Coaching for Competence

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

Tanner (2006), had introduce the term ‘thinking like a nurse’. When I read this article I was wondering what it means and takes to think like a nurse, I am a nurse by profession and yet I don’t even know what it means. In order to be a professional nurse, nurses are required to learn to think like a nurse. To my surprise, to be able think like a nurse, a nurse got to clearly defined and understands what is critical thinking and clinical reasoning. Both terms are powerful terms and these terms explain the mental processes nurses use to make certain that they are doing their most excellent thinking and decision making for their patient’s better outcomes.

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

The co-operative nursing assignment has given me the opportunity to use my critical thinking, decision-making, leadership, and clinical nursing expertise learned throughout the RN-BSN program. “The fostering of critical thinking as one of the terminal learning goals of nursing education based on the idea that critical thinking is important not only in the nursing workplace, but also in nursing education” (Shin, Jung, Shin & Kim, 2006, p. 233). My

There are many issues in nursing that we, as nurses, can have a profound impact on changing. Using nursing theory, we can improve clinical practice and thereby positively influence the health and quality of individuals (McEwen & Wills, 2014). Benner’s theory of Novice to Expert illustrates how nurses evolve through clinical experience and education to become expert clinicians. Theory can be used to guide nursing practice when combined with clinical knowledge and critical thinking; such is the case in the ambulatory (outpatient) care setting. Ambulatory care nursing is complex and encompasses autonomous, as well as collaborative practice using evidence based information across a variety of outpatient health care settings (AAACN, 2017). This paper will look at the lack of specialized nursing education in the ambulatory setting, as well as, Patricia Benner’s Novice to Expert middle-range nursing theory. It will also look at how Benner developed her theory and how her Novice to Expert Theory has been used previously in the ambulatory setting. Lastly, I will address how Benner’s theory could be used to address the lack of specialized nursing education in the ambulatory setting.

Advanced Beginner is the next stage in Patricia Benner’s model. Nurses considered to be in this stage have had enough real life experiences to note different aspects of a situation. They base their assessments of patients on previous experiences similar to the current patient they are providing care for (Benner, 1984). Nurses performing at this

Nursing school provides theoretical knowledge of basic nursing care concepts, but the limited exposure in the clinical practice setting makes transitioning into the role of the professional nurse very difficult for new graduate nurses (Ellis & Hartley, 2012). A study performed by the National Council of State Boards of Nursing, revealed many employers feel that newly licensed RNs are not fully prepared to perform common tasks in a basic practice setting, thus resulting in a 27.1% turnover rate for first year nurses (Dresher-Crumpley & McElroy, 2015)). The Journal of Nursing Administration (2008) revealed the average

Senior Preceptorship: Peds ED Molly Maguire St. John Fisher College WSON From Novice to Expert Patricia Benner shares her ideas on The Dreyfus Model of Skill Acquisition and how it can be used to describe the progression of a nurse from novice to expert (Benner, 1982). While working in the pediatric emergency department, I have seen nurses from all five levels of The Dreyfus Model of Skill Acquisition. The first level is the novice nurse. Novice nurses, typically new graduates, have no experience in the field and are forced to use rules and guidelines to facilitate the care they provide (Benner, 1982).

There has been a lot of talk about critical thinking during my four years of nursing school, with an array of different meaning and explanation; some was even unfathomable and baffling. Not so long ago, during my early years as a novice nurse, I didn’t pay much attention to the word, critical thinking. From where I used to work, decision making skills of nurses do not have a strong foundation. Every time there was a problem regarding patient care, it was immediately referred to the attending physician and then I would just carry out orders without sometimes thinking it through. I was a task-worker who simply carried out doctors’ orders and followed a fixed set of rules. That is how I practiced before, reckless and impulsive. I never rethink and reconsider decisions made by doctors. I never admit to a lack of knowledge. I was too proud of myself .Luckily, it didn’t cost any patient lives but it could have. I wasn’t thinking and acting like a professional nurse. To think like a nurse requires that to learn the content of nursing; the ideas, concepts and theories of nursing and develop intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers (Heaslip, 1993) ¬ a realization that I just have found out recently. My perspective about critical thinking change immensely while taking this course. Not only because it covered different aspects of critical thinking but also

Future roles also can change for nurse. More and more opportunities obligates nurses to contribute and lead patient quality of care that’s not only means simple care management of patients, but also focus on preventive and wellness versions. Many nurses work as “health coaches “helping patient transition after hospitalization and into the home or rehabilitation setting that demonstrates promoting wellness. As part of the changes in reimbursement depends on quality of

The preceptor assists the novice nurse in bridging the gap between education and clinical practice (Sonya Blevis, 2016). In an NETP (Nurse Entry To Practice), a new graduate is partnered with an experienced nurse who is proficient in teaching a novice. New graduate nurse gets to work in the ward for 1 year and have 6 weeks of orientation phase. Staff nurse introduces the new staff member to the nursing, medical and non-medical team, orientates to the unit and guides until the orientation is complete. Preceptor hands down the torch to the preceptee by orientating, imparting knowledge and ward traditions, teaching new skills, overseeing new staff when the task is implemented and gives positive and/or negative feedbacks. The preceptor needs to offer a conducive learning environment and must be able to give opportunities for the new graduate staff member to ask questions when there are uncertainties. Creating a good relationship is essential when working with a new staff member. Analyzing one 's flexibility and adaptability are crucial to success. Transitioning from a 6 to 8 weeks clinical placement to the real nursing world can be overwhelming. This is where the preceptor enters to break the barrier that will hinder the new graduate to excel in her chosen field. While the success of transitioning to the real world is multi-faceted, the foundation of transition success begins on the first day the new nurse graduate enters the facility (Adams, P et al, 2014)

With a large number of nurses retiring in the next five years, we can expect to see the majority of nurses in practice to be new graduates. Although new graduates have the minimal competency to preform safe care, they lack the experience of the soon to be retirees. Knowledge, skills, and attitude encompass how nurses conduct patient care and these competencies are matured over time. The amount of responsibility can be overwhelming for a novice nurse to take on during their transition from education to practice, therefore, it is important to consider the transition prior to graduation. According to Roux (2018), "Nursing students build this competency skill throughout their educational experience's, particularly in semesters immediately prior

The path to nursing leadership most often progresses from novice to expert nurse and then onto a novice nurse manager. The novice nurse manager is asked to lead and rarely given the tools or knowledge to be successful in this new role. The Dreyfus Model of Skill Acquisition discussed by Patricia Benner includes the following five levels of competency in the clinical nurse (Benner, 1982):

Education for the novice nurse must be designed to boost clinical reasoning and develop clinical judgment. Student nurses and new grads are very task oriented and have difficulty visualizing the whole picture. They must learn to put all the pieces together and be able to formulate a conclusion or “clinical judgment” of what is needed for the patient. According to Kathleen Masters (2017), “the student must learn to think like a nurse”.

Patricia Benner described the first stage as the novice nurse who is taught general rules to perform tasks without any, or very few, clinical experience. This rule-governed behavior is limited and inflexible (“From Novice to Expert”, 2013). Most nursing students are in the novice stage while they are completing their educational requirements (Cherry & Jacob, 2014). Although they have some exposure to clinical experience, it is limited and under the guidance of a nursing instructor rather than in a “real world” setting. According to Cherry & Jacob (2014), once the nursing student graduates, he or she will begin the progression into the advanced beginner stage (second stage). The advanced beginner nurse is able to make some judgment calls based on having experience in actual situations and performance is adequate. During this stage, the nurse begins to formulate principles to guide actions (“From Novice