C L I N I C A L N U R S I N G IS S U E S

Understanding experience in nursing

Paul Arbon BSc, MEd, PhD, RN, FRCNA, MAIES, Grad Dip Health Ed, Dip Ed
Professor of Acute Care Nursing, University of Canberra and Canberra Hospital, Woden Act, Australia

Submitted for publication: 25 February 2003

Accepted for publication: 26 August 2003

Correspondence: ARBON P. (2004) Journal of Clinical Nursing 13, 150–157

Paul Arbon Understanding experience in nursing
Professor of Acute Care Nursing Background. This paper reviews research that considered the life stories of experi-
University of Canberra and
enced nurses and the relationships between life experience, the way in which people
Canberra Hospital
find meaning in their experience(s), the development of nursing knowledge, and the
PO Box 11
Woden Act 2606
influence of these events and understandings on the characteristics and clinical
Australia practice of experienced nurses.
E-mail: paul.arbon@act.gov.au Aims and objectives. The dominant perspectives in nursing about the place of
experience in the development of nurses’ practice are considered and the paper
argues for a broader understanding of experience; placing experience within the
context of nurses’ lives, connection with others and their individual understandings
about nursing care.
Relevance to clinical practice. The place of experience in the development of nurses
has not been well understood although the nursing discourse continues to value
clinical experience highly. Becoming experienced as a nurse is described as a pro-
gressive and continuous interaction between experience, meaning and the lived
world resulting in a personal and unique understanding of practice. The culture and
discourse of nursing have tended to exclude or dampen individual difference and the
paper considers a more expansive understanding of the place of experience and
individual difference in nursing and the relevance of this perspective for the edu-
cation of nurses.

Key words: clinical experience, education, experience, expertise, nursing practice

(non-clinical) experience(s) and is restricting our appreciation

Introduction
This paper considers the dominant perspectives in nursing
about the place of experience in the development of nurses’
practice and argues for a broader understanding of experi-
ence; placing experience within the context of nurses’ lives,
connection with others and their individual understandings
about nursing care.
Experience seems to play a fundamental role in the devel-
opment of the features of nursing practice that differentiate
nursing work from mere technical intervention. However, the
nursing literature about experience is, generally, focused on the
role of clinical experience rather than other forms of experi-
ence. This emphasis on clinical experience apparent in the
nursing literature fails to capture the influence of other
of other influences on nurses’ development.
Additionally, review of the literature about the develop-
ment of exemplary nursing practice leads to the conclusion
that the individuality of nurses, that may be related relatively
more to their non-nursing experiences, tends to be over-
looked within the profession and among authors who write
about this field. The uniqueness apparent in the ways that
individual nurses relate to others and enact their practice is
interesting and seems to be associated with personal under-
standings about who they are and what is important to them.
These features of the individual appear, often, to be related to
their life experience(s) and not just experience in clinical
situations as a nurse; and this is reflected consistently in
nurses’ stories about practice.

