BENNER’S STAGES OF NURSING EXPERTISE

I. Getting to know the theorist

Patricia Benner
- (she was born in Hampton, Virginia, and spent her childhood in California, where she
received her early and professional education)
- she has a rich background in nursing (this included working as a Head nurse and an
Intensive care staff nurse)
- known as a nursing theorist and author (she published nine books including from novice to
expert, nursing pathways for patient safety, and the primary of caring)
- along with his husband, they consult around the world regarding clinical practice
developmental models (CPDMs)
II. Theoretical sources of the Theory
- derived from the Dreyfus Model of Skill Acquisition ---- (another model of how learners
acquire skills through formal instruction and practicing)
- to provide a more objective way for evaluating progress of nursing skills and subjects
(Dale, et al; 2013) ---- (Dr.Benner adapted the model to provide a more objective way for
evaluating progress of nursing skills and subjects) (Dr. Benner’s theory is not focuses on
how to be a nurse, rather on how nurses acquire nursing knowledge – one could gain
knowledge and skills without ever learning the theory, while the Dreyfus model is a
model based on observations)
- her research was aimed at discovering if there were distinguishable, characteristic
differences in the novice’s and expert’s descriptions of the same clinical incident (it aims
to seek if there’s such commonalities or differences in the levels of nursing expertise)
III. Major concepts and definitions
- The model essentially discusses how an individual begins in the novice stage and as new
skills and knowledge are gained, progresses through a number of stages to end in the
expert realm. ---- (Patricia Benner’s research and theory work provides the profession of
nursing of how a novice individual becomes an expert after developing his/her skills and
had an understanding of patient care over time from a combination of a strong
educational foundation and personal experiences)
- Dr. Benner believed experience in the clinical setting is key to nursing ---- (because it
allows a nurse to continuously expand their knowledge base and to provide holistic,
competent care to the patient)
- Dr. Benner categorized nursing into 5 levels of capabilities
a. Novice
- The person has no background experience of the situation in which he/she is
involved ---- (which means the person has no previous experiences with the
situation at hand, since the novice has no previous experience, there is an
inability to use discretionary judgement or the right to decide something based on
one’s own judgement)
 - There is difficulty discerning between relevant and irrelevant aspects of the
situation ---- (unlike attributes and features, aspects cannot be objectified
completely because they require experience based on recognition in the context of
the situation)
- Generally, this level applies to students of nursing ---- (but Benner has suggested
that nurses at higher levels of skill in one area of practice could be classified at
the novice level if placed in an area or situation unfamiliar to them) (these
inexperienced nurses function at the level of instruction from nursing school.
They are unable to make the leap from the classroom lecture to individual
patients. Often, they apply rules learned in nursing school to all patients and are
unable to discern individual patient needs. These nurses are usually new
graduates, or those nurses who return to the workplace after a long absence and
are re-educated in refresher programs)
- Also struggles to decide which tasks are most relevant to accomplish since there
are no concrete rules to regulate task performance or relevance in real-life
situations (Benner, 1982) ---- (Context-free rules and objective attributes must be
given to guide performance)
- They are taught general rules to help perform tasks, and their rule-governed
behavior is limited and inflexible (They are told what to do and simply follow
instructions)
b. Advanced Beginner
- An advanced beginner nurse leader had some experience, but may need the
influence and guidance of a mentor (The advanced beginner needs assistance and
support in the clinical area by setting priorities to ensure that important patient
need do not go unattended according to Benner (1982)).
- Benner (1982) describes them as an individual who has been involved in enough
real-world situations that the recurrent component is easily identified (the person
can demonstrate marginally acceptable performance having coped with enough
real situations to note or to have pointed out by mentor, the recurring meaningful
components of the situation)
- Nurses functioning at this level are guided by rules and oriented by task
completion (the main problem in this level is that, although the individual may
have some clinical knowledge, the focus is on the rules and guidelines that have
been taught.)
c. Competent
- The competent nurse or nurse manager is able to prioritize tasks at hand by
utilizing past experiences (Benner (1982) describes the competent individual as
someone who has been on the job for two or three years and is able to see actions
in terms of goals or plans)
- The individual is able to work in an efficient and organized manner due to
conscious, deliberate planning (the competent stage of the Dreyfus model is
typified by considerable conscious and deliberate planning that determines which
 aspects of current and future situations are important and which can be ignored
(Benner, 1982))
- The competent stage is the most pivotal in clinical learning (because the learner
must begin to recognize patterns and determine which elements of the situation
warrant attention and which can be ignored)
- The competent leader is one who lacks the multi-tasking talents and flexibility (of
proficient leaders, but is able to consciously plan using abstract and analytic
principles that focus on long-term goals or plans)
d. Proficient
- The proficient nurse or administrator has a holistic understanding of the situation
at hand, which allows for a more improved decision-making process. (Now the
proficient nurse or administrator recognizes the most salient aspects and has an
intuitive grasp of the situation based on background understanding)
