Our Lady of Fatima Uiversity- Cabanatuan City

College of Nursing

PATRICIA BENNER
Novice-Expert Model

RAINIEL L. DIAZ
Patricia Benner, RN, PhD,
FAAN, FRCN
Benner : As Author
Dr. Benner is the author of books including:
1.From Novice to Expert
2. The Primacy of Caring
3.Interpretive Phenomenology: Embodiment,
Caring and Ethics in Health and Illness
4. The Crisis of Care
5.Expertise in Nursing Practice: Caring,
Clinical Judgment, and Ethics
6. Caregiving
7. Clinical Wisdom and Interventions in
Critical Care: A Thinking-In-Action Approach.
 Is an internationally noted researcher and lecturer
on health, stress and coping, skill acquisition and
ethics.

 Recently elected an honorary fellow of the Royal

College of Nursing.

 Staff nurse in the areas of medical-surgical,

emergency room, coronary care, intensive care
units and home care.

 Currently, her research includes the study of

nursing practice in intensive care units and
nursing ethics.
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.
 There is difficulty discerning between
relevant and irrelevant aspects of the
situation.
 Beginner to profession or nurse
changing area of practice (Frisch,
2009)
 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
 The advance beginner stage in the Dreyfus
model develops when 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.
 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.
 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.
 The expert nurse, with an enormous
background of experience, now has an
intuitive grasp of each situation and
zeroes in on the accurate region of the
problem without wasteful consideration
of a large range of unfruitful, alternative
diagnoses and solutions.
 The expert operates from a deep understanding
of the total situation.
Benner’s Original Research
Goal:
– Compare Novice & Expert Nurse’s 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 Benner’ s
Goal:
Theory
– 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 Benner’ s Theory
Nursing applies Benner’s 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)
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.
Modern Theorists
Benner is a relatively
modern theorist, with her
work having been done
in the early 1980’s.
Since that time health
care has seen the
advent of DRG’s,
managed care, an
increase in the acuity of
patients in the hospital
related to early
discharge and bounce
back admissions.
 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.
The mediocre teacher tells. The good
teacher explains. The superior teacher
demonstrates. The great teacher inspires.
- William Arthur
Ward