Enhancing Nursing Excellence
in a Time of Change and Cost-Containment

The Goals

• Identify Strengths and Impediments to Practice
  
• Identify Skilled Nursing Practice
  
• Articulate Experiential Clinical Learning from Nursing Practice
  
• Make Visible the Best of Nursing Practice
  
• Renew Clinical Nurses in Discovering the Strengths of their Practice
  
• Share Clinical Knowledge Among Nursing Staff
  
• Build a Managerial Focus on Developing the Strengths of
• ractice
  
• Develop a Culture of Professional Quality and Excellence
  
• Promote Based on the Level of Nursing Practice Skill
  
• Understand New Graduate Transition to Hospital Practice and Means of Retention.
  

The Problem

Highly skilled nursing practice is often unrecognized by nurses and managers, alike, and by those making decisions about the number of R.N.'s available for patient care. In a hospital environment where acutely ill patients need the highest quality nursing care, concrete strategies are needed to make visible and enhance the highest quality in clinical nursing expertise. In the current health care climate, astute clinical judgment and expert caring practices have never been more important for quality health outcomes. Developing critical paths and case management methods do not guarantee the availability of clinical nursing expertise to deliver cost-effective and reliable quality patient care.

Experiential clinical learning is expensive in human and economic terms. Much of that knowledge is hidden and contained within the practitioner. Making experiential knowledge and clinical wisdom available through reflection and the articulation of that knowledge enhances local practice knowledge and system design.

Sources of Solutions

• Make skillful nursing practice visible to all areas in the hospital.
  
• Move the environment and culture of the nursing staff to focus on identifying recurring patient problems and strategies for improving patient care outcomes.
  
• Identify the best of clinical nursing practice as sources of clinical knowledge and models providing concrete strategies for increasing expert clinical and ethical judgment.
  
• Help nurses at all levels to see their own practice and have the methods to share their clinical knowledge with their peers.
  
• Gain an understanding of the strengths and issues of nursing practice in the hospital.
  
• Support nursing unit managers in their role of developing nurses in their practice.
  
• Provide staff nurses with the authority, knowledge and accountability to determine nurses ready for promotion based on practice level skills.
  
• Promote, recognize and reward based on skilled nursing practice performance.
  
• Design specific educational supports for each level of skill acquisition.
  
• Identify issues for new graduate nurses and how to increase their retention.

Based on over 20 years of continuing research on nursing practice and skill acquisition, Benner Associates brings to hospitals and their nursing divisions, a plan and process to put in place a set of solutions to many of the problems facing nursing in the current environment.

Working through the renewal of the clinical practice development in the hospital, this approach and methodology focuses on nursing practice and on recognizing, rewarding, and enhancing the practice and the practitioner.

Benner Associates assists the hospital in creating a clinical practice development system that moves beyond abstract descriptions or activities used to determine practice skill and helps create professional peer review procedures utilizing clinical narratives to identify advanced nurse practice.

Good clinical reasoning requires reasoning across time about the particular patient through transitions in the patient's conditions and the clinicians understanding. Expert clinical judgment is developed through recognizing the nature of the specific clinical situation through developing an ongoing clinical grasp and clinical forethought. Relational skills are central to good clinical judgment though they may lag behind the development of technical skills.
Benner Associates works with nursing management and staff development, at all levels, particularly at the crucial unit level, to understand skill acquisition, stages of development of staff nurses, and the use of clinical narrative methodology to promote the development of clinical expertise. This approach helps management identify system problems across the hospital that impedes advanced nursing practice.

Benner Associates provides support in creating clinical practice development and promotion systems and managerial growth. By focusing on nursing practice, skill levels are identified and the clinical knowledge of excellent practitioners is made visible, creating a culture of excellence.

Among the outcomes experienced by hospitals using this approach are:

• Increased recognition of excellent nursing practice by the professional community.
  
• Appreciation of one's level of knowledge and skill by the nurse and nurse peers.
  
• A means of sharing and growing the knowledge of clinical practice among nurses.
  
• The creation of a clinical system that retains and rewards expert nurses in patient care.
  
• The retention of nurses in the hospital who represent and model excellence in clinical practice at both advanced and new graduate levels.