Benner Associates
Executive Summary of Services
Background
In a highly changing health care environment, the core of the hospital is patient care and the core of the core is the practice of the nurses who are with patients on a 24 hour basis. Whether the hospital finds itself in a time of strong or lean financial resources or a time of nursing shortage or surplus, the key question is whether, in this era of highly acute patients, there are nurses who have an excellence of practice that can directly affect how a patient progresses to discharge and reduce unnecessary recidivism.
Current Problems
- Promotion of nurses to advanced levels of pay without any relationship to level of nursing practice skill.
- Advancement systems based on minimal standards rather than on excellence.
- Failure to identify the most highly skilled nursing practitioners resulting in the loss of their clinical knowledge and skill to other nurses.
- Lack of an authentic clinical practice development and promotion system forcing many expert nurses to leave direct patient care for other roles in the hospital.
- Failure of other health care team members and decision makers to see the critical role of expert nursing practice in the care of patients and families and the overall success of the hospital.
- Poor linkage between patient outcome data and the essential means for creating good patint care outcomes and high reliability.
Methodology
This approach uses a researched-based explication of the development of clinical expertise. Guided by research on the Dreyfus model of skill acquisition, clinical narratives are analyzed for skill level and themes of nursing practice. The methodology assumes that the organizational resources and constraints of the local setting determine the availability of expert clinical practice. Starting with the identification of the best of the current practice, the system seeks to grow and extend the general level of practice. The focus of the consultant process is aimed at teaching the clinical practice development committee and other relevant groups how to define the themes and characteristics of nursing practice and to gain an understanding of how the clinical narratives provide evidence of the clinical practice levels of nurses seeking promotion. The clinical practice development committee develops descriptive characteristics of each level of practice drawing from local clinical exemplars which illustrate themes of practice and levels of skill. The review and sharing of practice as a basis for promotion, takes place formally in a peer review committee comprised primarily of clinical staff nurses. This strategy promotes the public sharing of expert practice narratives as a way of developing a vision for and a culture of excellence.
General Process in the Creation of a Clinical Practice Development System
- Interactive presentations to appropriate groups on the research on practice and skill levels and the narrative methodology.
- Develop and define the strengths and difficulties of nursing practice from the clinical narratives of a group of highly skilled nurses across the hospital.
- Enhance consensus about the nature of excellent practice in the local setting.
- Develop skill as a group in determining level of skill through review of the narratives and conversations with the nurses about their practice.
- Establish the promotion process and portfolio for advancement, initially at the proficient-expert level, with the creation a peer review system.
- Develop a source of coaching support to assist nurses in the development of their promotion portfolios and clinical narratives.
- Work with nursing managers on their role in understanding skill acquisition and developing and advancing nurses in their practice.
Projected Outcomes
- Identification of the "expert" nursing practitioners and their advanced clinical knowledge providing a resource for advancing the level of nursing practice in the hospital.
- Promotion of nurses on the basis of the level of their practice skill.
- The creation of a peer-based review process which focuses on practice, skill, and clinical knowledge development.
- The opportunity to shift the climate and culture of the nursing system to a focus on excellence thereby raising the level of nursing practice.
Final Product
The result of a series of consultation visits by a team from Benner Associates will be a clinical practice deveopment system in which there is strong consensus that those persons promoted demostrate in their practice a skill level commensurate to the level of promotion. The system, if implemented properly, will develop both a person's practice and the general nursing practice in the hospital. It will also create steps to enhance the role of clinical nursing management and hospital education as sources of creative design and development for the nurse as a knowledge professional.
Level and Length of Consulting Support
- Approximately five on-site visits of two days duration involving one to two consultants per day for a minimum of 17 person-consulting days.
- Usual length of direct involvement to implementation is ten months to a year.
This approach represents a major shift in ways of thinking about clinical practice and identifying persons ready for promotion, especially at advanced practice levels. It also recognizes the need to attend to issues around the promotion system related to management and education.
Project Team
Drawn from members of Benner Associates, the team members are brought into the consultation process as the plan is implemented. The knowledge and experience of various associates is made known to the client group as the consultation unfolds and it is determined who from the team would be most knowledgeable and helpful at a particular point in the process.
Return to Home Page Up a Level