Nursing Presidency Program: A Case Study

A nursing theory allows the nursing profession to define and differentiate nursing care practice from other professional disciplines. The work of Patricia Benner has been crucial in setting a stage to standardize education and career progression for the nursing profession. The nursing care practice has been changing exponentially since the development of the theory From Novice to Expert. It has enabled facilities across the nation to achieve a higher level of patient care due to its ability to identify the needs of each of the stages of a professional nurse’s career progression.

Patricia Benner is known as one of the most recognized theorist of our time. Patricia born in 1955 in Hampton, Virginia spent most of her childhood in California. It was there that she received her professional education. This paper will focus on her Novice to Expert theory using the Model of Skill Acquisition through defining concepts within her conceptual framework, identifying assumptions within her theory, discussing the significance of her theory as it relates to advanced practice nursing, and addressing how applicable her theory is to actual nursing practice.

In the traditional health care model, formal learning is not complete when a physician receives their medical degree and white coat at the end of their academic program. Medical school graduates are required to complete an accredited hospital residency program to become licensed to practice medicine, (Jolly, Erikson, & Garrison, 2013). However, acute care nurse practitioners (ACNPs) are not afforded, nor expected to complete, the same educational requirements. The current expectation that a new graduate ACNP learn their advanced nursing role “on-the-job” is unacceptable and leads to decreased job satisfaction and preparedness. In the every-changing climate of health care, the development of required residency programs for ACNPs should be maintained as a priority.

The publication from the institute of medicine has garnered much interest since its publication in 2010 focusing on the future of nursing and the implementation of this with in the nursing community. The nursing profession has over 3 million members and is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 IOM (Institute of Medicine). One of the recommendations is that of a nurse residency program for new nurses or nurses transitioning into new clinical practice areas. The area I work in is home health and this is a growth area the need for a residency program cannot be over stated home

Nursing can be a demanding career, but the benefits far much outweigh the challenges. Most importantly, it’s the rewards it offers by allowing an opportunity to make a difference in another person’s life through the provision of care when they need it. Just as Patricia Benner theorized in her book “Novice to Expert,” nursing encompasses both educational knowledge and extensive clinical experience acquired throughout one’s career. This far, I continue to acquire knowledge and clinical knowhow which will promote proper and efficient care to patients. Since I began practicing one year ago in a long-term healthcare facility, I have interacted with patients, families, physicians and other members of the healthcare team to coordinate patient’s care which has enabled me to gain confidence in myself. While I cannot deny that it was difficult to transition from a student to a licensed nurse, I learnt to overcome these challenges and focus on my strengths. Practicing as an LPN has provided a platform to learn and gain experience even though the duties and responsibilities are limited by the scope of practice.

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

Some of the dilemmas associated with today’s nursing force are: Many are under-educated and task-oriented, unaware of their patient’s plan of care, medical histories, or pertinent results. Too many rely on clinical coordinators and team leaders, when it comes to critical thinking, therefore, miss out on the vital fundamentals, which make nursing such an honorable profession (Grietens, 2007, p. 10). In order to create a stronger, more knowledgeable nursing workforce, entry-level requirements for RNs, as well as APRNs, need to be uniform. In addition, research shows bachelors and masters prepared nurses, result in better patient outcomes. An example of a proposed solution includes:

Multiple deans from AACN baccalaureate programs and chief nursing officers from UHC hospitals recognized the need to create a national residency program to support and educate new graduates in their position as clinical nurses (Goode, Lynn, McElroy, Bednash, & Murray, 2013). Although there were many different university hospital NRPs, there was not a standard program with a specific completion time or standardization of content. NRPs ranged in completion time from 4 weeks to 2 years (Goode & Williams, 2004). UHC and AACN acknowledged that a standard curriculum was needed to help graduate nurses transition into a professional registered nurse, as there is increasing complexity of patients related to advancing technology and treatments.

Advance practice nursing has been applied to variety of roles like Acute Care Nurse Practitioner (ACNP), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse- Midwife (CNM) and Certified Registered Nurse Anaesthetists (CRNA). Even though clinical expertise is the core ingredient for APN practice, these nurses are expected to demonstrate competencies like use of holistic perspective, initiation relationship with patients, use of expert critical thinking and use of diverse health and illness management (AACN, 2006). Additionally they need to express core competencies like consultation, collaboration, leadership, research and expert coaching (NACNS, 2004). Experienced staff nurses may exhibit these competencies whereas the APN make it visible in their practices and they are believed to be basic components of every APN (Hamric B, 2009 p 84). Furthermore a brief consideration of Benner’s model is required to understand the acquisition of expertise in nursing. Benner defines expertise as a mixture of theoretical and practical knowledge and every APN begins as a novice and ends up with some expertise.

The beginning of a new graduate nurses career rarely begins easily, there seems to be a distinct disconnect between the fantasy of what it means to be a nurse and the reality of bedside nursing. Nursing school seems to feed into this disconnection, in that it does not prepare the new graduate registered nurse (NGRN) for their professional practice. What nursing school does is give the NGRN the basics, a peak into what is to come. The NGRN has to find out for themselves what the true meaning of being a nurse is and if it fits their preconceived ideas.

The evidence gathered supports the proposal of the nurse residency programs but more information is needed. Additional formal education would be utilized through internal audits of the program that will gather information to adapt the program for our facilities best interest over time. These internal audits are a way of evaluating the residency programs progress in having more comfortable

Coincidently, the standard educational background of these professionals is a Master of Science in Nursing. These programs are different from conventional master's programs in nursing because they also focus on visionary leadership, quality improvement and evidence-based practice. Thus, students will learn how to incorporate complex concepts and professional practices to create innovative nursing practices and systems. These programs also impart the skills needed to transform and enhance evidence-based care systems. The basic requirement to enter this program is an RN license and a Master’s of Science in

My chosen practicum will be teaching in the skills/simulation lab at NCMC. This paper will outline how the experience will enhance my knowledge and develop skills necessary to fulfill the role of nurse educator. The goals, objectives, and timeline will be discussed in this paper. The project that will be developed during the practicum experience will be a debriefing philosophy and evaluation tool to assess student learning with emphasis on critical thinking skills.

I am a recent baccalaureate graduate of Charleston Southern University. I received my Bachelor of Science in Nursing in May of 2015. On June 20, 2015, I received my NCLEX-RN results and became a registered nurse in the state of South Carolina. After considering my options for a graduate program, I happily accepted my offer from Case Western Reserve University and moved to Cleveland to pursue my graduate studies. Over the course of my undergraduate career, theories were included in the curriculum but not in depth. It is for this reason that I am excited to partake in this course – to learn the foundational and applicable theories of the nursing profession.

Apply Andragogy (Adult Learning theory) and Benner’s Novice to Expert framework to clinical instruction in nursing. Describe two ways you could facilitate learning in the clinical setting through application of these theories.