Benner's Novice to Expert Theory in Nursing Practice

Introduction to Benner's Novice to Expert Theory

The Novice to Expert theory, postulated by Patricia Benner, revolves around the cultivation of skills in nursing professionals. Benner argues that it is essential for nurses to gain skills through practical experience. In formulating this theory, she employs the Dreyfus Model of Skill Acquisition as applied to practicing nurses. The Dreyfus Model holds that an expert in the making passes through five skill levels: novice, advanced beginner, competent, proficient, and expert. As a nurse climbs this skill ladder, his or her skill set changes positively in a number of meaningful ways (Benner, 1984).

The Five Stages of Skill Development

The foundation stage is the novice. According to Benner (1984), a novice is an individual who is new to the field and has no prior experience of the clinical environment in which they currently work. It is important for a novice nurse to be exposed to new clinical environments so that they can develop their skills. Benner also argues that novice nurses should be coached on patients' conditions in a purposeful and measurable manner, which helps them identify symptoms despite having no prior experience. Novice nurses do not typically carry a heavy workload due to their limited ability to handle clinical activities. They are also subjected to strict rules in order to avoid errors — rules that can compromise their flexibility to such an extent that they perceive all elements of a clinical situation as a single undifferentiated whole. They rely solely on issued instructions and cannot yet reason and act independently (Benner, 1984).

The second stage is the advanced beginner. According to Benner, the advanced beginner nurse demonstrates reasonably acceptable performance, having encountered a sufficient number of situations to recognize recurring patterns. These recurring aspects are universal traits that require prior experience to identify. The advanced beginner is therefore someone who has moved through enough situations to successfully develop guiding principles, which they now apply in new circumstances (Benner, 1984).

The third stage is the competent nurse. Benner asserts that a competent nurse is one who has worked for a minimum of two years in a consistent environment. Competency begins to emerge when a nurse can relate his or her daily actions to long-term objectives. The competent nurse is able to strategize based on the most relevant aspects of the challenge at hand, rather than weighing every possible factor equally. A competent nurse regards planning as a key component of establishing direction, and believes that any plan must be formulated through a conscious, analytical approach. This skill level is largely characterized by deliberate planning, which helps the nurse perform at an optimal level (Benner, 1984).

The fourth stage is the proficient nurse. A proficient nurse is able to perceive a clinical challenge as a whole, rather than focusing only on its individual components. This holistic outlook is not consciously calculated; rather, it develops in the subconscious through years of experience in similar situations. Perception is what drives the proficient nurse. This holistic understanding of situations enables sound decision-making. Experience has taught such nurses what to expect across a range of clinical circumstances, and — importantly — how to adjust plans to accommodate varied conditions (Benner, 1984).

Finally, there is the expert nurse. In essence, the expert nurse possesses a deep comprehension of clinical circumstances and has moved beyond the purely analytical approach. Instead, they possess an internalized command of situations, which they draw upon when responding to complex challenges. The expert nurse is therefore flexible, fluent, and highly skilled. Expert nurses can at times rely on "hunches" to guide their responses; however, Benner emphasizes that they must remain extensively skilled in the use of analytic tools, since such tools are critical when intuition proves incorrect. An expert nurse no longer depends on abstract rules and regulations, but draws on genuine experiential knowledge. Expert nurses also possess an advanced perception of circumstances — they no longer view a situation as isolated pieces assembled together, but as a coherent whole in which specific elements hold particular relevance. The expert nurse thus engages fully with clinical circumstances, rather than observing passively from a distance (Benner, 1984).

Consider, for example, a newly qualified nurse entering a Coronary Care Unit (CCU). Even with strong academic preparation, she cannot immediately lead complex clinical operations. Nurses should be aware of this reality so they are not frustrated when assigned a limited scope of practice upon entering a new environment. Academically educated nurses bring a solid theoretical foundation and the ability to analyze situations in order to understand each patient's condition. With experience, they also develop the capacity to identify the building blocks of the larger clinical picture and understand how its components interrelate. Over time, nurses deepen their empathetic engagement with patients and their families, drawing on patient histories to inform both present and future care decisions. Expert nurses are consistently found consulting with colleagues when decisions are particularly complex or demanding (Walker-Reed, 2016).

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13–34.

Boshuizen, H. P., Bromme, R., & Gruber, H. (Eds.). (2006). Professional learning: Gaps and transitions on the way from novice to expert (Vol. 2). Springer Science & Business Media.

Marriner-Tomey, A. (1994). Nursing theorists and their work. St. Louis: Mosby.

Walker-Reed, C. A. (2016). Clinical coaching: The means to achieving a legacy of leadership and professional development in nursing practice. Journal of Nursing Education and Practice, 6(6), 41.