| Summary: | There is a difference in the quality of the nursing practice between expert and non-expert nurses. A hallmark of expert practice is the ability to identify early signs of complications and quickly act to prevent patient problems. Benner (1984, 1996) described the development process of becoming an expert nurse, requiring extensive experience in clinical setting. Not all nurses develop expertise after extensive experience; some practice for many years at the competent level, efficiency managing patient care with, but not developing expertise. Benner noted that expert nurses developed the “skill of involvement” and worked in supportive environments, while experienced non-experts were task oriented, with little connection to their patient, working in poor environments. Chandler's (1986) applied Kanter's (1977) empowerment theory to nurses and reported that work empowerment (including opportunity, support, resources, and information) affected nurses work performance. Expert nurses have identified relationships with mentors, peers and patients/families as important to expert nursing practice. The purpose of this study was to explore the relationship between work empowerment, work relationships and level of nursing expertise in experienced acute care nurses. The Human Subjects Committee of the University and the Internal Review Board of the health system approved the study. The investigator invited a stratified random sample of nurses with five years or more experience to participate in the study. One hundred fifteen subjects agreed and completed the Conditions of Work Effectiveness Questionnaire (Chandler, 1986, 2002), the Clinical Nursing Expertise (Lake, 2002) survey and a demographic information sheet. Considered individually, work empowerment explained 6% of nursing expertise; work relationships explained 20% of nursing expertise; work empowerment explained 37% of work relationships (p < 0.05). In the final combined model, work relationships and experience in the specialty are explained 26% of nursing expertise (work relationships, 16%, and experience in the specialty area, 9%, F = 19.325, p = .000). Work empowerment did not contribute directly to nursing expertise; the influence of work empowerment was indirect, through work relationships. The results of this study indicated that experience acute care nurses' perceptions of opportunities, support resources, and information moderately explained their work relationships. These work relationships, together with experience in the specialty area explained 26% of nurses' reported expertise.
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