Background

Journal

Our Novice to Expert Endeavors

by: MJ Salonga, RN

S: “Patience with our patients is the key.” 

O: Found this nurse in the unit, ambulatory, busy-looking. More or less oriented to time, place, and person. With dry oral mucosa, on nothing per orem since the shift started. With symmetrical chest expansion, noted to be tachypneic, almost struggling for breath. Abdomen flat, not distended. Pulses full, bounding at +2. No contraptions noted but seen holding used intravenous tubing, urinal, dry and wet cotton, and medication tray. Skin cold to touch, pale in color. Due to void.

A: Risk for Caregiver role strain related to multiple demands of patients

P: For the nurse to sustain competent and compassionate nursing care and for her to function best albeit the demands placed to her.

I: (in the making…) :)
by: Rocelle Joan Sasa, RN



I can say Patricia Benner’s From Novice to Expert  shows the stages in the development of the career of nurses. I believe this may also be applicable not only to us but also to varied professions as well.

Novice.
I had my first clinical exposure during my second year in College (2003-2004). It was also the time when we first wear our duty uniforms in the hospital and in the community. To be specific, I had my related learning experience in the delivery room of Ospital ng Maynila and my community days were spent in health center in Sta. Cruz, Manila.  Different feelings were felt as  we say, ‘everything firsts.’  But we do have a Clinical Instructor (C.I.) to teach and guide us.
We were also exposed in areas such as Medical Surgical Ward, Operating Room, Pediatric Ward, Intensive Care Unit, and Psychiatric Ward to cite some when I was a student. In these areas, we were given patient assignments, do specific nursing interventions like, Vital signs taking, CBG monitoring, preparation and giving of medications, health teaching, getting intake and output, charting, making an individualized NCP as supervised by our C.I. I can say that our tasks are being ‘spoon-fed.’ That is, the Clinical instructor will tell us what can we do or not.  



The transition from a student to a practicing nurse was somewhat challenging for me as I was not employed immediately. Before I started working in PGH, I had volunteered in a hospital in Paranaque for about a year, had assisted and acted as a private duty nurse when needed and also tried being a company nurse.




Advanced Beginner
Gaining enough experience during my student,  volunteer, and training days, I can say that when I started to practice in the institution, I acted as an advanced beginner being guided by rules. But still whenever faced with uncertain situations,  I still seek the advice of my Senior nurses. There is little supervision more of with adjustment in the clinical area where I was assigned – Medicine Department. 

Competent
Gone were the days, I went home late to finish my bedside care and my documentation in the area tasked with 1 is to utmost 17 patients. I already know how to effectively manage my time having acquired the rules and being able to prioritize and solve different problems of patients with sound judgement, and also being able to intervene according to their needs. The nurse is also able to form his own rules that may facilitate his care while maintaining delivery of optimal nursing care to his patients.




Proficient
As for me my immediate supervisor, my Head Nurse is the concrete example of a proficient nurse. Endowed with years of experience in the hospital, she is managing the unit holistically. Specifically, she is handling the management of the entire ward or unit, its staff, from institutional workers to nurses and also, ensuring quality care to patients and their families.


Expert
In the hospital, we have the Deputy Director for Nursing, the highest position of a nurse in the Administrative Department of our institution. She’s able to solve nursing-related problems easily without focusing much on rules. She is frequently invited to attend seminars as a resource person and share her own rich experiences. She also goes personally in each unit to see the needs of our patients and plan and intervene on how to meet those needs. 
by: Tammy L. Sulit, RN


Nursing Theories are like matches.. They are useless unless they are lit.




The different nursing theories can bestow different contributions in honing our practice. Owning a value system and a systematized set of actions from these theories enable us to function effectively and efficiently as nurses.

The nursing theory that has a strong impact to my practice is Patricia Benner's Novice to Expert theory. Usage of her theory in planning my career path is important since it can assess as well as evaluate the kind of nurse I am becoming to have a consolidated self-concept.

It ASSESSES me:

Her theory enabled me to identify which level of the ladder I am currently standing. It confronts me with the reality thus I will have a clearer view of the remaining things to pursue to climb up the ladder. 3 years ago, I was a complete novice equipped with my diploma but with no clinical experience. As of this point, I already gained 2-3 years of experience which can be considered under competent phase. As of this point I am expected to plan my actions base on my conscious, abstract and analytical thinking. By assessing myself, it will also be clearer for me which duties to perform and which ones to consult. Self-assessment is also a good tool to boost my self morale. Knowing that there is professional growth and that i'm capable of improvement then I will strive harder to achieve greater heights, which in this case to become an expert to my chosen nursing field.

It GUIDES me:

The ladder pattern of the theory serves as my guide on the kind of path I plan for my career . I can designate specific goals on specific phases and let those be my target. My next target level is to become a proficient nurse. A proficient nurse is expected to be more holistic and acquire a more improved decision-making skill. I want to be a nurse-anesthetist in Kuwait soon. I believe that that kind of specialization in nursing will give me more opportunities to decide independently. Nurse anesthetists act like Anesthesiologists, and they have more crucial decision making tasks than just a DR nurse which what I am now. Putting up goals like these are like a guide I yield from lesrning the theory. My expert level perhaps is to make my own academe for Nurse Anesthetists here in the Philippines.

It EVALUATES me:

Looking unto my current position will aware me of how hastened I have grown in this field. It can alarm me of my slow increment of rising. It can basically ompare my present from my past allowing me to see my fallbacks or insufficiencies. As for my personal experience, I guess I am climbing the ladder on a correct timing. I believe I am just on the right stage for my age and for my years of experience.

It is important therefore that we use and materialize these theories to our daily practice, or else they will just remain as concepts... nothing more.