Nursing Integrative Practicum Program Comparison of Critical Thinking Processes of Novice & Expert Nurses

Novice Nurses

Their knowledge is organized as separate facts. They must rely heavily on resources (texts, notes, preceptors). They lack knowledge gained from actually doing (e.g., listening to breath sounds).

The Novice Nurse:

  • Tends to focus so much on actions, they forget to assess before acting
  • Need clear cut rules
  • Is often hampered by unawareness of resources
  • Is often hindered by anxiety and lack of self-confidence
  • Must be able to rely on step-by-step procedures. Tends to focus more on procedures than on the patient response to the procedure.
  • Becomes uncomfortable if patient needs preclude performing procedures exactly as they learned.
  • Have limited knowledge of suspected problems; therefore they question and collect data more superficially.
  • Tends to follow standards and policies by rote.
  • Learns more readily when matched with a supportive, knowledgeable preceptor or mentor.

Expert Nurses

Their knowledge is highly organized and structured, making recall of information easier. They have a large storehouse of experiential knowledge (e.g., what abnormal breath sounds sound like, what subtle changes look like).

The Expert Nurse:

  • Assesses and think things through before acting.
  • Knows when to bend the rules.
  • Is aware of resources and how to use them.
  • Is usually more self-confident, less anxious, and therefore more focused.
  • Knows when it's safe to skip steps or do two steps together. Are able to focus on both the parts (the procedures) and the whole (the patient response).
  • Comfortable with rethinking procedure if patient needs require modification of the procedure.
  • Has a better idea of suspected problems, allowing them to question more deeply and collect more relevant and in-depth data.
  • Analyzes standards and policies, looking for ways to improve them.
  • Is challenged by novices' questions, clarifying their own thinking when teaching novices.

Excerpts borrowed from Alfaro-LeFevre, R. (1999). Critical thinking in nursing. Philadelphia: W.B. Saunders.
Reprinted with permission.