Professional Confidence: A Powerful Enabling Mechanism in the Transition to Becoming a Specialist RN: Qualitative Findings from a Mixed Method Study

Abstract

Although the seminal work of Patricia Benner's Novice to Expert clearly identifies the five levels of nursing practice, there is a paucity of research on the learning and transitional processes that occur between these levels. The objective of this paper is to explore the transition to Specialist Registered Nurse (RN) in the learning and professional context. The study utilises a concurrent nested design based on complementarity strategies as part of the mixed method design. The study was undertaken in a large tertiary hospital setting in Australia. Participants were RNs undertaking postgraduate specialist nursing courses (n = 39) with a nested cohort of Intensive Care Nursing Course participants (n = 7). The quantitative component investigated the influence of learner attributes (e.g. approach to learning, strategic control of study and self-efficacy) on the participants' academic learning outcomes. Questionnaires were distributed to RNs on all specialist courses (n = 39). The qualitative component utilised a case study approach to explore and explain the learning and transitional experiences of the Intensive Care Nursing Course participants. The paper reports the key findings from the qualitative component of this study. The transition from RN to Specialist RN involved a qualitative cognitive shift in thinking, the development of competence and transformation in the level of nursing practice. Additional learning and cultural phenomena assisted the RNs' patterns of learning and knowledge acquisition. The emergence of 'professional confidence' was at the heart of the learning and transitional process from a competent to proficient level of nursing practice (specialist RN). 'Professional confidence' emerged as an outcome and a property of learning in the professional context. 'Professional confidence' is a powerful enabling mechanism in the transition to become a Specialist RN. There are several implications for nursing and nursing education derived from this study.