PATRICIA BENNER

Stages of Nursing
Expertise:
Novice-Expert
Model
Irene N. Lopez, RN, MN
Patricia Benner, RN, PhD,
FAAN, FRCN
An Influential Nurse in the Development of the
Profession of Nursing

Patricia Benner’s research

and theory work provides
the profession of nursing
with what we now know as
the Novice to Expert
model, also known as
Benner’s Stages of
Clinical Competence.
Benner’s work as applied to
the nursing profession is
adapted from the Dreyfus
Model of Skill Acquisition.
Skill Acquisition

“The utility of the concept of skill

acquisition lies in helping the
teacher understand how to assist
the learner in advancing to the
next level” (McClure, 2005)
The Dreyfus Model of Skill
Acquisition
 Dr. Benner categorized nursing into 5 levels
of capabilities: novice, advanced beginner,
competent, proficient, and expert.
 She 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.
 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.
 Novice
 The person has no background
experience of the situation in which
he or she is involved.
 Learns about practice out of contexts
through lectures and books.
 Guided by rules
 Actions limited and inflexible
 Generally this level applies to nursing
students.
 Novice

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.
Advanced Beginner

 Nurses functioning at this level are guided by

rules and oriented by task completion.
 Has experienced sufficient real nursing
situations.
 Still requires mentor or experienced nurse to
assist with defining situations, to set priorities,
and to integrate practical knowledge (English,
1993)
 Competent
 After two to three years in the same area of nursing
the nurse moves into the Competent Stage of skill
acquisition.
 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 nurse devises new
rules and reasoning procedures
for a plan while applying learned
rules for action on the basis of the
relevant facts of that situation.
 Competent

 Consciously aware of actions as long term goals

 Feeling mastery within the situations
 Lacks speed and flexibility
 Engages in conscious deliberate planning to elicit
actions
 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
decision-making skills have developed” (Frisch, 2009)

 The performer perceives the information as a whole (total

picture) rather than in terms of aspects and performance.

 Proficient level is a qualitative leap beyond the competent.

 Nurses at this level demonstrate a new ability to see changing

relevance in a
situation including the
recognition and the
implementation of
skilled responses to the
situation as is it evolves.
 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 expert performer no longer relies on an analytic principle
(rule, guideline, maxim) to connect her or his understanding of
the situation to an appropriate action.
 Automatically focuses on the problem
 Performance is fluent and flexible

 The expert operates from a deep understanding

of the total situation.
Four Domains of Nursing
Paradigm

1. Client/Person
2. Health
3. Environment/Situation
4. Nursing
 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.”
- Dr. Benner
 Health
 Dr. Benner focuses on the lived experience
of being healthy and being ill.
 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.
Environment/Situation
 Benner uses situation rather than environment
because situation conveys a social environment
with social definition .

 “To be situated implies that

one has a past, present, and
future and that all of these
aspects… influence the
current situation.”
- Dr. Benner
 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.”
 Nursing is viewed as a caring practice whose
science is guided by the moral art and ethics of care
and responsibility.
 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.
 Hospital Survival
Her theory of expert nurses is
critical today as the profession
begins to realize the aging of
the members of its workforce
and the increasing age of the
population who will require
more nursing services. Her
theory is applicable today, as it
was at its publication, and
provides us with a foundation
to use for assigning clinical
competence, a tool to use to
assess competence in the staff
nurse.
What can Nurse Leaders do?
Nurse leaders can help address
the issues of nursing shortage and
staff retention by supporting new graduate nurses by:
•Advocating for transition or residency programs to
competency, confidence & satisfaction of new RNs
•Maintaining a healthy working environment
 Not using novice RNs to cover for staffing shortage
before the end of orientation period
 Zero tolerance for lateral violence or bullying
•Supporting experienced RNs who are serving as
preceptors and mentors for novice RNs
Shaping our Future Nurse
Leaders
• New graduate nurses are the future employee
pool
• Job satisfaction & retention are greatly influenced
by the quality of orientation and support received
by the new graduate nurse.
• A positive experience will encourage the now
proficient nurse to mentor novice nurses & give
them the same positive experience he/she had
during the transition period.
T h e m e d i o c re t e a c h e r tells. T h e g o o d
teacher explains. The superior teacher
d e m o n s t r a t e s . T h e g r e a t t e a c h e r i n s p i re s .
- William Arthur
Ward
Shaping our Future Nurse
Leaders
• New graduate nurses are the future employee
pool
• Job satisfaction & retention are greatly influenced
by the quality of orientation and support received
by the new graduate nurse.
• A positive experience will encourage the now
proficient nurse to mentor novice nurses & give
them the same positive experience he/she had
during the transition period.
T h e m e d i o c re t e a c h e r tells. T h e g o o d
teacher explains. The superior teacher
d e m o n s t r a t e s . T h e g r e a t t e a c h e r i n s p i re s .
- William Arthur
Ward