Benner Analysis Paper

Scott Hultquist

Daemen College

Benner Analysis Paper

I was first introduced to the Benner and the Dreyfus model of skill acquisition nine months after I graduated from a two year nursing institute. I had been hired to work in an Intensive Care Unit. Of course I was excited and could not wait to begin my new career. I was told that orientation was going to be six months long and that the first three months would only be class room training. I was a little disheartened because I thought I was ready to work as a professional nurse in an extremely busy unit. In retrospect, I was wrong I definitely needed that orientation. The first day on the unit with my preceptor was very memorable. She was a nurse that had been working on the unit for the past thirty-five years and didn’t have any plans to retire. She said to me, “Scott, I know you think you know everything; but in fact you really don’t know anything yet.” Her statement confused me as I had just graduated from school and completed half of my orientation process. I felt that I could handle anything that was presented to me. My preceptor went on to say, “nursing is about caring, I can teach anyone the skills and the theory but if you do not care about people then you will never be an expert nurse. At that point I was uncertain of how things were going to proceed. Throughout this paper I will explain my journey using the seven stages of the Benner model and how I perceive my levels of competency. The Dreyfus model of skill acquisition will show how my competencies are measured. I will discuss my strengths and weaknesses and what I can do to turn my weaknesses into my strengths. I will also talk about my future career goals and where I see envision myself in five years.

Caring

The word caring, in my opinion, means that I want to do what is right and in the patient’s best interest every time, regardless of patient or situation. I believe that there would many definitions if people were asked to describe or define the term caring. In addition, I believe that in order to be a good nurse, the nurse must have the ability to put personal feelings aside and act as a patient advocate, a true liaison, for that patient and the patient’s family in their time of need. My very first day in the Intensive Care Unit was an eye opener. My preceptor told me that the unit was short staffed and she and I would have to take a full patient load of four patients. I was immediately overwhelmed and could not understand how she would be able to teach me anything if we were responsible for providing care to four very ill people. The very first room we entered contained a patient who was going through withdrawal and was extremely combative and verbally abusive. I felt as though I was in a jail cell not a hospital room. My preceptor looked at me and said this will be a great day; you are going to learn a lot. She walked over to the restrained patient and began talking to him. At the time of the initial contact, the patient was extremely agitated and was trying desperately to get out of his restraints. My preceptor began by speaking with him in a gentle, reassuring tone in an attempt to try to calm him down; at the same time loosening and ultimately removing the restraint form his right arm. I was unsure what was going to happen; needless to say I was a little frightened. The patient immediately calmed down and began to speak more rationally. The preceptor explained to me that restraints are not always necessary and that people often times respond better to nurse who is compassionate and who has a reassuring, calm voice. Over the next fifteen minutes, the restraints were removed from the patient and he was able to carry on a rational conversation with me. It was at that point that I had realized that I had a long way to go before I could truly understand what it meant to be a caring nurse. I was a novice and the road to being an expert was going to be a steep steady climb.

The helping role

I needed to change my schedule due to personal reasons and the only shift that would work for me was in an Intermediate Level Care Unit. The Intermediate Level Care unit, an intensive care unit, is a unit that specializes in long term chronic illness, most of the patients were on ventilators and required large amount of resources. I was working the night shift and was the charge nurse due to call offs. It was only my third week in the unit, when I received an order for a terminal wean. The patient had a chronic illness and had been on a ventilator for the past six weeks and did not show any signs of improvement; in fact, every time the weaning process would begin, it would have to be discontinued due to the patient’s oxygen saturation levels dropping which in turn caused the patient to struggle to breath. I was okay with the order and knew the patient would be more comfortable with morphine infusing. The night was going well until I received a phone call from the patient’s family. Initially they decided to go home and asked to be contacted when the patient had passed. During the phone call, they inquired if they would be permitted to return to the hospital so that they could be with their father throughout the process. Up until this point, I had never been asked that question. I told them they were more than welcome to return to the hospital and sit beside their father until he passed. The order I had was to titrate the morphine to patients comfort level. The family arrived and very quietly sat in the room holding the patients hand speaking softly about the past and how much they were going to miss him. I had been out of the room for only a few moments when the call light came in. I went in the room to see what was needed, when I entered I saw a middle aged man sitting next to his father and the patient’s wife seated on the other side of the bed, both crying and staring at the patient. The patient’s son said that his father was in pain he needed more morphine. I assessed the patient and noticed he was breathing quite a bit heavier and appeared to be gasping for air. I increased the morphine dose and pulled up a chair beside the son. I reached my hand out and began talking about his father, about the past and what a great guy he must have been. I was able to bring back happy memories and good times. I sat in that room for my entire shift with the patient’s family. About an hour before the end of my shift the patient passed away. I walked out of the room with my head held high knowing that I provided the best possible care to the patient and his family. According to Benner I would be a novice in handling end of life issues; however I felt like I was an expert at that time. I was able to give the family comfort and at the same time ease the patient’s pain, making that horrible time pain free and tolerable for everyone involved.

