Student Progression: From Novice to Expert

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Student Progression From Novice to Expert

• Laurie Heline CRNA, MS
• Clinical Coordinator Oakland University-Beaumont
  Graduate Program of Nurse Anesthesia

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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.  

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Clinical Instruction Importance

• A profession that is not growing is dying.

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Clinical Instructor

• Fill many different roles
• Anesthesia provider
• Employee
• Clinical teacher

5
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

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5 Steps an RN Takes to Become a CRNA

• Novice learner
• Advanced Beginner
• Competent Student
• Proficient Student
• Expert Practitioner

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• 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.

8

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

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Novice Learner

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

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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

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Novice Learner

• Eager
• Enthusiastic
• Motivated
• Lack of Flexibility
• Anxious
• Afraid
• Uncertain
• Frustrated
• Overwhelmed

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Novice Learner

• Anesthesia students in the first months
• Average cases
• 27 cases at end of first semester
• 155 at end of second semester

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NoviceLearnerWhat 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

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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 comfortable
• Make some interventions based on experience

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The Advanced Beginner

• 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

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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

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The Advanced Beginner

• 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

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The Advanced BeginnerWhat Can We Do?

• Help student with psychomotor skills
• Recognize that
• Dependent on instructors knowledge
• Hesitant to voice opinions
• Still task focused
• Need help with prioritization
• Dont always have good rationale
• Allow students to make good and bad decisions

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The Advanced BeginnerWhat Can We Do?

• 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

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The Competent Student

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

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The Competent Student

• 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

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The Competent Student

• Must still analyze possibilities of each
  situation and think through options
• Challenge instructors knowledge and authority at
  this stage
• Demonstrate competency in some areas and novice
  behavior in others
• Complacent

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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 process
• When time is right, discuss with the student and
  attempt to elicit rationale for behavior

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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

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The Proficient Student

• 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

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The Proficient StudentWhat Can We Do?

• Encourage the independence
• Remind them even seasoned practitioners
• Seek help
• Share tasks
• Request consultation when needed
• Complacence, so continue to challenge
• Senioritis behaviors

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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

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The Expert Practitioner

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

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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

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Clinical Instructors

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

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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