43 From novice to expert: Sharing professional development
experience in different practice settings
Yanika KOWITLAWAKUL
Assistant Professor
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
Alice Lee Centre for Nursing Studies, National University Health System, Singapore Correspondence to
Yanika KOWITLAWAKUL
Alice Lee Centre for Nursing Studies
Yong Loo Lin School of Medicine
National University of Singapore
Level 2, Block MD 11
10 Medical Drive
Singapore 117597
Tel: (65) 66011766
Fax: (65) 67767135
Email: nuryk@nus.edu.sg Keywords
expert; professional development; nursing;
novice Abstract
Nursing professional development is a lifelong learning process through
continuing education. The main goal is to maintain nursing competency
to enhance nursing practice and patience outcomes. The rapid change
in healthcare delivery systems and new sophisticated health information
technology has driven the learning needs for health care professionals.
Individuals learning needs and healthcare organisation support are
significant components in enhancing continuing education programme and
activities for nursing professional development. Nurses are responsible to
understanding and recognising their own learning needs and then make
plan for their own professional development. Healthcare organisations also
play a significant role in supporting nurses and providing the continuing
education programmes and activities. The purposes of this paper are to
share the author’s experience on professional development in different
healthcare settings, and to discuss the continuing education programmes/
activities and professional development in the current practice. Introduction
Nursing professional development has been defined as “the lifelong
process of active participation by nurses in learning activities that assist
in developing and maintaining their continuing competence, enhance
their professional practice, and support achievement of their career
goal” (American Nurses Association, 2000, p. 1, as cited in Dickerson,
2010). The development begins with basic nursing education and
continues throughout the career through continuing education and
advanced academic education. All nurses have a responsibility for nursing
profession to maintain and develop nursing knowledge and practice to be
able to provide optimal health care services to patients and community
(Fowler, 2011). Nursing knowledge and practice have changed in a fast
pace and it requires to increase nurses competency. For example, the
rapid introduction of health information technology and new medications
has increased learning needs for nurses (Covell, 2009). New regulations,
accreditations, professional standards for nursing practice also require
nurses to gain and sustain competencies in providing patient care. As a
result, safety, quality, efficiency, and effectiveness of practice are often
emphasised in the nursing continuous learning programmes.
It has been almost five years since I shifted my career from a bed-side nurse
in intensive care unit (ICU) to an educator working in academic setting. I
often thought back when I was a young nurse and wondering how I have
come this far. I worked in ICU at a hospital in Bangkok, Thailand, for five Volume 40, No. 3, July - September 2013 44 From novice to expert: Sharing professional development experience in different practice settings years. Then, I went to America and worked as a nurse
for 12 years. Throughout my nursing career, I attended
numerous classes, workshops, conferences, and etc.,
to sustain and increase my nursing competency. The
purposes of this paper are to share my experience
and perception on nursing professional development,
briefly in Thailand and America, and to discuss on
the continuing nursing education and professional
development in the current practice. Experience on professional
development
I received my Bachelor of Science in Nursing (BSN)
degree in 1991, from a university in Thailand, and
received my licence right after the graduation. I started
working as a registered nurse in ICU, and attended
a one-day hospital orientation. After the hospital
orientation, I had to follow a nurse preceptor for one
month. I remembered that I did not have to attend any
in-services, workshop, or conference, except one basic
life support class. Most of the time, I just went to work
and tried to complete doctors’ orders. I only talked to
the doctor when they asked me about patient family
and patients’ parameter. The charge-nurse would
follow rounds and discussed with the doctor for me.
At that time, I found that work was easy because I
just mainly focused on patient care and complete the
doctors’ orders. I was not motivated and did not feel
the needs to increase my knowledge or advance my
education. However, Thai nurses now are very busy
with their professional development plans that have
been provided by the employers. The healthcare
systems, standard of nursing practice, and continuing
education programmes have changed dramatically
after I left Thailand to America in 1997.
