Expertise in Nursing Practice

1. Expertise in Nursing Practice Chapter 7 Impediments to the development of Clinical knowledge and Ethical judgment in critical care nursing

2. Expert or Experienced Nurse ? • 25 nurses described by supervisors as experienced but not expert • Practice does not follow the Novice to Expert pattern as described by Benner • At least 5 years of experience in the ICU Setting • Quality of Practice considered “Safe” but not expert • Quality of Practice severely restricts the development of clinical knowledge and ethical judgments

3. Common Themes Overall lack of development of clinical knowledge Inability to recognize ethical issues in their work

4. Structure of Practice Little memory of about patients Unable to describe a critical incident that made a difference in their practice Unable to remember specifics of even the most recent cases Do not experience themselves as making clinical and ethical judgments

5. Clinical Judgment Cannot make distinctions between patients Fail to recognize that patients respond differently to similar situations. No attention to providing comfort in critical situations Only one issue of practice exist – improvement of or lack of improvement in physical condition

6. Ethical Judgment Deferral of responsibility for clinical decisions Find responsibility frightening Do not see themselves as making a difference Disengagement from patient

7. Fundamental Issue • Lack of knowledge of the qualitative distinctions embodied in expert nursing practice

8. Further Discussion Does this structure of practice lead to inadequacies in patient care? What are solutions?