From Novice To Expert: Excellence And Power In Clinical Nursing Practice
Theorist Dr. Patricia Benner
Tricia Ulferts
Northern Illinois University
Introduction
Dr. Patricia Benner is a nursing theorist whose experience with the Dreyfus Model of Skill Acquisition has earned her many awards and honors for her contribution to the nursing profession. In her work From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Dr. Benner introduced the concept that expert nurses develop skills and understanding of patient care over time using a sound educational base and having prior experiences(Benner, 1982). Her theory proposed that one could learn knowledge and skills by “knowing how” without ever learning theory “knowing that.”(Parker Jones, 2007)
Dr. Benner stated that “Increased acuity levels of patients, decreased length of hospitalization, and the proliferation of health care technology and specialization have increased the need for highly experienced nurses. The complexity and responsibility of nursing practice today requires long-term and ongoing career development.” (Benner, 1982, p. 402). She believed experience in the clinical setting is the key to nursing because it allows a nurse to continuously expand their knowledge base and to provide holistic, competent care to the patient. Even after thirty-two …show more content…
years her work is just as relevant now as it was then.
Her model began with nursing practice and with an understanding that day to day situations were more complex than they appear. She found that nurses’ experience and acquire skills that are necessary to become an expert in nursing practice (Altmann, 2007). Her theory provide us a framework that supports lifelong learning for nurses. It is applicable to nursing practice, research, as well as education.
Background/Historical perspective
Patricia Sawyer Benner was born in August, 1942, in Hampton Virginia. She grew up there with her parents, Shirley and Clint Sawyer. She had two sisters, one older and one younger making her the middle child of the family. Her father was in the ship building business and moved the family to Ontario, California when she was young (Sitzman & Wright Eichelberger, 2011).
She became interested in nursing while working as an admitting clerk at a local hospital while she attended Pasadena College. Pasadena College didn’t have a formal nursing program so she decided to switch to Pasadena City College. Here is where she obtained her associate of science in nursing while simultaneously receiving her bachelor’s degree in 1964 from Pasadena College. She went on to achieve a master’s degree in nursing from the University of California at San Francisco in 1970 and a PhD. at Berkeley in 1982 (Sitzman & Wright Eichelberger, 2011).
Patricia married Richard Benner in August of 1967. She has two children, a son born in 1973 and a daughter born in 1981. She is a Professor Emerita at the University of California, San Francisco, where she has taught and done research there since 1979. She has published nine books and numerous articles over the years. Her theory ‘Novice to Expert’ was published in 1982 ("From Novice to Expert," 2013). She went on to receive Book of the Year from The American Journal of Nursing for the years 1984, 1990, 1996, as well as 2000 ("From Novice to Expert," 2013).
Dr. Benner worked in the areas of medical-surgical, emergency room, coronary care, and intensive care units. She then became a nurse researcher at the University of California at San Francisco. This was where she studied clinical nursing, the nature of nursing and how nurses gain experience. While Benner worked, she was introduced to the skill acquisition work of philosopher Hubert Dreyfus and his brother, Stuart Dreyfus. She found that the Dreyfus Model of Acquisition could be generalized and applied to nursing (Altmann, 2007).
Theory
Patricia Benner’s research and theory work provide the profession of nursing with the Novice to Expert Model; known as Benner’s stages of clinical competence. Benner acknowledges that she utilizes the same five stages which come from the Dreyfus Model of Skill Acquisition. It explains the five stages of novice, advanced beginner, competent, proficient, and expert to acquire expertise in nursing practice (Altmann, 2007).
To evaluate the use of the Dreyfus model and incorporate it into her theory Dr. Benner performed interviews and observations of nurse clinicians. These nurses had a span from the new graduate to nurses that had practiced for many years and were considered highly skilled from their management team at the time. She also used narrative accounts of actual nurses in practice to provide lived experiences to help in the understanding of each skill stage. This concept explained that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences (Benner, 1982).
