NOVICE TO EXPERT

Or when Alice/Allen fell into the hole how did she/he find her way out?

Think About It

n What is your greatest concern about your transition from school to practice?

Reality Shock

n Three Stages

– Honeymoon

– Shock and Rejection

– Recovery

Honeymoon

n Sees the world of nursing looking quite rosy

n Often fascinated with the thrill of “arriving in the profession

Shock and Rejection

n Has excessive fear and mistrust

n Experiences increased concern over minor pains and illness

n Experiences decrease in energy and feels excessive fatigue

n Feels like a failure and blames self for every mistake

More Shock and Rejection

n Bands together and depends on people who hold the same values

n Has a hypercritical attitude

n Feels moral outrage

Recovery

n Beginning sense of humor is the first sign

n Decrease in tension

n Increase in ability to objectively assess and evaluate work setting

n Crucial period for conflict resolution

Dealing with Reality Shock

n Increase number of patients while in school

n Work a real shift

n Move from observation to taking control

n Mentors/preceptors

n Ask managers what their expectations are of new grads

Dreyfus Model of Skill Acquisition

n Studied test pilots and how they reacted to emergencies during simulations.

n Focus was on pilots eyes.

n Dreyfus noted that as the pilot gained proficiency, their eyes focused on different things in their visual field.

n Dreyfus uses driving a car as an exemplar.

Phenomenology

n In this type of research the question to be answered is:

– What is the meaning of this experience for this/these subjects?

– Benner began using the Dreyfus model to see how the levels he developed for the pilots applied to nursing.

Five Levels

n Novice

n Advanced Beginner

n Competent

n Proficient

n Expert

Role Transitions

n NOVICE

– Nursing student

– Experienced nurse in a new setting

– Characteristics

n No clinical experience in situation expected to perform

n Needs rules to guide performance

n Experiences difficulty in applying theoretical concepts to patient care

n ADVANCED BEGINNER

– Last semester nursing student

– Graduate nurse

– Characteristics

n Demonstrated ability to deliver marginally acceptable care

n Requires experience in actual situation to recognize it

n COMPETEMT

– 2-3 years of clinical experience

– Characteristics

n Conscientious, deliberate planning

n Begins to see nursing actions in light of clients long-term plans

n Demonstrates ability to cope and manage different and unexpected situations that occur

n PROFICIENT

– Nurse clinicians

– Nursing faculty

– Characteristics

n Ability to recognize and understand the situation as a whole

n Demonstrates ability to anticipate events in a given situation

n Holistic understanding enhances decision making

n EXPERT

– Advanced practice nurse clinicians and faculty

– Characteristics

n Demonstrates an understanding of the situation and is able to focus on the specific are of the problem

n Operates from an in-depth understanding of the total situation

n Demonstrates highly skilled analytical ability in problem solving, performance becomes masterful

Perceptual Awareness of Expert Nurse

n Perceptual awareness is central to good nursing judgment

– Expert nurses describe perceptual abilities as “gut feeling”, “sense of uneasiness”, “feeling that things aren’t quite right.”

– Expert nurses move from these perceptions to a definitive evaluation of the patient’s condition.

Skilled Performance

n Benner does not mean how well you can put a catheter in or give a shot.

n Skilled performance is a whole field that a nurse works in

n Benner describes skilled performance as:

n 1. Movement from theory to use of past experience to guide performance

n 2. Learner’s perception of the situation changes from one in which all bits of information are seen as equally important to being able to view the situation in a context and able to pick our the relevant information needed for action.

n 3. Passage from detached observer to involved performer

n Prevents single factor thinking

n Collective wisdom passed on through

– Dialogue

– Questions

– Conferring

– Advising

Social Embeddedness

n Prevents single factor thinking

n Collective wisdom passed on through

– Dialogue

– Questions

– Conferring

– Advising