In America, as a foreign nurse, I had to pass two
examinations to be eligible to work as a registered
nurse. The first examination was the Commission
on Graduates of Foreign Nursing Schools (CGFNS)
examination. The second one was the National Council
Licensure Examination (NCLEX). The CGFNS certificate
is required for the foreign nurses before taking the
NCLEX in some states, but some States do not. The
CGFNS certificate is very important document in
applying for working-permit and green card (permanent
resident). If you do not have the CGFNS certificate, the
Homeland Security may not give you permission to
work as a nurse unless your family is American citizen
or they apply the green card for you. According to the
NCLEX, it is a national nursing board examination that is required for nursing students before she/he becomes
a registered nurse. Most of nursing schools have used
the NCLEX passing rate as an outcome measure for
the success of the undergraduate programmes. The
NCLEX is not an easy test to pass. I had to take the
examination three times before I became a registered
nurse. The licence has to renew every two years, and
certain continuous education hours are required for
each State Board of Nursing. Because of the strong
and structured nursing board registration, I started to
plan my professional development to meet the nursing
registration criteria.
In 2000, I was hired to work in a telemetry unit in a
hospital in Virginia. During my first year of working,
I gained more understanding of the healthcare
delivery system in America via the orientation
and preceptorship programme. The orientation
programme for a new nurse took almost one week
and it was conducted by the teaching and learning
department in the hospital. All lectures were delivered
by nurse educators. After the orientation programme,
I had to learn and work closely with my preceptor
for three months. During the three months period, I
was sent to attend several classes, such as basic life
support, electrocardiogram, in-services, workshops,
and hospital and unit (ward) competencies. There were
a lot of learning opportunities that the organisation
provided me. I realised later that the hospital had put a
lot of investments on the professional development of
their employees. They believed that the better health
outcomes and organisational performance came from
high competency of healthcare providers. I worked in
telemetry for two years and then was transferred to
ICU.
Before starting working in ICU, again, I had to attend
two-week orientation programme for critical care
unit. This programme intensively taught by ICU nurse
educators. Then, I had to follow an ICU preceptor for
three months. I had to take ownership of the patients,
perform a head-to-toe assessment on every patient
and every shift (12-hours shift), document patient
assessment and all parameters, provide nursing
care and comfort, work closely with the family and
healthcare team, discuss directly with the doctor about
patient conditions and plan of care, and collaborate
with other healthcare professionals independently. The
majority of patient and family were well educated. So, I
had to inform the patient and family almost everything
that I had to do. Because of the high standard of
nursing practice and demand of the healthcare service, Singapore Nursing Journal From novice to expert: Sharing professional development experience in different practice settings current knowledge on the diseases, health policy,
protocol, guideline, etc., my knowledge and skills
need to be updated. The hospital was very supportive
on professional development and provided a lot of
opportunities for continuing learning. The hospital
provided tuition assistance as one of employees’
benefit without any contract. I was able to pursue
my doctorate in nursing, and at the same time, was
working as a bed-side nurse until I graduated. Discussion
Based on my experience, there are two keys
components that enhance the continuing professional
development and career success; one is the individual
learning needs and the other one is the organisational
support. In literature, enhancing nursing professional
development is through nursing continuing education
and organisational investment in professional
development activities (Covell, 2009; Ulrich, 2006).
Mensik, Scott, Martin, and Horton (2011) developed
a framework for professional nursing practice and
development based on the scope and standards of
practice of American Nursing Association (ANA), 2010.
The framework comprises of three core contributions;
1) to patients, 2) to nursing profession, and 3) to
society. The connections of the three components
resulted excellent patient care. According to the
framework and literatures, the optimal goal for nursing
continuing professional development is to provide an
excellent patient care and best healthcare services for
the society. To achieve the goal, nurses and healthcare
organisation administrators have to work closely
together.
Nurses can achieve their own learning needs
through their own experiences and formal education
programmes which may or may not be part of a
continuing education plan of healthcare organizations
(Jantzen, 2007; Munro, 2008). Jantzen (2007)
conducted a qualitative study to explore learning
experiences of first-line acute care nurses in Canada.
She found that learning through experience was a
significant domain theme, which included learning
from one’s own experience and the others’ experience.
Most of nurses have learned from their own and
others’ mistakes. However, fear and stigma might be
factors that contribute to covering up the mistakes
(Edmondson, 2000, cited in Jantzen, 2007). As a
result, it decreases opportunities for individuals and
organisational learning in clinical practice. Individuals
learning needs are associated with employers or Volume 40, No. 3, July - September 2013 45 healthcare organisations’ policy or demands. If there
is a conflict between individual personal ambitions
and the organisation’s demands, it can create tension
within the organisation (Munro, 2008). It is important
for nurses and organisation administrators to clarify on
the individuals’ learning needs and the organisations’
professional development plan at the beginning of
the employment to prevent the conflict and problem.
