CHAPTER 1 The concept of expert to novice is not new to me. In part, because I have had so many roles in nursing. I like to challenge myself and try something new. Each time I try something new, it is with angst that I am, once again, a novice! —Jill In response to the nursing shortage, many schools of nursing have increased recruitment and enrollment of nursing students (Culleiton & Shellenbarger, 2007). Although this is necessary to meet the increasing health care needs of today’s society, it seriously exacerbates the ongoing nursing faculty shortage. Lecture-style classrooms may be able to accommodate more students with less impact on faculty numbers; however, clinical teaching and some of the more learner-focused active methods of teaching that are becoming increasingly more popular in nursing classrooms require a higher faculty-to-student ratio. Depending on the clinical setting, the clinical agency policies, and the respective state board of nursing mandates, faculty-to-student ratios in the clinical setting can range from 1:15 to 1:6, and even 1:1 in a preceptor model of instruction. Unfortunately, as the numbers of nursing students increase, the numbers of nursing faculty may not. The aging faculty who are close to retirement, the lower salaries in academia, and an insufficient pool of potential nurse educators in graduate programs (American Association of Colleges of Nursing, 2014) are all cited as factors in the ever increasing shortage of qualified nursing faculty. At present, nursing schools are attempting to expand their programs to accommodate the increasing numbers of applicants required to fill the over 1 million new nursing positions that projections indicate will be needed by 2022 (Robert Wood Johnson Foundation, 2014). At the same time, hospitals are struggling with how to address the “preparation-to-practice” gap that has been identified. New graduate nurses constitute over 10% of the nursing staff for a typical hospital and this number is certain to increase in the future. A national survey of schools of nursing and hospitals showed that although 90% of nursing faculty believe that their graduates are prepared to provide safe and effective care, 90% of hospital-based educators are questioning the practice readiness of new nurse graduates (Nurse Executive Center, 2008). Thus, many hospitals are implementing nurse residency programs in an effort to accelerate practice readiness of new graduates. Experienced nurse clinicians at these institutions will be called on to serve as clinical educators for these new nurses. Many of these expert clinicians have not yet experienced what it is like to teach and find themselves, once again, a novice. They may have a bachelor’s, master’s, or doctoral degree, but no experience or formal preparation in teaching and learning (Anderson, 2009; Schriner, 2007). Benner (1982) has characterized a novice nurse as a beginner who must have rules to guide practice, because there is no experience from which to draw conclusions. The rules, however, are context-free, so that the novice does not know which rules are most relevant in a real situation or when an exception to the rule should be considered. This type of discretionary judgment is developed through experience. Thus, it is important to identify ways to enhance competency and confidence of expert clinicians as they move into a new educator role. Nursing history is rich in stories, but a focus on the science of nursing has sometimes obscured the stories of real life experiences that can teach us so much. In an effort to address the need for mentoring of new clinical faculty, the authors designed and implemented a Clinical Nurse Educator Academy to prepare experienced clinicians for new roles as part-time or full-time clinical nurse educators (Cangelosi, Crocker, & Sorrell, 2009). Through written narratives, 32 nurse clinicians shared their perspectives as they prepared for new roles as clinical nurse educators. This chapter presents stories focused on participants’ responses to the following interview prompt: Think about what it is like to move from a role as an “expert” to a “novice.” Describe an incident that reflects your concerns about moving from the clinician to the clinical nurse educator role. Jill’s comment at the opening of this chapter reflects the essence of other participants’ comments: Moving to a new role as clinical nurse educator left the nurse clinician once again feeling like a novice. The participants, however, did not see the novice role as negative, but rather a time for them to learn new skills. Although being a novice was described as being “unsettling,” “uncomfortable,” and causing “mixed feelings,” these participants embraced the chance to be a novice again and forward their career goals. April clearly verbalized the benefits she realized from being a novice: I have been a nurse for 32 years. I have been a novice many times. I have been an expert a few times.… Being a novice makes me feel young.… I allow myself to be a novice, to not know everything and to learn from others and the job itself. Anne shared her feelings about why she embarked on the transitional journey toward the role of clinical nurse educator: The most memorable events in my career of feeling good about making a difference have been the times I had to hold my breath, put fear aside, and dive right in! Veronica described how she realized that putting herself in the role of “student” again was providing her with important new skills and self-confidence: I absorbed all of what had just happened, and I processed what it all meant to me. Suddenly, I felt rejuvenated—and free. I didn’t have to be the Perfect Teacher. I could make mistakes. And moreover, I could make those mistakes in front of everyone, and it would still be okay. Susan described her reflections about putting herself in the role of a novice so frequently, coming to the conclusion that it was the right thing for her: I did have an “a-ha” moment or personal epiphany today when I realized that by trying on many nursing-related hats throughout my professional career, I often keep myself at the level of novice—not always, but often enough to note this. What is that about? Does it protect me from assuming responsibility? I don’t think so, since most of my positions have been in management, and I seem to always rise to a leadership role of some kind. Still, I think it’s important for me to consider the possible secondary gain in frequently returning to the level of novice. Or am I just a lifelong learner who is not uncomfortable in the role of novice? I have played a lot of roles, and learned a lot along the way, including how to become very good at most of my jobs, which means that I have learned how to learn, or at least how I learn best. Isn’t this the point of the journey in the first place? If one is not learning, not growing, one is stagnating, or worse. I am passionate about lifelong learning, for myself, and encourage it in others.