficient UAP to an utter novice nurse, I find it encouraging to read that I probably won't have to feel like I'm stagnating, 10 years from now. As anxious as I am to learn the skills I need, I'd hate to think I was going to run out of things to learn.

[pickledpepperRN]

There was a nursing study we learned recently in school, or maybe it was a theory, but called "From Novice to Expert". I read the difinition of an expert, because after 14 years of med-surg surely, I'm an "expert. But actually I'm not.

I'm very comfortable with my job, and precept students and new grads, but I'm hardly an expert. I learn things every day and I have to look up a lot of things the students ask me, and more often I'm learning from them and asking them questions. :)

Our patients are so sick that there is less time for the narrative (we thought we were just talking) that allows us to learn from others experience.

From Novice to Expert by Patricia Benner, Nursing Scholar and Theorist - http://www.eden.rutgers.edu/~kmckee/

I met Pat Benner when i took a 1.5 hour program at NTI in San francisco in 1991.

Her book and seminars are very enjoyable and worthwhile.

She truly advocates for patients and nurses with creative intelligence and heart.

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).

[pickledpepperRN]

Oops!

I didn't realise this is the Male Nurseing Forum.

Hey, I went to NTI with a male colleague that year.

[Tweety, BSN, RN]

That's o.k. Spacenurse, females have been posting here from Day #1.

Yes, Brenner, thanks for the lesson!

[CraigBSN02]

In which nursing speciality do you feel that once you're trained and spent a little bit of time in the field you know what to do exactly?

The thing with me is that I want to learn a speciality and want to become an expert in it and know how to do my job.

I don't want to ask for help. (Help may not be availabe since it's usually short staffed).

I guess what I am really trying to ask is in which specialty that you worked on took the least amount of time to learn and be an expert?

I mean, you can do the job in your sleep........

The reason I ask this is because I don't want to be constantly bombarded with new things and have to keep asking for help.

Let me know from your personal experience.

In which speciality do you feel that you can do your job in your sleep?

Thanks,

Aaron

PS: Please respond only if you've worked in that speciality. Thanks.

My goodness, I can't begin to tell you how wrong your post is... but I'm going to try.

Aaron, I think you really need to reconsider your choce of nursing as a career, if that's your mindset. ANY practice in the field of medicine involves change... it's inevitable. The human body is NOT a known quantity. To echo what others have said, usually two years in any given speciality will give you a comfort level so that you don't go home thinking, "Gee, I hope I didn't kill anyone".

However, once you enter nursing school, the feeling of ignorance will slowly dissipate. When you learn the basics of the body and how it responds, you'll become more confident. Once you master the basics (A&P, biochemistry, major disease processes), you'll start applying what you have learned.

I've worked in Emergency nursing for 3 years; I take my CEN in a few weeks, I've also applied for board certification (CardioVascular) in the following month, and I STILL constantly look up disease processes in my PDA and double-check my drug guide and ask my co-workers questions. You have to learn that working in any nursing field is a collaborative process; you don't work in a vacuum. Emergency is a fun, fast-paced, constantly changing field and that's the beauty of it. You need to know a little bit of everything to function effectively.

Please elaboarate on your question a little further, I'm curious as to why you asked this question.

-Craig

RN, BSN... and others

[SEOBowhntr]

I am at a point in my career in which I am often times the "Expert," frequently relied upon for explanations etc. Am I at a point in which I can sleep on the job, or am bored with the job??? NO!!! I am at a point in which I have become more of a teacher to my fellow staff than a student, but every day on the job you'd better learn a little something, or you're not putting enough into it. Are there jobs out there where you can almost sleep on the job in nursing??? Well, there is OR nursing!!!! LOL J/K to you OR nurses who may be offended, but you guys get poked at a lot by the general population of nurses. One of my former co-workers moved himself on to bigger and better things, but after working with me for about 4 yrs, he had become real close to the level that I am at, which may be as close to expert as many will ever achieve (not to break my arm patting myself on the back). Now he is in his new job elsewhere, and he is teaching staff new things and techniques that I taught him 2 or 3 years ago and he is seeing great results, 2 months in a new job and he is in charge of the Cardiac Stepdown Unit.

In nursing if we don't give all of our knowledge away readily to ensure that others are as good or better nurses than ourselves, we've cheated the profession and our patients!!!

[CraigBSN02]

My goodness, I can't begin to tell you how wrong your post is... but I'm going to try.

On further review (and a thorough Google search), I think this is a guy who is in his prereqs. I found similar posts at Studentdoctor.com and others with general career-type questions.

Sounds like he should shadow a nurse, MD, or whatever he's interested in. :-)

Go here: Google search

-Craig J.

RN, BSN... and others

[anonymurse]

Yeah Tweet, I was really frustrated until I read "From Novice to Expert" and finally understood the progression; it calmed me all down. Got to meet Benner (she was at our school for a Carnegie Institute study). Awesome intellect. Got her to autograph my cap for my 4 y/o daughter too (they didn't have a capping ceremony for our class but at least they did dump a cap on my desk; they didn't give caps to guys at all back when they did the ceremony).