RUNNING HEAD: CRITIQUE OF BENNER’S NOVICE TO EXPERT
Critique of Benner’s From Novice to Expert
Joshua C. Lincoln
Ferris State University
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Abstract
This paper is a critique of Patricia Benner’s From Novice to Expert theory using middle range
theory analysis and an exploration of how the theory was generated and how it has been used in
the clinical and educational setting. This paper also examines some inadequacies with Benner’s
theories as they pertain to strict scientific constructivism.
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Critique of Benner’s From Novice to Expert
This paper is a critique of Benner’s (1982) theory of skill acquisition From Novice to
Expert. Benner’s model has been widely used, but this critique will determine if her theory
withstands both external and internal criticism. Methods of scientific validity and reliability
must be applied to Benner’s theory to ensure it meets the criteria for mid-range nursing theory.
Mid-range theories allow theorists to be presented with a reliable result, but also engender
further testing to ensure its reliability. As a result, mid-range theories can be further delineated
into micro theory to explain very specific phenomenon (Walker & Avant, 2011). Theory acts as
the guiding principle of research (Peterson & Bredow, 2009). A scientific theory has to be
formed from a hypothesis and be tested before it can become a theory. It then must be retested
and refined before it can become valid. In nursing, practice begets theory, but theory begets
valid research. Once validity is ensured, practice is then modified and the cycle continues. This
paper will analyze if Patricia Benner’s theory “From Novice to Expert” (1982) meets the
guidelines for mid-range theory using analysis guidelines from Peterson & Bredow (2009) and
Chin and Kramer (2011). It will also describe some research that has been generated from her
theory and how it can be applied to the nursing education arena.
Benner’s model is based on the Dreyfus Model of Skill Acquisition (1980), and applied
by Benner in a general manner to nursing practice. The Dreyfus model, and subsequently
Benner’s model, postulates that professionals “pass through five levels of proficiency: novice,
advanced beginner, competent, proficient and expert” (Benner, 1982, p. 402). The Dreyfus
Model (1980) was developed as a model to explain how students learn. It was primarily focused
on learning acquisition of chess players, airline pilots, automobile drivers and adult learners of a
second language. There was a strong need to understand how students advance beyond the
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stages of analysis and reaction based on rules to an advance and intuitive understanding of
materials and situations. Benner applied this model to nursing because prior to her application
there was little description of nursing as a progressive profession. For a more linear description
of Benner’s 5 steps of skill acquisition (see Appendix). Benner tested her theory based on
interviews with graduate nurses, senior nursing students and experienced nursing clinicians
(Benner, 1982)
Theory
Novice
A further break down of the levels finds that a novice, as defined by Benner, merely
observes patient signs and symptoms that can be analyzed without concurrent situational
awareness. “Common attributes accessible to the novice include weight, intake and output,
temperature, blood pressure, pulse and other such objectifiable [sic], measurable parameters of
the patient’s condition” (Benner, 1982, p. 403). Novices lack the ability for discretionary
judgment due to their lack of experience within a given situation. At this nurses are operating
under grand theory but are generally not aware of the processes in which they are operating.
They are simply following overarching ideals based on what they have been told.
Advanced Beginner
The next level, advanced beginner “is one who can demonstrate marginally acceptable
performance. According to English, (1993) this level should be attained after a foundational
program. This is discongruent as the foundation should be laid in nursing school which is
contradictory to Benner’s theory. It does however bring up a question about whether or not a
“novice” is considered to be a nursing student versus a graduate nurse. Benner suggests that
novice nurses are graduates, thus they should attain the advance beginner level after an
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orientation to the floor. This means that at the advance beginner level the nurse has begun to feel
more comfortable with institutional guidelines, but is also using prior situations to guide practice.
The advanced beginner is starting to see beyond the constrictions of simplistic measurable
parameters and begins to perceive nursing more as a process than a task. This idea is wonderful
albeit incomplete, as it does not account for the clinical situations the novice was exposed to and
the inherent abilities they have. Benner is not clear on her assumptions about who should teach
the novice to recognize situations that would propel them to advanced beginner. The advanced
beginner can now see more of the mid-range theory application, but is still basing, without being
aware, most decisions on grand theoretical concepts. For example, an advanced beginner may
start to see the similarities of a current patient to one they have previously treated.
Competent
A competent nurse as defined by Benner is one who has been a nurse for 2-3 years and is
starting be become more self actualized and less constrained by institutional guidelines (Benner,
1982). For example, the nurse may be more aware of long term goals and base care on more
intuitive and evidence based practice and less on task oriented machinations. The competent
nurse can see how the use of situational analysis along with abstract thinking can improve care
and organize time. The competent nurse is aware of the nursing process, and operating under
mid-range theory, usually without being aware of it.
