Understanding skill acquisition among registered nurses: the ‘perpetual novice’ phenomenon

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Aims and objectives.

To determine whether the perpetual novice phenomenon exists beyond nephrology nursing where it was first described.


The perpetual novice is a state in which nurses are unable to progress from a novice to an expert in one or more essential clinical skills which are used in their practice area. Maintaining clinical competence is essential to quality patient care outcomes.


An exploratory, sequential, mixed methods design was used, comprised of a quantitative component followed by in-depth interviews.


Registered nurses employed in one of four roles were recruited from two university-affiliated hospitals in London, Ontario, Canada: Clinical Educator, Clinical Nurse Specialist, Advanced Practice Nurse and Nurse Practitioner. Participants were first asked to complete and return a survey and demographic questionnaire. Following the return of the completed surveys, ten participants were interviewed to enhance the results of the surveys.


The results of the surveys confirmed that the perpetual novice phenomenon exists across multiple nursing care areas. Four contributing factors, both personal and structural in nature, emerged from the interviews: (1) opportunities for education, (2) the context of learning, (3) personal motivation and initiative to learn and (4) the culture of the units where nurses worked.


The perpetual novice phenomenon exists due to a combination of both personal factors as well as contextual factors in the work environment.

Relevance to clinical practice.

The results assist in directing future educational interventions and provide nursing leaders with the information necessary to create work environments that best enable practicing nurses to acquire and maintain clinical competence.

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