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Clinical nursing issues
Authors who have presented recent arguments about the
place of experience in the development of nurses include for
example, Battersby & Hemmings (1991); Arbon et al.
(1993); Benner (1993, 1996); Fraser (1994); MacLeod
(1996); Carberry (1998); Hart et al. (1998); Hicks &
Hennessy (1999) and Williams et al. (2001). The discourse
about experience in nursing is, arguably, the product of a set
of views about experience that constitutes a paradigm for the
development of nurses. Within this paradigm it is understood
that clinical experience will add to the knowledge and skill
possessed by nurses and that experience is cumulative and
leads to a set of attributes, which can be identified generally
in experienced nurses and which contribute positively to their
practice.
Clinical experiences are the experiences of nurses as they
practise and other forms of experience have been excluded
from the discourse and from consideration. Indeed, other
forms of nursing experience, such as the experience gained
when nurses are hospitalized themselves (Lawler, 1991), have
also, generally, been excluded from consideration although
they are often recorded in anecdotal literature. The debate
within the nursing discipline about the role(s) of experience
has been limited, therefore, by the relatively prevalent and
taken-for-granted understanding that it is clinical experience
that is paramount in the experiential development of nurses
as practitioners. In some ways this approach has the potential
to reduce the nurse – as a person – to the sum of the ability to
perform clinically (in its narrowly defined sense).
This paper is based on the findings of a major research
project (Arbon, 2001) that investigated nurses’ accounts of
their experience(s) and considered the ways that experience(s)
influences nurses’ practice. The research investigated the role
of experience(s) in the development of meaning and self-
knowledge in nursing. It involved the collection of the life
stories of experienced nurses and considered the relationships
between life experience, the way in which participants found
meaning in their experience(s), the development of nursing
knowledge, and the influence of these events and understan-
dings on the clinical practice of experienced nurses partici-
pating in the research.
The research method was built upon the general concepts
and understandings of hermeneutic phenomenology, and also
the more recent patterns of inquiry within the genre of
storytelling and narrative. These approaches are comple-
mentary and give access to an understanding of the dynamic
features of meaning-making that are apparent in the life
stories of experienced nurses. A group of 10 nurses, each with
at least 10 years of experience as a nurse, participated in the
research providing insight into the role of meaning and
understanding, drawn from experience in all its forms

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157
Understanding experience in nursing
(clinical and non-clinical), in their practice. Participants were
asked to relate their life story and discuss how life events
influenced their understanding of patients and their nursing
practice. Participants were interviewed on several occasions.
Interviews were semi-structured and moved from a broad
narrative of the participants life onto more detailed discus-
sion of particular life events and their apparent meaning and
import for the nurse. A thematic analysis of the transcripts of
each in-depth interview provided the basis for conclusions
about the role of life experience in the development of these
nurses and underpins the assertion that there is a need for a
broader understanding of the role of experience in the develo-
pment of nurses. Excerpts drawn from the research tran-
scripts have been included in this paper and, although it is
important that isolated statements are understood in the
wider context of the interview and research process, these
exemplars will help to illuminate the findings of the study.
These findings provide some insight into the development and
practice of this group of experienced nurses and raise a
number of issues and ideas about how nurses develop their
unique understandings and style of practice. These tentative
conclusions are presented here to encourage future and more
focused research.
Experience and the development of expertise
The discourse about the effect of experience should be
considered separately from the discourse about the devel-
opment of expertise because these are different phenomena
and are manifested differently by practitioners. Understan-
dings about the development of expertise in nursing have,
generally, been drawn from unsophisticated and simple
developmental models. The models presented by Benner
et al. (1992), Benner (1996) and Steele & Fenton (1988)
provide examples of linear developmental processes for
nursing expertise. These models incorporate several recur-
ring ideas: development as a nurse is a linear process; is
cumulative; temporal; and dependent on the interaction that
seems to occur between exposure to clinical forms of
experience and learning. Therefore, to these authors, the
knowledge that underpins expert nursing practice is accu-
mulated, over a period of time, from learning about nursing
in real and complex nursing situations.
While this synopsis of the models of development that exist
in the nursing literature may not do justice to the concepts
underpinning each model, it can be argued that the idea of
expert practice is founded on this common set of understan-
dings about how the process might work. Indeed, while
expertise is understood as a phenomenon that is specific to
field(s), context(s) and situation(s) and not a transportable
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P. Arbon
and inherent characteristic of individual nurses, nursing
models of expertise will provide only a short-form and
generalizable description of the development of skilled
practice within a defined nursing care situation. This kind
of narrow reductive model can provide the foundation for the
development of generic understandings about nurses and
their practice, such as those apparent in nursing competencies
and the competency-based assessment and training of nurses;
but it will be inadequate as an understanding of how and why
experienced nurses practise. The prevailing view of nurses’
expertise, in the broader sense, is limiting and too narrowly
focused.
This paper argues that nurses experience their development
as nurses in more complex ways than those the literature
would suggest. For many nurses, experience has generated
meanings and understandings about themselves and others
that appear to be individual, personal and transferable across
fields of practice.
These nurses are unique practitioners in the sense that they
may be more or less well equipped to function in ways that
would be considered expert in different fields and, indeed, in
different situations and contexts within their field of practice.
For example, a nurse practising in a specialized field, in the
context of a unique unit or ward and in the situation of dealing
with an individual patient, will be more or less able to develop a
therapeutic relationship and achieve their goals for care. It may
be the situation that determines, in part, the level of expertise or
ability to enact expert practice that is apparent among
experienced nurses rather than an internal set of knowledge
alone. Therefore, the concept of expert practice does not seem
to explain adequately the experience of nurses as they interact
with patients in different settings and circumstances:
If you asked the patients if I was good some would say ‘yes’ and some
would probably say ‘she was just like all the rest’. Some people you
would click with more than others. It wasn’t an age thing or a sex
thing or length of stay, just some people you would click with.
(Research participant in Arbon, 2001, p. 204)
Nonetheless, experienced nurses do seem to have character-
istics that make a difference, in most situations, to the quality
of their interaction with others. The concept of the expert
nurse has limited, and overly simplified, our understanding of
exemplary practice and the discourse in nursing should be
redirected toward understanding the characteristics of experi-
enced nurses.
The role of clinical experience
The view that experience should be understood in its breadth
and complexity and that these understandings can be applied
152
to our discussion of the place of experience in nursing does
not constitute an argument against the role of clinical
experience as an important form of experience for nurses.
Reed’s (1996) cogent argument for primary experience
supports the important place that clinical forms of experience
have in the development of nurses and their practice. Clinical
experience constitutes a significant part of the life experience
of nurses and is a powerful form of primary experience.
Indeed clinical experience may impact as much on our
understanding of self in non-clinical situations as it does in
clinical ones. Primary experience, as a form of meaningful
experience, results in relatively more experiencing, remem-
bering, reminiscence and review of meaning. Vicarious
experience can also be a powerful form of experience for
nurses and this view is consistent with published research
(Younger, 1990; Sutton et al., 1996; Hart et al., 1998) that
addresses the use of scenarios, video, observation and other
forms of secondary experience in the education of nurses.
However, primary experience is different, more immediate
and often more challenging (Abrahams, 1986; Reed, 1996)
because in primary experience the nurse is a principal actor
and an interpretation and reaction is required. Primary
experience cannot, generally, be ignored or dealt with later in
the same way as much secondary experience can.
Uniqueness and wholism
The theorizing about experience contained in this paper
suggests that clinical experience (as with other forms of
experience) plays a role in how we understand ourselves in
the lived world both at work and in other contexts. It seems,
however, appropriate for our discussion of the role of
experience in nursing to move past the taken-for-granted
and limiting conception of the link between clinical experi-
ence and clinical knowledge development. A broader and
more complex understanding that includes clinical and other
forms of experience provides a more adequate perspective on
the interplay between experiencing, meaning-making and
nurses’ practice than confining the spectrum of influence to
practice settings. Several research participants provided
insight into the way in which their understanding of others
changed over time and the influence of life experience:
I can remember becoming more aware about how other people felt, it
was gradual, you look at your father when he’s lost his wife, you’ve
lost your mother, but how does this man feel when he’s lost his life’s
partner. (Research participant in Arbon, 2001, p. 160)
Well a few of those things changed me, made me a little more...
toughened me up... probably made me less meek and mild _ How did

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157
Clinical nursing issues Understanding experience in nursing

it change me? Because lots of things were changing me, I’d become a Meaning-making is the complex process through which
mother and I’d had some deaths in the family that changed me all in existing meaning is re-formulated in the midst of new
this time. (Research participant in Arbon, 2001, p. 165) experience and new meaning and understanding is developed.
There is good support for the idea that nurses, and others,
An additional benefit of a broader understanding of experi-
commonly move through experience prereflectively (Janoff-
ence in nursing is that it is then possible to acknowledge the
Bulman, 1992; MacLeod, 1996). That is, when situated in
unique characteristics of individual practitioners that often
familiar contexts and performing everyday tasks, practition-
seem to be more dependent on their non-clinical experience
ers give relatively little thought to their actions and move
and individual personalities and character. Nurses bring to
through experiences utilizing pre-existing meanings and
practice understandings about people and situations that they
taken-for-granted understandings.
utilize in their work and that are grounded in understandings
Meaning-making is most often apparent when people are
about the lived world that they have developed from
troubled by experience and this often occurs when something
experience in all its forms. This understanding of nurses as
unusual or unexpected happens. The most detailed analysis of
individuals resonates well with the philosophical and ideo-
this phenomenon is found in literature that addresses the
logical stand that nursing has taken in recent times in support
impact of traumatic and extreme experience (Rehorick, 1986;
of the idea that patients should be understood as unique
Janoff-Bulman, 1992). Everyday experience, however, can
individuals.
also be interrupted by situations that cause the practitioner to
It may be appropriate to re-cast this philosophy and
pause, reflect and re-interpret. It is important to consider how
acknowledge that it applies equally to nurses themselves.
the features of nursing situations that are troubling for
Nursing theorists have sought to define nursing practice in
practitioners and cause them to question aspects of practice
ways that have tended to deny the individual and situational
may change and evolve with experience. A characteristic
facets of practice and the educational practices of nursing
feature of being experienced in nursing is referred to as
have reinforced this view. The nursing profession has strongly
noticing (MacLeod, 1996); that is, recognizing elements of
supported the importance of individual difference for patients
experience that are not congruent with established meanings
but has not applied this philosophical stance very effectively
and understandings and are, therefore, troubling. Troubling
in respect of its own members. For example, as Forchuk
and noticeable experiences are determined for nurses by their
(1995) has argued, the contemporary discourse in nursing
perspectives and priorities in practice; as experienced nurses
considers the effect (and therapeutic value) of nursing
become more comfortable and confident in their own practice
interventions, the skilled elements of care, but has paid
they are able to extend their interest from the merely
relatively little attention to the therapeutic nature of an
technical aspects of care provision to the broader features
individual nurse’s practice. It is incongruous that the nursing
of the care environment and individuals within it:
literature has conceptualized patients in an wholistic way,
acknowledging their uniqueness or particularity but has not, Well there’s probably two aspects to nursing, if you’re intelligent, and
with a few exceptions (e.g. Davis, 2001), considered the you like to apply your skills. Skills, which in turn could result in job
understanding of nurses in this way: satisfaction. There’s a thrill out of using a defibrillator, and a thrill
also out of being nice to people. So it really consists of two parts
Probably the thought that everyone’s an individual, and that they’ve
doesn’t it. (Research participant in Arbon, 2001, p. 163)
got feelings, and that one must make them feel comfortable. I’ve got
better at that as I’ve got older. I’ve always cared but I’m a better carer
I have changed in the way I nurse ___ in the way I understand about
now than I was as a young person. (Research participant in Arbon,
caring for people and those sorts of things. c. I. And um, what about
2001, p. 163)
um, in terms of those segments and things, in relationship to your
nursing at least, you’ve changed I guess it’s fair to say, have you
Experience and the development of meaning changed in the way you nurse, in the way you understand about
caring for people and those sorts of things?; My work now is about
The idea that the place of experience in nursing needs to be
caring ___ whether that helps one change…c. S. Yes, and wether
considered from a perspective that acknowledges the com-
that’s because um, my work now is about caring, whether that helps
plex and inter-related nature of our experience(s) leads us to
one change; It [my work] used to be more about the practical aspect
consider the way(s) in which experience influences meaning
and less about the other aspect…c. I. Mm, it’s more about that aspect
and understanding. The process of meaning-making is at the
and less about the other aspect; and less about the inner me.
centre of the relationship between experience, the meanings
(Research participant in Arbon, 2001, p. 185)
that are derived and knowledge.

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157 153
P. Arbon
MacLeod (1996) refers to noticing as a feature of practice
and observes that experienced nurses who are confident in
their own practice seem to notice features of the care
environment more readily, understand what needs to be
done and act effectively. Noticing is a characteristic of
experienced nurses; and the ability to be troubled by aspects
of the care situation is related to several other features that
develop with experience, including becoming receptive, being
motivated to understand others’ lived experience and the
adoption of a personal practice style that moves beyond
normative approaches to care(ing):
Spending time with patients and relatives just happened by chance. It
was just luck. Later on that changed and if you sat down with
someone for an hour and didn’t do you’re ten o’clock obs[ervations]
well too bad. There was a big philosophy change. (Research
participant in Arbon, 2001, p. 206)
Nurses are fundamentally concerned about providing safe
and effective nursing care. Beginners in nursing have been
shown to be focused primarily on basic nursing activities
(Benner, 1984; Calkin, 1984; Benner et al., 1992) and it is
only with more experience and the development of a level of
comfort about their practice, that nurses are able to give
attention to other features of their work. Put another way, for
less experienced nurses, it seems that the aspects of nursing
that are troubling are those associated with safety and the use
of technology. With time and experience nurses become more
adept at these fundamental nursing activities, become more
comfortable and confident with their ability to provide safe
care, and can focus more attention on the caring, interper-
sonal and connecting side of practice. Experienced nurses, in
familiar nursing contexts, seldom have cause to be troubled
by issues associated with safety and technology and find
themselves increasingly interested in understanding the indi-
vidual patient, connecting with them and developing a
therapeutic relationship. Experienced nurses are, therefore,
generally troubled by experiences with patients that are
associated with caring and connecting. Experienced nurses
become more confident about their performance and relat-
ively more focused on understanding others and acting in a
purposeful and therapeutic way. Experienced nurses are
confident and comfortable with close empathic relationships
and motivated to notice and understand others’ lived worlds,
and to practise in a way that takes others’ circumstances into
account:
Well it seems to have sneaked up through, probably through
experiences, sometimes you hurt people yourself unintentionally,
but you do, you’re different, and you don’t always understand…
(Research participant in Arbon, 2001, p. 158)
154
I can definitely see there are two sides to a story. I can see where
they’re coming from. I can see why people would make a choice not
to immunise and I can see why people are really pro immunisation.
[It’s the] same with euthanasia. People say what’s your opinion and I
look at each of those and I can’t have an opinion because in a sense I
can see the two sides. I’ve moved from everything being black and
white and my way to seeing both sides of the story. (Research
participant in Arbon, 2001, p. 192)
Becoming experienced
In developing an understanding of experience in nursing and
what it is like to be experienced it is apparent that becoming
experienced is understood by nurses as a continuous rela-
tionship with the lived world and new experience(s):
You learn most of what you know from experience. You’ve got your
childhood experiences and the examples that you have with your
parents and your brothers and sisters and your relatives and your
friends, it’s all copying or learning. It’s experience, your experience as
a child, all of these things as well, and you tend to think that the
whole world is like that and then as you go to school and kids kick
you and tease you and you learn that people aren’t all the same and
um, again, experience. Learning, as you get older. You don’t know
much about the big wide world out there, you gradually experience
that as well, it influences the way you think about the way we live.
(Research participant in Arbon, 2001, p. 133)
This phenomenon, becoming experienced, is not a linear
process. It is tempting, however, from the perspective of
modern Western understandings about experience and the
development of expertise or skill, to allow theorizing about
the place of experience in nursing to be pulled toward an
understanding of becoming experienced that invokes a devel-
opmental pathway, from not being experienced to being
experienced, which is linear, cumulative and temporal. We
commonly understand people’s experience in this way as with
time, and more experience, people become better at the skill or
performance that is the focus of our attention. At times, the
nursing discourse reflects this kind of understanding of
development and this is particularly apparent in the debate
about competency in nursing and the development of exper-
tise. However, nursing practice is not experienced only as a
skill or set of skills and cannot be described adequately in such
a simple way. In recent times, several nurse commentators
have argued against the development of simplistic understan-
dings about nursing work (Sutton & Arbon, 1994; Carberry,
1998). Nursing practice is, in the experience of nurses, an
existential and embodied phenomenon and is more appropri-
ately understood as a way of being and interacting with the
lived world as well as requiring particular technical expertise.

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157
Clinical nursing issues
In the discourse about the place of experience in nursing it
is assumed, as noted previously, that experience leads to
improved practice and eventually, in a linear fashion, to the
attainment of expertise. This simple model does not fit with
the experience of nurses and does not reflect the complex
understandings that nurses have about their practice across
fields or in differing circumstances and with different people.
For example, it is apparent that nurses establish relationships
with others that vary in their quality and nature (Forchuk,
1995). Also, experienced nurses describe the important
features of their practice in ways that can be described as
‘performance,’ in the sense that practice must be effective and
safe, and ‘understanding’ and ‘acting,’ in the sense that being
therapeutic requires that nurses understand others and have
the desire to intervene when it is appropriate. Performance
may vary across fields and contexts and the experienced nurse
may be more or less prepared to provide expert level skilled
practice in a new situation. Nonetheless, being experienced in
nursing is characterized by the acquisition of meanings and
understandings that have arisen from experience. While
performance may be limited in a new setting, understanding
and the desire to act therapeutically are, in the experience of
nurses, personal and portable features of their understanding
of themselves as nurses. The effect is that experienced nurses
carry the caring and connecting characteristics of their
practice with them and these are not diminished significantly
in differing contexts. Being experienced in nursing can be
conceptualized as a way of being, a positioning of oneself in
practice or an outlook and, for experienced nurses, is
connected to an understanding of who they are, what
motivates them, and what they find fulfilling:
My abilities or my attributes as a nurse changed. I value the
importance of little things in nursing. You know the caring. I see the
caring in nursing, being washing patients, feeding them and looking
after relatives. (Research participant in Arbon, 2001, p. 188)
The term, expertise, captures in a limited way, the perform-
ance of nurses within the established parameters of setting
and practice field. Expertise is context dependent whereas
being experienced is an existential and experiential phenom-
enon. Nurses understood as merely expert may, conceivably,
exist in a practice world where much is taken for granted and
there is a sense that there is little left to be learned.
Being experienced and becoming experienced are concep-
tualized as existing together or, in other words, as co-present.
If there is a process at work in the development of experi-
enced nurses it is not associated with a developmental
pathway but rather with the effect of experience on the
understandings that nurses use in their practice. As nurses
become more experienced they place greater value on their

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157
Understanding experience in nursing
experience and understandings about their own and others’
lived worlds. This in turn promotes the value of experience in
a cyclic way, that is, it is a self-perpetuating effect in which
experience influences meaning.
Facilitating nurses’ development
Much of the research and discussion about nursing that has
been generated in the past few decades has focused on the
development of education strategies and programmes that
will facilitate the development of nurses. While the emphasis
has shifted over the years from a focus on psychomotor skill
acquisition through development and application of scientific
forms of knowledge and more recently to the application of
‘nursing knowledge’ to practice, there has been evident
throughout this period a concern with the production of
skilled graduates who can make decisions effectively and take
appropriate action in clinical situations. This contemporary
focus on the production of skilled graduates reflects an
overriding concern with safe practice.
Consideration of the experience of nurses in a broader
fashion draws attention to the need to consider the personal
elements of competence in nursing and leaves us to question
how nursing can facilitate the personal development of
beginning nurses. The work of Benner (1984) focused
attention on the development of clinical skill and expertise
in nursing and began a new line of interest in nurses’ abilities.
Others (Tuxworth, 1989; Neary, 1994) have drawn attention
to the need for skilled technical practice and the development
of standards against which these ‘measurable’ features of
nursing work can be assessed. We are left with, arguably, the
most difficult set of questions; which relate to our under-
standing of features of nursing practice that are not readily
measurable and are associated with the practice of individual
nurses. The development of these features, which I have
referred to previously as ‘portable’ because they are not
context dependent, remains a challenge for nursing research-
ers. Stotland et al. (1978) highlight this issue in their study of
student nurses by demonstrating that individuals who score
more highly on empathy scales, and might therefore readily
develop the caring and individual side of their practice, tend
to avoid close patient interactions. This effect is, arguably,
the result of their capacity to understand the import of the
care situation but, unexpectedly, may lead to an avoidance of
close patient care situations.
Nurses develop caring and connecting attributes not simply
because they have experience but because they have begun to
draw upon their experience in a different way over time.
Coming to awareness that situations are complex, that
different actors may take different perspectives and develop
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P. Arbon
different meanings, is important. Understanding difference in
this way provides the starting point for nurses to think of
themselves as actors in the lived world of others. This
developing understanding is, in part, what makes experienced
nurses therapeutic in nursing situations and it inheres in the
individual as a therapeutic being. The question remains:
What do we do to facilitate this kind of development for
nurses and; what do we do that retards its development? Is it
possible to promote the development of these features of the
experienced nurse or do we need to wait for each individual
to come to these understandings in their own time? The
answer, as one might expect, is a little of both. A related
question that lies beyond the scope of this paper is what is
lost to the health system when experienced nurses leave the
profession and why they no longer choose to practise
nursing?
It may be possible to facilitate the development of these
experiential features for some nurses through modification of
teaching and learning approaches and by structuring practice
settings differently. The success of such strategies is largely
un-tested although it can be argued that many of those
programmes that draw on reflective processes have begun to
move down this pathway. Of principal importance here is our
understanding of reminiscence as a sub-set phenomenon of
reflection. Developing the ability of new nurses to reminisce
and make effective use of the understandings about them-
selves that can be generated by reminiscence is one step
toward developing experiential attributes. Reminiscence
requires reflection on our own meaningful experience and
provides the foundation for a developing understanding of
self that can be applied to practice. Teaching that involves
reflection upon meaningful personal experience creates a new
set of dilemmas for those involved. These relate to the
exposure of past difficult, or traumatic events and managing
the outcomes of this kind of reflection.
In addition to the further development of educational
strategies to assist in the development of the experiential
attributes of nurses there is a need to re-consider the
prevailing work culture in nursing and to work toward the
development of nursing environments that recognize the
importance of personal development as a nurse and value the
individual characteristics of practitioners. This seems increas-
ingly more problematic to achieve as nursing is determined
progressively more by economically driven management
models of service delivery.
Conclusion
The beginning practitioner is focused, at least in the earliest
period of their career, on survival in their new world of
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2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 150–157
practice and this entails, often, intense concentration on the
development of skills that will ensure that they can practise
safely in a complex and highly technological work environ-
ment. The more experienced practitioner has generally
moved on to a position in which safe and technically complex
care is a taken-for-granted feature of their practice and these
nurses can, therefore, begin to direct their attention to the
caring and connecting aspects of practice.
Beginning nurses are also, often, confronted by the need to
re-evaluate their own self-concept because they are now
defined as a qualified nurse and confronted with experience
that is challenging and, at times, emotionally disturbing. The
unique development of individual nurses depends upon
personal growth involving self-awareness, motivation, a
sense of presence with and for others and the ability to
notice others’ situation. These developments tempered and
influenced by experience make nurses ready and receptive to
a commitment to understand the lived world of others. The
challenge for nursing is to facilitate and value the develop-
ment of this ‘other side’ of nursing practice equally with the
skilled and technical aspects of care.
Practitioners in nursing can be understood as unique
individuals possessing character(istics) that are apparent in
the style and effect of their practice. Although wholism, as a
concept, has not been articulated in a consistent fashion and
several meanings are found in the literature, it is a concept
that underscores and reflects nurses’ desire to provide care
that accounts for individual needs and differences between
people. It is incongruous that the desire to understand
individuals in this way has not been adequately transferred to
our understanding of nurses.
Contributions
Study design: PA; data analysis: PA; manuscript preparation
and literature review: PA.
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