This paper examines Patricia Benner's influential theory of nursing expertise, which describes how nurses transition from novice to expert through accumulated clinical experience. Grounding the discussion in Benner's key attributes of expert nursing — including intuitive grasp, fluid performance, and experience-based knowledge — the paper identifies a practice problem focused on supporting nurses as they move from proficient to expert practice. Three annotated reference sources are reviewed: a critique of Benner's intuition theory proposing an alternative framework, a UK-based redefinition of nursing expertise through the Expertise in Practice Project, and an analysis of clinical reasoning concepts and research in nursing education.
A brief review of Dr. Patricia Benner's theory on the transition from novice nurse to expert nurse provides the grounding for the three resources selected in this reference list. Benner held strong beliefs about the validity of skills and knowledge gained through experience, and introduced the idea that an expert level of nursing is achieved as patient care is provided over time — and as that knowledge is integrated with the formal training nurses receive when earning a degree in nursing. Benner is famously known for asserting that a nurse could "gain knowledge and skills (knowing how) without ever learning the theory (knowing that)."
Dr. Benner posited a three-pronged approach to knowledge in the applied disciplines of nursing specifically — and medicine in general — that entails extending practical knowledge through research and clinical experience. She asserted that a nurse could not truly achieve expert status in the profession without having acquired considerable experience as a practitioner.
Several attributes are associated with the expert level of nursing according to Benner, including the following:
1) An expert nurse "no longer relies on principles, rules, or guidelines to connect situations and determine actions." 2) An expert nurse "has much more background of experience." 3) An expert nurse "has an intuitive grasp of clinical situations." 4) The "performance [of an expert nurse] is now fluid, flexible, and highly proficient" ("Nursing Theories").
The concept that expert nurses exercise intuition in their practice has been the focus of considerable debate in the discipline. The role of intuition in clinical expertise raises important questions about how nursing knowledge is defined, measured, and taught.
The practice problem proposed here is a nursing leadership issue concerning how best to support nurses as they transition from proficient to expert through personalized definitions of nursing expertise. This topic is of particular interest because the nursing profession has become globalized, with cross-border recruiting of nurses increasingly common. As nurses trained in diverse educational and cultural contexts enter new healthcare environments, leadership strategies that account for individualized pathways to expertise become especially important.
"Three annotated sources on intuition, expertise, and reasoning"
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