Expertise in Nursing Practice

Abstract

Nursing theory and practice intertwine in a mutually supportive bootstrapping process as the nursing graduate develops skill. A theory must be a new whole in which decontextualized elements are related to each other by rules or laws. It seems that it is more plausible to believe that sufficient experience, accompanied by no theoretical knowledge, could produce skilled coping behavior. The study of the skill-acquisition phenomenon has shown that a person usually passes through at least five stages of qualitatively different perceptions of their task as skill improves. Performance improves to a marginally acceptable level only after the novice has considerable experience coping with real situations. While this encourages the advanced beginner to consider more objective facts and use more sophisticated rules, it also teaches the learner an enlarged conception of what is relevant to the skill. A more subtle and refined discrimination ability is what distinguishes the expert from the proficient performer. It is our hope that we have put into words once again what nurses and all clinicians know in their practice and that the marginalized caring practices presented here compel the reader to consider the societal worth and knowledge inherent in the caring, diagnostic, and therapeutic work that nurses do. As well, it is our hope that practitioners from other fields will join us in this conversation so that together we can design better institutions of public caring—in our schools, families, social work, courtrooms, and in all places where protection of vulnerability, sponsorship of growth, and the promotion of better citizenship occurs. The synthesis of the work on the Dreyfus Model of Skill Acquisition is drawn from Benner (2005).