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Nursing Expertise and Workplace Environment


The following paper analyzes a scientific article devoted to the problem of nursing education and expertise in which the authors hypothesize on the dependence of the latter on the workplace environment. The authors use a secondary dataset analysis to determine whether there is a positive association between the workplace environment, the staff’s proficiency, and the nurses’ expertise; although the results do not conform to their expectations, the article is valuable in terms of its implications for future studies. The following analysis addresses the purpose, the hypothesis, the materials and methods used in the research; an evaluation of the results is also provided.

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The article under analysis is devoted to nursing expertise which is the basis for qualified healthcare. The purpose of the work is to assess the ways in which the workplace environment impacts the expertise of individual practitioners. Under the environment a set of contexts is understood, particularly the levels of training and service background of the colleagues and the workplace atmosphere. To estimate the impact of the contexts on the practitioners’ expertise, the authors used the model that included several ways of context influence mainly concerning interaction. No particular interaction mode was analyzed; on the contrary, the authors preferred to refer to them as a single pattern which, combined with an advantageous workplace atmosphere, would boost the practitioners’ professional development (McHugh & Lake, 2010). A hypothesis was put forward that nurses surrounded by skillful and educated colleagues in an atmosphere of competence and knowledge were likely to expose higher levels of expertise themselves. A prediction was made that the staff’s professionalism could serve as a basis for the nurses’ training through constant information exchange.

Materials and Methods

Developing a theoretical framework for their research, the authors firstly had to conduct a review of literature to define some basic notions to work with. Firstly, the concept of expertise was delineated as a combination of theory and practice in clinical decision-making. Secondly, the idea of experience was differentiated as the ability to refer to one’s own practical background. Although it is not indispensable, it is stated that the atmosphere in healthcare establishments where the staff lacks experience tends to be more stressful. As a consequence, the authors deemed it necessary to take experience as a context variable, as well as education. The latter was delineated as a variable because research has shown the negative association between mortality rates and the practitioners’ education levels. Another variable was the workplace atmosphere; a collaborative environment with established communication can be positively associated with the nurses’ acquired skills.

To determine the association between the individual and context variables, a method of secondary dataset analysis was used. The authors relied on the data retrieved from a survey involving a cohort of acute-care nursing practitioners over Pennsylvania. The inclusion criterion for the hospitals sample was that the number of surveyed practitioners was at least 15. The final sample, thus, consisted of 8,611 nursing practitioners. The gathered data consisted of self-reported expertise level of each practitioner and a questionnaire where the respondents were asked to characterize the environment they worked in.

The results of the questionnaires were primarily descriptive. They were further analyzed using a proportional odds model which is the most optimal with variables that are categorical-dependent. Another reason such model was chosen was that it tackled the overall issue of correlated assumptions and simultaneously provided a detailed and precise model of dependent variables.

Research Results

As it was stated, the overall sample size was 8,611 practitioners, the majority of which were women with a mean age of 39. The average practical background was 13.2 years, with 38% of practitioners having an educational degree no lower than baccalaureate. In their questionnaires, the nurses had to evaluate the workplace environment of their healthcare establishments. The estimation ranged from favorable to unfavorable, with an intermediate characterization. This “mixed” workplace atmosphere was attributed to more than 60% of institutions.

The study revealed there was a positive association between the nurses’ education level and expertise. It was also found out that education serves as a significant factor of improving the general level of proficiency within each particular institution. The more nursing baccalaureates were practicing within an institution, the more practitioners were self-reporting as Advanced. On the other hand, the authors’ prediction did not prove true. Despite the fact that there is a solid body of literature evidentiating the correlation between the practitioners’ expertise and healthcare quality, there was no association found between the workplace atmosphere and the expertise. The authors explain the lack of proof to their hypothesis by assuming that the PES-NWI test the questionnaire was based on failed to encompass all factors influencing the practitioners’ acquired skills. In addition, no association between the practical background and expertise was discovered. The authors explain it by the fact that they only measured experience by duration while the practitioners’ actual practice exposure is a crucial factor, at that. As their recommendations, the authors enlist promoting education, particularly BSN, among nurses, describing the means of achieving a higher educated practitioners rate within healthcare institutions.

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There are some limitations to this study. Firstly, a secondary dataset analysis was deployed which could potentially increase the error. In addition, the data was retrieved from a cross-sectional study; such design provides high-quality evidence but is insufficient in causality prediction. Also, the findings cannot be generalized since the sample represented state population, not exceeding the borderlines of Pennsylvania. Also, the initial study was accomplished in 1999 meaning the data is still more distant.


To conclude, the given study appears a credible piece of scholarly writing. The investigators have produced solid work the results of which might have considerable implications for future research in the field of nursing education. The theoretical framework developed by the authors is extensive, encompassing and subsequently differentiating such concepts as expertise, education, professionalism, etc. The authors use a dataset involving a sample of more than 8,000 participants; such approach can be considered appropriate since a more extensive sample facilitates the exactitude of the study. The authors show their professionalism as researchers deploying the proportional odds model and successfully operating variables. The results of the study have proved unexpected for the authors but they have accepted the result as it was without trying to manipulate the data, which is yet another credibility factor. More importantly, the results of the investigation might suggest the preceding research on the subject of nursing proficiency as associated with the workplace environment is outdated by now. Before making such a conclusion, however, the possible limitations need to be considered, which is what the authors do. The scope of the study, the extensive sample size, the robust data analysis method and the conscientious acceptance of the hypothesis failure make this article a valuable piece of writing.


McHugh, M., & Lake, E. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research In Nursing & Health, 33(4), 276-287. Web.

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