Understanding clinical expertise: Nurse education, experience, and the hospital context
Research in Nursing & HealthPublished 1 June 2010
Matthew D. McHugh, Eileen T. Lake
Citations197
SJR quartileQ1
SJR score0.90
SNIP1.00
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise.
Abstract
Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise.
Keywords
MedicineHealth ProfessionsNursing
EconometricaA Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity
26,139 Citations1980Halbert White
JAMAHospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
5,188 Citations2002Linda H. Aiken
In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.
AJN American Journal of NursingFROM NOVICE TO EXPERT EXCELLENCE AND POWER IN CLINICAL NURSING PRACTICE
4,691 Citations1984Patricia Benner
This work uncovers the Knowledge Embedded in Clinical Nursing Practice and discusses the Dreyfus Model of Skill Acquisition Applied to Nursing and its implications for Research and Clinical Practice.
Regression Models for Categorical Dependent Variables Using Stata
4,667 Citations2014J. Scott Long, Jeremy Freese
This book discusses models for ordinal and nominal independent variables, and describes the development of models for Nominal Outcomes with Case-Specific Data and its use in Stata.
JONA s Healthcare Law Ethics and RegulationAmerican Association of Colleges of Nursing
3,052 Citations2002Edward L. Beard
Introducing Multilevel Modeling
2,913 Citations1998Ita G. G. Kreft, Jan de Leeuw
The Stata Journal Promoting communications on statistics and StataGeneralized Ordered Logit/Partial Proportional Odds Models for Ordinal Dependent Variables
2,106 Citations2006Richard Williams
Research in Nursing & HealthDevelopment of the practice environment scale of the nursing work index†‡
1,752 Citations2002Eileen T. Lake
Five subscales were derived from the Nursing Work Index to measure the hospital nursing practice environment, using 1985-1986 nurse data from 16 magnet hospitals, and all measures were highly reliable at the nurse and hospital levels.
JAMAEducational Levels of Hospital Nurses and Surgical Patient Mortality
1,721 Citations2003Linda H. Aiken
In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.
Medical CareNurse Burnout and Patient Satisfaction
976 Citations2004Doris C. Vahey, Linda H. Aiken +3 more
Improvements in Nurses’ work environments in hospitals have the potential to simultaneously reduce nurses’ high levels of job burnout and risk of turnover and increase patients’ satisfaction with their care.
Nursing ResearchMeasuring Organizational Traits of Hospitals: The Revised Nursing Work Index
864 Citations2000Linda H. Aiken, Patricia A. Patrician
The NWI-R has been found to capture organizational attributes that characterize professional nursing practice environments and its ability to explain differences in nurse burnout is found.
JONA The Journal of Nursing AdministrationEffects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
844 Citations2008Linda H. Aiken, Sean P. Clarke +3 more
Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments.
JONA The Journal of Nursing AdministrationEffects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
804 Citations2009Linda H. Aiken, Sean P. Clarke +3 more
AJN American Journal of NursingExpertise in Nursing Practice, Caring, Clinical Judgment, and Ethics
602 Citations1997&NA;
The meaning of expertise in nursing practice is examined through the nurse's use of scientific knowledge, professional experience, and careful attention to each patient's changing condition in this book.
Bulletin of Science Technology & SocietyUsing the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education
574 Citations2004Patricia Benner
The usefulness of the Dreyfus model for understanding the learning needs and styles of learning at different levels of skill acquisition is demonstrated.
Nursing ResearchThe Impact of Hospital Nursing Characteristics on 30-Day Mortality
491 Citations2005Carole A. Estabrooks, William K. Midodzi +3 more
Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients as well as the size, teaching, and urban status of the study hospitals in a fixed-effects model.
Health Services ResearchImplications of the California Nurse Staffing Mandate for Other States
397 Citations2010Linda H. Aiken, Douglas M. Sloane +6 more
When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.
Health AffairsNursing: A Key To Patient Satisfaction
397 Citations2009Ann Kutney‐Lee, Matthew D. McHugh +5 more
The nurse work environment was significantly related to all HCAHPS patient satisfaction measures and patient-to-nurse workloads were significantly associated with patients' ratings and recommendation of the hospital to others, and with their satisfaction with the receipt of discharge information.
Health Services ResearchHospital Nurse Practice Environments and Outcomes for Surgical Oncology Patients
376 Citations2008Christopher R. Friese, Eileen T. Lake +3 more
This study is one of the first to examine the predictive validity of the National Quality Forum's endorsed measure of the nurse practice environment and could reduce adverse outcomes for hospitalized surgical oncology patients.
Journal of Advanced NursingImpact of hospital nursing care on 30‐day mortality for acute medical patients
338 Citations2006Ann E. Tourangeau, Diane Doran +5 more
Just as hospitals and clinicians caring for patients focus carefully on completing accurate diagnosis and appropriate and effective interventions, so too should hospitals carefully plan and manage structures and processes of care such as the proportion of Registered Nurses in the staff mix, percentage of baccalaureate-prepared nurses, and routine use of care maps to minimize unnecessary patient death.
Nursing ResearchVariations in Nursing Practice Environments
337 Citations2006Eileen T. Lake, Christopher R. Friese
Considerable variation exists in the quality of hospital nursing practice environments across hospitals and to examine their associations to hospital bed size, community size, teaching intensity, and nurse staffing levels.
