Getting Your Feet Wet: Becoming a Public Health Nurse, Part 1

Abstract

While the competencies and theory relevant to public health nursing (PHN) practice continue to be described, much less attention has been given to the knowledge derived from practice (clinical know-how) and the development of PHN expertise. A study was designed to address this gap by recruiting nurses with varied levels of experience and from various practice sites. A convenience sample of 28 public health nurses and seven administrators/supervisors were interviewed. A subsample, comprised of less-experienced public health nurses, were followed longitudinally over an 18-month period. Data included more than 130 clinical episodes and approximately 900 pages of transcripts and field notes. A series of interpretive sessions focused on identifying salient aspects of the text and comparing and contrasting what showed up as compelling, puzzling, and meaningful in public health nurses' descriptions. This interpretive analysis revealed changes in understanding of practice and captured the development of clinical know-how. In Part 1, we describe the sample, study design, and two aspects of clinical knowledge development--grappling with the unfamiliar and learning relational skills--that surfaced in nurses' descriptions of early clinical practice. In Part 2, which is to be published in the next issue of Public Health Nursing (SmithBattle, Diekemper, & Leander, 2004), we explore gradual shifts in public health nurses' understanding of practice that led to their engagement in upstream, population-focused activities. Implications of these findings for supporting the clinical learning of public health nurses and the development of expertise are described.

Moving Upstream: Becoming a Public Health Nurse, Part 2

“…The above excerpt supports the argument developed in Part 1 (see SmithBattle, Diekemper, & Leander, 2004), namely, that the beginner's reliance on external guidelines and classroom principles and theories, while important, must yield to the ''real world'' of practice. In Part 2, additional exemplars highlight how the development of practical reasoning, perceptual skills, and responsiveness to clients supplants inexperienced public health nurses' theoretical understanding and promotes a situated understanding of practice (SmithBattle, Drake, & Diekemper, 1997).…”

Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

“…Doubt was expressed by all PHNs in the study, most commonly by questioning responses to a given situation, asking themselves ‘what did I do wrong’ and taking client decisions personally. SmithBattle, Diekemper and Leander [50] in their study of the development of PHN clinical expertise noted that the tendency to want to “fix” client problems was common, particularly among less-experienced practitioners. This desire to fix leads to the inevitable realization that they cannot.…”

“…This ability to see the broader perspective was indicative of gains in the PHN’s relational and perceptual skills [16] allowing them to see achievement over time. Literature supports that discussion with experienced colleagues assist with the development of perspective and in identification of over-involvement [14,50]. As the impact of worry and doubt may stem from the gap between theory, or program guidelines, and the unpredictability of the practice environment, this is a significant area where supervisors need to focus their reflective supervision goals [16].…”

Differences Between Novices' and Experts' Solving Ill‐Structured Problems

“…Similarly, SmithBattle et al. () found that struggling with the unfamiliar and learning relational skills were key aspects of PHN expertise development. Exploring characteristics of PHNs, Eckhart () found that the critical elements of caring, commitment, and empowerment contributed to PHN expertise.…”

“…Studies related to expertise in public health nursing have examined the development of a population-focused practice (Diekemper, SmithBattle, & Drake, 1999a,b); nurse insight into expertise development (Langley, 1997;SmithBattle, Diekemper, & Leander, 2004); and characteristics of expertise (Eckhart, 1988;McMurray, 1992;Vellinga, 1979). Diekemper et al (1999a,b) used phenomenology to investigate expertise among PHNs in various practice settings.…”