Benner's Novice to Expert Theory

This section reviews Benners theory of "Novice to Expert" as well as briefly discusses
competencies decided by the Board of Nurse Examiners and by Universities. Benner's
theory helps delineate competencies and realistic expectations of self and students.
Competencies help us clearly assess learning outcomes.
Patricia Benners Novice to Expert
Background
Benner's (1984) theory, based on the work of Dreyfus & Dreyfus, examines skill
acquisition and development (Benner, 1984). Benner (1984) conducted a
phenomenological study evaluating preceptors with newly graduate nurses "to ascertain
and understand the differences in clinical performance and situation appraisal of
beginning and expert nurses" (p. 14). Benner (1984) wished to evaluate the differences
between practical and theoretical knowledge and describe practical knowledge through
the provision of competency examples of nursing practice. Using the Dreyfus & Dreyfus
model and after analysis of data, Benner (1984) described five levels of skill's
acquisition, including teaching and learning needs for each level. Benner (1984) also
clearly states "experience based skill acquisition is safer and quicker when it rests upon
a sound educational base (p. xix).
Five Levels of Skills Acquisition
Novice: Benner (1984) states novices have no experience in the area where they
are involved. This usually implies a nursing student, but may also include an
experienced nurse working in a new area. Waldner and Olson (2007) state "at
the first level, the novice nurse focuses attention on objective, measurable
attributes, such as weight or vital signs" (p. 5). A novice will follow the rules
learned in the classroom and may not understand how to apply that knowledge
within context of a real life situation (Benner, 1984; Waldner & Olson, 2007).
Advanced Beginner: "Advanced beginners are ones who can demonstrate
marginally acceptable performance" (Benner, 1984, p. 22). They have benefited
from practical experiences, but rely on those experiences to gain confidence in
their clinical skills (Waldner & Olson, 2007). Benner (1984) cites the example of
assessing a patient's readiness to learn depends on prior experience educating
patients. Instructors and preceptors can facilitate learning by providing general
guidelines to the advanced beginner, although experience is needed for
application to occur (Benner, 1984).
Competent: Competent nurses have about three years experience at the same
job (Benner, 1984). These nurses are able to see overall goals and are able to
manage most aspects of clinical practice, but lack the speed and flexibility of a
proficient nurse (Benner, 1984). "The competent nurse starts to see the impact
nursing actions [have] in relation to a more comprehensive patient picture"
(Waldner & Olson, 2007, p. 6). Benner (1984) suggests preceptors can facilitate
learning by playing decision-making and prioritization games.
Proficient: A characteristic of the proficient nurse is the ability to understand
situations as wholes rather than in terms of tasks (Benner, 1984). The nurses'
experience provides the nurse with the ability to recognize the most important
attributes of a situation (Benner, 1984). "Instead of using clinical guidelines and
protocols for assessment an din determining a course of action, proficient
nurses read a situation and decide on their actions" (Waldner & Olson, 2007, p.
6). Benner (1984) states proficient nurses learn best with the use of case studies
or "grand rounds".
Expert: "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 (Benner, 1984, p. 31). The expert has an "intuitive grasp of
each situation" (Benner, 1984, p. 32). Benner (1984) suggests expert nurses can
be evaluated through systematic documentation, asking them to serve as
consultants for other nurses, and through story telling.
Competencies
Generally, facilities and individuals have specific ideas about what the level of
competency for students should be. These competencies may include a good work
ethic, an expected skills proficiency, and the ability to critically think and apply theory to
practice. These expected competency levels may conflict with the actual capability of
the student. It is important for the preceptor to review clinical outcomes for each
course with the faculty and student; the preceptor should communicate with faculty
regarding the level of expected performance. Benner's (1984) theory may be utilized to
help determine level of competency. Board of Nurse Examiners and most Universities
and Colleges has outlined expected outcomes for graduates of Texas nursing programs.
Please click on the links below for information regarding these competencies:

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing
practice. Menlo Park, CA: Addison-Wesley Publishing Company
Waldner, M.H. & Olson, J.K. (2007). Taking the patient to the classroom: Applying
theoretical frameworks to simulation in nursing education [Electronic version].
International Journal of Nursing Education Scholarship, 4(1), 1-14.