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| 5 Levels of Competence (Benner's Framework) |
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| Novice, advanced beginner, competent, proficient, expert |
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| rely primarily on standards of care, unit procedures and md/rn orders to guide patient care |
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| (1-2 years) increased clinical understanding, technical, organizational skills, and able to anticipate the likely course of general patient care events |
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| 3-5 years. increasingly accurate grasp of situations and when grasp is missing has a sense of uneasiness/discomfort |
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| management of multiple tasks simultaneously with skill in performance, timing and anticipation evident; thinkin in action |
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| stems from realization that the way graduat taught in school not necessarily the way things are actually done on the job |
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•Workers have specialized roles/tasks
•Extensive rules
•Overall orientation to rational, efficient implementation of goals
•Hierarchical authority structure
–Increasing shared governance |
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•Specialized competence with an intellectual foundation (total knowledge and skills) for global approach to work
•Extensive authority, influence, responsibility in exercising special competence
•Commitment
•Peer control/authority |
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| Reality Shock Conceptualized |
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Definition
professional values <------>Bureaucratic values
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Role conflict, role deprivation |
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Reality Shock
Four Phases |
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• Honeymoon Phase
• Shock (Rejection) Phase
• Recovery Phase
• Resolution Phase
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•New nurse in orientation
–“Just as imagined”
– “I am so glad I chose nursing”
– “I will be part of changing the future of healthcare” |
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•Orientation (“honeymoon”) period is over
•Cognitive dissonance
•Anxiety
•Discomfort, rejection of new environment |
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•Return of humor
•Less tension
•Begin to understand new culture |
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•Adjustment to the new environment |
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Legal authority to practice a profession in the U.S. comes from each state or territorial government: 61 across the states and territories. |
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| Three types of occupational regulation |
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•Registration
•Licensure
•Certification |
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•Process by which a state or other jurisdiction (or association) maintains a list of people who have informed the governing body that they perform professional services for the public, in a particular field.
•Least restrictive, common for nursing in Europe |
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•A state or other jurisdiction has laws and regulations that specify who can provide a particular service or who can call self a member of a particular profession.
•Without meeting the state requirements for licensure, which typically involves a level of attained education, experience, and examination performance, you cannot practice certain professions.
•Title protection vs. practice protection
•Even though we are called “Registered Nurses” we actually are a licensed profession in the U.S. and in many other countries. |
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•Private regulation. Typically the state or federal government doesn’t have a law or regulation that covers a subspecialty. In the absence of government-mandated regulation, a trade association or an independent certifying body develops a standard.
•Beyond-minimal knowledge/ competence in a nursing specialty; not generally required by licensing bodies or employers |
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•Protects the public
•Requires a nurse to demonstrate a minimum level of knowledge
–Currently there is not a skills demonstration |
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| Role of Regulatory Boards |
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•Administer state’s nursing practice act
•Grant and renew licenses
•Take disciplinary action when provisions of the act are violated |
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| How does a State Board of Nursing provide protection? |
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•By assessing the competence of the health care practitioner
–Entry-level: NCLEX-RN examination developed and managed by the National Council of State Boards of Nursing
•All examinees in every state take same exam
–Continued competence
•Some states have mandatory continuing education requirements
•Continuing debate on how to ensure continued competence |
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| Continuing Education Requirements |
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Definition
•30 contact hours every 2 years required in PA as of 2008
•Some states have particular requirements about content: infection control in NY, etc.
•Conferences, grand rounds, CE in the institution, journals, books, Internet--also teaching content sometimes counts
•Need to maintain records by accredited CE providers
•Maintain a portfolio of educational programs attended, clinical experiences (including clinical hours), evidence of self-reflection and of application of expertise required in some jurisdictions and for some certifications |
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The primary role of Boards of Nursing is to protect public safety. If there is specific evidence that casts significant doubt about your physical or mental health, your competence, or your moral suitability to provide care, Boards can and will restrict or revoke your right to practice. |
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Major types of misconduct resulting in disciplinary action (complaint-driven process)
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· Bad apples” – nurses who intentionally violate trust and commit criminal acts on job
· Criminal conviction off the job
· Serious med error
· Falsification of information and other documentation problems
· Narcotic control issues
· Impaired nurses
· Incompetence
· Practicing outside scope of practice
· Abandonment
· Inappropriate therapeutic relationships and boundary violations |
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§ Guiding principles for the role of the nurse in future patient care delivery |
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· The core of nursing is knowledge and care
· Care is user-based
· Knowledge is access-based
· Knowledge is synthesized
· Relationships of care
· The “virtual” and the “presence” relationship of care
· Managing the journey |
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| Four ways to deal with reality shock. |
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Definition
o Rutters – low professional and bureaucratic orientation
v AKA refrigerator nurse – only there to make $$ because they need a new refrigerator
o Organization women and men – low professional orientation, high bureaucratic orientation
v We have to cross our t’s and dot our I’s; get very carried away with following rules
o Lateral arabesquers – high professional orientation, low bureaucratic orientation
v Lose sight of clinical practice, always taking a new job, want to return to “ivory tower” (ideal practice presented to us during our education)
o Bicultural troublemakers – high professional and bureaucratic orientation
v Understand the system, but shake it up when necessary; able to maintain passion within the bureaucracy |
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