As healthcare knowledge and technology advance rapidly, there are increasing demands upon nurses to maintain a high standard of practice. Those nurses are expected to be expert in their field. To achieve this, nurses are seeking the knowledge and skills from any reachable source. Nursing expertise is the most common source of knowledge and skills to novice nurses. I believe that expert nurses are precious resources. Therefore, in the next few papers, I will define and explore the role of nursing expertise.
The concept of expertise has been discussed by many disciplines. Expertise consists of those characteristics, skills and knowledge of a person or a system, which distinguish experts from novices and less experienced people (Wikipedia, 2010). The Oxford English Dictionary de¬?nes an expert as ‘having special skill at a task or knowledge in a subject’. The expert has high levels of procedural knowledge and skills (knowing how) as well as declarative knowledge (knowing what), and contextual ¬‚exibility (knowing when and where) (Dunphy & Wiliamson, 2005).
Expert nursing is considered an important part of achieving high quality patient care (Aitken, 2003). I believe working with expert nurses is an opportunity to gain skills as well as knowledge to maintain high quality patient care. In clinical area, it has been noticed that patients and their relatives are seeking the most expert person to ask questions and clarify their doubts. In Emergency Room, I have noticed that the patients and the relatives always observe what is going on, who is the most active nurse and whom the patients are asking more frequent among the nurses. By that, they identify the expert nurses in the scene. However, some patients prefer more cheerful nurses or nurses whom they know previously. Johnston (2005) argues that interpersonal skills and qualities such as kindness, warmth, compassion and genuineness are as important as being expert.
A theory developed by Dreyfus and Dreyfus (1986) which proposes that the road from novice to expert nurse encompasses ¬?ve stages. In the ”novice” stage, beginners learn through instruction and they acquire speci¬?c facts, features and actions. The second stage is ”advanced beginner” At this stage, nurses start to use and make sense of overall characteristics of the situation when their previous experience makes it possible. In the ”competence” stage, nurses organize their actions in terms of hierarchical long-range plans. An increased level of efficiency is noticed in this stage. In the ”pro¬?ciency” stage, situations are perceived as a whole rather than as unconnected aspects. Finally, in the ”expertise” stage, not only the understanding of the task, but also the decision of what to do next is intuitive. Given their deep understanding of the situation, experts act naturally without explicitly making decisions and solving problems.
Embodied knowledge is the kind of global integration of knowledge that develops when theoretical concepts and practical ‘know how’ are re¬?ned through experience in actual situations (Benner 1984). Based on that, expert nurses have various roles in the clinical area.
Expert nurse as a Teacher:
Expert nurses have a big role in teaching. In clinical area, novice nurses and nursing students are directed by expert nurses. Some expert nurses teach as a part time in nursing universities. However, not necessarily all experts nurses are good teachers (Bransford et al, 1999)
Expert nurse as a Team Leader:
Expert nurses lead the nurses in the clinical area. They obligate assignments and tasks, lead in emergency situations and speak in behalf of their nurses.
Expert Nurse as a Role Model:
The credibility of nurses as expert is linked to the expectation that they model high standard behaviors, and their effectiveness as role models is judged on the basis of observable compliance with these behaviors. Therefore, novice nurses try to imitate the expert nurses.
Expert nurse as a Manager:
Expert nurses manage different departments such as wards, quality and assurance department, infection control department and nursing administration.
Expert nurse as Decision Maker:
Research has found that experience is vital to decision making (Higgs & Jones, 1995). Expert nurses make decisions based on their knowledge and previous experience.
Bransford et al. (1999) outlined important characteristics of expertise. First, experts recognize features and meaningful patterns of information that are not noticed by novices. For example, expert nurses may be able to extract key pieces of information from a patient’s details, which he or she then combines to make a diagnosis that would not be immediately apparent to a novice nurse. Second, experts have acquired a great deal of content knowledge which is organized in ways that re¬‚ect deep understanding. Third, experts have a knowledge which is Conditionalized on sets of circumstances. Fourth, experts are able to retrieve their knowledge with little effort. Fifth, experts are not necessarily good teachers. Sixth, experts have varying levels of ¬‚exibility in their approach to new situations.
The emancipatory action research conducted by the RCN, ”Changing patients’ worlds through nursing practice expertise”, (2005), developed a conceptual framework identifying ¬?ve key attributes required in practice expertise. These being:
Holistic practice knowledge
Knowing the patient
Clinical expertise is the ability and con¬?dence to use multiple forms of knowledge and the use of self in an appropriate and seamless manner, which is holistic, and individually tailored for each patient to promote individual patient choice and empowerment (Hardy et al., 2002). It is also characterized by high levels of clinical knowledge, assertive clinical leadership and patient focused involvement (Edwards, 1998). Therefore, achieving high quality patient care needs expert nurses. Beside, such a high qualified expert nurses are considered a precious recourse for any institute or health care facility.
In Bahrain, Bahraini nurses represent sixty percent of the working nurses. Such a figure makes us proud of ourselves. Besides that, Bahraini nurses are highly qualified, whom you can count on them in various nursing fields, without forgetting the role of CHS and RCSI to provide a high standard education in nursing sciences.
In conclusion, I have brie¬‚y reviewed role of nursing expertise. The ability to articulate the nature and value of nursing expertise is likely to be important in a move towards standardization of care and the increasing emphasis on following clinical guidelines and care protocols (Christensen & Hewitt-Taylor, 2005). I totally agree on following clinical guidelines and care protocols but without under estimating the role of nursing expertise.
Royal College of Nursing, 2005. Changing patients’ worlds through nursing practice expertise: A Royal College of Nursing Research Report 1998-2004. London, RCN.
Edwards, B., 1998. A&E nurses constructs of the nature of nursing expertise: a repertory grid technique. Accident and Emergency Nursing 6, 18-23.
Aitken LM (2003) Critical care nurses’ use of decision-making strategies. Journal of Clinical Nursing 12, 476-483.
Benner P.E. (1984) From Novice to Expert. Excellence and power in clinical nursing practice. Addison-Wesley, Menlo Park, CA, USA.
Bruce C. Dunphy, and Stacyl. Williamson, 2005. In Pursuit of Expertise. Advances in Health Sciences Education 9: 107-127.
Bransford, J.D., Brown, A.L. & Cocking, R.R. (1999). How People Learn: Brain, Mind Experienceand School. Washington, DC: National Academy Press.
Higgs J. & Jones M., eds (1995) Clinical Reasoning in the Health Professions. Butterworth Heineman, Oxford.