- The individual’s performance is guided by maxims (due to seeing a situation its
entirety (Benner, 1982)) ((Benner, 1982) describes maxims as pieces of evidence
that can provide direction to what is important in the situation)
- Nurses at this level demonstrate a new ability to see changing relevance in a
situation (it includes the recognition and the implementation of skilled responses
to the situation as is it evolves)
e. Expert
- The expert performer no longer relies on analytical principle to connect his or her
understanding of the situation to an appropriate action (Benner, 1982) (analytical
principle is the rule, guideline, or maxim) (rules, guidelines, and maxims are no
longer relied upon because the individual is able to grasp the situation and
understand what needs to be accomplished at this point, like being able to identify
the region of the problem without losing time considering a range of alternative
diagnoses and solution)
- The expert operates from a deep understanding of the total situation
- Focuses on the whole picture even when performing tasks
IV. MAJOR ASSUMPTIONS OF THE THEORY/ METAPARADIGM IN
NURSING
The Metaparadigm of Nursing according to Dr. Patricia Benner
1. Client/Person
- “The person is a self-interpreting being, that is the person does not come into the
world predefined but gets defined in the course of living a life” (a person doesn’t
enter the world advanced but rather it learns everything while living)
2. Health
- Health is defined as what can be assessed whereas well-being is the human
experience of health or wholeness
- Well-being and being ill are understood as distinct ways of being in the world
(Dr. Benner focuses on the lived experience of being healthy and being ill)
3. Environment/Situation
 - “To be situated implies that one has a past, present, and future and that all of these
aspects influence the current situation: -Dr. Benner
- Benner uses situation rather than environment (because situation conveys a social
environment with social definition)
4. Nursing
- Nursing is described as a caring relationship, an “enabling condition of
connection and concern” -Dr. Benner
- “Caring is primary because caring sets up the possibility of giving and receiving
help”
- Dr. Benner understands that nursing practice as the care and study of the lived
experience of health, illness, and disease and the relationships among the three
elements
V. THEORETICAL ASSERTION
- Benner (1984) stated that there’s always more to any situation than theory
predicts. The skilled practice of nursing exceeds the bounds of formal theory.
(Concrete experience facilitates learning about the exceptions and shades of
meaning in a situation) (The knowledge embedded in practice can lead to
discovering and interpreting theory; precedes and extends theory, and
synthesized and adapts theory in caring nursing practice).
- Clinical knowledge is embedded in perceptions rather than precepts. (perception
in medical terms the mental process of recognizing and interpreting an object
through one or more of the senses stimulated by a physical object and precepts in
another term is a teacher or mentor) (rather than precepts, clinical knowledge
can be also in experiences)
- Formal rules are limited and discretionary judgment is needed in actual clinical
situations (In genuine clinical situations, formal rules are limited, and
discretionary judgment is required)
- Clinical knowledge develops over time and each clinician develops a personal
repertoire of practice knowledge that can be shared in dialogue with other
clinicians (clinical knowledge evolves over time, and clinician builds a personal
library of practice knowledge that can be shared with other clinicians during
discussions)
- Perceptual awareness is central to good nursing judgment and begins with vague
hunches and global assessments that initially bypass critical analysis; conceptual
clarify follows more often than in precedes (Benner, 1984)” (good nursing
judgment begins with vague hunches and global evaluations that bypass critical
analysis at first; conceptual clarification follows more frequently than it
precedes)
- “Discovering assumptions, expectations, and sets can uncover an unexamined
area of practical knowledge that can then be systematically studied and extended
or refuted” –Benner, 1984 (discovering theories can open up another unknown
area of practical knowledge that can be studied or extended or refuted)
 - Expertise develops when the clinician tests and refines propositions, hypotheses,
and principle-based expectations in actual practice situations (Benner, 1984)
(expertise is gained when a therapist verifies and refines hypotheses, assertions,
and principle-based expectations in real-world settings)
- This model helps to develop skilled nursing practice through experience and
encounter variety of situations (exposure and experience in the clinical setting
helps the nurses develop and gain more knowledge as well as the skills in
providing efficient, competent and excellent care to the patient)
VI. USE OF EMPIRICAL EVIDENCE
1. Benner’s early worked focused on the anticipatory socialization of nurses. Benner and
Kramer (1972) studied the differences between nurses who worked in special care units
and those who worked in regular hospital units. (Benner conducted a systematic
evaluation of the competencies, the job finding, and the work-entry problems of new
graduate nurses.)
2. From 1978 to 1981, Benner was the author and project director of a federally funded
grant, Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation,
known as the AMICAE project. (This research led to the publication of Benner’s Stages
of Nursing Expertise and numerous articles, Benner directed the AMICAE project to
develop evaluation methods for participating schools of nursing and hospitals in the San
Francisco area. It was an interpretative, descriptive study that led to the use of Dreyfus’
five levels of competency to describe skill acquisition in clinical nursing practice. In
describing the interpretative approach, Benner explains that it seeks a rich description of
nursing practice from observation and narrative accounts of actual nursing practice to
provide the text for interpretation).
3. Nurses’ descriptions of patient care situations in which they made a positive difference
