Patricia E. Benner
R.N., Ph.D., FAAN
By Courtney Madsen, Barb Lentz, Denise Lyon, Yvonne Robles, Dawn Kooiman, and Lynda Chase
Historical Evolution of Theory:
Novice to Expert
Born in Hampton, Virginia
Grew up in California
Degrees:
Baccalaureate~ Pasadena
College- 1964
Masters in Nursing~University
of California- 1970
PhD~ University of California1982
Published From Novice to Expert1984
Became a Fellow in the American
Academy of Nursing- 1985
Model as Framework for Patient
Assessment
Novice to Expert
The Novice: First Year of Education
No background experience
Instructor provides clear directions
Students are coached and need supervision
Advanced Beginner: New Graduate
Now have full legal and professional
responsibilities
Style of evaluation still lacks
Continues to rely on textbook s/s and may
have difficulties recognizing subtle variations
Model as Framework for Patient
Assessment Cont.
Competent Stage: 1 to 2 Years in Practice
Time for planning of the immediate future
related to learned information from past
experiences
A nurse can now forecast using planning and
analysis
More subtle s/s are now recognized
Model as Framework for Patient
Assessment Cont.
Proficiency:
A nurse now has an enhanced ability to read a
situation
Now open to correction an discomfirmation of
a situation
Responsiveness to changes and critical
thinking unfolds
Model as Framework for Patient
Assessment Cont.
Expertise:
Now attends primarily to actions rather than
assessment of signs and symptoms
The integrated rapid response is the
hallmark of expertise
More proficient in an emergent situation
Model used in Clinical Practice
Implement a staff development program
A clinical ladder evaluation tool
Novice: ICU nurse transferred to the OR, these
require very different nursing skills
Advanced Beginner: New graduate nurse on a
med-surg floor would require a much more in-depth
orientation than a nurse with previous experience
Competent: An OB nurse has the ability to care for
a patient on a labor and delivery unit, but if a more
difficult and serious situation arises a proficient or
expert OB nurse would need to step in
Model used in Clinical Practice
Cont.
Proficient: A cardiac rehab nurse recognizes
changes in the patients ECG monitor while the
patient exhibits exertion. The nurse immediately
implements her skills from knowledge and expertise
that appropriately prevent a worsening outcome
Expert: ICU nurse caring for a post open-heart
patient in which he or she is able to anticipate needs
from various tests and readings. This nurse also has
the ability to teach using a through explanation to
the patient and family.
An expert nurse exhibits leadership qualities
and is a good preceptor to new nurses
Model used in Clinical Practice
Cont.
Clinical Ladder Evaluation Tool: It can be used as
an advancement program for nurses. A clinical
ladder helps with retention of experienced nurses
“Clinical ladders recognize and reward nurses
for their clinical development and expertise,
while encouraging them to remain involved in
direct patient care activities”
As a nurse moves along the ladder, they need
to show proof of advancement in their practice
such as continuing education and leadership
qualities
Model within Nursing Education
The movement from novice to expert reflects
learning and shows changes in three aspects of
performance
Working paradigm shifts from reliance on
abstract principles to concrete past
experiences
Shifts from seeing situations as discreet
unrelated parts, to seeing situations as part of
a whole
Position shifts from detached observer to
involved performer
Studies show novice professionals tend to govern
their practice with rule-oriented behavior.
Interested in the Dreyfus model of skill acquisition
and applied it to nursing
Area of concern~ not how to do nursing, but rather,
“how do nurses learn to do nursing?”
Worked several years in intensive care, then
became a nurse researcher
Studied the nature of nursing practice and how
nurses gain expertise
Studied with Richard Lazarus who developed a
theory of stress and coping
Influenced by Heidegger, who stressed
phenomenological descriptions of people defined by
their concerns, practices, and life experiences
Metaparadigms
Person: A self interpreting being that becomes
defined in the course of living a life. A person is
embodied
Four major aspects of understanding
The situation
Their body
Their personal concerns
The fact that they are only temporary
When caring for the person, nurses tend to all
four aspects
Metaparadigms cont.
