Clinical exemplars describing expert staff nursing practices

This study was undertaken to identify and describe expert staff nursing practices in a large teaching hospital in south-western USA.

Differentiation of the skill level of staff nurses is important for assuring safe, quality care. In the current atmosphere of corporate, downsizing, shortened hospital stays, cross training and continued high staff nurse turnover rates, it is of critical importance to identify and describe the essential contributions of expert nursing practice and to recognize and reward nurses according to their skill level.

Clinical situation interviews and participant observations were conducted using the interpretative phenomenological research approach. Narrative data were obtained and analysed systematically in multiple stages to identify and describe recurring meanings, themes, exemplars and constitutive patterns.

The final stage of data analysis involved interpretation of the narrative text using Benner's (1984) 'domains and competencies of nursing practice' as a framework. These competencies were validated in this study and 16 new competencies were identified.

Expert staff nursing practices described in this project are not behaviours commonly defined as organizational expectations in performance appraisals for staff nurses. These practices need to be incorporated into position descriptions, performance appraisals and clinical ladders to recognize, foster and acknowledge the significance of expert nursing practice.