Responses to Work Complexity: The Novice to Expert Effect

Jeri L. Burger,1 Karen Parker,1 Linda Cason,2 Sheila Hauck,3 Denise Kaetzel,4 Cathy O'Nan,5 Ann White1

Abstract

The purpose of this study was to explore the differences in how advanced beginners, competent, and expert nurses prioritize and reprioritize patient care. This qualitative study had a purposive sample of 23 nurses on cardiac/telemetry units at five hospitals. Four themes emerged from the data: cognitive strategies, communication, integration of roles, and response to the work environment. As the nurses progressed in expertise, they were better able to organize, more effectively deal with interruptions, anticipate patient needs, integrate varied nursing roles into their work, and communicate effectively. The significance of this study is the identification of factors that affect the nurse's ability to work productively in today's care environment. It increases understanding of the graduate nurses' perception and response to the complexity and work of nursing. An understanding of these factors provides the basis for further research to understand and promote transition of nurses from advanced beginner to expert.

The complexity of care in the acute care environment provides significant challenges for all nurses. How the nurse responds to these challenges influences the patient care provided and the nurse's satisfaction with work performance. The increasing demands in the acute care setting affects patient safety as nurses navigate through prioritization, communication with other members of the health care team, provision of continuity of care between providers, and management of a challenging workload. To improve patient care, it is essential to understand how the level of nurse competency affects the individual nurse's response to this complex work setting. The work of nursing includes the implementation of technical skills along with cognitive processes and decision making. Research has shown that skill development and cognitive processing develops over time with experience and varies with level of competency. This study builds on the work on skill acquisition, work complexity, and nurse competency. Benner (1984) applied the Dreyfus model of skill acquisition to nursing. This systematic study described five levels of proficiency (novice to expert) that nurses go through to achieve expertise in skilled nursing interventions and clinical judgment. [Read More...]

---

1 University of Southern Indiana, Evansville 2 Deaconess Hospital, Evansville, Indiana 3 St. Mary's Medical Center, Evansville, Indiana 4 Memorial Hospital and Healthcare Center, Jasper, Indiana 5 Methodist Hospital, Henderson, Kentucky Corresponding Author: Jeri L. Burger, University of Southern Indiana, Evansville, IN Email: jlburger@usi.edu

---

Research Resources

* Novice to Expert Appraisal

---

Discussion:

• How does this research study "look different" compared to the other featured virtual journal club research article?
• What competency category do you fall in (page 500)? Did you find that you respond to your workload like your peers at MH and other local hospitals?
• What theme (cognitive strategies, communication, integration of roles, response to the work environment) did you relate to the most? Why?

Please comment to join in the discussion.