What do I do now?: clinical decision making by new graduates.

Newly graduated nurses (NGNs) are thrust into roles that some purport they are inadequately prepared to handle. This study investigated the experience of NGNs as they made clinical judgments in the critical care setting. Three themes emerged: developing confidence in practice, seeking assistance, and decision making.

Creating innovative models of clinical nursing education.

Although nursing care has changed significantly over the past 30 years, methods to clinically train nursing students have not. The traditional model of clinical nursing education, where a faculty member oversees a group of six to eight students on an acute care unit for a 4- to 8-hour shift, provides a haphazard approach to learning. A need exists to find innovative ways to effectively train more nursing students to better prepare them for today's health care environment.

Defining and integrating informatics competencies into a hospital nursing department.

Expanding use of complex patient information management systems and communication technology in healthcare organizations requires nurses to possess core competencies that until recently were not considered as integral to practice as those of a strictly clinical nature. Organizational changes necessary to formally integrate informatics competencies into nursing practice require strong partnerships among facility nursing leaders, educators, and informaticists. The authors describe a strategic initiative one acute care organization used to develop nursing practice that ensures use of system tools to manage patient information, support clinical decision making, optimize workflow, and communicate with members of the care team.

Healthcare workforce development through an international workshop series: nursing care of older adults.

A critical need exists to educate the international healthcare workforce on the care of the older adult. This article describes an interdisciplinary program to address the nursing needs of older adults via a series of workshops in Russia. Strategies to bridge international healthcare and educational cultures are demonstrated.

The performance appraisal as a developmental tool.

This article describes the key components and outcomes of a performance appraisal tool designed to measure and support the development of registered nurses. The tool is organized by the domains of nursing and based on the novice-to-expert framework. Core competency statements reflect required nursing behaviors.

From random access opportunity to a clinical education curriculum.

The purpose of the clinical education curriculum is to improve student achievement of course competencies through the creation of structured learning experiences that are scaffolded to the curriculum and the level of the student; to ease the strain of clinical education on the clinical agencies; and to ease the transition of the student role to that of the professional nurse. As educators, we realize that we can no longer rely on random access opportunity for the development of practice skills. We must structure our clinical education, like we structure our course content, to be appropriate to the learning outcomes and the developmental level of the student.

Development at the bedside: evolutionary development of the experienced registered nurse.

The purpose of this study was to describe the evolution of skills acquisition required for nurses to develop expertise within their clinical specialty. The goal of the research was to identify a professional career path that could be better supported through institutional infrastructures and educational programs. The results of the study demonstrate that reinforcing developmental and support loops serve as the living foundation for experienced practice and identify blockers and competing forces for skill acquisition.