Nearly 40 years ago, Patricia Benner codified the stages of clinical competence for a nurse. Reaching the expert stage requires several years of delivering the same type of care. RNs who reach this stage—typically after more than a decade of practice—draw on highly valuable knowledge, skills, and intuition when delivering care and coaching other nurses. Expert RNs are scarce, both because it takes so long to develop this level of mastery and because experience alone is no guarantee that a nurse will achieve expert-level competence.
Historically, there have been few distinctions on paper between novice and expert nurses’ job descriptions, despite the very different skill level that expert nurses bring to the role. As the number of expert nurses declines due to retirements, organizations must do all they can to scale the impact of remaining expert nurses beyond the patients they care for directly.
There are two ways to scale the impact of expert nurses. First, elevate their role on the care team. Shift from a staffing model where each nurse carries a similar patient load (regardless of competency level) to one where an expert nurse formally leads a team of less experienced nurses.
Structuring a team this way requires upfront investment to assess each nurse’s competency level and indicate it in the scheduling system. Successful implementation also requires identifying nurses who are not only experts but also have the potential to be strong team leaders. Experienced nurses used to providing direct care will need training and support to delegate effectively in their new role.
The second way to scale the impact of expert nurses is redefining how they support new grads. Expert nurse preceptors should work with new grads only on advanced skills later in onboarding, while less experienced preceptors teach baseline skills earlier in onboarding. This tiered preceptor model allows more new grads to benefit from expert preceptors’ experience than if expert preceptors worked with a smaller set of nurses throughout their full onboarding. Expert preceptors can further scale their impact by coaching less experienced preceptors.