The Teaching-Coaching function

I have only been a nurse for the past three years. In that time I have moved from a staff Nurse to a Nurse Manager of a rural hospital. I truly believe that my past career as a paramedic has allowed all these transitions to take place smoothly. I currently have staff meeting once a month and at each meeting I incorporate some aspect of training. When I first started this process the nurses had very mixed emotions and felt like they did not need the training. In fact, one of the nurses said to me, we work in an Emergency Department why do I need to know how to extricate someone from the back seat of a car. I explained to the nurse that because some patients arrive via personal vehicles, we must be able to remove them from the vehicle in an appropriate manner so as to not cause any additional problems. Approximately three months later, in the middle of the afternoon on a winter day, a vehicle pulled into the ambulance entrance, a hysterical women exited the vehicle, and ran into the emergency department screaming that her husband had collapsed in the driveway while he was shoveling snow. She had called 9-1-1 but there was a delay in response so she decided to transport him herself. The wife and the neighbor were able to get the patient into the car and then the wife transported him to the hospital. The nurse who questioned the training three months earlier was working that day. She remembered the training that she received a few months prior and acted appropriately. She immediately called a code blue and obtained some equipment, including a back board and gurney along with the defibrillator. She remembered that early defibrillation is one of the key elements to the survival of cardiac arrest. She applied the paddles, recognized a rhythm that could be defibrillated, and shocked the patient. The patient entered a non-shock rhythm and CPR was started in the back seat while others assembled to help move the patient. The patient was moved into the trauma bay where all the heroic measures were performed which resulted in a positive outcome; the patient regained pulses and was transferred to a Cardiac Center for further treatment. The following day the nurse pulled me aside and thanked me for teaching her and giving her the confidence to perform the skills necessary to help make a difference. At that point in my career I would have graded my level, according to the Dreyfus scale, as proficient on the way to expert.

The Diagnostic and Patient Monitoring Domain

I was working in a small rural Emergency Department on the night shift. When a radio call came in, an ambulance was en-route to our facility with a two year old not breathing. When the ambulance crew entered they told me that the mother found the baby on the floor beside her crib, unresponsive and not breathing. The patient was placed in the trauma bay and everyone entered to help resuscitate the child. I remember the Doctor wanting to terminate all efforts of resuscitation prior to securing a definitive airway. I was the only one that spoke up and said, CPR had been performed since the patient had been found and that the patient could have only been in cardiac arrest for five to eight minutes, according to the mother’s statement. I knew that most babies go into cardiac arrest because of airway/respiratory issues, so I was very uncomfortable with terminating efforts until a definitive airway was secured. The Doctor agreed to intubate this child and in the process found a large pill partially occluding the child’s airway which was not dislodged with chest compressions. The foreign body was removed, the intubation was completed, and pulses we regained. If I was not confident in my abilities, I truly feel that the child would have died. I believe that I am proficient in my diagnostic and monitoring and extremely close to becoming an expert.

