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The second level is the advanced beginner stage. A nurse at the level has some clinical experience and can make marginally acceptable performance. Benner (1984) associates the term aspects to the advanced beginner. Aspect recognition is based on prior experience.
The third level is the competent stage. A competent nurse has been on the job for two to three years and is able to make long range goals or plans. At this level nurses showcase analytical thinking.
Benner’s model of skill acquisition explores five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. Each level represents a different level of skill that builds on past experience. The theory is modeled from the Dreyfus Model of Skill Acquisition. The Dreyfus model provides the concepts needed to differentiate between what can be taught by precept and what must be learned experientially from comparison of similar and dissimilar cases (Benner, 1984).
According to Benner, her method of research was deprived from Heideggerian phenomenology, founded by theorist Martin Heidegger. Heidegger moved away from the original phenomenology movement, originated by Hurrsel, and expanded on existential and hermeneutic (interpretive) dimensions (Finlay, 2009). Phenomenology studies the structure of various types of experience ranging from perception, thought, memory, imagination, emotion, desire, and volition to bodily awareness, embodied action, and social activity, including linguistic activity (Stanford Encyclopedia of Philosophy, 2013).
While in the novice stage, nurses should observe and learn from the expert nurses who act as preceptors, mentors, or instructors. Applying time and experience, nurses should pass through each stage acquiring the skills needed to get to the next level.
The fourth level is the proficient stage. Nurses at this level are able to view situations as a whole. Benner (1984) applies the term maxim to proficient nurses. Maxims are used to guide the proficient nurse to what happens next in a clinical situation.
To originate the theory of From Novice to Expert, Benner borrowed ideas from the Dreyfus Model of Skill Acquisition. The model was originally designed for chess playing, showcasing five levels of skills: novice, advanced, beginner, competent, proficient, and competent (Sitzman & Eichelberger, 2011).
The area of clinical internship, uses the theory’s intervention on clinical experience. Clinical internship is required for initial licensure for all nurses. The focus of the internship is to begin to integrate the new graduate into the role of a licensed nurse.
Clinical competencies are used to reflect practice and challenge nurses. The use of self-evaluation tool and portfolios are a way for nurses to document accomplishment for their organizations.
Patricia Benner is an author, educator, and researcher. She was the author and project director of a federally funded grant titled: Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation Project (the AMICAE Project). This research attempted to discover and describe knowledge embedded in nursing practice (Altmann, 2007).
A key note in this theory is that nurses can be an expert in one area of nursing but not necessarily an expert in another. According to McEwin and Wills (2014), this theory and model has been used in career development and continuing education in nursing. Areas of utilization include nursing management, clinical internships, staff development, and preceptorship. =
Benner’s use of philosophy was at a time where philosophy and science were mixing. Her research and practice was at the end and forefront of a century where philosophy should be continuous with science. Nursing care was being challenged with more complex patients with multiple diagnosis, this required critical thinking skills of every nurse. Nurses were coming from behind the scenes and gaining public attention to the nursing profession. Due to the change and growth in the healthcare organization, researchers, government leaders, and hospital officials were responsible to show improvement in healthcare.
The fifth level is the expert stage. Expert stage is the highest level, therefore it is the desired goal for a nurse. At the expert level the nurse is to demonstrate excellence in nursing and sometimes will rely on intuition when making clinical decisions.
From Novice to Expert, is a relevant tool for all nurses, to enhance care provided to patients. The theory is modern and it focuses on viewing the patient as a whole instead of a part. It is a model guide for knowledge, skill, and judgement. Specific areas of use are nursing management, clinical internships, staff development, and preceptorship. In the area of nurse management, the use of experiential learning tactics leads to a leadership role.
Cathcart, Greenspan, and Guinn (2010) implies like Benner’s theory, a similar pattern of first relying on job descriptions and leadership theories and then moving to a greater situated knowledge appears to be true for nurse manager practice as well.
Professional development in a one year internship for all new nurses.
Benner’s use of Heideggerian Principals of Research introduced the ‘paradigm’ into her phenomenological method. These philosophical underpinnings contribute to her views on the nursing metaparadigm. Benner (1984) defines person as a self-interpreting being. A person does not come into the world predefined but gets defined in the course of life. Benner (1984) defines environment as a social environment with social definition and meaningfulness. Benner (1984) defines health as the human experience of health or wholeness. Benner (1984) defines nursing as a caring relationship that includes the care and study of the lived experience of health, illness, and disease.
The central concepts related to the theory are those of competence, reflective practice, skill acquisition, experience, clinical knowledge, and practical knowledge (McEwin & Wills, 2014). Each of these concepts are defined within the context of the theory. Santos (2015) states that when using the interpretive phenomenological method, the researcher seeks to understand the world of concepts, habits, and practices presented through narratives of participants and specific actions.
Altmann, T. (2007). An evaluation of the seminal work of Patricia Benner: Theory or philosophy? Contemporary Nurse, 25, 114-123.
The theory is somewhat complex in the concept of intuition. Benner explains that an expert nurse delivers an intuitive approach in the care he or she provides, but is not clear on defining intuition. English (1993) critiques Benner’s use of intuition as a function of the expert nurse.
Benner P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
Cathcart, E., Greenspan, M., & Quin, M. (2010). The making of a nurse manager: The role of experiential learning in leadership development. Journal of Nursing Management, 18, 440-447.
This one year process promotes the theory’s use of real-life practice.
English, I. (1993). Intuition as a function of the expert nurse: A critique of Benner’s novice to expert model. Journal of Advanced Nursing, 18,387-393.
Finlay, L. (2009). Debating Phenomenological Research Methods. Phenomenology & Practice, 3(1), 6-25.
McEwen, M. & Wills, E. (2014). Theoretical basis for nursing. 4th edition. Wolters Klumer, Philadelphia, PA.