patients with similar symptoms.
patients with similar symptoms.
Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms.
Stage 2 Advanced Beginner: Those are the new grads in their first jobs; nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience.
Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners.
Stage 4 Proficient: At this level, nurses are capable to see situations as “wholes” rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events.
Stage 5 Expert: Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don’t occur as expected.
Beginner nurses focus on tasks and follow a “to do” list. Expert nurses focus on the whole picture even when performing tasks. They are able to notice subtle signs of a situation such as a patient that is a little harder to arouse than in previous encounters.
The significance of this theory is that these levels reflect a movement from past, abstract concepts to past, concrete experiences. Each step builds from the previous one as these abstract principles are expanded by experience, and the nurse gains clinical experience. This theory has changed the perception of what it means to be an expert nurse. The expert is no longer the nurse with the highest paying job, but the nurse who provides the most exquisite nursing care.
