THEORETICAL FOUNDATION IN NURSING
PATRICIA BENNER in the novice’s and expert’s descriptions of the
“Stages of Nursing Expertise Nursing same clinical incident.
Philosophies”
NOVICE
From “Novice” to “Expert”
Has no background experience of the
Born in Hampton, Virginia on August 1942.
situation in which he/she is involved.
BSN from Pasadena College; Master’s Degree in Difficulty in discerning between
Medical-Surgical Nursing from the University of relevant and irrelevant aspects of the
California and Ph.D. from the University of situation.
California, Berkeley in Stress and Coping and Beginner to profession or nurse
Health under the direction of Hubert Dreyfus changing area of practice
and Richard Lazarus. Applies to nursing students.
ADVANCED BEGINNER
AS AN AUTHOR:
The advanced beginner stage in
Dr. Benner is the author of books including: Dreyfus model develops when the
1. From Novice to Expert person can demonstrate marginally
2. The Primacy of Caring acceptable performance having
coped with enough real situations to
3. Interpretive Phenomenology: Embodiment,
note, or to have pointed out by
Caring and Ethics in Health and Illness
mentor, the recurring meaningful
4. The Crisis of Care components of the situation.
5. Expertise in Nursing Practice: Caring, Clinical Nurses functioning at this level are
Judgement and Ethics guided by rules and oriented by task
6. Caregiving completion.
7. Clinical Wisdom and Interventions in Critical Still requires a mentor/experienced
Care: A Thinking-In-Action Approach nurse to assist with defining
situations, to set priorities, and to
An Influential Nurse in the Development of the integrate practical knowledge.
Profession of Nursing 5 years
Benner’s research and theory work provides the COMPETENT
profession of nursing with what we now know After 2-3 years in the same area of
as the Novice to Expert Model also known as nursing, the nurse moves into the
Benner’s Stages of Clinical Competence. Competent Stage of Skill Acquisition.
Benner’s work as applied to the nursing Is the most pivotal in clinical learning
profession is adapted from the Dreyfus Model because the learner must begin to
of Skill Acquisition. recognize patterns and determine
which elements of the situation
Skill Acquisition – “The utility of the concept of skill warrant attention and which can be
acquisition lies in helping the teacher understand how ignored.
to assist the learner in advancing to the next level” The competent nurse devises new
(McClure, 2005) rules and reasoning procedures for a
plan while applying learned rules for
5 LEVELS OF CAPABILITIES action on the basis of the relevant
Believed experience in the clinical setting is key facts of that situation.
to nursing because it allows a nurse to PROFICIENT
continuously expand their knowledge base and After 3 to 5 years in the same area of
to provide holistic, competent care to the nursing, the nurse moves into the
patient. Proficient Stage.
Her research was aimed at discovering if there “The nurse possesses a deep understanding
were distinguishable, characteristic differences of situations as they occur, less conscious
THEORETICAL FOUNDATION IN NURSING
planning is necessary, critical thinking and - Is defined as what can
decision-making skills have developed” be assessed whereas well
(Frisch, 2009) being is the human
The performer perceives the experience of health or
information as a whole (total picture) wholeness.
rather than in terms of aspects and - Well-being and being ill
performance. are understood as
Proficient level is a qualitative leap distinct ways of being in
beyond the competent. the world.
Nurses at this level demonstrate a Environment/Situation - Benner uses situation
new ability to see changing relevance rather than environment
in a situation including the because situation
recognition and the implementation conveys a social
of skilled responses to the situation environment with social
as is it evolves. definition.
EXPERT - “To be situated implies
This stage occurs after 5 years or that one has a past,
greater in the same area of nursing present and future and
(experienced nurses changing areas that all of these aspects…
of nursing practice may progress influence the current
more quickly through the 5 stages) situation” – Dr. Benner
The expert performer no longer relies Nursing - Is described as a caring
on an analytic principle (rule, relationship, an “enabling
guideline, maxim) to connect her/his condition of connection
understanding of the situation to an and concern.” -Dr. Benner
appropriate action. - “Caring is primary
The expert nurse, with an enormous because caring sets up
background of experience, now has the possibility of giving
an intuitive grasp of each situation and receiving help”
and zeroes in on the accurate region - Is viewed as a caring
of the problem w/o wasteful practice whose science is
consideration of a large range of guided by the oral art
unfruitful, alternative diagnoses and and ethics of care and
solutions. responsibility.
The expert operates from a deep - Dr. Benner understands
understanding of the total situation. that nursing practice as
the care and study of the
lived experience of
4 DOMAINS/METAPARADIGM health, illness and
Client/Person “The person is a self- disease and the
interpreting being, that is relationships among the
the person does not three elements.
come into the world
predefined but gets
defined in the course of WHAT CAN NURSE LEADERS DO?
living a life” -Dr. Benner Can help address the issues of nursing shortage
Health - Dr. Benner focuses on and staff retention by supporting new graduate
the lived experienced of nurses by:
being healthy and being
ill.
THEORETICAL FOUNDATION IN NURSING
Advocating for transition or residency
programs to increase competency,
confidence and satisfaction of new RNs.
Maintaining a healthy working
environment; not using novice RNs to
cover for staffing shortage before the
end of orientation period and zero
tolerance for lateral violence/bullying.
Supporting experienced RNs who are
serving as preceptors and mentors for
novice RNs.
New graduate nurses are the future
employee pool.
Job satisfaction and retention are
greatly influenced by the quality of
orientation and support received by the
new graduate nurse.
A positive experience will encourage the
new proficient nurse to mentor novice
nurses and give them the same positive
experience he/she had during the
transition period.