Expertise in nursing practice : caring, clinical judgment - Springer ...

12 Expertise in Nursing Practice
STAGE 3: COMPETENCE
With moreexperience, the number of potentially relevant elements of a
real-world situation that the learner is able to recognize becomes overwhelming.
At this point, since asense ofwhat is important in any particular
situation is missing, performance becomes nerve wracking and
exhausting, and the student might wonder how anybody ever masters
the skill.
To cope with this problem and achieve competence, people learn
through instruction or experience to adoptahierarchical perspective.
First, they must devise a plan or choose aperspective, whichthendeterminesthoseelements
of the situationto be treatedasimportant and those
that can be ignored. By restricting themselves toonly a few of the vast
number of possibly relevant facts and features, decision making becomes
easier.
Thecompetent performer must devise new rules and reasoning procedures
forthechosen plan orperspective determinationso that learned
rules foractions based onrelevant facts can thenbe applied. These rules
are not aseasily come by as the rules given beginners in texts and lectures.
The problem is that there are a vast number of different situations
that the learner may encounter, many differing from each other in subtle,
nuanced ways, and in each a plan or perspective must be determined.
There are, in fact, more situations than can be named or precisely defined,
so no one can prepare forthe learner a list of what to do in each
possible situation. Thus,competent performers have to decideforthemselves
what plan to choose without being sure that it will be appropriate
in the particular situation. Now, coping becomes frightening rather
than exhausting, and the learner feels great responsibility for his or her
actions. Priorto this stage, if the learned rules did notwork out, the performer
could rationalize that he had not been given good enough rules
rather than feel remorse because ofa mistake. Of course, at this stage,
things often work out well, and a kind of elation unknown to the beginner
isexperienced, so learners find themselves on anemotional roller
coaster.
This combination of necessity and uncertainty introduces animportant
new type ofrelationship between the performer and his or her environment.
The novice and the advanced beginner, applying rules and
maxims, feel little orno responsibility for theoutcome oftheir acts. If
they have made no mistakes, an unfortunate outcome is viewed asthe
result of inadequately specified elements or principles. The competent