Evolution of Expertise Among Critical Care Nurses

Purpose: Nurses are highly skilled educated professionals who are called upon every day to incorporate accurate clinical assessment skills; decisive critical thinking and judgment skills in a dynamic, oftentimes emotionally charged situation to effectively manage multiple patients with complex emotional and medical conditions. The nurses’ role is highly complex and demanding as they maintain a constant vigil at the patient’s bedside twenty-four hours a day, seven days a week to ensure optimal healthcare outcomes. Through this vigil, those patient outcomes will be directly impacted by the expertise and care of the bedside nurse. According to the literature, development of expertise is directly correlated with three fundamental requirements: a) a tremendous amount of dedicated work, b) time, and c) relevant experience. Experts in most domains attain their highest level of performance after 10,000 hours of dedicated practice (Weiss & Shanteau, 2014). This is equivalent to ten years of dedicated and relevant experience within the expert’s respective domain. Within the domain of critical care nursing the skill level of the bedside nurse has been directly correlated with quality patient outcomes, greater reimbursements, and decreased operational costs. This presentation represents a study that was designed to explore the emic perspective of the critical care nurse as it relates to expertise, expert performance and the critical care nurses journey in the achievement of expert performance.

Methods: This study used a grounded theory qualitative methodology. Data was collected through in-depth participant interviews with open-ended questions. Benner’s (1982, 2011) seminal model of skill acquisition, Novice to Expert, provided the theoretical structure and framework guiding the development of participant inclusion/ exclusion criteria and data collection. However, as expertise was considered within the dynamic critical care environment, Ericsson and Smith’s (1991, 2010) expert performance approach was used to strengthen Benner’s Novice to Expert Model providing valuable structure and insight into the concept of expertise (Causer, Barach & Williams, 2014). As themes were identified the expert performance approach provided valuable evaluative strategies to facilitate understanding of expert nuances and processes within critical care practice.

The purpose of this study was to examine and explore the critical care nurse’s personal perceptions of expertise, expert performance and the transition from novice to expert in clinical practice. The study addressed the following questions:

a) How would you define the expert nurse in clinical practice in critical care?

b) What criteria or characteristics would you use to define expert performance in clinical practice in the critical care unit?

c) How does one become an expert in critical care?

d) In your experience what factors have supported or hindered your professional development?

Results:  Study findings supported three major themes: a) experience with sub-themes diversity and intensity; b) knowledge with the sub-theme critical reasoning; and c) self-actualization with sub-themes personal presence, and life-long learning. Furthermore, data findings supported the researcher’s assertion that “tacit” knowledge is a more appropriate term to represent the requisite knowledge base and diversity of experience demonstrated by nurses in actual clinical practice rather than the term “intuitive grasp” as found in current literature.

Conclusion:  The research findings of this study hold significance for nurse educators and professional nurse leaders alike who are in a position to foster professional development and clinical expertise for young nurses entering the nursing profession. Future implications for research would need to focus on understanding and adding to the body of knowledge as it relates to the influence of the individual, personal presence and further refinement of the understanding of the expert and expert thinking on the unconscious or automatic plan.