Novice to expert emergency nursing

Anna D’Ambrosi1

1Calvary Health Care ACT, Bruce ACT, Canberra, Australia

Emergency nurses pride themselves on the provision of consistently high quality patient care quality patient care measured against clinical and pastoral metrics. This important element of work and personal achievement exists in all Emergency nurses whether they are by experience and/or qualifications a beginner, novice, competent, proficient or expert

The literature suggests that health services benefit from providing the novice nurse a comprehensive yet flexible education program that will incrementally shape the expert clinician. It is essential that this novice to expert pathway is frequently evaluated and accordingly adjusted to ensure the effectiveness of such programs in a constantly evolving profession.

Progression through the designated levels of emergency nurse competency requires the parallel advancement of qualitative (cognitive skills) and quantitative attributes and skills (metacognitive skills).

Qualitative attributes include enthusiasm for practice, self-motivation, intuition, emotional involvement, commitment and personal satisfaction from professional opportunities. It is not possible to apply a simple standard or mark for these characteristics, and additionally they are dynamic in nature and affected by many factors including personal and workplace circumstances.

Quantitative skills are those that can be measured by a standard metric. These include academic qualifications, clinical knowledge, procedural competency and clinical practice. Once attained, these credentials are often regarded as perpetual.

There are two challenges for the health service around the development of the nurse on the capability continuum. The first is the recognition that the nurse requires simultaneous progress in both the qualitative and quantitative attributes. The nursing practice environment needs to perform as a total supportive clinical learning environment to result in emergency nurses transiting from novice to expert. Mentoring and personal development programs need to be provided concurrently with academic or qualification based learning activities.

The second is the service needs to accept that a nurse can make a significant contribution and be a critical nurse team member without wanting to pursue or achieve expert status. If a nurse does not have high levels of the qualitative attributes listed previously the nurse can still be valuable and proficient within the scope of practice that this determines.

Every service should strive to provide a nursing practice environment that continuously upskills its staff against measureable criteria. Additionally, that environment should readily offer the necessary support and opportunities to enable the emergency nurse to explore the potential of their qualitative attributes at the time they feel ready to do so.


Anna D’Ambrosi is a senior Emergency Nurse at Calvary Public Hospital in Bruce, Canberra. Anna successfully completed a Degree in Bachelor of Nursing from the University of Canberra in 2006, Post Graduate Certificate in Clinical Nursing (Emergency) from the Australian Catholic University in 2009 and she is currently completing a Leadership and Management Diploma from JCE Positive Outcomes.

Anna has accomplished a high standard of competency in emergency nursing, providing advanced nursing care including advanced life support, is a member of the medical emergency team, patient flow management and triage.

Anna also provides education to emergency staff and clinical governance as the leader of the Blood Safe Quality Portfolio, where she manages many valuable departmental projects.

Anna is an Australian Rugby League Sports Trainer and has National Accreditation Level 1 R.L.S.T..