Benner S Theory and the Concept of Nurse Competence

¶ … Benner's Novice To Expert Theory

and Application to Modern Nursing

Nurse competence is an important concept in today's nursing practice since it is directly linked to patient outcomes. The link between this concept and patient outcomes is also attributed to how nurse competence is related to integrating nursing knowledge into practice. This paper provides a concept analysis of the concept of nurse competence in relation to Benner's Novice to Expert Theory. The main goal of the article is to examine the relevance and application of this theory to modern nursing with regards to the concept of nurse competence. This discussion includes how the theory contributes to nursing knowledge, analysis of the concept of nurse competence, analysis of the concept's attributes, and application of the concept.

Keywords: nurse competence, concept, analysis, Benner's Novice to Expert Theory, nursing practice, professionals, professional growth and development.

Concept Analysis: Benner's Novice to Expert Theory and Application to Modern Nursing

Nurses are mandated with the responsibility of providing essential healthcare services to millions of people across the globe in different healthcare settings. One of the most important requirements for these professionals as they engage in provision of healthcare services is developing, maintaining, and assessing nurse competence. The nursing profession is increasingly faced with the need to ensure and promote nurse competence in order to enhance patient outcomes through effective delivery of care. This paper will focus on examining the development of nursing competence through a concept analysis of Benner's novice to expert theory and its application to modern nursing. Nurses develop experience and competence in specific areas of nursing they find themselves practicing through various stages of skill acquisition i.e. novice, advanced beginner, competent, proficient, and expert.

Nursing Theory

As previously mentioned, the nursing theory selected for this concept analysis is Benner's Novice to Expert Theory. This theory is suitable for this paper since it contributes to the development of nursing knowledge in different ways. The relevance of this theory to the concept analysis of nursing competence is also attributed to the fact that nursing is an exceptional field in which the practitioner's experience is the most important factor in development of knowledge and professional growth. Generally, Benner used reflective practice when examining this profession in order to develop the distinctive attributes and knowledge relating to nursing competence and experience (Sunkes, n.d.).

Dr. Patricia Benner developed Novice to Expert Theory following her work in exploring the stages of clinical competence. This theory has developed to become one of the most beneficial frameworks for evaluating the needs of nurses at different phases in their professional growth and development. Benner's Novice to Expert Theory postulates that expert nurses develop or generate skills and understanding of their respective roles in nursing field over time. The skills and understanding of the specific roles in nursing practice are developed through suitable academic background and a series of experiences in the field. Notably, the theory does not focus on how an individual develops to become a nurse but emphasizes on how these professionals acquire nursing knowledge. As a result, the theorist concludes that there are five major stages of clinical competence i.e. novice, advanced beginner, competent, proficient, and expert. Through these stages, nurses develop necessary experience and competence in the specific areas they find themselves practicing in the nursing field.

Benner's Novice to Expert Theory has contributed to the development of nursing knowledge in different ways. One of the major ways through which the theory has contributed to development of nursing knowledge is by promoting an understanding of how nurses acquire competence. The theory demonstrates how nurses progress in each stage of professional growth with regards to knowledge and experience, which are crucial components of nursing competence. The theory has contributed to development of nursing knowledge by demonstrating central concepts i.e. skill acquisition, clinical knowledge, competence, experience, and practical knowledge that result in better clinical reasoning ability and positive healthcare outcomes (McEwen & Wills, 2014, p.232).

Secondly, the theory has contributed to development of nursing knowledge by developing a continuum of skills acquisition that has identifiable phases. The continuum of skills acquisition which contributes to nursing knowledge is demonstrated in the theory's central concepts. Third, Benner's Novice to Expert Theory has contributed to development of nursing knowledge by promoting reflective practice, which is an important factor through which nurses enhance their clinical reasoning ability. Through reflective practice, the theory is utilized to improve innovative changes, knowledge development, and professional growth within the nursing professional.

The Selected Concept

The selected concept from Benner's Novice to Expert Theory is nurse concept, which is an important factor in enhancing patient care. The theory will be used to examine the concept of competence in relation to nursing, especially with regards to knowledge development, nursing research, and practice. From a theoretical framework, the concept of nurse competence is the basis for professional growth and development across various stages of clinical competence. Nurses enhance their skills and understanding of patient care in their respective specialties in this field through the concept of nurse competence. Actually, it is relatively difficult to examine and understand how nurses can enhance patient care without examining the development of nurse competence across the various stages in professional growth and development.

According to Smith (2012), one of the greatest challenges in today's nursing profession is developing, maintaining, and assessing nurse competence (p.172). This is a major challenge because nurses are mandated with the task of providing essential care to a huge population that is hospitalized annually because of injury or illness. This responsibility requires nurses to develop competence in order to provide competent and safe care to patients. Therefore, the concept of nurse competence is directly related to the quality of healthcare services, which is a major public concern, especially because of increased incidents of medical error in today's healthcare system.

The development of nurse competence requires establishing a strong theoretical framework that guides professional growth and development in the nursing field. However, there is relatively limited literature on the concept of nurse competence because of difficulties in determining how to promote and ensure nurse competence. Moreover, there is lack of a solid definition of this concept because of widespread confusion and inconsistencies relating to the concept. Given the prevalent confusion and inconsistencies surrounding the definition of this concept, it is increasingly difficult to evaluate nurse competence in light of the increased demands for patient safety in the ever-increasing complex healthcare setting and environment. However, Benner's Novice to Expert Theory provides a suitable theoretical foundation for examining the concept of nurse competence in relation to development of nurse knowledge and application to modern nursing practice.