… But in order to learn, one must start at a position of incompetency, which can be very uncomfortable, and for many adults, intolerable. This is why people stop learning. They can’t stand exposing the fact that they don’t know something. If you can stand to feel temporarily and situationally incompetent, the world can teach you so many things! Eileen described how being a novice again had helped her understand how her students may feel. This gave her a great deal of personal and professional satisfaction: I had forgotten how anxious students are about accomplishing simple tasks. I was forced to begin thinking about nursing from the novice point of view. The observations and conclusions made on a daily basis by seasoned nurses are not something that can be taught in a 4-hour clinical.… If we put ourselves in the place of the student and remember what it was like for us, we have an opportunity to make a huge difference in a student nurse’s professional journey. Ellyn also reflected on what had helped her when she was first a novice nurse and how she now wanted to help others love the nursing profession: We all must remember that we also were novices once. Those who took the time to nurture and mentor us have done us a great service; moreover, they are the reason why we stuck it out through rough times and helped us to learn to love the nursing profession. Although it was clear that participants appreciated the necessity of feeling like a novice as they transitioned to the nurse educator role, they also faced this transition with a mix of excitement and anxiety. The theme “leaving my comfort zone” that emerged from analysis of the research interviews illustrates these ambivalent feelings. Joanie described how it was difficult to leave her comfort zone to enter an area where she was a novice again, but she knew it was an excellent opportunity, even though she still had considerable fear about it. Her detailed reflection is included here because it captures the ambivalence about the transition to the novice role that so many of the participants seemed to feel: Advancing in my clinical nursing career was a process that was gradual, unassuming, and rather comfortable. I worked as a newly graduated nurse in med–surg (because that’s what one usually did in the ’70s), and then switched to a specialty area. Over a span of 28 years, I became increasingly competent and proficient in the pediatric and newborn arena. I climbed the clinical ladder as far as I could go. I became certified in my field and was considered somewhat of an expert. With ever-increasing knowledge, experience, and confidence, I felt accomplished, credible, and well respected. All was right with the world! Why would I upset this perfectly stocked apple cart? When another opportunity became available, however, I decided to leave my comfort zone and forge ahead. This was a scary proposition for me, however, because this particular opportunity wouldn’t have me advancing at the bedside and this didn’t follow the natural progression of my career path. Woe is me! I thought that I had a fairly good grasp of what the job entailed.… I was pumped and excited to get those new nurses assigned to good preceptors, to orient students to the NICU [neonatal intensive care unit] and to do the best that I could in this new role. Although I was definitely a beginner in this new role when I started almost 4 years ago, and received only minimal orientation, I wasn’t too apprehensive and felt that if I came upon an unfamiliar situation I could probably “just wing it.” I had a positive attitude, good intentions, and support from management. Plus, it meant a pay raise and no holiday/weekend requirements. This might just work out fine. And then I had my “a-ha” moment. Shortly after starting this new position, I took a trip to California and brought along some nursing journals to read in the plane. I don’t remember which particular state we were flying over at the time, but I do remember that I was in the plane when I read something that really gave me a jolt. It was an article about clinical experiences for nursing students and the responsibilities of both student and instructor. The student is owed (and deserves) an instructor, preceptor, and/or unit facilitator, who is well versed and properly educated on evidence-based methods regarding knowledge acquisition, effective teaching strategies, and supportive relationship building. The “new” and “old” hires merit someone who understands how psychomotor and social skills are acquired and enhanced and where each person is on their career journey. Good intentions can only go so far. I knew then that although I had many years of life and career experience, I was a mere babe in the area of staff and student development. I also realized that I must further my formal education and keep current on issues related to this new endeavor because that is what is owed to those whom I support and orient. Hopefully, I have become increasingly competent, proficient, and credible in this new role. However, I don’t think that I ever will (or should) become too comfortable in this position. There is too much at stake for that to happen.
Moving From an “Expert” to a “Novice” Role
THE STORIES
Embracing the Novice
“Leaving My Comfort Zone”
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