Early in my own training as a registered nurse, I was inspired by Dr. Patricia Benner’s seminal work, From Novice to Expert, which insightfully describes how nurses develop their practice over time, reaching different milestones while accumulating clinical experience.1 Focus and approach to new situations change at each level.
Benner describes novice nurses having no experience; use rules to help perform tasks, aiming to follow instruction. With some actual experience, advanced beginner nurses show acceptable performance and begin to form principles to guide their actions. Approximately 2 to 3 years into practice, the competent nurse is more aware of long-term goals, having gained perspective from planning their own actions; efficiency and organization are key at this level. The proficient nurse perceives and understands situations as whole parts, having a holistic understanding of nursing, leading to better decision making. The expert nurse no longer primarily relies on principles, rules, or guidelines to connect situations and determine actions. Expert nurses have a deeper background of experience and an intuitive grasp of clinical situations, and they perform with fluidity, flexibility, and high-proficiency.
Changing focus in navigator development Similarly, in the development of my role as an oncology nurse navigator, there seems to be a progression, which is most evident through the questions that physicians have asked about my role. The nurse navigator role’s focus moved from logistics, to education, then counseling, and finally into care transitions.
Logistics Early on, they asked, “What is a navigator? How will this help me?”
At this stage, much of my practice focused on logistics, helping patients with newly diagnosed prostate cancer make consultation appointments and coordinate treatment schedules. Much of my time was spent trying to recruit patients, and urging physicians to refer patients to me.
Education As the nurse navigator program grew, the physicians asked, “What is the navigator teaching my patients? How do I refer?”
As my role developed, I began to spend more time with patients during individualized education sessions, teaching them about their new diagnosis and answering questions about the treatments to follow. Less time was spent on recruiting patients, and seeing the navigator become one of the expected appointments for patients receiving a new diagnosis.