The Importance of Theory

McKenna, L., & Newton, J. M. (2009). After the graduate year: a phenomenological exploration of how new nurses develop their knowledge and skill over the first 18 months following graduation. Australian Journal of Advanced Nursing, 25. Retrieved from http://web.a.ebscohost.com.proxymu.wrlc.org/ehost/pdfviewer/pdfviewer?sid=57a243af-c0d3-4f81-addf-041456493db3%40sessionmgr4005&vid=1&hid=4206

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.

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.

Patricia Benner, a well-known nursing theorist who published From Novice to Expert, theorizes how a nurse should progress through their career. Benner’s theory explains what stage of nursing one is in based on your education and the amount of time one has worked in a specific nursing field. She describes the five stages of the theory: novice, advanced beginner, competent, proficient, and expert. While this theory has its limitations, it is beneficial to the well-being of both the nurse and patient and that is proven by real world clinical practice.

All APN have to progress through the stages Benner identified in her novice to expert theory of nursing practice. In order to make a better transition, it is important for APNs to make a personal assessment and reflect upon their own strength, weakness, goals and objectives. A personal assessment is the first step of a professional development plan. Benner’s novice to expert model is an important self-assessment tool that APN can use to identify the strength, weakness, goals, and

When most experienced registered nurses hear the word shock, they begin to use their critical thinking skills to determine the patient’s immediate need. However, new graduate nurses in the career field are faced with a different type of shock; they are faced with transitional shock. Transitional shock is a theory created by Judy Duchscher. Her theory is based on reality shock which is a term coined by Marlene Kramer. Reality shock is when new nurses recognize clinical practice and the classroom setting are two different worlds (Hentz and Gilmore, 2011, p.134). When new graduates transition to a registered nurse position, it does not happen with ease. Over the years, there has been a rise in concern with this transition. As new graduates move in the career field, they may feel anxious and uncertain about their new responsibilities. Unfortunately, when there is a high demand of nurses, new graduate nurses are expected to begin a new job at full speed, but they are not able to handle the fast pace position they are placed in. When new graduates are expected to accomplish task they are unprepared for, it sets them up for transitional shock. To minimize transition shock for new graduates, finding a mentor, preceptor, seeking an internship or residency program may help ease the transition.

The first pattern of knowing in nursing presented is the Empirics: the science of nursing. Carper (1978) described this empirical knowing as factual evidence and proven medical research or documentation used for patient treatment. This empirical knowledge is vastly related explanations and predictions from facts and things that have been proven. This author believes that most of this scientific evidence or knowledge stems from books and clinical experiences gained in healthcare facilities under the leadership of trained educators or licensed medical providers. This author believes this because as a nursing student, she will learn nursing techniques such as inserting foley catheters, and doing injections first by observing the nursing

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.

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.

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.

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.

She believed that years of experience is what ultimately sets apart a novice and expert nurse. “Clinicians at different levels of practice live in different clinical worlds, recognizing and responding to different situated needs for action” (Alligood & Tomey, 2010, p. 141).

Therefore, theory is the necessary for research and data. If there’s no theory testing would seem pointless for research. Without research, clinical observations merely would need to determine effective interventions. Therefore, objective means may not exist to test for subjective observations of the client and their related problems or issues.

The credibility of a profession is based upon its ability to create and apply theory. Nursing as a whole has not been at the forefront of theoretical research being much more practical or hands-on in nature. Unless nurses increase the value placed on research and the body of knowledge that establishes the legitimacy of their practice then nursing will remain in a subordinate position in the medical environment. Theorists anticipated that by conceptualizing models of nursing, practitioners would be able to become more autonomous in their clinical settings while increasing the visibility and authority of nursing as a discipline. It

In today’s world, it is essential to incorporate nursing theory into practice. Patricia Benner, through her work, “has provided essential understanding of how knowledge and skills are acquired and directly applied to nursing practice, education, research and administration” (Altmann, 2007, p. 114). According to Benner’s model of skill acquisition, “the nurse passes through five stages of career development, novice, advanced beginner, competent, proficient and expert” (English, 1993, p.387). Specific patterns of behavior, thinking, and performance is present in each stage. The most experience is associated with the expert nurse and the least experience is possessed by the novice nurse (Benjamin, 2007). This model is based on ascending level of proficiency and the key concepts of this model are: competence, skill attainment, experience, clinical knowledge and practical knowledge