Benner proposed that a nurse could gain knowledge and skills without actually learning theory (Parker Jones, 2007). She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience (Benner, 1982). The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. A novice is a beginner with no experience. They are taught general rules to perform tasks. The rules that they follow are very limited and inflexible. Since they have no experience with the new situations they face, they must use pre-instructed rules to guide their performance. In other words, they are told what to do and simply follow instructions. The difficulty the novice faces is the inability to use their own judgment (Benner, 1982). The advanced beginner shows adequate performance, and has gained prior experience in actual nursing situations. This person is one who has coped with enough real situations and can now recognize recurrent meaningful situational components. These components are recognized, based on previous experiences, and they begin to formulate in order to guide the nurses actions (Benner, 1982). One aspect that Benner points out is that “novices and advanced beginners can take in little of the situation-it is too new, too strange. They have to concentrate on remembering the rules they have been taught” (Benner, 1982, p. 404). The next stage is competent. A competent nurse generally has two or three years’ experience on the job in the same field. For example, two or three years in intensive care. The experience may also be in similar day-to-day situations. These nurses are more aware of long term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization (Sitzman & Wright Eichelberger, 2011). The competency stage is characterized by “a feeling of mastery and the ability to cope with and manage the situation of their clinical setting” (Benner, 1982, p. 405) With continued practice the competent nurse comes to the proficient stage. A proficient nurse perceives and understands different situations as whole parts. He or she has a much more holistic understanding of nursing. This helps them improve their overall decision making skills. These nurses learn from experiences and what to expect in certain situations. They can also modify plans as needed. Experience gives the proficient nurse the ability to recognize a situation that may not be normal (Benner, 1982). The last level is the expert level.
“The expert nurse, with his/her enormous background of experience, has an intuitive grasp of the situation and zeros in on the accurate region of the problem without wasteful consideration of a large range of unfruitful possible problem situations” (Benner, 1982, p. 405). They no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and a better perspective grasp of clinical situations. Their performances are fluid, flexible, and highly proficient. Benner’s writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse (Parker Jones,
2007). These different levels of skills show changes in the three aspects of skilled performance. The first is the movement from relying on concrete principles to using past experiences to guide actions. Then a change in the learner’s perception of situations as whole parts rather than separate pieces. Lastly you see a passage from a detached observer to an involved performer, engaged in the situation rather than simply outside of it ("From Novice to Expert," 2013). The levels reflect movement from reliance on past principles to the use of past experience and change in the perception of the situation as a complete whole with certain relevant parts. Each step builds on the previous step as principles are refined and expanded by experience and clinical expertise (Sitzman & Wright Eichelberger, 2011).
Summary
Benner’s theory of from novice to expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients. It also indicates the importance of career ladders within clinical nursing practice ("From Novice to Expert," 2013). We know that in many states having licensure as a Registered Nurse (RN) is the basic entry level required for the profession of nursing (Parker Jones, 2007). “Licensure ensures that an individual has acquired the knowledge and skills to function as an RN but it does not indicate expertise in a particular area. Healthcare has become more complex and specialized, with the need for nurses to acquire advanced skills to meet expanding health care needs” (Parker Jones, 2007, p. 13). In todays’ nursing we can see and understand the need for clinicians and clinical specialists in the patient care setting. Many have argued that this model is more of a philosophy than a theory. The statements have said that Benner’s work is not quantitative research and that there are issues with the use of narratives (Altmann, 2007). “A nursing philosophy can be defined as the conduct, thought and the nature of the nursing practice. Philosophy begins when someone contemplates, or wonders, about something” (Altmann, 2007, p. 114) Many opponents also state that her model is interpretive. She had to use her own judgment from what she gathered from her observing and the narrative accounts that were part of her research. In reading through this research I discovered how I have evolved in my own nursing practice. I remember being the new RN in the critical care unit and asking myself why I was there. I had read the books and performed the basic skills in my clinical rotations. I was amazed as I watched my preceptor move about the room to take care of our patient with the greatest of ease. It was second nature to her. I had no idea what she was doing and why she was doing those specific tasks. After a six month orientation I was left to take a patient assignment on my own. I was definitely a novice. Looking back I can see how I grew into now what I would consider myself to be a proficient nurse.
References
Altmann, T. K. (2007, May-June). An evaluation of the seminal work of Patricia Benner: Theory or philosophy? Contemporary Nurse, 25, 114-123.
Benner, P. (1982, March 1982). From Novice to Expert. The American Journal Of Nursing, 82, 402-407. Retrieved from http://www.jstor.org/stable/3462928
Nursing Theories: a companion to nursing theories and models. (2013). Retrieved from http://currentnursing.com/nursing_theory/Patricia-Benner_From...
Parker Jones, M. (2007). Nursing Expertise: A look at theory. Journal of Legal Nurse Consulting, 18(2), 12-15.
