The Process of Skill Mastery

Nurse educators and preceptors are often selected for their roles because of their experience and expertise. But did you know that experts may have blind spots that prevent them from recognizing learners' needs and chunking tasks into individual skills? This article reviews the stages of the competence model and describes the process of skill mastery.

The Conscious Competence Learning Model

Skill development occurs along a continuum called the Conscious Competence Model. Learners progress from being unaware of what they do not know (i.e., unconscious incompetence) to realizing their own knowledge and skill gaps (i.e., conscious incompetence) to successfully applying knowledge and skills to clinical scenarios (Sidebar 1).¹ Nurse educators and preceptors commonly operate at the unconscious competence level where their actions become reflexive and automatic, lacking awareness of the shortcuts they take when processing information.

Sidebar 1: The Four Stages of Competence¹

• Unconscious incompetence: I do not know what I do not know.
• Conscious incompetence: I recognize a problem, but I do not have the knowledge or skills to solve the problem independently.
• Conscious competence: I can solve the problem or do the skill with focused attention, but I cannot anticipate unexpected circumstances.
• Unconscious competence: I can analyze problems, recognize patterns, anticipate needs, and apply skills in diverse settings.
  

Component Skills

A component skill is a basic skill that can be combined with other skills to execute complex tasks. Skill mastery describes the ability to perform component skills fluently and know when and where to apply them appropriately.² Perioperative nurses function in dynamic and complex environments that require the integration of many skillsets. Therefore, educators and preceptors need to know how to break down complex tasks into component skills.

For example, if you ask an experienced nurse to setup an OR for a case, they know exactly what you mean. If you ask a new nurse to setup an OR, they will need to think about each step of the process, which includes several skills, such as

• reading and interpreting the surgeon’s preference card,
• gathering additional equipment or supplies,
• determining the room configuration for the procedure,
• placing the packs and trays on the appropriate tables,
• opening all items with aseptic technique, and
• monitoring for sterility during the setup process.

The nurse educator can plan classroom learning and practice for the component skills to build confidence before the new nurse attempts to set up an OR suite with their preceptor for the first time. Some tips for breaking down complex tasks are provided in Sidebar 2.

Sidebar 2. Tips for Breaking Down Complex Tasks

For nurse educators

• Break down complex topics into individual skills.
• Explain each skill, demonstrate the skill, and then allow the new nurse to practice the skill.
• Once the new nurse becomes proficient in the individual skills, start combining skills.
• Once the new nurse is comfortable performing the skills in the expected sequence, introduce unexpected changes to foster critical-thinking skills.

For preceptors

• If your preceptee looks lost when asked to complete a task, ask clarifying questions to understand where the knowledge or skills gap exists.
• If your preceptee seems overwhelmed, prompt them by asking what task they would do first.
• Be patient with your preceptee.
• Ask your preceptee for feedback about your teaching skills.
  

References

1. Ulrich B. Mastering Precepting: A Nurse’s Handbook for Success. New York, NY: Sigma Theta Tau International; 2019.
2. Ambrose S, Bridges MW, DiPietro M, Lovett MC, Norman MK, Mayer RE. How Learning Works: Seven Research-based Principles for Smart Teaching. Hoboken, NJ: Jossey-Bass; 2010.

AORN Resources

Open access:

• OR Educators: Take Your Practice to the Next Level | AORN

AORN members can access:

• Innovative and Effective Education Strategies for Adult Learners in the Perioperative Setting - AORN Journal
• Tips for Being an Effective Nurse Preceptor - AORN Journal