s tudent p rogression : f rom n ovice to e xpert laurie heline crna, ms clinical coordinator oakland...
TRANSCRIPT
STUDENT PROGRESSION: FROM NOVICE TO EXPERT
Laurie Heline CRNA, MS
Clinical Coordinator Oakland University-Beaumont Graduate Program of Nurse Anesthesia
OBJECTIVES At the conclusion of this presentation,
the learner will:1. Discuss the five stages of progression
an RN takes to become a CRNA in clinical education.
2. Identify the clinical instructor's role in each of these five stages of development.
NOVICE TO EXPERT THEORY
Developed by Dr. Patricia Benner Develop skills over time through a
sound educational base as well as a multitude of experiences
Difference between “knowing that” versus “knowing how”
5 STEPS AN RN TAKES TO BECOME A CRNA
Novice learner Advanced Beginner Competent Student Proficient Student Expert Practitioner
Graduate students are exposed to more facts in one year than their
grandparents were in a lifetime
The sum of all that is known is doubling every seven years.
NOVICE LEARNER
Enter as successful ICU nurses Unfamiliar with the OR Process of anesthesia is mysterious No anesthesia experience, little
knowledge
NOVICE LEARNER
Learning must begin somewhere Learn from didactic work theories to
guide actions Theories and rules provide general
rules but do not cover all possible situations
Task-oriented Vary greatly in abilities
NOVICE LEARNER Eager Enthusiastic Motivated Lack of Flexibility Anxious Afraid Uncertain Frustrated Overwhelmed
NOVICE LEARNER Anesthesia students in the first months Average cases:
27 cases at end of first semester155 at end of second semester
NOVICELEARNERWHAT CAN WE DO?
Set clear, detailed expectationsProvide as much consistency as
possibleRemind to focus on patientGuide in organizing tasks
Checklists Mnemonics
Care plansRecognize that students need to gain
confidence
THE ADVANCED BEGINNER
Generally sometime within second semester to beginning of third semester
Marginally acceptable performance Acquired enough knowledge and
experience to:Recognize important aspects Begin to feel comfortableMake some interventions based on
experience
THE ADVANCED BEGINNER
Students have:Limited knowledgeMisunderstood conceptsMay apply knowledge incorrectly
Still focused on tasks but not as overwhelmed by the environment
Small deviations from routine may derail
THE ADVANCED BEGINNER
Perform routine preparation in 30 minutes
Can plan for successive case Skills improving but can continue to
struggle with mask ventilation, poor body mechanics, intubation
Still need constant supervision, should be able to recognize when to ask for help
THE ADVANCED BEGINNER Quickly doubt own ability leading to a
viscous cycle of:performance anxietyself-flagellationfurther failure
Feel responsibility for decision making lies with those who have superior knowledge and experience
THE ADVANCED BEGINNERWHAT CAN WE DO?
Help student with psychomotor skillsRecognize that:
Dependent on instructor’s knowledge Hesitant to voice opinions Still task focused Need help with prioritization Don’t always have good rationale
Allow students to make good and bad decisions
THE ADVANCED BEGINNERWHAT CAN WE DO?
Instructors hesitant to ask questions because think student may have more theory knowledge than themDevelop stock questionsAsk student to explain concept to them
Help identify distinctions of common anesthesia events and share rationale for decision making
THE COMPETENT STUDENT
After 150-200 anesthetics3rd semester end with 271 cases
Able to manage an ASA 1-2 patient undergoing a simple surgical procedure with minimal assistance
THE COMPETENT STUDENT
Demonstrate:Familiarity with variety of basic anesthesia
situations Identify significant aspects of a situationAnticipate events that may occur Improved organizational skillsCan integrate sensory input from
numerous sourcesOwnership, becoming patient advocateTrust in self and comfort with knowledge,
skills, and abilities
THE COMPETENT STUDENT
Must still analyze possibilities of each situation and think through options
Challenge instructor’s knowledge and authority at this stage
Demonstrate competency in some areas and “novice” behavior in others
Complacent
THE COMPETENT STUDENTWHAT CAN WE DO?
Suggest alternatives Ask the student to teach the instructor
something When challenged by a student,
understand this may be part of growth processWhen time is right, discuss with the student and attempt to elicit rationale for behavior
THE PROFICIENT STUDENT
Not necessarily related to the number of months the student has been in the program
Students soon to graduate exemplify proficient level behavior, an entry-level practitioner
Can see the big picture Beginning to show signs of intuitive decision
making Some technical skills excellent, others may
need more practice
THE PROFICIENT STUDENT
May feel overly responsible OR become overly confident Believe their knowledge is more current
than instructorsResults in the potential for humbling errors
No longer concerned with merely performing tasksSeek to prevent common problems and
minimize adverse events
THE PROFICIENT STUDENTWHAT CAN WE DO?
Encourage the independenceRemind them even seasoned
practitioners:Seek help Share tasksRequest consultation when needed
Complacence, so continue to challenge
“Senioritis” behaviors
THE EXPERT PRACTITIONER
Unusual for students to reach Not all CRNAs reach No longer rely on principles, rules, or
guidelines Have difficulty verbalizing how they
make decisions or respond to certain events
Can deal with various possibilities and quickly switch plan of action
THE EXPERT PRACTITIONER Even expert can revert to novice role
when confronted with:New drugNew techniqueUnfamiliar situation
Can still make wrong decisions
NOVICE TO EXPERT MODEL
Way to examine SRNAs clinical growth and development
Some grow rapidly, while others take longer to achieve milestones
We must recognize impact we have on facilitating or hindering learning as we are held in high esteem by students
CLINICAL INSTRUCTORS
Thank you for all you do for our students and the
profession of Nurse Anesthesia!
BIBLIOGRAPHY Benner PA. From Novice to Expert: Excellence
and Power in Clinical Nursing Practice. Commemorative Ed Upper Saddle River, NJ: Prentice-hall, Inc, 2001.
Benner PA, Tanner PA, Chesla CA. Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics. New York, NY: Springer Publishing Company, Inc; 1996.
Hendrichs B, Thompson J. A Resource for Nurse Anesthesia Educators. Park Ridge, Ill: AANA Publishing, Inc; 2009.
http://currentnursing.com accessed 6/15/2011
http://typhongroup.net accessed 9/15/2011