For those of you who follow me on twitter, you know that I try to write a daily nursing tip. Sometimes, these tweets generate discussion. One tip in particular that seemed to get people talking was this:

“Don't palpate both carotid arteries at the same time or press too firmly; pt could faint or become bradycardic.”

I did ponder posting this one, because really – don’t all nurses know this already? But then I got to thinking – did I know this already as a nursing student? As a new nurse? When did I learn this?

It’s been a while since I was in nursing school, but I do remember learning a lot about nursing theory, even more about care plans, and of course, I’ll never forget the steps of the nursing process (assess, diagnose, plan, implement, evaluate!) I can’t deny that all of these things built the foundation of my nursing knowledge. But what isn’t clear to me is when the clinical skills and knowledge became ingrained in my brain – when I learned how to calculate a dopamine infusion to maintain someone’s systolic blood pressure above 85 mmHg, when I learned to approach a family about end-of-life issues, or how I learned to prioritize the needs of critically ill patients. When did these things happen?

In 1984, Patricia Benner published From Novice to Expert: Excellence and Power in Clinical Nursing Practice. In her landmark work, the author describes nurses as going through five stages of development – novice, advanced beginner, competent, proficient, and expert – with each stage building upon the knowledge and skills of the previous one. Think of your own experiences – where do you fit in this model? How will you get to the next level?