7 Evidence Appraisal: Nonresearch 159Clinical expertise (Level V), both skill proficiency and professional judgment, is
gained through the combination of education and clinical experiences. Personal
judgments arising from past and present nurse-patient interactions, and knowl-
edge about what works within the organization or system, add depth to that ex-
pertise. Nurses who practice within an evidence-based framework are committed
to personal growth, reflection, self-evaluation, accountability, and lifelong learn-
ing (Dale, 2006).
The Expertise in Practice Project (Hardy, Titchen, Manley, & McCormack, 2006)
identified and examined attributes of nurse expertise and enabling factors. Attri-
butes of expertise included:
■■ Holistic practice knowledge: Drawing from a range of knowledge bases
to inform action
■■ Skilled know-how: Enabling others by sharing knowledge and skills
■■ Saliency: Observing nonverbal cues to understand each individual’s
unique situation
■■ Moral agency: Consciously promoting each individual’s dignity, respect,
and individuality
■■ Knowing the patient/client: Promoting patient decision-making within
the context of each individual’s unique perspectiveEnabling factors for nursing expertise included:
■■ Reflectivity: The ability to continually reconsider, reassess, and reframe
one’s work
■■ Organization of practice: Organization and prioritization of workload
■■ Autonomy and authority: Taking responsibility for consequences of dif-
ficult decisions
■■ Good interpersonal relationships: Being intentional in relationships
■■ Recognition from others: Regular feedback and acknowledgment of
work