Sitzman, K., & Wright Eichelberger, L. (2011). Understanding the Work Of Nurse Theorists: A Creative Beginning (2nd ed.). []. Retrieved from Https://play.google.com/books/reader.com
Tricia Ulferts
Northern Illinois University
Introduction
Dr. Patricia Benner is a nursing theorist whose experience with the Dreyfus Model of Skill Acquisition has earned her many awards and honors for her contribution to the nursing profession. In her work From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Dr. Benner introduced the concept that expert nurses develop skills and understanding of patient care over time using a sound educational base and having prior experiences(Benner, 1982). Her theory proposed that one could learn knowledge and skills by “knowing how” without ever learning theory “knowing that.”(Parker Jones, 2007)
Dr. Benner stated that “Increased acuity levels of patients, decreased length of hospitalization, and the proliferation of health care technology and specialization have increased the need for highly experienced nurses. The complexity and responsibility of nursing practice today requires long-term and ongoing career development.” (Benner, 1982, p. 402). She believed experience in the clinical setting is the key to nursing because it allows a nurse to continuously expand their knowledge base and to provide holistic, competent care to the patient. Even after thirty-two …show more content…
years her work is just as relevant now as it was then.
Her model began with nursing practice and with an understanding that day to day situations were more complex than they appear. She found that nurses’ experience and acquire skills that are necessary to become an expert in nursing practice (Altmann, 2007). Her theory provide us a framework that supports lifelong learning for nurses. It is applicable to nursing practice, research, as well as education.
Background/Historical perspective
Patricia Sawyer Benner was born in August, 1942, in Hampton Virginia. She grew up there with her parents, Shirley and Clint Sawyer. She had two sisters, one older and one younger making her the middle child of the family. Her father was in the ship building business and moved the family to Ontario, California when she was young (Sitzman & Wright Eichelberger, 2011).
She became interested in nursing while working as an admitting clerk at a local hospital while she attended Pasadena College. Pasadena College didn’t have a formal nursing program so she decided to switch to Pasadena City College. Here is where she obtained her associate of science in nursing while simultaneously receiving her bachelor’s degree in 1964 from Pasadena College. She went on to achieve a master’s degree in nursing from the University of California at San Francisco in 1970 and a PhD. at Berkeley in 1982 (Sitzman & Wright Eichelberger, 2011).
Patricia married Richard Benner in August of 1967. She has two children, a son born in 1973 and a daughter born in 1981. She is a Professor Emerita at the University of California, San Francisco, where she has taught and done research there since 1979. She has published nine books and numerous articles over the years. Her theory ‘Novice to Expert’ was published in 1982 ("From Novice to Expert," 2013). She went on to receive Book of the Year from The American Journal of Nursing for the years 1984, 1990, 1996, as well as 2000 ("From Novice to Expert," 2013).
Dr. Benner worked in the areas of medical-surgical, emergency room, coronary care, and intensive care units. She then became a nurse researcher at the University of California at San Francisco. This was where she studied clinical nursing, the nature of nursing and how nurses gain experience. While Benner worked, she was introduced to the skill acquisition work of philosopher Hubert Dreyfus and his brother, Stuart Dreyfus. She found that the Dreyfus Model of Acquisition could be generalized and applied to nursing (Altmann, 2007).
Theory
Patricia Benner’s research and theory work provide the profession of nursing with the Novice to Expert Model; known as Benner’s stages of clinical competence. Benner acknowledges that she utilizes the same five stages which come from the Dreyfus Model of Skill Acquisition. It explains the five stages of novice, advanced beginner, competent, proficient, and expert to acquire expertise in nursing practice (Altmann, 2007).
To evaluate the use of the Dreyfus model and incorporate it into her theory Dr. Benner performed interviews and observations of nurse clinicians. These nurses had a span from the new graduate to nurses that had practiced for many years and were considered highly skilled from their management team at the time. She also used narrative accounts of actual nurses in practice to provide lived experiences to help in the understanding of each skill stage. This concept explained that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences (Benner, 1982).
