Transcript Mentoring and Precepting – Transition from Novice to Expert

Mentoring-Precepting:
Transition from Novice
Susan A. Boyer, RN, M.Ed.
Vermont Nurses In Partnership
Executive Director
Expert
Mentoring & Precepting
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New graduates struggle with building
capability as they enter into practice
In new specialties even capable nurses
revert to a novice level of capability
This morning we will explore what is
needed to support transition along the
continuum towards competence
–as a nurse and
–as a preceptor in the clinical setting
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Objectives:
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Differentiate the practice of a colleague
with consideration of "novice to expert"
levels of capability.
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Build a teaching plan that fosters the
development of critical thinking capability.
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Describe the impact of developmental
support in the clinical setting.
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Experiential Learning
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Dreyfus' theory of experiential learning
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A developmental model
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Benner worked with Dreyfus model of skill
acquisition for 21 years
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Application of experiential learning theory
to the development of nursing practice
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Nursing Requires:
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Benner writes that nursing requires both
Techne and Phronesis
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Techne – explicit knowledge related to
procedural or scientific knowledge
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Phronesis – is more complex; it is reasoned
practice that is developed through
experiential learning, where the nurse is
continually improving her or his practice
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Techne
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The rational method involved in producing
an object or accomplishing a goal/objective
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The intent is making or doing, not simply
"disinteresting understanding.“
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Also has meanings/implications that relate
it to art – techne is the craft presentation
of the art, in this case the art of nursing
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Phronesis
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The virtue of moral thought, usually translated
"practical wisdom”
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Aristotle - not only the ability to decide how to
achieve a certain end, but also to reflect upon and
determine that end, the ability to achieve
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the application of practical knowledge knowledge framed by exposure to other
perspectives, ideas and disciplies.
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Phronesis
- More than Just knowledge
To think about how and why we should act in
order to change things, for the best.
 Gaining phronesis requires time, as one must
gain both the habit and understanding of
correct deliberation
 Phronesis is reasoned practice, employed
through experiential learning, where the nurse
is continually improving their practice
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Novice to expert
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Novice
Advanced beginner
Competent
Proficient
Expert
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Traits and capabilities
Novice (0)
seeks rules and recipes to guide action
Advanced
beginner
Competence
seeks strategic and contextual knowledge;
begins to know when rules can be broken
(4)
able to monitor own performance and make
conscious choices about what to do
Proficiency
increased use of intuition and tacit knowledge;
'reads' the learning situation easily, sees its
events as connected and explicable
Expert (9)
characterized by fluency and automaticity; fully
adapted to, and in control of, the situation
Framework, Berliner (1988); Years experience data from James Leach (1996)
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Transition between levels
Transition does not equal time/years
• Regression when faced with new situation/specialty
• Transition takes time and experience
– Experiential learning
– Reasoned practice
– Gain the habit and understanding of deliberation
• Move more quickly to next level
– Apply prior learning
– See what the core concepts are
– See how concepts can be applied in new
situation
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Application to competence
Development & evaluation
Performance Scoring
 Identified Limitation (Novice)
 Capable (Advanced Beginner)
 Performs Independently (Competent)
 Proficient
 Expert
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Scoring key categories
1 – Identified
Limitation requires
BENNER’S
Novice - Inflexible, rule-based.
2 – Capable - familiar
Advanced Beginner – start
direct guidance &
support, little or no
experience with skill
with skill/equipment, but
may need assistance,
seeks help when
unfamiliar with
process/skill
Little or no background
understanding
to use and make sense of
situational elements & depend
on the context. Temporal focus
is immediate & present
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Benner’s
3 – Performs
independently
– knowledgeable to perform
these tasks safely as a result
of training & experience
Competent
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Increased efficiency, planning is
still conscious, abstract, analytic,
and deliberate.
4 – Proficient
-situations are perceived as a
– extensive experience in this
whole rather than as
area/skill, able to teach and
unconnected aspects
mentor others
5 – Expert
– all of the above; fluid
performance; ensures
evidence-based practice for
clients and agency
- Understanding of task, also the
decision of what to do next, is
intuitive and fluid.
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Transition from novice
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What supports development and
transition along these levels of capability?
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To develop capability,
competence & confidence
Use reflection, questioning, storytelling, feedback, experience and
success to foster development
 Support holistic care
 Focus on concrete critical thinking
development questions/discussion
 Clearly defined expectations
 A plan for the learning process
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What are the goals ?
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What patients need – a safe and
effective care provider
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What a preceptor needs – evidence
that this care provider can provide
safe and effective care
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What will this evidence look like?
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Competency Expectations
 Clearly
defined expectations
 Performance
outcomes statements
◦ What does a nurse do?
◦ What is most important?
◦ Tasks vs. Phronesis
◦ Procedures vs. Critical Thinking
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Concrete Teaching Plan
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Clinical teaching is more effective
when it is planned
Components of a teaching plan
– Goals
– Clearly defined expectations
– Instructional strategies
– Teaching time is required for
instruction, observation, allowing practice, giving
feedback, documentation, discussion of case
scenarios/stories/issues/what ifs.
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Critical elements
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For planning
Performance expectations
 Instructional strategies
 Concrete Critical Thinking Development
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Clinical Coaching Plans
Instructional Performance Met?
Strategies Expectations
Comments
Reflection on practice/learning
(concrete C.T. development)
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Critical elements
- for learner, for safety
Identify and explore resources
 How to find the info?
 Recognize limits of capability
 Seek help/assistance/information
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Fostering critical thinking
skill development
Assist with organization/prioritization
 Provide reflection regarding aspects of a
clinical situation
 Focus on concrete critical thinking
development questions/discussion
 Clearly defined expectations
 A plan for the learning process
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Learning Environment
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What every learner needs – a safe
learning environment
Basic principles of teaching/learning
– Simple to complex
– Success builds success
– Allow practice, even failure
– Allow time for learning and discussing
– Feedback, Correction, Change direction
– Safety for patient and learner
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Experiential Learning
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Instruction in the clinical setting
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Differentiating between performance
outcomes and instructional strategies
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Determining behaviors that foster
Critical Thinking development
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Critical Thinking: Novice
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Expert
Data gathering from multiple sources
Distinguish relevant from irrelevant
Identifies missing information
Checks accuracy
Predicts beyond the presentation
Extends thinking beyond the medical record
Evaluates differing points of view
Identifies and examines alternatives
Flexibility - change in assignment
Willingness to reconsider
Anticipates & Manages complications
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Support for Internship/Orientation
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Teaching preceptors
Communication
 Interpersonal skills
 How to provide experiential learning
while protecting safety
 Teaching how to teach, how to foster
critical thinking development
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History of VNIP
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What we have learned
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Measurable outcomes - help to ‘sell
the concepts/program’
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The value of standardization and
collaboration
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Expectations for the future of this
collaborative project
www.vnip.org
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REFERENCES:

Benner, P. (2004). Using the Dreyfus model of skill acquisition
to describe and interpret skill acquisition and clinical
judgment in nursing practice and education. Bulletin of
Science,Technology & Society, 24, 188-199
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NCSBN Position paper (2005) Clinical Instruction in
Prelicensure Nursing Programs. August 2005. Accessed on
3/21/08 at
https://www.ncsbn.org/pdfs/Final_Clinical_Instr_Pre_Nsg_pr
ograms.pdf
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