Student Progression: From Novice to Expert

1. Student Progression: From Novice to Expert Laurie Heline CRNA, MS Clinical Coordinator Oakland University-Beaumont Graduate Program of Nurse Anesthesia

2. 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.

3. Clinical Instruction Importance A profession that is not growing is dying.

4. 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”

6. 5 Steps an RN Takes to Become a CRNA • Novice learner • Advanced Beginner • Competent Student • Proficient Student • Expert Practitioner

7. 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

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

10. 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

11. Novice Learner • Eager • Enthusiastic • Motivated • Lack of Flexibility • Anxious • Afraid • Uncertain • Frustrated • Overwhelmed

12. Novice Learner • Anesthesia students in the first months • Average cases: • 27 cases at end of first semester • 155 at end of second semester

13. 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

14. 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

15. 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

16. 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

17. 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

18. The Advanced BeginnerWhat Can We Do? • 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

19. 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

20. 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

21. 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

22. The Competent Student 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. The Expert Practitioner • Even expert can revert to novice role when confronted with: • New drug • New technique • Unfamiliar situation • Can still make wrong decisions

29. 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

30. Clinical Instructors Thank you for all you do for our students and the profession of Nurse Anesthesia!

32. 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