American Journal of Infection ControlOrganizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses
293 Citations2002Sean P. Clarke, Joan L. Rockett +2 more
Nurse staffing and organizational climate are key determinants of needlestick risk and must be considered with the adoption of safety equipment to effectively reduce sharps injuries.
Annual Review of SociologyContextual-Effects Models: Theoretical and Methodological Issues
281 Citations1984H. M. Blalock
JONA The Journal of Nursing AdministrationNurse Experience and Education
230 Citations2001Mary A. Blegen, Thomas Vaughn +1 more
Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates, but adverse occurrence rates onunits with more baccalaureate-prepared nurses were not significantly better.
Journal of Clinical NursingPoor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals
218 Citations2008Masako Kanai‐Pak, Linda H. Aiken +2 more
Improved nurse staffing and working relationships with physicians may reduce nurse burnout, job dissatisfaction and low nurse-assessed quality of care in Japanese hospitals.
American Journal of Critical CareCompetence and Certification of Registered Nurses and Safety of Patients in Intensive Care Units
211 Citations2009Deborah Kendall‐Gallagher, Mary A. Blegen
Advances in Nursing ScienceExpert Performance in Nursing
191 Citations2007K. Anders Ericsson, James Whyte +1 more
Research on nursing expertise during the last decades is reviewed from the perspective of the expert-performance approach, which focuses on reproducibly superior performance in everyday life to propose explanations for repeated failures to find reliably superior performance for nurses with longer professional experience.
Western Journal of Nursing ResearchClinical Reasoning in Experienced Nurses
169 Citations2003Barbara Simmons, Dorothy M. Lanuza +3 more
Nurse Education TodayMoving from novice to expert – the value of learning in clinical practice: a literature review
114 Citations2004Dorothy Field
A wide review of educational literature is presented, to discover how both the constructivist and the sociocultural approach to learning will promote nursing expertise.
Research in Nursing & HealthOrganizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses
109 Citations2010Patricia A. Patrician, Jingjing Shang +1 more
Poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings in AMEDD hospitals in the U.S. Similar to findings in civilian samples
JONA The Journal of Nursing AdministrationCharacteristics of Nurses and Hospital Work Environments That Foster Satisfaction and Clinical Expertise
100 Citations2002Barbara Jo Foley, Carolyn C. Kee +3 more
Characteristics of nurses and their work environment at two military hospitals were described to help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing process that are not effective.
Journal of Professional NursingHallmarks of the professional nursing practice environment
67 Citations2002
This white paper was prepared by the AACN Task Force on Hallmarks of the Professional Practice Setting with a focus on quality standards for bachelor's-degree and graduate-degree nursing education.
American Politics QuarterlySTUDYING CONTEXTUAL EFFECTS ON POLITICAL BEHAVIOR
61 Citations1988John W. Books, Charles L. Prysby
Policy Politics & Nursing PracticeExamining the Impending Gap in Clinical Nursing Expertise
57 Citations2007Liana Orsolini-Hain, Ruth E. Malone
Without careful planning, efforts to address the numerical shortage may inadvertently worsen the expertise gap, contributing to unsafe care and affecting nursing retention.
Applied Nursing ResearchThe relationship of nurses' professional characteristics to levels of clinical nursing expertise
49 Citations2009Kathleen L. Bobay, Deborah L. Gentile +1 more
This research suggests that nurses may require more on-the-job experience for the development of clinical nursing expertise than what has been reported in the literature.
Nursing and Health SciencesRecognition of expertise: An important concept in the acquisition of nephrology nursing expertise
44 Citations2003Ann Bonner
The results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.
Image the Journal of Nursing ScholarshipThe Effect of Education on the Practice of Nursing
27 Citations1991Wendy B. Young, Evelyn L. Lehrer +1 more
Results of an ordered probit model using data from the 1986 Biennial Survey of Illinois RNs show that baccalaureate nurses perform high skill functions more often, indicating that education does influence the nature of work activities.
Applied Nursing ResearchMultilevel models in health outcomes research
22 Citations2006Eileen T. Lake
Health outcomes research often involves analysis of data that are nested within hierarchical groups, such as patients or nurses in hospitals, which poses serious methodological issues that challenge the assumptions of traditional data analysis methods.
Journal of Professional NursingDifferentiated levels of nursing work force demand
20 Citations1998Christine Kovner, Jennifer Schore
The review of practice and organizational differences across the hospital, nursing home, and ambulatory care sectors suggests that baccalaureate-prepared RNs in hospitals may have a more strongly differentiated role relative to those in nursing homes and ambulance settings.
Journal for Nurses in Staff DevelopmentPreceptorships
18 Citations2008Marsha L. Moore
It is suggested that when preceptorships are linked to the nursing department's mission and goals, the department's ability to adapt to change is enhanced.
PubMedMeasuring hospital medical staff organizational structure.
12 Citations1979S. M. Shortell, Thomas E. Getzen
Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined and it is suggested that these dimensions can be used to develop an empirical typology of hospital doctor organization structure and to investigate the relationship between medical staff organizations and public policy issues related to cost containment and quality assurance.