Patricia Benner's Novice to Expert Theory in Nursing Practice

Introduction: The Evolving Role of the Modern Nurse

Twenty-first century nursing is an evolving, rewarding, but challenging occupation. Unlike nurses in the past, the modern nurse's role is not limited to that of a physician's assistant, but rather takes on a critical partnership role with both doctor and patient. This role is multidimensional: advocate, caregiver, teacher, researcher, counselor, translator, and case manager. Of course, care is of the utmost importance and includes those activities that assist the client physically, mentally, and emotionally. This requires a holistic approach to the patient as a person — not a disease, number, or statistic (Mariano, 2005). Using nursing theory and scholarship can help expand a nurse's toolbox, as well as keep the nurse current with practice and philosophical ideas. Case histories, for instance, provide a way to examine different aspects of nursing theory with tangible, tactical solutions, as well as points for strategic discussion (Alligood, 2009, intro).

Overview of Benner's Theory

The following matrix provides a high-level overview of Benner's theoretical framework:

Theorist: Benner — Description: Five levels of capability: novice, advanced beginner, competent, proficient, and expert; four domains of nursing: client/person, health, environment, and nursing. — Change Situation: Change as the natural evolution of practice, gleaned through experience.

Benner's theory focuses on the nature of nursing practice and the way it evolves through chronology, technical improvement, and lifelong learning. For Benner, this process centers on the movement of base knowledge — that is, book learning — through experience in seeing medical situations as holistic, actionable, and patient-centered. Nursing becomes fluid, and much like the educational principles of Bloom's Taxonomy, it takes knowledge, builds upon it until there is unique analysis, and finally achieves synergism in practice. Using her theoretical approach, one can move more quickly through the stages by understanding the needs and concerns of the patient through divergent ideas and beliefs (Altman, 2007).

The Five Stages of Nursing Development

Benner's theory focuses on the process of becoming — becoming a nurse clinically, becoming a caregiver, and becoming an expert in one's field. She based her theory on the Dreyfus model, which has five basic stages: novice, advanced beginner, competent, proficient, and expert. This is a sliding scale, and Benner believes there is a constant need for the evolution of growth and knowledge in order to become the best possible nurse. To advance between stages, nurses must use reflection not only to gain knowledge but to understand how best to utilize that knowledge (Benner, 2009, p. 77). The stages may be conceptualized as follows:

Novice: A basic beginner with no experience who needs to learn general rules that are context-free, with limited flexibility and judgment. This stage can be characterized as "Tell me and I will do it" — the nurse needs to learn and adapt as quickly as possible.

Advanced Beginner: Demonstrates performance and acumen; gains some experience and brings prior knowledge to bear; begins to formulate how theory can translate into action. This stage involves several "aha" moments in which clinical knowledge moves into actionable offerings.

Competent: Two to three years of on-the-job experience; more aware of the big picture and long-term goals; develops perspective and abstract thinking. The nurse begins to take on the core competencies of leadership and the development of both staff and self.

Proficient: Perceives and understands situations as a whole; employs holistic decision-making; able to adapt and modify in response to changing situations. Reflects a calmer, more synergistic approach to the field, and a greater ability to combine interpersonal, carative, and clinical paradigms.

Expert: No longer relies on principles, rules, or guidelines to act; possesses clinical and personal expertise; demonstrates an intuitive grasp of situations; performance is fluid, flexible, and expert (From Novice, 2011). Continually evolving by using evidence-based and best-practice techniques, networking, pursuing further education, and engaging in growth and continual development.

The Competent Stage and Clinical Judgment

The competent stage is the most pivotal in clinical learning because the nurse must recognize patterns and determine how to filter them. The nurse devises new rules and reasoning procedures to create a plan that accounts for quantitative clinical rules while also incorporating the qualitative and holistic individualities of the patient into the paradigm for care. The goal is to become a clear thinker — to manage emotions as needed without allowing them to dominate the situation. At the same time, a caring paradigm must be maintained, because it enables the modern nurse to both give and receive help effectively.

Benner's theory reflects a movement from a situation in which a nurse seeks direction to one in which the nurse helps provide answers. This is particularly relevant to her belief that change management in modern healthcare is one of the more important aspects of practice for all stakeholders. Medical care engenders rapidly changing situations, priorities, and needs. Experience works through these changes by continually assessing the situation and drawing on the nurse's full toolkit to provide solutions. Benner's model also requires that the patient change: that change involves accepting some responsibility for one's health condition — not as a matter of blame, but as a way of respecting one's own body, avoiding harmful behaviors, and acting in ways that promote rather than undermine carative principles (Benner et al., eds., 2009).

The reason Benner's model is important when discussing other nursing theories lies in its seminal nature as a framework for generalized care and its widespread use in actual practice. Three major templates exemplify this: (1) nursing is required because of the individual's inability to perform self-care in many medical situations; (2) as adults mature, they deliberately learn and master actions that help direct their survival, quality of life, and well-being; and (3) the product of nursing systems should be the nurse's advocacy in helping people meet their self-care requirements and avoid unnecessary dependency on others (Altman, 2007).

Conclusion: Clinical Judgment and Care

Movement between skill levels reflects the changes the individual makes across three basic aspects of performance: (1) from reliance on abstraction to using concrete experience; (2) a perceivable change in the learner's perception of situations, from fragmented to holistic; and (3) the movement from a detached observer to an involved professional. Together, these shifts define the trajectory of clinical judgment and care that lies at the heart of Benner's enduring contribution to nursing theory.

References

From Novice to Expert. (September 16, 2011). Nursing Theories. Retrieved from: http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html

Alligood, M. and A. Tomey. (2005). Nursing Theory: Utilization & Application. Denver, CO: Mosby.

Altman, T. (2007). An evaluation of the seminal work of Patricia Benner. Content Management Group — Contemporary Nursing, 25(2): 114–23.

Benner, P., et al., eds. (2009). Expertise in Nursing Practice. New York: Springer.

Benner, P., Wrubel, J. (1982). Skilled clinical knowledge: The value of perceptual awareness. Journal of Nursing Administration, 12(5): 11–14.

Mariano, C. (2005). An overview of holistic nursing. NSNA Imprints. Retrieved from:

McNiesh, S. (2007). Demonstrating holistic clinical judgment. Holistic Nursing Practice, March/April 2007, pp. 68–78.