“present the uniqueness of nursing as a discipline and an art” – (Benner 1984) (More
than 1200 nurse participants completed questionnaires and interviews as part of the
AMICAE project. Paired interviews with preceptors and preceptees were “aimed at
discovering if there were distinguishable, characteristic differences in the novice’s and
expert’s descriptions of the same clinical incident”
4. “Describe characteristics of nurse performance at different stages of skill acquisition”
-Benner (1984) (Additional interviews and participant observations were conducted with
51 nurse-clinicians and other newly graduated nurses and senior nursing students.)
5. These levels reflect a movement from past, abstract concepts to past, concrete
experiences. (Each step builds from the previous one as these abstract principles are
expanded by experience, and the nurse gains clinical experience) (This theory has
changed the perception of what it means to be an expert nurse. The expert is no longer
the nurse with the highest paying job, but the nurse who provides the most exquisite
nursing care)
(The purpose of the inquiry has been to uncover meanings and knowledge embedded in
skilled practice. By bringing these meaning, skills, and knowledge into public discourse, new
knowledge and understandings are constituted according to Benner)
VII. ACCEPTANCE BY THE NURSING COMMUNITY
1. Benner’s model had a significant impact on practices throughout the healthcare realm.
(The model allows for skill acquisition and knowledge to be gained as an individual
progress through each stage. The model also discusses important teaching strategies for
each stage of the model)
a. skill acquisition
b. knowledge gained individually
c. teaching strategies
2. A study was released by Fennimore and Wolf (2011) from a hospital in Pittsburgh that
initiated a program to assist in the preparation and education for nurse managers and
administrators based on the novice to expert model by Dr. Patricia Benner
 The program included:
- Leadership texts, articles, lectures, self-assessment tools and homework
assignments (Managers identified through evaluations and feedback that they
appreciated tools given during the training which included identifying turnover
trends, conducting behavioral interviews, and completing team assessment which
identified work styles)
3. Titzer, Shirey, and Hauck (2014) released an article in which Benner’s novice to expert
model was described as an “effective framework for leadership developmental and
competency measurement, mentoring programs, advanced nursing practice skill
acquisition, and professional advancement ladder” (The study conducted by Titzer et al.
(2014) chose participants with management aspirations to attend a program that would
enrich management knowledge through workshops, mentoring, and group activities. The
study found that participants who completed the program had increased leadership and
management competencies at the end of the program and also demonstrated that
individuals who participated in the program had an increase in confidence with
assuming a leadership position after the program.)
VIII. ANALYSIS
a. Clarity
Benner is quite clear in her discussion of how to apply the phases from being a novice to
becoming an expert. (it gave a criteria on each level , for example in the novice level, it is
an individual who doesn’t have an experience, in the advanced beginner level, it has a
background but still needs the direction or instruction of a mentor, and so on and so
forth)
b. Simplicity
Benner’s idea appears straightforward, as it establishes a schedule and learning curve for
a nurse’s advancement. (Benner use lengthy expert descriptions that do not actually
describe what is required to achieve certain levels of knowledge, and his qualifications
are insufficient.) (Benner only provided the years of experience of an individual before
attaining the next level of expertise)
c. Generality
Benner’s theory stands out in this regard since it ignores the standard constructivist
approach in its attempts to explain real-world nursing. (Benner was clearly not
 attempting to be explicit in how a nurse achieves new levels of expertise, but rather that
becoming an expert is a sum total of experiences and intuition that cannot be quantifies,
but can be done if students and novices are given the tools and framework to flourish.)
d. Accessibility
One only needs to keep track of a novice’s progress to the expert level. (It is not
necessary to provide a clear description of what it means to be an expert)
e. Importance
Based on the amount of work it has generated, Benner’s idea has been extremely
influential (This effort to define nursing excellence has resulted in changes in clinical
and didactic nursing education. It has supplied educators with a set of tools to help them
reconsider their teaching methods).
IX. APPLICATION OF THE THEORY
1. Benner’s model has been used in the nursing profession to make innovative changes in
how knowledge is acquired and developed, continuing education’s rationale, and serve as
a foundation for how nurses build and improve skills based on acquiring experience
(going back to the theoretical assertion earlier, nursing can be learned through
experiences rather than precepts, so Benner’s model is applied to make innovative
changes, because nursing is learned through precepts, that’s why Dr. Benner wanted to
change this concept of learning in nursing)
2. The model is one of the most useful frameworks for assessing nurses’ needs at different
stages of professional growth (so, it is said that the model is used in assessing the nurses’
needs at different stages of professional growth)

References
Adiong, M. A. (2014). Retrieved from Patricia Benner (Novice to Expert Theory):
https://www.slideshare.net/xenna_85/patricia-benner-38508791

Andrea Davis. (2021). Patricia Benner: Novice to Expert – A Concept Whose Time Has Come. Retrieved
from https://www.nursingald.com/articles/16408-patricia-benner-novice-to-expert-a-concept-
whose-time-has-come-again

Patricia Benner's Novice to Expert. (2015). Retrieved from

http://psbennersnsgtheory.blogspot.com/2015/09/the-theoretical-assertions_29.html

Petipirin, A. (2020). Nursing Theory. Retrieved from https://nursing-theory.org/nursing-

theorists/Patricia-Benner.php