Catalyzing Innovation Among New Nurses by Facilitating Adaptive Expertise

In recent years, nurse leaders and nursing organizations have called for transformation of nursing practice through innovation (IOM, 2011; Position Statement, 2004). Although innovation is cited as an essential component to nursing practice and nursing education, additional research is needed to understand how to best promote innovation among nurses. One approach to catalyzing innovation is through applying the principles of adaptive expertise. First coined by Hatano and Inagaki (1986), adaptive expertise is defined as personal growth in an individual as he or she utilizes the routine knowledge they have mastered to face new problems and arrive at innovative solutions. Although Opre (2015) correlates adaptive expertise to the transfer of learning that occurs over time and with vast amounts of experience, innovation that stems from adaptive expertise can occur among new nurses as well as seasoned nurses.

Registered nurses as adaptive experts are poised to generate innovative ideas of improved patient care and clinical practice. Mylopoulos and Wood (2017) make the case that clinicians need to have the ability to differentiate between situations that call for routine knowledge and those that require an innovative approach. Within the increasingly complex healthcare system, nurses are faced with unique challenges on a regular basis. Facilitating nurses to become adaptive experts, enables them to address routine situations as well as new challenges in healthcare. There are multiple factors that correlate to RNs developing into adaptive experts who innovate solutions that lead to a transformation of the profession.

Promoting adaptive expertise is a two-pronged process which must address both the mindset of the clinician and the environment of the workplace. Working with Canadian medical students, Mylopoulos and Regehr (2009) explored the essential aspects of medical school educational practices to promote adaptive expertise among new physicians. On the individual basis they noted a need to ingrain in the minds of the new clinicians the idea of adaptive expertise as an expected attribute. They approached the notion of adaptive expertise as a set of learned behaviors that develop with repeated opportunities to hone the skills. They also addressed the necessary environmental components such as providing future clinicians opportunities to explore and resolve realistic problems. Repetitive exposure to problems that require innovation promote the learners’ ability to develop into innovative problem solvers. In her work in the United States, Reed (2018) explored the notion of adaptive expertise and the potential to innovate among new nurses. Her findings demonstrated new nurses had the propensity to innovate a myriad of potential improvements and solutions to workplace issues. However, a related but challenging finding in this study is the reality that these new nurses did not share their innovative ideas beyond the setting of the focus group interview. This raises issues of environmental factors that may impede innovative behaviors rather than support them. The findings of these studies have implications for nursing education and nursing clinical practice.

Nurse educators are positioned to play a direct role in catalyzing innovation among new nurses. They are poised to introduce the concept of adaptive expertise as one of the transformative outcomes of nursing education. Nurse educators can provide early and frequent opportunities for learners to engage in problem solving, initially in simulated environments and then transitioning to authentic caring experiences. For adaptive expertise to flourish it must be introduce early in the clinician’s educational experience and fostered as the learner continues their educational journey (Mylopoulos & Regehr, 2009). Role-play, role-modeling, experiential learning and problem-based learning are a few strategies the nurse educator can employ.