The Patricia Benner nursing theory of Skill Acquisition in Nursing or the “from Novice to Expert model” developed based on the study of the acquisition and development of skills by chess players and airline pilots in emergency situations. As the individual progress through these levels, they demonstrate changes using concrete experiences.Second, they move from analytic, rule based thinking to intuition. Third, the learner’s perception changes from a situation composed of equally relevant parts to a complex whole in which certain parts are more relevant than others. Fourth, they move from a detached observer to an actively involved performer. (Benner & Wrubel 1989)
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
- Advanced beginner
Stage 1: Novice
Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases, hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no “life experience” in the application of rules.
“Just tell me what I need to do and I’ll do it”
Stage 2: Advanced Beginner
Advanced Beginner are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience.
Stage 3: Competent
Competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware. For the competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic, contemplation of the problem, The Conscious, deliberate planning that is characteristic of this skill levels help achieve efficiency and organization. The competent nurse lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The competent person does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most salient, most important.
Stage 4: Proficient
The proficient performer perceives situations as whole rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long term goals. The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The proficient nurse can now recognize when the expected normal picture does not materialize. The holistic understanding improves the proficient nurse’s decision making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones.
Stage 5: The 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. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnosis and solutions. The expert operates from a deep understanding of the total situation.
Patricia Benner Nursing Theory: From Novice to Expert
Seven Domains of Nursing Practice
- Helping role
- Teaching or coaching function
- Diagnostic client-monitoring function
- Effective management of rapidly changing situations
- Administering and monitoring therapeutic interventions and regiments
- Monitoring and ensuring quality of health care practices
- Organizational and work-role competencies
Allgood, Martha Raile, et al 2006 Nursing Theory Utilization and Application 3rd edition. Missouri: Mosby Inc.
Benner P (1984) From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, Addison-Wesley.
Morriner, Tomey, Ann 1994. Nursing Theorists and their works. INdiana: Mosby -Year Book Inc.