Proficient
The proficient nurse is able to be more situationally aware and focuses on the patient as a
whole using a more holistic view of medicine (Benner, 1982; Benner, 1985; Benner, 2010). This
allows the nurse to modify care based on experience and make decisions based on his or her
analytical processes and abstract abilities. This person has usually been a nurse for 4-5 years. At
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this level the nurse is using mid-range theories and also may be choosing which theoretical
constructs to follow.
Expert
The expert operates with high efficiency and thinks in theoretical abstractions that are not
guided by general nursing principles. This allows the expert to become a theorist in practice, and
be aware of phenomenon that may increase nursing knowledge and theoretical abstractions. The
expert nurse is learning by seeing the entire process of not only the patient but of the situation.
The expert nurse no longer thinks in the minutia of the novice or even the competent nurse. This
is the level that Benner believes should be achieved in approximately 5 years of practice. The
expert nurse is now back to using grand theories, however, these are probably constructs of their
own. Whether published or not, the expert nurse is thinking on theoretical planes.
Benner’s reason for developing this theory was to try to explain how a nurse achieves the
level of expert and how that process is developed. She makes it quite clear that her theory is a
beginning of understanding and not a constructivist analysis that is wholly quantifiable. Rather it
is a guideline to help nurses, nursing students and nurse educators give nurses the tools and
guidelines necessary to achieve the expert role.
Analysis as Mid-Range theory
It behooves nursing theorists to ensure theories they are using to further define clinical or
educational practice use commonly accepted modalities to analyze whether a theory meets
scientifically acceptable criterion. The categories for analysis suggested by Peterson & Bredow
(2009), used are Internal Criticism under which are the sub categories adequacy, clarity
consistency, logical development and level of theory development. Also being used is External
Criticism under which are the sub categories complexity, discrimination, reality convergence,
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pragmatic, scope, significance and utility. Within the process of the Peterson & Bredow (2009)
analysis the elaborative questions asked by Chinn & Kramer (2011), will be integrated. Chinn &
Kramer (2011), questions are: is this theory clear; is this theory simple, is this theory general; is
this theory accessible and is this theory important?
Internal Criticism
Adequacy
Benner’s 1982 theory accounts for the subject it is intending in that it recognizes the valid
application of The Dreyfus Model to nursing practice. It does not however completely explain
how a nurse will obtain each level of expertise. This is clearly delineated by English (1993), in
that Benner’s lack of explanation of the expert role does not meet the scientific constructivist
approach that is testable with limitation of independent variability.
Clarity
Benner is quite clear in her description of the application of the steps from transitioning
from a novice to an expert, but what is unclear is how the independent variables are accounted
for, which again leaves her theory open to criticism in the constructivist model. Chinn and
Kramer (2011), suggest that a theory must be clear not only to the reader, but clear in its use of
semantics. English (1993), writes “According to this model it is unclear at what stage one
becomes an expert, and if there are better experts than others, i.e. are there stages of expertise or
is expert a unique and final state”(p. 389)? This is an important question because it is not simply
a matter of semantics. Benner is attempting to delineate what an expert by using peers to
determine expertise. This could be interpreted as self serving, but it is at the very least nonmethodological.
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Consistency
This is where English’s (1993) critique of Benner is appropriate in that Benner does not
clearly define the concept of expert. In her use of language to describe nursing expertise, Benner
fails to delineate what exactly a nurse must do to achieve the next level in the model, therefore
consistency within the model is unclear. However, this may not have been the intent of Benner’s
initial theory. She has further defined these roles in later works, but as to her initial attempt
English (1993) has a valid argument.
Logical Development
This is a difficult part of analyzing any theory is that it asks the critic to make
assumptions about assumptions. Peterson & Bredow (2009), ask that in order to meet the
criterion of logical development, that the theory being analyzed is based on something that has
been proven. This of course is actually impossible as scientific proofs must be deemed scientific
law to be considered “proven”. In this case, Benner based her theory on the Dreyfus Model,
which is simply a quantification of how people transition from novices to experts. One must ask
how in a clinical setting with the variables of experience, intelligence, confidence, workplace
variability and educational background, that Benner can even attempt to quantify and qualify
what it means to be an expert (English, 1993).
Level of Theory Development
Benner’s theory is unique in that it operates at both the grand and mid-range theoretical
levels. This, in no way, invalidates the operational significance of it being a mid-range theory,
but it does demonstrate that the theory is in need of refinement. It seems inverted wherein the
novice is operating under strict institutional guidelines using grand theoretical models based on
patient safety and evidence based practice, but as they progress through the levels of cognitive
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advancement there is a transition to mid-range theory. However, when a nurse reaches the
expert level it seems clear that there is a transition back to grand theory wherein the overarching
philosophy is related to principles applicable for more theory generation.
