| The purpose of this adult education workplace learning study was to determine how nurses gain clinical expertise through informal learning strategies as they engage in daily patient care.;While there is little doubt that nurses learn a great deal from formal nursing education programs, there is also consensus among nursing educators and advanced clinicians that the essential core of clinical learning is gained through repeated episodes of caring for patients in actual clinical situations. However, very little is known about these tacit learning processes in terms of the learning strategies employed (e.g. trial and error, coaching, role modeling, mentoring) or the resources utilized (e.g. supervisors, peers, subordinates, physicians). In addition to identifying these important strategies and resources, this study sought to clarify factors which facilitated or impeded informal learning.;The study site was a mid-size acute care urban hospital, part of a large medical center complex including colleges of medicine, graduate studies, nursing, and health related professions.;The methodology included the use of a constructivist paradigm in a case study approach using qualitative data. Twenty-three nurses, identified by their supervisors and peers as "expert" clinicians participated. Data collected through the use of semi-structured interviews and critical incidents was transcribed and coded, the resulting categories used to interpret the findings.;The study conclusions revealed that there was minimal institutional support for informal learning despite the importance of such learning to clinical skill building. Further, novice nurses relied heavily on solitary trial and error learning as they built their initial clinical learning base. As they advanced along the clinical learning curve, coaching by both peers and physicians became more prominent as did learning through observation, preceptoring, and role modeling. Subjects reported minimal learning from either supervisors, group membership, or networking.;Recommendations suggested the need for the establishment of learning partnerships between novices and their more advanced peers, a more well developed preceptorship program, the better utilization of physician coaches, supporting initiatives involving the utilization of group learning modes, and, in general, greater support for informal learning by both hospital administrators and by nursing supervisors. |