Gould, Drey, and Berridge (2006) explored nurses’
experiences of continuing professional development
in the United Kingdom and found that, nurses
experienced the insufficiency of existing courses’
content related to practice. However, some nurses
felt valued and motivated through the opportunities
to undertake the continuing education development
programmes/activities that were offered by the
healthcare organisations. In this case, it suggested
that the continuing education programmes should
be relevant to current clinical practice to keep nurses’
interest and motivated.
Organisational culture/environment, mission, vision,
and managerial style clearly impact on nursing
continuing professional development (Covell, 2009;
Jantzen, 2007; Murphy & Calway, 2008). Healthcare
organisations have to ensure public safety and nursing
professional registration through the maintenance of
employees’ competencies with continuing education
programmes (Munro, 2008). The definition of
competency in nursing is not only focused on clinical
skills, but also understanding the science beside
the skills and reflecting/evaluating nursing abilities
to achieve the desire outcomes (Allen et al., 2008).
Hence, the continuing nursing programmes/activities
are trend to follow the new scope and standards of
nursing practice from nursing registration guidelines to
fulfil the goal of nursing professional development.
Many organisations now are offering nurses financial
support for professional development activities,
such as attending conferences, workshops, specialty
certification, and tuition assistance/reimbursement
for college and university courses (Covell, 2009).
Organisations’ in-service and access to online learning,
books, journal, and clinical-simulation laboratories are
also conducted within the organisations. These are
considered as the organisational investment on nurses’
professional development. Therefore, the outcomes
of the investment are expected to be measured
and evaluated on nurses individually, patient, and
organisations’ outcomes (Covell, 2009). Examples of
expected outcomes of the continuing professional 46 From novice to expert: Sharing professional development experience in different practice settings development programmes are; increasing nurses’
knowledge, maintaining professional competency,
increasing
self-confidence,
facilitating
career
development, and enhancing clinical decision-making
skills (Gould et al., 2006; Hughes, 2005). In addition,
patients had greater satisfaction with care, and
organisations were able to recruit and retain nurses
and maintain a good standard of patient care (Gould,
Drey & Berridge, 2006). The successful of professional
development programme can be measured as
indicators mentioned above. Conclusion
The awareness of my professional development
was started when I obtained the nursing license in
America, and then I was more aware when I worked
in the hospital. To me, the Board of Nursing and
healthcare organisations played a significant role in
the professional development process. The Board
of Nursing establishes the scope and standard of
nursing practice and registration regulations, and
then healthcare organisations used that to guide the
professional development programme for nurses. As
mentioned, the goal of professional development is to
provide the best care to patients and community. To
achieve the goal, the continuing learning programmes
should be planned based on both individual and
healthcare organisation needs. The individuals learning
needs and healthcare organisation expectations
should be clarified and discussed at the beginning of
the employment to prevent conflict. The continuing
education programmes need to be relevant to current
nursing practice. Finally, the continuing education
programmes and activities need to be evaluated on
nurses, patients, and organisations outcomes. Fowler, J. (2011). Professional development part 1:
The importance of professional development.
British Journal of Nursing, 20(21), 1383.
Gould, D., Drey, N., & Berridge, E. (2006). Nurses’
experiences
of
continuing
professional
development. Nurse Education Today, 27, 602-609.
Hughes, E. (2005). Nurses’ perceptions of continuing
professional development. Nursing Standard,
19(43), 50-54.
Jantzen,
D.
(2007).
Reframing
professional
development for first-line nurses. Nursing Inquiry,
15(1), 21-29.
Mensik, J. S., Scott, K. A., Martin, D. M., & Horton,
K. (2011). Development of a professional nursing
framework. The Journal of Nursing Administration,
41(6), 259-264.
Munro, K. M. (2008). Continuing professional
development and the charity paradigm: Interrelated
individual, collective and organizational issues
about continuing professional development. Nurse
Education Today, 28, 953-961.
Murphy, G. A., & Calway, B. A. (2008). Professional
development for professional: Beyond sufficiency
learning. Australian Journal of Adult Learning,
48(3), 424-444.
Ulrich, B. (2006). Professional development in nursing:
Good for everyone. Nephrology Nursing Journal,
33(5), 484. References
Allen, P., Lauchner, K., Bridges, R. A., Francis-Johnson,
P., McBride, S. G., & Olivarez, A. (2008). Evaluating
continuing competency: A challenge for nursing.
The Journal of Continuing Education in Nursing,
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Dickerson, P. S. (2010). Continuing nursing education:
Enhancing professional development. The Journal
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