Nursing Expert: The Five Levels Of Nursing Practice

Nursing Expertise
Liberty University

According to Benner, there are five levels of experience regarding nursing (2001). The levels of nursing range from novice to expert (Benner, 2001). This information is based on the Dreyfus Model which was designed by Stuart Dreyfus (Benner, 2001). It is important for nurses to become experts in their field and to guide novice nurses.
The first stage of nursing practice is novice (Benner, 2001). A novice is a beginner who has no experience. During this time the novice nurse is adjusting to the environment and picking up basic skills. A novice can include a brand new nurse or a nurse who has recently moved to a new unit (Benner, 2001). This nurse is focused on learning the
rules and is not at a point where she can be very flexible. She lacks the judgment to make decisions outside of the rigid rule-set she is being taught (Benner, 2001).
The second stage is the advanced beginner. The advanced beginner is still very focused on rules (Benner, 2001). This nurse has some experience with this patient base and is able to make acceptable decisions (Benner, 2001). This nurse has difficulty prioritizing because she is so focused on completing all of the tasks that are at hand (Benner, 2001). Clinical experiences should be guided by a competent nurse so that they are offered more than guidelines (Benner, 2001). third stage of experience by the nurse is competent. This typically means the nurse has been in this field for two years or more (Benner, 2001). This nurse is able to plan out her day but is not as fast as a higher stage of experience. She does feel comfortable with the aspects of nursing on her unit (Benner, 2001). She does make deliberate choices to make her day move more smoothly (Benner, 2001).
The fourth stage of experience is proficient. This nurse sees the whole picture (Benner, 2001). She is able to feed off of her experiences. She is able to make goals for her patient and to visualize the path they will take (Benner, 2001). The proficient nurse is able to understand what is most important in the tasks she must complete. She is guided by the flow of the unit and not overwhelmed by her patient acuity. She can use her past experience to help her current situation (Benner, 2001).
The expert nurse is the final stage of experience (Benner, 2001).
This nurse is on autopilot. The answers seem obvious to this nurse because she uses her experiences and not guidelines to make her decisions (Benner, 2001). This nurse is able to speak and make decisions with a certainty because it is second nature to her (Benner, 2001). She is able to understand the patient and what is going on with them (Benner, 2001).
Over a year ago I changed my area of nursing to the psychiatric field. Prior to that point I had some patients with a primary psychiatric diagnosis but mainly medical patients. I had experience with a family member who suffers from bipolar disorder as well. At this point I feel as though my stage of experience is competent.
A competent nurse is able to plan out her day but may not be as fast as a more experienced nurse (Benner, 2001). When I come into work in the morning I already know about my day. I am prepared for the unit that I will be working on that day. Ahead of time I have secured items that will make the shift run more smoothly. I have a deck of cards for patient use, coloring books, arts and crafts, and cigarettes. Many times there is a lapse of time in the schedule and patients who are bored tend to act out aggressively. Some of the patients who come in do have a smoking habit but no cigarettes, I keep a pack in my work bag because I have seen an entire unit erupt in chaos over a
cigarette.
Preparation is the way I control my day in an uncontrollable environment.
Having the right tools makes the day manageable. I have a packet of nursing group topics so that I can start a group at a moment’s notice. The schedule does not always go as planned. A pen light and scissors are always at hand because those are the clinical tools I make most use of in my practice.
The way I interact with my patients can change the dynamic of the milieu. Each psychiatric patient has to be treated like an individual. Having a depressed patient, a manic patient, and an actively psychotic patient on a psychiatric unit is no different than having a patient with a pacemaker, a valve replacement, and a bypass graft together on a telemetry unit. Different patients call for different interventions.
When dealing with any patient it is important to make sure you are aware of the situation and have any necessary information prior to meeting with the patient (Bowers, 2010). I make sure that I have reviewed the patient’s information before I interact with them. It is important to introduce yourself to the patient (Bowers, 2010). It is sometimes best to offer increased personal space (Bowers, 2010). When I come into work I always try to be at my very best so that I can be positive and optimistic. This approach can be motivating not only for patients but also for other staff members (Bowers,
2010).
It is important not to appear anxious to a patient (Bowers, 2010). I try to be calm especially when dealing with a psychotic or aggressive patient. Sometimes a patient will begin to mimic the nurse’s behavior so I want the patient to mimic me being calm, not loud or anxious. Body language and voice tone are equally as important as what is being said. Sometimes I have noticed that in my practice, adolescents especially will attempt to “get a rise” out of staff by yelling and threatening. Many of the kids come from abusive home situations and a tense environment is comfortable for the patient. I try to offer suggestions and choices when talking to a psychiatric patient. The interaction between nurse and patient when trying to get a patient to do something can determine if the nurse will be successful (Bowers, 2010). I use a calm voice and make sure the patient is aware of the rationale. The patient may require several prompts in order to do a simple task. When a patient is in a facility such as a psychiatric hospital they are already feeling a loss of control so it is important for them to be able to make some choices regarding their care.
When a patient is having delusions or hallucinations it can be appropriate to question or even at times challenge the patient (Bowers, 2010). A question can be posed which allows the patient to reflect on their delusions and come to a conclusion themselves if it is plausible or not. When a patient is deep in psychosis, it may make them escalate to challenge their delusions. I have witnessed a nurse tell a patient that another patient was not their son. The patient began to escalate, but the nurse persisted in challenging the patient. Ultimately the patient became out of control and aggressive and almost broke down the door to the nurse’s station. He required restraint and medication. Had the nurse tried a different approach, the crisis situation could have been avoided. I am flexible when having a conversation with a patient because sometimes it is necessary to lead the conversation in a different direction.
Sometimes I feel as though I can handle any issue that comes up. There are other times that I really am not sure what to do in a situation, but I always come up with an appropriate response. Each patient is an individual and must be treated as such. What works for one patient will not automatically work for another. There are, however, patterns that patients follow related to their diagnosis. As I continue to work in this field I anticipate becoming more experienced until the point where I am an expert in the psychiatric field.

References
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. (Commemorative ed.). Upper Saddle River, New Jersey: Prentice Hall.
Bowers, L. (2010). How expert nurses communicate with acutely psychotic patients. Mental Health Practice. 13(7), 24-26. Retrieved from http://search.proquest.com/docview/217220210?accountid=12085