Benner proposed that a nurse could gain knowledge and skills without actually learning theory (Parker Jones, 2007). She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience (Benner, 1982). The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. A novice is a beginner with no experience. They are taught general rules to perform tasks. The rules that they follow are very limited and inflexible. Since they have no experience with the new situations they face, they must use pre-instructed rules to guide their performance. In other words, they are told what to do and simply follow instructions. The difficulty the novice faces is the inability to use their own judgment (Benner, 1982). The advanced beginner shows adequate performance, and has gained prior experience in actual nursing situations. This person is one who has coped with enough real situations and can now recognize recurrent meaningful situational components. These components are recognized, based on previous experiences, and they begin to formulate in order to guide the nurses actions (Benner, 1982). One aspect that Benner points out is that “novices and advanced beginners can take in little of the situation-it is too new, too strange. They have to concentrate on remembering the rules they have been taught” (Benner, 1982, p. 404). The next stage is competent. A competent nurse generally has two or three years’ experience on the job in the same field. For example, two or three years in intensive care. The experience may also be in similar day-to-day situations. These nurses are more aware of long term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization (Sitzman & Wright Eichelberger, 2011). The competency stage is characterized by “a feeling of mastery and the ability to cope with and manage the situation of their clinical setting” (Benner, 1982, p. 405) With continued practice the competent nurse comes to the proficient stage. A proficient nurse perceives and understands different situations as whole parts. He or she has a much more holistic understanding of nursing. This helps them improve their overall decision making skills. These nurses learn from experiences and what to expect in certain situations. They can also modify plans as needed. Experience gives the proficient nurse the ability to recognize a situation that may not be normal (Benner, 1982). The last level is the expert level.
“The expert nurse, with his/her enormous background of experience, has an intuitive grasp of the situation and zeros in on the accurate region of the problem without wasteful consideration of a large range of unfruitful possible problem situations” (Benner, 1982, p. 405). They no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and a better perspective grasp of clinical situations. Their performances are fluid, flexible, and highly proficient. Benner’s writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse (Parker Jones,
2007). These different levels of skills show changes in the three aspects of skilled performance. The first is the movement from relying on concrete principles to using past experiences to guide actions. Then a change in the learner’s perception of situations as whole parts rather than separate pieces. Lastly you see a passage from a detached observer to an involved performer, engaged in the situation rather than simply outside of it ("From Novice to Expert," 2013). The levels reflect movement from reliance on past principles to the use of past experience and change in the perception of the situation as a complete whole with certain relevant parts. Each step builds on the previous step as principles are refined and expanded by experience and clinical expertise (Sitzman & Wright Eichelberger, 2011).
Summary
Benner’s theory of from novice to expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients. It also indicates the importance of career ladders within clinical nursing practice ("From Novice to Expert," 2013). We know that in many states having licensure as a Registered Nurse (RN) is the basic entry level required for the profession of nursing (Parker Jones, 2007). “Licensure ensures that an individual has acquired the knowledge and skills to function as an RN but it does not indicate expertise in a particular area. Healthcare has become more complex and specialized, with the need for nurses to acquire advanced skills to meet expanding health care needs” (Parker Jones, 2007, p. 13). In todays’ nursing we can see and understand the need for clinicians and clinical specialists in the patient care setting. Many have argued that this model is more of a philosophy than a theory. The statements have said that Benner’s work is not quantitative research and that there are issues with the use of narratives (Altmann, 2007). “A nursing philosophy can be defined as the conduct, thought and the nature of the nursing practice. Philosophy begins when someone contemplates, or wonders, about something” (Altmann, 2007, p. 114) Many opponents also state that her model is interpretive. She had to use her own judgment from what she gathered from her observing and the narrative accounts that were part of her research. In reading through this research I discovered how I have evolved in my own nursing practice. I remember being the new RN in the critical care unit and asking myself why I was there. I had read the books and performed the basic skills in my clinical rotations. I was amazed as I watched my preceptor move about the room to take care of our patient with the greatest of ease. It was second nature to her. I had no idea what she was doing and why she was doing those specific tasks. After a six month orientation I was left to take a patient assignment on my own. I was definitely a novice. Looking back I can see how I grew into now what I would consider myself to be a proficient nurse.
References
Altmann, T. K. (2007, May-June). An evaluation of the seminal work of Patricia Benner: Theory or philosophy? Contemporary Nurse, 25, 114-123.
Benner, P. (1982, March 1982). From Novice to Expert. The American Journal Of Nursing, 82, 402-407. Retrieved from http://www.jstor.org/stable/3462928
Nursing Theories: a companion to nursing theories and models. (2013). Retrieved from http://currentnursing.com/nursing_theory/Patricia-Benner_From...
Parker Jones, M. (2007). Nursing Expertise: A look at theory. Journal of Legal Nurse Consulting, 18(2), 12-15.
Sitzman, K., & Wright Eichelberger, L. (2011). Understanding the Work Of Nurse Theorists: A Creative Beginning (2nd ed.). []. Retrieved from Https://play.google.com/books/reader.com