Nursing Presidency Program: A Case Study

Leadership is encountered in every occupation and in everyday life. In nursing, leadership is not only prevalent; it is crucial to patient care and employee satisfaction. The nurse leader that was interviewed was a nurse at the Newport Hospital in Newport, Washington. This is a small hospital in a rural community. She is a charge nurse in the acute care unit, as well as in charge of leading infection control in the hospital. With these roles comes a lot of responsibility, and tasks that must be completed in a timely manner to create a workflow for the rest of the staff. There is a lot of juggling and balancing everything that is included in all of those positions.

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.

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.

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.

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

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:

The concept of nurse residency programs is not by any means a new concept. Programs have been grounded on Benner’s theory of novice to expert. Benner established the notation that nurses develop skills and understanding of job skills over time through an education also with hands on experiences. She noted a nurse passes through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert and was generally reached only after years of gaining experience as a practicing nurse. A nurse residency can facilitate new nurse graduates to transition smoothly through the levels and sometimes even more quickly. As a new graduate a nurse residency program is very appealing, not only does it help mentor you through novice period but also helps develop competent nurses for the organization.

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

With an ever-increasing body of knowledge in the field of nursing, more education is being required to enter the field of nursing. Many healthcare institutions are raising the educational requirements in order to become employed or maintain employment in their facilities. Healthcare organizations are transitioning to hiring registered nurses (RN) who have a higher level of education, such as, a graduate from a Baccalaureate Degree Nursing (BSN) program. The goal of these institutions is to have nurses with a broader array of skills that can meet the growing demands of our patient population. BSN prepared nurses are recognized for their well-rounded skills in critical thinking, management, case management and health promotion versus Associate Degree nurses (ADN)/Diploma nurses that focus on direct patient care.

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.

When transforming into new nurse educators, nurses often discover they are not as prepared as they would hope to be; Billings & Halstead (2012) report that purposeful preparation for the role must be provided. A nurse proficient “in practice”, caring for patients in an advanced practice role or managing a patient care unit, is not necessarily proficient to teach clinical skills to others. Cangelosi, Crocker, and Sorrell state, “Teaching is not a natural byproduct of clinical expertise, but requires a skill set of its own” (2009, p.371). In 1984, Benner applied the Dreyfus Model (1980) to describe challenges experienced during skill acquisition. Incorporating five stages, the model explains that when expert clinicians begin their roles as novices, their performance is guided by rules; during this transitional phase of skill acquisition, Benner notes that performance may be unsuccessful as rules cannot define most relevant tasks to perform in actual situations. As a result, novice educators will often compare feelings of inexperience similar to those of undergraduate students entering clinical practice.

Effective training and education of staff to evaluate competency is challenging. The current lack of regulations regarding nursing curriculum results in a vast disparity of experience and ability. When a leader looks at the new graduate registered nurse it is imperative to understand that all new graduates are not equal in knowledge and experience. Initial education is only the foundational start for the nursing professional. Nursing leadership must provide the tools and mentoring necessary to do their jobs effectively, safely and efficiently. Benner's novice to expert theory can be used as the equalizer to narrow the educational and experience gap between nurses. So much of a students knowledge is built on experience in the clinical setting, it is difficult to ensure that all student training and knowledge is equal. . Benner's theory “predicts that nurses with higher competencies will identify problems more quickly based on subtle clues” (Larew, Lessans, Spunt, Foster & Covington, 2006, p. 18). This need to develop nursing competency supports the need for practice in the clinical environment and a continued evaluation and mentoring program in the work environment.. A well organized structure of a residency program allows close observation and opportunity to support staff through transition from student to nursing professional while placing high value on safety and

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.

Benner’s Novice to Expert theory places the onus on nursing leadership and educators to design orientation processes to aid the new nurse in the transition from school to practice. One such recommendation states, “a new-graduate residency program lasting at least 1 year with planned coursework, mentoring, and use of first-person experience-near-nursing narratives of experiential learning to help new nurses reflect on their experiential learning and articulate what