As baby boomers age and the complexity of healthcare problems increases, the nursing shortage will most likely intensify. More than 1 million new and replacement nurses will be needed by 2012, according to the latest projections from the U.S. Bureau of Labor Statistics.1
In addition to recruiting nurses into the profession, retaining our new graduate nurses will help ease the shortage. As spring arrives, the long tradition of training and mentoring new nurses begins again. This tradition's continued success is integral to the endurance of our profession. The first impression a new critical care nurse forms is an important one that may last his or her entire career. The experience of being mentored and coached can be very positive, helping to retain nurses in critical care; a negative experience may lead nurses to leave the specialty or the profession.
While I'm excited to represent Nursing2006 Critical Care as editor-in-chief, it's interesting to find myself back in the "novice" role. The renewal that comes with this position gives me pause to reflect on the professional development of a nurse.
The framework Patricia Benner, RN, PhD, FAAN, described for acquiring skills and knowledge in nursing practice in her landmark work From Novice to Expert: Excellence and Power in Clinical Nursing Practice gives us an important tool for supporting one another.2 According to Benner, expert nurses develop skills and an understanding of patient care over time through a sound educational base and a variety of experiences. She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that").2 Her premise is that developing knowledge in applied disciplines such as nursing involves the extension of practical knowledge through research and understanding the "know-how" of clinical experience. Therefore, experience is a prerequisite for becoming an expert.
Novices in nursing practice haven't had real experiences with the situations in which they're expected to perform, so they require instructions or rules.2 For example, the novice nurse may not realize that a patient is going into pulmonary edema as he or she is concentrating on setting the monitoring lines for a central venous catheter, whereas an expert clinician can recognize the symptoms at the doorway, synthesize the information, and come up with a plan of care in 5 minutes flat. Just as I rely on my expert mentors to learn how to be an editor-in-chief, the novice critical care nurse relies on the expert critical care nurse to teach, mentor, and hopefully inspire, so he or she can successfully evolve from novice to expert.
If experience is required to become an expert, we have to provide that opportunity for new nurses in a safe, nurturing environment. This responsibility to help our new colleagues develop should be one that we accept gladly and view as a challenge to improve our own practice.
As we celebrate National Critical Care Awareness and Recognition Month, let's remember what it's like to be a novice nurse, and share those experiences with our new colleagues as they begin the journey.
Kate J. Morse, RN, CCRN, CRNP, MSN
Editor-in-Chief, Director of Nurse Practitioners Chester County Hospital West Chester, Pa.
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