From Novice to Expert, Patricia Benner

By Lisa Nutt Jackie Savage Amy Scanlon

From Novice to ExpertTheory Development

Source of Theory Early 1980s University of California, Berkley, Benners qualitative research related to the Dreyfus & Dreyfus Five Stage Model of Mental Activities Skill Acquisition 1984 Benner publishes From Novice to Expert:

Excellence and Power in Clinical Nursing Practice

Theory defines skill levels in nursing and establishes best practices for nursing education (Frisch, 2009)

From Novice to ExpertTheory Development

Description of Theory- Five Stages of Skill Acquisition in Nursing Stage I- Novice Beginner to profession or nurse changing area of practice (Frisch, 2009) Explicit rule based knowledge and behavior (Altmann, 2007) Stage II- Advanced Beginner Nurse begins to incorporate real-life experiences in practice into knowledge base (Frisch, 2009) Still requires mentor or experienced nurse to assist with defining situations, to set priorities, and to integrate practical knowledge (English, 1993)

From Novice to ExpertDescription of Theory

Stage III-Competent
After two to three years in the same area of nursing the nurse moves into the Competent Stage of skill acquisition The nurse still relies on conscious planning, efficiency, and organization skills

Stage IV- Proficient

After three to five years in the same area of nursing the nurse moves into the Proficient Stage The nurse possesses a deep understanding of situations as they occur, less conscious planning is necessary, critical thinking and decisionmaking skills have developed (Frisch, 2009)

From Novice to ExpertDescription of Theory

Stage V- Expert
This stage occurs after five years or greater in the same area of nursing (experienced nurses changing areas of nursing practice may progress more quickly through the five stages) The nurse develops an intuitive grasp of situations and experiences The expert nurse operates from a deep, holistic understanding of the situation or experience (Frisch, 2009) According to Altmann (as cited in Carper, 1978) the expert incorporates the ways of knowing, empiric knowledge, moral/ethical knowledge, personal knowledge, and aesthetics into their practice of nursing

Benners Original Research

Goal:
Compare Novice & Expert Nurses descriptions and responses to the same clinical situations

Participants:
21 nurse preceptors & 21 new graduate nurses 51 experienced nurses 11 newly graduated nurses 5 senior nursing students

Collection of Research:
Interviews with narrative accounts of situations Observation of behaviors in clinical settings (Benner, 1984)

Nursing Education Incorporates Benners Theory

Goal:
Identify if simulating unstable patient scenarios by providing interactive teaching will transition nursing students to higher levels of expertise

Participants:
190 Adult Health Nursing Students

Collection of Research:
Observation of students in simulated patient rooms with manikins providing clues to clinical scenarios

Conclusion:
Development of nursing competency requires practice and clinical simulation provides a safe, structured learning experience (Larew, Lessans, Spunt, Foster, and Covington, 2006)

Nursing Application of Benners Theory

Nursing applies Benners Theory through:
Nursing school curriculum Building clinical ladders for nurses (Frisch, 2009) Developing mentorship programs
Preceptors for student nurses Mentors for newly graduated nurses (Dracup and Bryan- Brown, 2004)

Development of the Clinical Simulation Protocol (Larew et

al., 2006)