Lifelong learning - Editorial

Nancy J. Girard

This time of year brings the start of a new school year for millions of people, young and old alike. For many, this means the beginning of professional nursing school or work toward additional or advanced degrees. Many also look forward to this new or continuing challenge with apprehension and, some, with dread. Education is a very personal thing, and each of us interprets our experiences in light of our own progress, abilities, and past experience.

For me, school always has been interesting and even fun. I love learning new things, the dialogues and stimulation of new thoughts, and investigating different ways of looking at a problem. I think that is why I ended up with a doctoral degree--I like to learn and am a forever student. Many people have told me that when they get out of school, they don't want anything more to do with education; however, we have become a nation of lifelong learners because of a number of factors, including the explosion of technology, changes in surgical techniques and procedures, a switch to less invasive and more ambulatory surgery, and requirements from licensing and accrediting agencies that mandate continuing education content.

FROM EXPERT TO NOVICE AGAIN

Nowhere is it more evident that lifelong learning is necessary than when we change jobs. One novice-to-expert theory says that when we go from a known area of practice where we are an expert to a new one, we become a novice again. (1) This can be painful because of a lack of knowledge. Anyone moving unto a new specialty, such as going from an ambulatory surgery center to a tertiary center surgical orthopedic room, will become a novice again for a short time. The same can be said about someone moving into a new position, such as from a circulating nurse to a unit educator.

Historically, hospital administrators have taken a person who has worked in their hospital for years as a wonderful, competent, expert staff nurse and moved hum or her into management. Administrators assume that "This person is loyal and a good worker, so let's promote her. She can handle anything--yes and no. Nurses are extremely versatile and will adjust no matter what the assignment is, but management today is a very different career and has become very complicated. Additional learning is essential if someone is to survive as a new manager. Regardless of whether that knowledge is acquired formally, informally, or via self learning, it still must be obtained.

INFORMAL VS FORMAL EDUCATION

Many believe that an expert clinical nurse easily can move into formal academia or vice versa. This idea is alluring because the shortage of nursing faculty members has become critical. The concept, however, is unrealistic. Both formal and informal education are important and needed in this era of lifelong learning, but there is a difference between formal and informal education, and the novice rule discussed above quickly may become apparent when a clinical nurse moves into academia.

In community college or university settings, education requires a general curriculum, and educators must adhere to policies set by educational accrediting agencies, such as state boards of nurse examiners and state higher education coordinating boards, as well as the National League of Nursing or the American Association of Colleges of Nursing. There also are regional accreditation boards, so public schools often are not free to change curricula at will. Private colleges may have more flexibility in determining a curriculum, and changes may occur more quickly.

Undergraduate baccalaureate or associate degree students usually are a mixed lot--some have never set foot in the door of a hospital, and the only thing they know about nurses is what they see on television. (I have some interesting stories about perceptions of what nursing is, but that is for another time). Some are entering nursing as a second career. Some are coming back for advanced degrees. The needs of each of these very different types of learners must be met by the same program. Additionally, in associate degree and baccalaureate programs, most schools are mandated to develop a generalist nurse who has a smattering of knowledge about every major area in which a nurse can be employed today. The curriculum must teach these students about medical-surgical, psychiatric, community, obstetric, and pediatric nursing, to name a few.

There is a tremendous amount of information about every specialty today. For example, the entire introduction to basic knowledge of medical-surgical nursing is given in one course during one semester (ie, 15 weeks). Clinical practicum may take place one or two days a week, so the entire clinical experience may be only 30 days long. Faculty members may be able to carve out time for only two to three class periods to teach students everything about the preoperative, intraoperative, and postoperative periods. There is no way any student can come out of these undergraduate programs with anything but basic knowledge and skills. To move beyond this, they have to continue to learn.

Staff member or unit educator development requires expert clinicians as teachers, regardless of their level of education, because it is critical that nurses become and remain competent in skills used in their area. They also must know how to think critically and quickly. Staff educators play a crucial role in providing this necessary continuing education. Teaching and learning principles are the same wherever they occur, but it is the system in which educators work that sets policy and procedures. For example, staff member development must consider the dictates of patient and hospital needs as well as accrediting bodies, such as the joint Commission on Accreditation of Healthcare Organizations. Additionally, students in continuing education usually are nurses who are licensed and have at least the same basic knowledge and beginning nursing skills. Most unit educators serve a specific body, such as the OR, so all their students are similar and they can assume a level of knowledge that they can build on or expand.

CONCLUSION

Nurses entering health care today are generalist nurses, so individuals must continue their education as an ongoing activity. The rapid advances and changes in health care mean that they will never be able to stop learning.

One of the major ways preoperative nurses continue to learn is by reading the AORN Journal. One of the ways experienced nurses can help their colleagues continue to grow and learn is by sharing their experiences. Help your peers and contribute to someone's lifelong learning by writing an article today for the AORN Journal that reflects your experience and knowledge.

NOTE

(1.) P E Benner, From Novice to Expert: Excellence and Power in Clinical Nursing; Practice (Menlo Park, Calif: Addison-Wesley Publishing Co, Inc, 1984) 307.

NANCY J. GIRARD

RN, PHD, FAAN

EDITOR

COPYRIGHT 2003 Association of Operating Room Nurses, Inc.
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