Analysis of the Concept

The concept of competence is an idea that has attracted a lot of attention in past few decades mainly because of the confusion and inconsistencies surrounding this idea. However, it is a relatively hard idea to avoid when focusing on the concept of competence in education and training as well as its application in practice (Mulder, 2007, p.5). Generally, competence is a term that is used to refer to the state or extent of being knowledgeable or possessing necessary or required qualities and abilities to develop or function in a particular way. Given the difficulties in understanding the meaning and translation of the concept of competence, the practical use of this idea is relatively difficult to understand.

Similarly, the concept of competence in relation to nursing practice is characterized by numerous inconsistencies and confusion as nursing scholars and theorists struggle to identify a suitable definition for this concept. Nonetheless, the competence is one of the most commonly utilized terms in the nursing profession across the globe and is defined in different ways by various healthcare practitioners (Garside & Nhemachena, 2012, p.541). The various attempts to define this concept have been based on the ability of registered nurses to function and perform effectively. Actually, nurse educators attempt to define and understand this concept through examining ways in which professionals in the field develop critical-thinking skills or clinical reasoning abilities to perform effectively in today's complex healthcare environment.

Benner (1984) defines nurse competence as the ability to carry out respective nursing tasks through integrating knowledge in order to realize desired nursing outcomes or results. In this case, she argues that nurse competence is developed over time as the professional grows from being a novice to an expert. According to Carlson & Contrades (1989), the concept of nurse competence postulates that nurse experts start as nursing students because clinical practice is a developmental process. Benner's Novice to Expert Theory concurs with this definition by providing a framework that enables nurse educators and students to consider clinical practice as a developmental process. Therefore, nurses develop clinical competence as they progress and grow through the different stages in this profession.

Secondly, nurse competence can be defined as the ability of nurses to possess necessary interpersonal skills when delivering patient care to generate better patient outcomes. This definition is based on the premise that patients not only assume but also expect nurses caring for them to be competent (Smith, 2012, p.172). As a result, patients consider nurses to be competent if they possess and demonstrate appropriate interpersonal skills that help in achieving desired outcomes. This implies that nurse competence is not only demonstrated through necessary knowledge and skills but also shown through effective interpersonal skills when delivering patient care in respective practice. Since nurse competence or clinical practice is a developmental process, nurses develop and refine these interpersonal skills over time. Nursing knowledge and skill acquisition is a developmental procedure in which nurses undergo the various stages as they progress from being novices to experts in this field.

Analysis of the Concept's Attributes

Following a review of literature, the characteristics that define the concept of nurse competence are experience, proficient skills, and integrating knowledge into practice (Smith, 2012, p.176). According to Benner's Novice to Expert Theory, experience is an important element in clinical practice since theory is insufficient in imitating the complexities of real clinical practice and is essential in developing nurse competence. The significance of experience in developing nurse competence is that nursing knowledge and interpersonal skills are developed over time. Nurse competence also requires proficient skills given that nurses acquire these skills with time as they increase their knowledge and experience. Notably, nurses may be at varying levels or stages of competence in different skills relating to nursing practice. This concept also requires possessing and integrating necessary knowledge into nursing practice since knowledge is also beneficial if it's integrated into practice.

Model Case

Upon graduation from an accredited nursing institution and program, Christine Sharon was employed in a hospital. She was placed into a nurse preceptor program for the first 6 months and provided a supportive work environment where she was subjected to supervision from her mentor. The preceptor program helped her develop experience, proficient skills, and translating knowledge into practice. As she developed in these areas, the she started working will less supervision until she was completely able to function as an independent, competent nurse. Currently, Christine has developed to become one of the most productive nurses in this hospital and also works to mentor new graduate nurses employed in the hospital.

This model case demonstrates the transition of a nurse from a novice to a competent professional as shown in Benner's Novice to Expert Theory. The case shows the successful implementation of Benner's theory through a process model for education of nurses. Marble (2009) developed a five-step model to help promote a culture of staff and leadership development through elements that promote career development in the workplace. These elements are evident in this case since the workplace provided an engaging, motivating, and high-performing workplace that fostered Christine's professional growth.

Related Case

Patients have constantly complained of poor delivery of patient care services by nurses in Benders Hospital. While these nurses achieved desired patient outcomes, they have been accused of being rude to patients while carryout their respective responsibilities and duties. The hospital's board of directors has investigated the issue and found that these nurses are overconfident in addition to possessing proficient skills and effectively integrating knowledge into practice. The board has planned for a 3-day workshop to train nurses on how overconfidence is a dangerous phenomenon in nursing practice despite being competent.

Illegitimate Case

A nurse at St. Mary's Nursing Care Home has refused to undergo a mandatory training program that focuses on improving patient care and enhancing patient outcomes. However, she continues to provide patient care services at the hospital as she awaits the final decision by the management. During this period, the nurse has continued to make several medical errors while discharging her duties to an extent that a lawsuit has been filed against the hospital for medical malpractices by the nurse. The nurse continues to make these errors despite graduating with a degree in her specialty field.