External Criticism
Complexity/Simplicity
Benner’s theory is quite simple on the surface as it delineates a timeline and learning
curve necessary for a nurse to progress; however, it lacks the constructivist approach and
structure needed to limit independent variables. Benner uses lengthy descriptions of the expert
that do not actually explain what is needed to attain levels of expertise and is wholly incomplete
in its qualifications as (in not limiting independent variables) she does not address how one can
apply her theories to all of nursing education and clinical advancement (English, 1993). Using
Chinn and Kramer (2011), this theory is simple in that the relationships between the concepts are
fairly linear (see Appendix). What is unclear is exactly how every nurse can achieve level
advancement.
Discrimination
Benner’s theory is very discriminatory in that it allows for further exploration of the
questions of how nurse’s transition from a novice nurse to an expert nurse, but her initial work is
simply a restatement of the Dreyfus Model without much clarification of how it is unique to
nursing. However, this has led to a myriad of further clarifications and research to apply her
work to nursing education in both the clinical and academic arenas.
Reality Convergence/Generality
This is where Benner’s theory shines in that it avoids the traditional constructivist
approach in its attempts to explain real world nursing. English (1993), asks how Benner’s theory
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can be accepted without a thorough description of what it means to be an expert. English is
missing the point of the paper. According to Darbyshire (1993), it is easy to understand why a
Western scientist would frown upon Benner’s theory as it is not as easily measurable and
quantifiable. This view however misses the point of Benner’s theory as a beneficial, alternative
method for understanding how a novice in a profession can become and expert. English (1993),
completely missed the point Benner was attempting in that a quantification of what is needed to
become an expert is not possible through tradition trial and error scientific testing. Analysis
using Chinn and Kramer (2011), asks if a theory is general or specific. It is clear that Benner
was not trying to be specific in how a nurse attains new levels of expertise, rather that becoming
an expert is a sum total of experiences and intuition that cannot be quantified, but can be
achieved if students and novices are given the tools and framework to excel.
Pragmatic/Accessibility
It is clear that testing Benner’s theory is difficult in the strict constructivist view, but to
test it one simply needs to observe novice advancement to the expert level. A clear definition of
what it means to be expert is not needed. The determination of an expert is not clearly
quantifiable; however, it is a state of mind that supersedes that of the average practitioner into
the theoretical constructs wherein nursing theory and evidence based practice are derived. Chinn
and Kramer, (2011) would suggest that, to define the undefinable is to invalidate expertise in any
form. “Only selected dimensions of highly abstract concepts may be empirically accessible. If
the concepts of a theory do not reflect empirical [constructivist] dimensions, they cannot be
explored or understood empirically” (Chinn & Kramer, 2011, p. 203). This does not make
Benner’s theory inaccessible. One cannot learn what it is to love by reading Shakespeare or by
defining it, but a person knows love when he/she feels it and sees it. This does not make being
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an expert an ethereal and esoteric ideal as English (1993) suggests, rather it is an attempt to
provide a framework for nursing education in clinical and academia. Benner not being able to
clearly define what it is to be an expert does not invalidate it as mid-range theory.
Significance/Importance
Benner’s theory has been highly significant based on the volume of work that has been
generated by it. This attempt to qualify nursing excellence has led to changes in both clinical
and didactic education. Even if one totally disagrees with Benner’s approach, it has at least
provided a tool set for educators to rethink how they teach. Based on analytical guidelines
provided by Chinn and Kramer (2011), the importance of this theory is astounding. The basic
assumptions about how people learn are based on highly accepted social learning theories
wherein “skills are communicated by example and are highly relevant to nursing” (English,
1993, p. 388).
Utility
In its infancy, Benner’s theory has generated many years of criticism and applause.
Many nursing researchers have based their theories on Benner’s ideas. This will be delineated in
the following section of this paper.
Application to Specialty Role
Many nursing schools have applied Benner’s theory to their curricula (Darbyshire, 1993).
In preparing graduate nurses, nursing schools have taken the approach of helping nurse educators
apply the general guidelines of what will give graduates the critical skills and cognition to be
able to excel in clinical practice. Benner has facilitated nursing education programs to “provide
a paradigm that assists nurse educators and students to see clinical practice as a developmental
process” (Carlson, Crawford & Contrades, 1989, p. 188). This assertion was made 22 years ago
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and it certainly still applies today. Benner’s theory in application has allowed expert nursing
practice to seem an attainable goal for the beginner as they understand that it is not simply time,
but exposer that will aid them in becoming experts.
