Novice Nurses

[Tweety, BSN, RN]

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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[CinLPN2RN]

This would make an interesting thesis paper. Thanks for the link, too.

Cindy

[nurse_wannabe]

I don't know if it's just because I have a splitting headache right now or what, but that book sounds rather complicated! :chuckle

I have to admit, I am scared to death to start working as an LPN. Just the thought of looking for a job makes me want to vomit. I feel like I know NOTHING, although I was a good student in school.

I just ordered a couple of books from walmart.com to read before I begin my job search (still debating whether to go to work as a GN or wait until I pass the NCLEX-PN).

They are:

(1) Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional by Donna Cardillo. http://www.walmart.com/catalog/product.gsp?product_id=1199567

(2) Training Wheels for Nurses: What I Wish I had Known my First 100 Days on the Job: Wisdom, Tips, and Warnings from Experienced Nurses by Barbara Arnoldussen. http://www.walmart.com/catalog/product.gsp?product_id=2527674.

I can't wait to get them in. If I can remember, I'll post on whether they are any good or not. The First Year as a Nurse one was recommended by someone from this board, so I'm sure it must be good.

[Altra, BSN, RN]

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.

Thank you for your post, and your confidence in us Tweety. :) It is much appreciated right now.

[Tweety, BSN, RN]

Thank you for your post, and your confidence in us Tweety. :) It is much appreciated right now.

I've been there and done that. I had some low days my first year when I questions why I became a nurse, that I wouldn't be a good nurse, and that I'd never catch on. I remember well those feelings. Too bad allnurses.com wasn't around back then. :)

[pickledpepperRN]

When i was a new grad LVN back in the Jurassic period I was blessed with RN charge nurses and LVN role models on the unit. I could go to them with any question.

If I forgot something I was quietly reminded.

Thank you Mila, Fran, Linda, and Fe! I am proud to call you friends. See you next week.

God bless your soul Mary. We think of you often.

nurse_wannabe:

I found the Cardillo book helpful. Havent read the others.

I suggest checking the Benner book out of the library. You can read the narratives from new nurses now. After you become competent you may enjoy the next chapters.

Only for a very few diagnoses have I reached the 'expert level"

I became a novice when a child was admitted to our adult ICU. Thank heaven for the clinical nurse specialist and pediatrician.

[presC.]

thanks tweety for boosting our confidence.. and as i've said on the other thread i'm wishing that my future preceptor will be like you. :)

i also like to buy that 2 books nurse wannabe, but no card to use (needed when buying online) i haven't seen one here in our bookstore yet.. so probably until i get there in us that's the first thing i'll purchase.. i'm excited!

[Dianne727]

Thanks Tweety!

A post from 3 years ago and the information is just what I needed. I have a test on this "stuff" tomorrow.

Dianne

[Quilter0225]

thanks tweety for boosting our confidence.. and as i've said on the other thread i'm wishing that my future preceptor will be like you. :)

i also like to buy that 2 books nurse wannabe, but no card to use (needed when buying online) i haven't seen one here in our bookstore yet.. so probably until i get there in us that's the first thing i'll purchase.. i'm excited!

i found the "tranining wheels" book at my local barnes & noble. i like it because you can pick it up and read for just a few minutes and still get something out of it. it has lots of short quotes from experienced nurses.