Help! Quick question from a nursing student

Columnist · Jan 13, 2013

Moved to Nursing Student Assistance for more response.

LadyFree28, BSN, LPN, RN · Jan 13, 2013

Hey esteemed nurses! I'm in my final semester of nursing school and I have an assgnment which requires that I ask a few interview questions of an RN. I've asked one who I know personally, but I'm nervous she might end up not remembering to answer them for me by the due date and I know she's got a lot going on in life these days so I don't want to harrass her. Here is a brief review of Benner's theory, and the questions I need answered are at the bottom. It shouldn't take very long, I would so appreciate if one of you might take a few minutes (seriously shouldn't take more than 5) of your very valuable time to answer them for me? Thank you in advance!!
review of benner's theory:
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
Novice
Advanced beginner
Competent
Proficient
Expert
Novice
Beginner with no experience
Taught general rules to help perform tasks
Rules are: context-free, independent of specific cases, and applied universally
Rule-governed behavior is limited and inflexible
Ex. Tell me what I need to do and Ill do it.
Advanced Beginner
Demonstrates acceptable performance
Has gained prior experience in actual situations to recognize recurring meaningful components
Principles, based on experiences, begin to be formulated to guide actions
Competent
Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day situations
More aware of long-term goals
Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization
Proficient
Perceives and understands situations as whole parts
More holistic understanding improves decision-making
Learns from experiences what to expect in certain situations and how to modify plans
Expert
No longer relies on principles, rules, or guidelines to connect situations and determine actions
Much more background of experience
Has intuitive grasp of clinical situations
Performance is now fluid, flexible, and highly-proficient
Different levels of skills reflect changes in 3 aspects of skilled performance:
Movement from relying on abstract principles to using past concrete experiences to guide actions
Change in learners perception of situations as whole parts rather than in separate pieces
Passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation
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QUESTIONS:
1. How long have you been practicing as a Registered Nurse?
2. Describe a typical day in your current practice.
3. Where do you see yourself along this (Patricia Benner's) continuum?
4. Describe a scenario from your practice that would demonstrate this level of your practice.
Thank you thank you thank you!!!

Ooh...going to come off as a total nursing geek, but I used Benner in my research class for my research proposal, so I would LOOVEE to help! Here are my answers:

1) I have been practicing as an RN for six months

2) I work at a pediatric medical day care. My pt ratio us usually 1:3; it can go up to 1:6-with an LPN taking 3 of my pts, sometimes with no LPN. My clients range from diabetics, failure to thrive, history of respiratory, as well as cardiac issues, even GI issues such as Hirshsprungs disease. Typical daily care includes basic assessments, including focused assessments for pt's with Neuro, GI, Cardiac, and Respiratory issues; post OP care and precautions; PO INH and GT med administration, Some PICC line med administration if required; rectal irrigation procedures, chest PT, humidified O2, suctioning for trached pts; NGT or GT feeds, PO feeding with recommendations from OT/ST, support teacher while instruction of children. Documentation of weights, growth chart plots, developmental scales and referrals to early intervention (if not done).

3) I would say proficient. I had this position as a LPN. I have been an LPN for seven years; had this position for 4 years, high tech ped nurse throughout my LPN career. I completed my BSN in May and was licensed in June, so there was not much of a transition at this position. I have accepted a position at a local PICU, so I will return to a novice in the PICU in February.

4) Example: When we started admitting clients with Diabetes, there were certain nursing judgments regarding how to cover insulin regarding carbohydrate exchange and BG levels. I was finding a correlation where some nurses would round up, while others were rounding down. I found the correlation due to nursing judgement and experience....novices were being extra cautious, while the pt rounding up used analytical skills-a competent skill set. Both had potential complication of not stabilizing BG and had the potential of not presenting a stable (or unstable) BG trend Based on researching both sides, I presented this information on the clinical committee (which I am a part of) and my manager and presented the idea of a two person check along with training of covering for carb exchanges. Any nursing judgement conflicts would be presented to the head nurse (called the clinical coordinator) and if, needed, verification from the PCP prior to administration of the insulin. I used holistic understanding as well as used the experience to provided better solutions to a potential solution modifying how we plan and administer care.

I hope this helps...I'm a fan of Patricia Benner and I truly believe her theory had helped me understand my patients and peers more, and understanding her theory had made my nursing career enjoyable!!!

Good Luck!!!

trauma_lama, BSN · Jan 13, 2013

Thank you thank you thank you!! You da bestttttt!!! ;-)

LadyFree28, BSN, LPN, RN · Jan 14, 2013

You're welcome and good luck!!!