Nursing is always changing and thus nursing education must change with it. It is the
obligation of all nursing educators to prepare student nurses for an uncertain future and it is
difficult (Thorne, 2006). This is where Benner’s theory is so advantageous, because regardless
of the changes in nursing practice, recognizing the novice to expert approach will ensure that
with the proper tools, a graduate nurse can and will become an expert. Benner, Sutphen,
Leonard and Day (2010) have called for a radical transformation in how nurses are educated and
much of this change is directly related to Benner’s original ideas of how nurses progress from
novice to expert. The use of clinical simulation and flow charts over care plans can be attributed
to research done using Benner’s assertions (Benner et al., 2010)
Detractors of Benner have called her demonstration of the expert role as being outside the
cognitivist construction which does not qualify it as a scientific theory but an esoteric and nonmethodological construction (English, 1993). As written earlier, there is some legitimacy in this
view as it is clearly difficult to define the role of expert using the scientific constructivist
viewpoint. Constructivist beliefs are derived from psychology and “view that there must be a
rational and often rule-governed explanation for skilled human behavior (Darbyshire, 1993).
Benner’s “research revealed the knowledge that is embedded in actual nursing practiced accrued
over time” (Carlson et al., 1989, p. 188), This clearly is a qualification that there is a
progression that changes in nurses cognitive and intuitive understanding through the years of
their practice.
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English (1993), suggests that Benner is being disingenuous and insulting to nurses by not
using a constructivist approach in the definitions of role attainment among nurses. Again
English is missing the main point that the transition from one level to the next is based on past
experience, situational awareness and the ability to apply critical thinking with clinical skills.
Benner makes some assumptions about nurses working from and intuitive framework, however
this intuition is not clearly defined nor testable (English, 1993). “As the expert nurse is held in
the Benner model to be a paragon of excellence, and someone to be emulated” (English, 1993, p.
392) it does require that to become an expert one must attain expertise. Yet Benner assumes that
a nurse gains expertise based on time and experience. This fails to account for individuality and
institutional experience, thus is not clearly testable. However it is clearly the opposite of the
intention of Benner’s theory. Benner’s theory helps nurses and nurse educators form a
framework for achieving the goal of becoming and expert.
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References
Benner, P. ((1982) From novice to expert. American Journal of Nursing, March, 402-407
Benner, P. (1985) From Novice to Expert, Excellence and Power in Clinical Nursing Practice.
Addison-Wesley, Menlo Park, California
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010) Educating Nurses: A Call for Radical
Transformation. San Francisco, CA: Jossey-Bass
Carlson, L., Crawford, N., & Contrades, S., (1989) Nursing student novice to expert-Benner’s
research applied to education. Journal of Nursing Education. 28(4) 188-190.
Chinn, P. & Kramer, M. (2011) Integrated Theory and Knowledge Development in Nursing. (8th
ed.). St. Louis, MO. Mosby.
Darbyshire, P., (1994). Skilled expert practice: is it ‘all in the mind;? A response to English’s
critique of Benner’s novice to expert model. Journal of Advanced Nursing, 19, 755-761.
Dreyfus, H.L. & Dreyfus S. (1980) A five stage model of the mental activities involved in
directed skill acquisition. Unpublished study, University of California, Berkeley.
English, I. (1993). Intuition as a function of the expert nurse: a critique of Benner’s novice to
expert model. Journal of Advanced Nursing. 18, 387-393.
Peterson, S., & Bredow, T. (2009) Middle range theories: Application to nursing research (2nd
Edition). Philadelphia: Lippincott, Williams, & Wilkins.
Thorne, S. (2006). Nursing education: Key issues for the 21st century. University of British
Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T
2B5
Walker, L., & Avant, K. (2011). Strategies for theory construction in nursing (5th ed.). Pearson:
Upper Saddle River, NJ
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Appendix
NOVICE
Operating under
Grand Theory
Taught general tasks to
perform
Rules are: context-free,
independent of specific
cases, and applied
universally
Rule-governed behavior
is limited and inflexible.
Ex: Tell me what to do
Advanced Beginner
Some Grand and midrange awareness
Demonstrates acceptable
performance
Has gained prior
experience in actual
situations
Principles, based on
experiences, begin to be
formulated to guide actions
Ex: I have seen this before
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Competent:
More use of individual
mid-range theory
2-3 years of
experience in a similar
or same clinical area
More aware of long
term goals in career
and practice.
Actions are based on
conscious, abstract, and
analytical thinking.
Ex: what if this happens?
Proficient
Mid-range and microtheoretical levels
Perceives and
understands situations as
whole parts
More holistic
understanding improves
decision-making
Learns from experiences
what to expect in certain
situations and how to modify
plans.
Ex: very adaptable to change
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Expert
Grand theoretical
constructs based on
personal expertise
No longer relies on
principles, rules, or
guidelines to connect
situations and determine
actions
Much more background
of experience
Has intuitive grasp of
clinical situations
Performance is now fluid,
flexible, and highly-proficient
.Ex: Sees need for theory and
research on observed
phenomenon