Understanding clinical expertise: Nurse education, experience, and the hospital context

Authors

  • Matthew D. McHugh,

    Corresponding author
    1. Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
    • Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217.
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    • Assistant Professor.

  • Eileen T. Lake

    1. Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
    2. Secondary Faculty, Department of Sociology, University of Pennsylvania
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    • Associate Professor.


  • This study was supported by the National Institute of Nursing Research (T32-NR-007104; P30-NR-005043; R01-NR-004513; Aiken, PI; and K01-NR00166; Lake, PI) and the Agency for Healthcare Research and Quality (K08--HS-017551; McHugh, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute for Nursing Research or the Agency for Healthcare Research and Quality. The authors thank the anonymous reviewers, Associate Editor, and Editor for their thoughtful reviews of and suggestions for this manuscript as well as Robert Lucero PhD, MPH, RN for his contributions to early drafts of this manuscript.

Abstract

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:276–287, 2010

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