Facilitating Early Practice Development in Nursing Using Novice to Expert Theory

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1 Facilitating Early Practice Development in Nursing Using Novice to Expert Theory Authors: Barbara Haag-Heitman, RN, MS, MA and Sara Schedler, RN, BSN April 10, 2004 © Barb Haag-Heitman - who grants permission for printing one copy for personal use. Abstract The first years of nursing practice constitute a critical period for professional practice development. Organizations are implementing programs to support nurses during this vulnerable time. This case study uses narrative accounts of practice to illustrate common concerns and characteristics of practice during these first years of development along the novice to expert trajectory. Also presented are examples of supportive interventions and practice strategies to facilitate clinical practice. Introduction The early years of nursing practice hold unique opportunities and challenges for the individual nurse learning the art and science of nursing and for organizations to support their development. The shift from new graduate to the RN role is perhaps the most stressful and crucial part of the transition into professional practice (Godinez, Schweiger, Gruver, & Ryan, 1999). Once off formal orientation, RNs in their first years of practice reveal a sharp decline in the support and guidance from experienced nurses (Hurst & Koplin-Baucum, 2003). New graduate nurses express concerns about staff not appreciating where they are in practice and worry that staff have unrealistic expectations of them in relation to their abilities (Evans, 2001). To ease this transition, many organizations have implemented nurse mentoring programs to support new practitioners during this transition phase (Beecroft, Kunzman,

2 & Krozek, 2001; Hurst & Koplin-Baucum, 2003; McHugh, Duprat, & Clifford, 1996; Owens et al., 2001; Strauss, 1997; Trevitt, Grealish, & Reaby, 2001). However, few organizations implement programs to promote life long learning and full organizational understanding and support for clinical practice development outside the preceptor/mentor relationship. The 2004 Scope and Standards for Nurse Administrators (ANA, 2004) identifies the importance of continuous learning practice development to promote sharing of expertise to subsequently facilitate positive health outcomes. It is critical that preceptors, experienced staff, educators, managers, and nurse administrators all operate from a collective understanding of clinical practice development. Dr. Patricia Benner’s work on skill development along a novice to expert continuum (Benner, 1984, 1994; Benner, Hooper-Kyriakidis, & Stannard, 1999; Benner, Tanner, & Chelsa, 1996) integrates learning and development into one reliable research based framework that is well suited for understanding and promoting both individual and organizational learning about practice. This paper examines personal and organizational factors that support practice development along a novice to expert trajectory. Presentation of a case study, incorporating actual clinical practice narratives, helps illustrate the progression in the development of clinical judgment and critical thinking over time. The narrative accounts from practice provide both the content and context for understanding clinical practice development while providing a mechanism for dialogue to support individual and organization learning (Benner et al., 1996; Haag-Heitman, 1999; McHugh et al., 1996).


Becoming a Nurse - A Case Study S.S. began her nursing career by participating in a nurse intern program while completing her undergraduate studies. Student nurse intern programs provide opportunities for students to gain experience and skills with many of the hospital’s routines and care activities, such as dressing changes and urinary catheter management; many of which they will be expected to delegate as a RN. These programs help bridge the gap between theory and practice and offer the opportunity for students to develop their first healthcare team professional relationships....
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