Relationships and patterns between expert and nonexpert critical care nursing practice and patient outcomes

It is well accepted that expert nurses improve patient outcomes when delivering direct patient care. It has been hypothesized that expert nurses also improve patient outcomes by developing the knowledge and skills of nonexpert nurses. A previous study demonstrated improved patient outcomes, defined as reduced incidence of preventable pulmonary complications, in a medical critical care unit patient population after the unit staff nurses were exposed to a unit-based expert nurse for six months. Field notes of the participant observations of the expert nurse and informal interviews with unit staff were collected.

Using the grounded theory field approach, the field notes were analyzed to identify the factors in the process by which the expert nurse changed the practice of nonexpert nurses to improve patient outcomes. The purposive sample consisted of 26 medical critical care unit staff nurses and 31 critical care patients.

Data were analyzed by the constant comparative method. Findings revealed that expert critical care nursing practice was characterized by a Gestaltic nursing process and independent practice and that nonexpert critical care nursing practice was characterized by a dissociative nursing process and dependent practice. The core category of conversion emerged to explain the process by which the expert nurse advanced the practice of nonexpert nurses in the Medical Critical Care Unit. Major categories of conversion were developing clinical expertise and team building.

Results of the study indicated that over six months a unit-based expert nurse converted the practice of nonexpert nurses to one more like that of the expert nurse. The nonexpert nursing practice became more Gestaltic and independent. The data indicated that the changes in nonexpert nursing practice made a difference in individual patient outcomes, as well as reducing the incidence of preventable pulmonary complications in the unit patient population. The study provided direction for provisional testing of the theory of conversion in developing nursing practice to improve the quality of patient outcomes.