III: TRANSITIONS TO THE ADVANCED PRACTICE ROLE
Table of Contents:
SCHOLARSHIP OF PRACTICE AND PROFESSIONALISM
Riley, Beal, Levi, and McCausland (2002) outlined the importance of the concept of scholarly practice for the nursing profession. Many nurse leaders have called for links between practice and scholarship (Diers, 1995; Meleis, 1987), and rather than espouse a model that emphasizes a purely academic approach to scholarship, they developed a model that emphasizes a practice approach to scholarship. Research on this domain explored clinical scholarship from the perspectives of practicing nurses (Riley, Beal, & Lancaster, 2008; Riley & Beal, 2013).
Although advanced practice nursing has explored the concept of novice nurse practitioner adjustment to the new role, there has been little in-depth exploration of the concept of clinical scholarship. Earlier work by Brykczynski (1989) addressed clinical judgment and nurse practitioner practice. Her research highlighted the essential elements involved in the day-today practice of nurse practitioners and provided additional understanding of the complexities of providing care in a variety of settings. The knowledge development embedded in the practice of advanced practice nursing and the role development processes identified in her study also added to the understanding of clinical scholarship for advanced practice. Advanced practice role transition and the importance of mentoring have continued to be studied in the advanced practice literature. However, these concepts have not been linked explicitly to the concept of clinical scholarship. The research on clinical scholarship with nurses that is identified in this chapter has important relevance for advanced practice registered nurses (APRNs).
Model for Clinical Scholarship
In response to the need for greater understanding and perspectives on the meaning of scholarship in nursing, leading nurse educators developed the universal model of nursing scholarship and identified four domains: knowing, teaching, practice, and service (Riley et al, 2002). This model is unique to nursing as a practice discipline; it is comprehensive in its design and identifies a range of scholarly activities relevant to nurses in a variety of settings. The Universal Model of Nursing scholarship identifies components of scholarship including service, education, knowledge development, and practice. This model on scholarly practice has been expanded to include practicing nurses' descriptions of scholarly practice (Riley & Beal, 2013, Riley, Beal, & Lancaster, 2008, Riley, Beal, Levi, & McCausland, 2002.). Although the research by Riley and colleagues has been conducted on practicing nurses, it has great potential for application to advanced practice nursing.
Definition of Scholarly Practice
Riley, Beal, and Lancaster (2008) offer a definition of scholarly practice based on their research that states, "Scholarly nursing practice is defined as a multidimensional way of thinking about practice that includes role attributes of active learner, out-of-the box thinker, passionate about nursing, available, and confident, and the role processes of lead, give care, share knowledge, evolve, and reflect" (p. 17). These role attributes and processes are outlined in Figure 15.1. This diagram highlights the many dimensions of the role of clinical scholar and the complexities involved in role enactment.
Four themes emerge in the model and include role identification in providing care, role evolution, reflective practice, and leadership. Role identification incorporates immersion in care, vigilance, and prioritizing the relationships involved in patient care. Role evolution includes the openness to learning from patients and families, advancing knowledge acquisition, and staying abreast of current evidence. The third theme of reflection in practice is reported as a multidimensional concept that allows nurses opportunities to consider anticipatory thinking about potential issues that could arise in practice. The fourth component of the model is identified as the nurse as a leader that was further developed in the areas of nurses looking to develop other nurses. This dimension of practice is often omitted in the discussions of role development, and identifying this component of scholarly practice requires additional exploration.
Early career perspectives concerning clinical scholarship suggest that nurses identify a very complex process of role development (Riley & Beal, 2013). As nurses become comfortable with clinical competence and decision-making skills, they develop an awareness of what expert scholarly practice embodies and an awareness of a goal that they are working toward (Riley & Beal, 2013).
Experienced acute care nurses identified components of scholarly practice with themes that were different from those for less experienced nurse. These nurses identified expert practice as involving less cognitive effort in the technical aspects of care, allowing for more focus on reflection and relationships with patients, families, and team members. Expert nurses view their professional identity as active
FIGURE 15.1 The scholar in nursing practice.
Source: Riley, Beal, & Lancaster (2008).
learner, out-of-the-box thinker, passionate about nursing, available, and confident. In addition, expert nurses characterized their roles as leading, caring, sharing knowledge with others, evolving, and reflecting on practice (Beal et al., 2008).
Experienced nurses highlight the ongoing challenges faced in their role. Their descriptions of providing care reflected a process of developing relationships with patients and families as an essential component of providing expert care as well as vigilance in identifying patient needs. Reflection was characterized by reflection on action, reflection in practice, and reflection for action. Reflection on action offered opportunities to critique clinical situations that had occurred to learn how to use their experiences to improve patient care. Reflection in action provided the opportunities to synthesize information about the patient while providing care. Reflection for action helped prepare for possibilities that might require action and provided an additional dimension to the concept of reflection (Beal et al., 2008).
The personal and professional characteristics that the nurses identified in their descriptions of novice and expert practice highlighted a dimension of practice that continues to enrich and inspire them to share with others, and to continually seek opportunities to further develop in their role. This research also provides additional depth to the understanding of the ongoing development of the roles of both the novice and expert nurse scholar. The refinement of these concepts of role attributes as well as processes is critical in our ongoing understanding.
The aforementioned model identifies the evolution of moving from technological practice to scholarly practice. The question remains: What is the scholarship of practice or scholarly practice? And what defines a nurse scholar? A scholar can be defined as person who has done advanced study in a special field and is a learned person (Merriam-Webster, 2011). "Other characteristics of scholars are that they typically know how to speak with authority, and are articulate in both written and oral communication" (Conrad & Pape, 2014, p. 88). An APRN who clearly articulates with authority fits the definition of a scholar.
Many of the day-to-day activities of the APRN, such as staying up to date with current guidelines or practice recommendations and participating in professional organizations, can be considered scholarship if this knowledge is transferred to others to improve practice or to enrich the profession (Conrad & Pape, 2014.) The role of scholar does not mean an APRN is limited to writing or presenting as a means of transferring knowledge. Additional roles demonstrating scholarly activity include teacher (preceptor, formal academic appointment, or staff educator), leadership roles in local state and/or national nursing organizations, and expert witness for litigation or policy development (Conrad & Pape, 2014; Lusk, 2014).
Before proceeding it is important to clarify that staying current or engaging in clinical practice is not sufficient to warrant being called a scholar. A scholar of nursing practice is one who contributes to the implementation of evidence-based clinical practices, comparative effectiveness research, quality improvement exercises, and translational research (Honig, Smolowitz, & Larson, 2013). Membership in a professional organization without engagement is not being a scholar. The scholar is a member but also uses membership and participation to foster policy or clinical changes.