1. CREATED BY JULLIA & NEETU
FROM NOVICE TO EXPERT
CREATED BY JULLIA & NEETU

2. About The Theorist Dr. Patricia Benner, R.N. BSN Ph.D
Dr. Patricia Benner introduced to concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well multitude of experiences.
She proposed that one could gain knowledge and skills (“knowing how”)without ever learning the theory (“knowing that”).
She further explains that their development of knowledge and applied disciplines such as medicine and nursing is composed of practical knowledge (know how) through research and the characterization and understanding of the “know how” of clinical experience.

3. Novice to Expert
Dr. Benner’s theory outlines the transition from a novice nurse through education and clinical experience to an expert in the field.
She categorized the theory into 5 stages including:
Novice
Advanced Beginner
Competent
Proficient
Expert

4. Novice
In novice or beginner stage implied to a nurse who has no experience in a situation in which they are expected o perform. They lack confidence to demonstrate safer practice and requires continual verbal and physical cue.
For example – a new graduate fresh out of Nursing School who is newly hired on a busy medical-surgical unit will have difficulty using problem solving skills to complicated clinical situations. At this level the new nurse is still developing their basic clinical skills and following taught rules to guide action in respect to different attributes.
For instance, novice nurse notices elderly patient confused and disoriented during her a.m. rounds. In the clinical setting, the novice nurse, with lack of experience may not address this unstable patient in a timely manner and spend too much time considering several possible causes. In such demographic there is a high probable link between delirium and infection such as UTI.

5. Advanced Beginner
Advanced beginner is one who can demonstrate marginally acceptable performance, this nurse is the one who has coped with enough real, previous similar situations to recognize general trends and can apply this knowledge to the new situation.
For instance, in the similar situation mentioned in previous slide of confused elderly patient with UTI, advanced beginner may spend less time questioning herself and be able to make decisions from the limited experiences she has already had.

6. Competent
At this stage the nurse has been in practice for 2-3 years. At this point the competent nurse is able to better plan and organize her days. She is not only able to handle daily patient’s demands but she is also prepared to handle the unexpected. The nurse is able to demonstrate efficiency, is coordinated and has confidence in her actions.
For instance, a competent nurse can coordinate a.m. medication pass, new admit, discharge teaching and several IV monitoring.
For the competent nurse, a plan establishes a perspective and the plan is based on considerable conscious, abstract, analytic contemplation of the problem.

7. Proficient
The proficient nurse perceives situations as wholes rather than in terms of chopped up parts or aspects so she understands a situation as a whole because she perceives its meaning in terms of long term goals. The proficient nurse learns from experience what a typical event to expect in a given situation and how plans need to be notified in response to this event. The proficient nurse can now recognize when the expected normal picture does not materialize. This 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 present situation are the important ones.
For instance, a patient completed antibiotic for UTI and required Foley catheter removal. While removing the catheter the nurse notes that the catheter tip is cloudy and mucoid. From her previous experience she determines this is abnormal and predicts there is still possible infection. As a prudent nurse, she cuts the tip of cather and sends to lab to be further cultured. Then she would call MD and describe the patient condition. Next she would perform interventions such as pushing fluids, monitoring temperature and furthering monitoring for confusion.

8. Expert
The expert nurse 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. Her performance becomes fluid and flexible and highly proficient. Highly skilled analytic ability is necessary for those situations with which the nurse has had no previous experience.
At this stage, there is much to learn from the expert nurse. At this level, the nurse no longer relies on analytical principles or rules to connect her understanding of the situation to appropriate action.
Cherry & Jacob (2011) describes an expert nurse is a one with knowledge and skills, and information. It gives an example on nurses who have expertise in areas such as physical assessment or technical skills, or who keep up with current information on important topics will gain respect and complies from others.

9. Significance of Theory
According to Benner these levels reflect movement from reliance on past abstract principles to the use of past concrete experience as paradigms and change in perception of the situation has complete whole in which certain parts are relevant.
Each step builds on the previous one as abstract principles are refined and expanded by experience and the learner gains clinical expertise.
This theory changed the professions understanding of what it means to be an expert, placing the designation not on the the nurse with the most highly paid or most prestigious position, but on the nurse who provided the most exquisite nursing care.
It recognized that nursing was poorly served by the paradigm that called for all of nursing theory to be developed by researchers and scholars, but rather introduced the revolutionary notion that the practice itself could and should inform theory.

10. Conclusion
Dr. Benner believed in the education of nurses in advanced practice.
She also pushed to develop an identity for the nursing profession separate from medical doctor.

11. Reference
Benner, P. : Novice to Expert; The American Journal of Nursing, Vol. 82 (3) (Mar .,1982), pp
Cherry, B., & Jacob, S. (2011) Contemporary nursing: Issue, Trends, & Management. 5th Edition. St. Louis. MO: Mosby.
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley