Competent Stage 3, or competent, nurses integrate theoretical knowledge with clinical experience in the care of patients and families. Care is delivered using a deliberate, systematic approach, and practice is guided by increasing awareness in patterns of patient responses in recurrent situations. These nurses demonstrate mastery of most technical skills, and begin to look at clinical situations from the patient's and family's viewpoints 4. These nurses demonstrate the ability to recognize situational changes that require unplanned or unanticipated interventions. They respond to most situations with confidence, speed, and flexibility.
Progression is from a task orientation to a holistic view of patient care.
These nurses develop effective relationships to the health care team in formulating integrated approaches to care. They interpret the patient's and family's experiences from a wider perspective, and can envision other possibilities. Expert Stage 5 nurses are expert practitioners whose intuition and skill arise from comprehensive knowledge thoroughly grounded in experience. Their practice is characterized by a flexible, innovative and confident self-directed approach to patient and family care. Expert nurses operate from a deep understanding of the total situation.