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Issues of clinical nursing expertise and clinical wisdom have been found to play an important role in ensuring the delivery of quality patient care. Nursing expertise and clinical wisdom are influenced by individual-level factors such as nurse’s years of experience and level of education (McHugh & Lake, 2010), as well as contextual factors such as the educational and experience levels of coworkers, motivation and engagement, and the nursing practice environment (Uhrenfeldt & Hall, 2007). The present paper discusses several issues related to nursing expertise and clinical wisdom with the view of demonstrating the level of understanding and experience with the concepts.
Expertise in Nursing
Clinical expertise has been defined in the literature as a crossbreed of practical and theoretical knowledge that enables the clinically competent nursing professional to show an intuitive capability to not only make critical clinical decisions efficiently but also to understand the whole nature of any given condition or situation (McHugh & Lake, 2010). These authors argue that “expertise influences nurses’ clinical judgment and quality of care and develops when a nurse tests and refines both theoretical and practical knowledge in actual clinical situations” (p. 277). Nurses are expected to develop these skills and capabilities as they progress through the five expertise levels proposed by Benner, Tanner, and Chesla (2009), from novice nurses (entry-level) to expert nursing professionals.
From the perspective of nursing practice, an expert nurse can be characterized as a nurse professional who has developed the theoretical and practical capability to recognize unexpected clinical outcomes or potential problems before they occur and address them at the earliest convenience due to a deep understanding of the whole situation. This characterization is similar to Benner’s description of an expert nurse, particularly in terms of demonstrating an intuitive grasp of each situation (theoretical and practical knowledge), diagnosing and addressing the problems without wasteful consideration of unfruitful or unproductive alternatives (efficiency and convenience), and exhibiting the highest analytic ability to be able to understand situations and contexts from a holistic perspective (Benner et al., 2009).
Advanced beginner and competent nurses need to be supported and facilitated to progress through the clinical expertise ladder. For example, nurses in these expertise levels need to be exposed to more training and education opportunities so that they can develop the speed and flexibility needed in clinical decision making. Additionally, health care facilities should ensure that nurses in the advanced beginner and competent phases work under the direction of expert nurses and other professional mentors to develop their experience and analytical capabilities. Such exposure, according to McHugh and Lake (2010), will help the nurses to recognize clinical situations holistically and inclusively devoid of wasteful considerations.
Lastly, it is important to provide nurses with work-life balance programs and other work-related benefits to ensure their retention in the healthcare system and subsequent gains inexperience. These support systems are already been provided in my practice and other facilities, though financial constraints and individual-level factors such as lack of time and lack of interest continue to act as barriers in the journey to achieve clinical nursing expertise.
Clinical wisdom in nursing can be defined as the significant dynamic of reflexivity on the part of proficient and expert nurse professionals that provides them with the capability to base sound judgments on deep understandings in conditions and contexts of uncertainty due to their accumulated psychological, philosophical, existential and spiritual knowledge. Clinical wisdom is often acquired, maintained, and fostered (cultivated) in practice settings through experience and knowledge transfer, rather than being taught in a classroom context (McKie et al., 2012).
Clinically wise nurses must demonstrate the capacity to balance the good for another with the common good, recognize the balance between effect and intellect in solving existing problems and challenges, as well as acknowledge the role of tacit knowledge in wise clinical practice (Haggerty & Grace, 2008; Uhrenfeldt & Hall, 2007).
Some many examples and vignettes demonstrate how nursing professionals use clinical wisdom. In one such example, a leading expert nurse educator used narratives and evidence-based teaching narratives to engage learners in understanding the best ‘fit’ for particular clinical evidence and protocols that could be used to address the symptoms of Parkinson’s disease among the elderly. The educator used evidence-based narratives to help nurse students to not only understand and remember the real-world applications related to the management of the disease but also to visualize the concepts that allow for further thought and questions (Haggerty & Grace, 2008).
The main benefit resulting from this example is that nurse students were able to develop a deeper comprehension of what was being taught since clinical practice becomes more visible via narratives. Expertise and clinical wisdom in the practice of other nurses can be promoted through exposing these professionals to experiences that enhance their critical reflection, critical reasoning, as well as judgment (Benner et al., 2009). In nursing education, for example, an expert nurse educator can rely on evidence-based practices to construct learning experiences that help students to synthesize clinical knowledge, share content-specific wisdom with others, and visualize concepts in a holistic approach.
Drawing from this discussion, it is evident that nurse expertise and clinical wisdom are important elements in the provision of quality care. These elements appear to be acquired via experience and sustained knowledge transfer processes, rather than fragmented learning episodes.
Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing practice (2nd ed.). New York City: Springer Publishing Company.
Haggerty, L.A., & Grace, P. (2008). Clinical wisdom: The essential foundation of “good” nursing care: Journal of Professional Nursing, 24, 235-240. Web.
McHugh, M.D., & Lake, E.T. (2010). Understanding clinical expertise: Nurse education, experience, and the hospital context. Research in Nursing & Health, 33, 276-287. Web.
McKie, A., Baguley, F., Guthrie, C., Jackson, C., Kirkpatrick, P., Laing, A.,…Wimpenny, P. (2012). Exploring clinical wisdom in nursing education. Nursing Ethics, 19, 252-267. Web.
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Uhrenfeldt, L., & Hall, E.D.C. (2007). Critical wisdom among proficient nurses. Nursing Ethics, 14, 387-398. Web.