Situation (Environment): Situation conveys a social
interaction, interpretation, and understanding
Each situation is individual because their
meanings, habits, and perspectives influence the
situation
People will react differently in each situation
because of their own personal interpretation
(Alligood @ Tomey, 2010, p. 149)
Health: Two aspects include health and well-being
Health~ can be assessed at the physical level
Well-being~ human experience of health
Metaparadigms cont.
Nursing: Nursing is viewed as a caring
practice whose science is guided by the moral
and ethical standards of care and
responsibility
Current Research Status
Benner’s model serves as a map that directs
care, and is used as a tool in current nursing
practice
Her work is useful in that it frames nursing
practice in the context of what nursing actually is
and does
Many occupations have adapted this model to
benefit their employees and their customers
Benner’s call is to “increase public storytelling”
to validate nursing as an ethical caring practice,
Unique Concepts
The model is situational, based on skill level and
changes in performance
Performance is a function of a nurse’s familiarity
with certain situations
Performance level can only be determined by expert
judges and the outcomes of the situation
Clinicians at different levels of practice live in
different clinical worlds
Author & project director of Achieving Methods of
Intraprofessional Consensus, Assessment and
Evaluation
Unique Concepts Cont.
Benner’s explanation of nursing practice goes
beyond rules and theories – based on “reasonable
behavior that responds to the demands of a given
situation”
Incorporated Lazarus’s stress and coping theory –
used this key concept to describe clinical nursing
practice in terms of nurses making a positive
difference by being a part of the situation in a caring
way
Novice to Expert concept, shows that clinical
experience becomes knowledge and theory
Benner differentiated between practical and
theoretical knowledge
Strengths and Limitations
Continue to learn through experience
Experience becomes a prerequisite for becoming an expert
Lays ground work for the development of preceptors and
mentors
Preceptors help new nurses deal with the uncertainty of the
clinical setting
Not everyone fits into this model
You need to be able to classify in order for the theory to work
No room for advancement or no opportunity for a certification
in a specialty area
Analysis:
Benner proposes that one could gain knowledge
and skills (“knowing how”) whithout learning the
theory (“knowing that”) (Dracup, 2004)
Accomplished by defining 5 levels of development
The novice sees the patient as a list of tasks
An expert sees all of the pieces and makes a
whole
Insights:
This model can serve as a basis for
developing a mentorship program at facilities
to support new nurses as they enter the field
This is particularly important with the
magnitude of nurses that graduate each year
Due to the changes in healthcare and
advancements in technology more nurses will
be needed
Longevity is increasing everyday and now
healthcare will be available to more people in
the future
Understanding this model and the five levels
from Novice to Expert will assist nurses with
excelling in their careers
References
•
Acclaim Images, LLC. Nurse Clipart. Picurtes and photos. http://www.picturesof.net/search_term_pages/nurse.html
•
Alligood, M .R. & Tomey, A. M. (2010). Nursing Theorists and their Work. Maryland Heights, MO: Mosby, Elsevier (978-0-32305641-0)
•
Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407.
•
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park,
•
California: Addison-Wesley Publishing Company.
•
Benner, P., & Tanner, C. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87, 23-31.
•
Benner, P., Tanner, C., & Chesla, C. (1992). From beginner to expert: Gaining a differentiated clinical world in critical care nursing.
ANS Advances in Nursing Science, 14(3), 13-28.
•
Benner, P. (2004). Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in
Nursing Practice and Education. Bulletin of Science Technology Society. Vol. 24. No. 3 Pp. 188-199. Doi
10.1177/0270464604265061
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Brykczynski, Karen A (2010). Caring, Clinical Wisdom, and Ethics in Nursing Practice, A.M. Tomey, M.R. Alligood, Nursing
theorists and their work (7th ed., pp.137-164) Maryland Heights, MD: Mosby Elsevier
•
Dracup, K. and Bryan-Brown, C. (2004) From Novice to Expert to Mentor: Shaping the Future. American Journal of Critical Care,
13 (6), 448-450. Retrieved from http://ajcc.aacnjournals.org/cgi/content/full/13/6/448
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Haag-Heitman, B. (1999). Clinical practice development using novice to expert theory. Gaithersburg, MD: Aspen.
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Marshall, June (2006). Retain top nurses with a clinical ladder. HCPro’s Weekly Update on the ANCC Magnet Recognition
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