Effective Management of Rapidly Changing Situation

I was a paramedic for twelve years prior to becoming a nurse. I became proficient at managing rapidly changing situations. My first night as a supervisor I had a call off in the Intensive Care Unit. I was responsible for two Intensive Care patients as well as carrying out the supervisor’s responsibilities. At around midnight, one of the patients in the unit began crashing, her blood pressure bottomed out and her heart rate was up in the hundreds. Due to working in a rural hospital I do not doctor coverage in the unit on the overnights. While I was treating the patient an overhead page came across stating that someone had absconded from the mental health unit. I was able to manage the patient, stabilizer her, and perform all the appropriate tasks and paperwork needed to safely return the mental health patient back to the facility without incident. As nurses we all need to get to the expert phase of this domain fairly quickly; patients and situations can change so rapidly that we may not have time to plan our actions; therefore, many times we just go into the reaction mode. A nurse who is an expert in this domain, as I feel I am, is a great asset and our abilities should be used to help train new nurses.

Administering and Monitoring Therapeutic Interventions and Regimens

Working as a paramedic I was able to perform endotracheal intubations in the field, as a nurse I am not permitted to perform such skills. I have been performing the skill for over twelve years now; however, I cannot perform the skill in a hospital setting due to regulations. I am an expert, due to my paramedic training and continuing education, in the maintenance of the intubated patient. In addition, I am very comfortable in caring for patients on the ventilator in the hospital setting.

Administering and Monitoring Therapeutic Interventions and Regimens

I started my nursing career at a major health center in the City. I quickly learned that I would always have everything I needed to offer the best patient care possible. It was not until I left the city hospital and obtained a job in a small rural Emergency Department that I would understand the concept of re-using equipment. Staff was working a cardiac arrest patient and had just terminated life-saving measures. The Respiratory therapist was gathering his equipment to be cleaned and sterilized. I had a Bag Valve Mask in my hand and was walking towards to trash to discard it when I heard the therapist ask me what I was doing; I informed him I was discarding the Bag Valve Mask because it was used. He explained that this was not standard practice, that the equipment was cleaned and reused. He further stated that the hospital did not have a policy about reusing equipment but that he was reprimanded in the past for using too much equipment; therefore, it was just easier to clean and reuse it. In my opinion, this was not acceptable so I immediately contacted the supervisor and made her aware of the situation. The problem has been rectified and as of that date, Bag Valve Masks are not reused, they are thrown out. As nurses we always have to monitor the quality of care provided, be cognizant about the facility and the resources available to provide the best patient care. At some point, we may be the only voice for the patient. I feel I am an expert in this domain and past experiences have taken me to that point. Experience is something that cannot be taken from us and ultimately each person determines how they incorporate their past experiences in their future endeavors.

Organizational and Work-Role Competencies

I have just been promoted to Nurse Manager of an Emergency Department. I am a novice in this domain. I am responsible for the entire operation of the department and responsible for all that happens within it. Needless to say, I am overwhelmed and confused with all my new responsibilities. I think with time and with help from other leaders I will transition through all the levels I have learned in Benner’s Model.

Strengths and Weakness

I feel that even though I have only been a nurse for three years, I have many strengths and a lot to offer as I grow into my new role as a Nurse Manager. In addition, I my need to learn to continue utilizing experiences I believe this will help me along this journey. I think that as nurses we have to show our strengths but let our weakness come to the forefront so we everyone can see them and help us become experts. Nurses are caring compassionate people who love to teach and come to the need of others.

My primary weakness is the fact I have only been a nurse for three years; sometimes I forget that I am a newer nurse and get discouraged at times because it takes a little time to fix things that are not quite right. I need to make myself slow down and take in all that is being offered to me.

Professional goals

I want to complete my BSN at Daemen College and immediately move into a Master program for strategic leadership and management. I would ultimately like to be the Chief Operating Officer of a large hospital system. I believe that if I become an expert in all of Benner Domains, it will be easier for me to accomplish my ultimate goal.

Summary

I used the Benner mole (1984) and the Dreyfus model of skill acquisition to describe my levels of competency. I defined caring and how I apply it to my practice today as well as how I pass what I have learned from my past experiences to my current employees. It is very easy for me to say I am an expert in nursing and according the Benner model I am an expert in many of the domains; however I still have a lot to learn.

Conclusion

This paper allowed me to reflect on the past three years and make me realize I have learned a lot. I look forward to the future and where nursing will take me. I appreciate the opportunities that I have been given and look forward to having many more, as my education continues; this is one paper I will never forget about writing.

References

Benner, P. (1984). From novice to expert. Redwood City: Addison-Wesley.