S TUDENT F ROM N P ROGRESSION OVICE TO E : XPERT Laurie Heline CRNA, MS Clinical Coordinator Oakland University Beaumont Graduate Program of Nurse Anesthesia

O

BJECTIVES

 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.

C LINICAL I NSTRUCTION I MPORTANCE

A profession that is not growing is dying.

C

LINICAL

I

NSTRUCTOR



Fill many different roles:

   Anesthesia provider Employee Clinical teacher

N OVICE TO E XPERT T HEORY

 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 S TEPS AN RN T AKES TO CRNA B ECOME A

 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.

 Think of a student at each stage  Anesthesia is both a science and an art

N OVICE L EARNER

   Enter as successful ICU nurses Unfamiliar with the OR Process of anesthesia is mysterious  No anesthesia experience, little knowledge

N OVICE L EARNER

     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

        

N OVICE

Eager Enthusiastic Motivated Lack of Flexibility Anxious Afraid Uncertain Frustrated Overwhelmed

L EARNER

N

OVICE

L

EARNER

 Anesthesia students in the first months  Average cases:   27 cases at end of first semester 155 at end of second semester

N OVICE L EARNER W HAT CAN WE DO ?

      Set clear, detailed expectations Provide as much consistency as possible Remind to focus on patient Guide in organizing tasks   Checklists Mnemonics Care plans Recognize that students need to gain confidence

T HE A DVANCED B EGINNER

 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 comfortable Make some interventions based on experience

T HE A DVANCED B EGINNER



Students have:

 Limited knowledge  Misunderstood concepts  May apply knowledge incorrectly 

Still focused on tasks but not as overwhelmed by the environment



Small deviations from routine may derail

T HE A DVANCED B EGINNER

 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

T HE A DVANCED B EGINNER

 Quickly doubt own ability leading to a viscous cycle of:    performance anxiety self-flagellation further failure  Feel responsibility for decision making lies with those who have superior knowledge and experience

T HE A DVANCED W HAT C AN B W E EGINNER D O ?

   Help student with psychomotor skills Recognize 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

T HE A DVANCED W HAT C AN B EGINNER W E D O ?

 Instructors hesitant to ask questions because think student may have more theory knowledge than them   Develop stock questions Ask student to explain concept to them  Help identify distinctions of common anesthesia events and share rationale for decision making

T HE C OMPETENT S TUDENT

  After 150-200 anesthetics 3 rd semester end with 271 cases  Able to manage an ASA 1-2 patient undergoing a simple surgical procedure with minimal assistance

T HE C OMPETENT S TUDENT

 Demonstrate:        Familiarity with variety of basic anesthesia situations Identify significant aspects of a situation Anticipate events that may occur Improved organizational skills Can integrate sensory input from numerous sources Ownership, becoming patient advocate Trust in self and comfort with knowledge, skills, and abilities

T HE C OMPETENT S TUDENT

 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

T HE C OMPETENT W HAT C AN W E S TUDENT D O ?

   Suggest alternatives Ask the student to teach the instructor something When challenged by a student, understand this may be part of growth process  When time is right, discuss with the student and attempt to elicit rationale for behavior

T HE P ROFICIENT S TUDENT

 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

T HE P ROFICIENT S TUDENT

 May feel overly responsible OR become overly confident  Believe their knowledge is more current than instructors  Results in the potential for humbling errors  No longer concerned with merely performing tasks  Seek to prevent common problems and minimize adverse events

T HE P ROFICIENT W HAT C AN W E S TUDENT D O ?

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Encourage the independence

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Remind them even seasoned practitioners:



Seek help



Share tasks

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Request consultation when needed

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Complacence, so continue to challenge

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“Senioritis” behaviors

T HE E XPERT P RACTITIONER

 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

T HE E XPERT P RACTITIONER

 Even expert can revert to novice role when confronted with:  New drug   New technique  Unfamiliar situation Can still make wrong decisions

N OVICE TO E XPERT M ODEL

 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

C

LINICAL

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NSTRUCTORS

Thank you for all you do for our students and the profession of Nurse Anesthesia!

B IBLIOGRAPHY

     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