1. Patricia Benner R.N., Ph.D., F.A.A.N., F.R.C.N.
Nursing theorist
From Novice to Expert
Kelly Lockhart
Sara Young
NURS 324
Spring 2013
Patricia Benner
(photo by Robert Foothorap)

2. Patricia Benner R.N., Ph.D., F.A.A.N, F.R.C.N.
Current Professor Emerita at the University of California, San Francisco
Has taught and been involved in research since 1979.
Well published in journals and books.
Named one of the American Academy of Nursing’s “Living Legends” in August, 2011.
Introduced her “Novice to Expert” theory in 1982.
Many publications refer to her nursing practice model.
Patricia Benner

3. Purpose Basic overview of nursing theory
Explanation of Patricia Benner’s work “From Novice to Expert” model
Relation of Benner’s work to current practices
Photo courtesy

4. What is nursing theory?
“A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and/or prescribing.”
Many nursing theories incorporate the four paradigms: nursing, person, health and environment
(Nursing Theories, 2012)

5. Why is theory important?
When nursing practice is built on sound theories, the profession is strengthened
Using theory in nursing helps us to:
Think critically
Analyze information and make clinical judgments
Assist in decision making
Support excellence in practice
Assist novices in becoming experts therefore improving patient care
(Black, 2011)
Photo courtesy

6. From Novice to Expert Nursing Model
“Patricia Benner developed a concept known as “From Novice to Expert”. This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences.” Benner’s theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert.
(Nursing Theory, 2011)

7. Benner’s Motivation for Novice to Expert
Nursing practice has been studied primarily from a sociological perspective as opposed to the study of nursing practice itself
Nursing knowledge is accrued over time; it is embedded in expertise. Thoughts are based on the Dreyfus model.
Knowledge has gone uncharted and unstudied because differences between practical and theoretical knowledge have been misunderstood
Well charted nursing practice and observation are essential for theory development
(Benner, 2001, p. 1)

8. Benner’s Philosophy
Benner “proposed that a nurse could gain knowledge and skills without actually learning a theory” Described as “knowing how” without “knowing that”
Development of knowledge in nursing is “a combination of knowledge through research and understanding through clinical experience”
(Nursing Theory, 2011)
Photo:

9. Benner’s influences Virginia Henderson
Benner has acknowledged that her “thinking has been influenced greatly by Virginia Henderson.”
Dreyfus model of Skill acquisition
Developed in 1980
Describes five levels of skill acquisition and development
Model showed advancement through the stages by changes in performance
Developed by studying chess players and pilots
Benner adapted the Dreyfus model for clinical nursing practice, basis for her work: Novice to Expert.
(Tomey & Alligood, 2006)

10. Dreyfus Model of Skill Acquisition
Skill Level
Mental function
Novice
Competent
Proficient
Expert
Master
Recollection
Non-situational
situational
Situational
Recognition
decomposed
Holistic
Decision
analytical
Intuitive
awareness
monitoring
Monitoring
absorbed
Table 1: The model in 1980 shows how skill acquisition changes for the given mental functions throughout advancement in the given skill levels. (Dreyfus & Dreyfus, 1980)

11. Dreyfus vs Benner
Dreyfus model including the 5 levels as of 1986 (moleseyhill.com)
Benner’s Stages of Nursing Proficiency (nursinginformatics.ca)

12. Benner’s stages of Nursing Proficiency
Novice to Expert
Benner’s stages of Nursing Proficiency
Novice
Advanced Beginner
Competent
Proficient
Expert
Photo courtesy

13. The Novice Begins with no prior experience
Taught rules to perform tasks
Rule governed behavior is limited and inflexible
Being a novice is not exclusive to students- any nurse entering a setting without prior experience with that particular patient population may be limited to the novice level
Photo:
(Benner, 2001, pp )

14. The Advanced Beginner
Can demonstrate marginally acceptable performance
Has gained prior experience in actual nursing situations
Formulation of guidelines or principles from prior experiences provide guidance in future experiences
(Benner, 2001, pp )
Photo courtesy

15. The Competent Nurse
Has been on the job in similar situations for 2-3 years
Aware of long term goals-- gain perspective from planning their own actions
Become more efficient and organized
(Nursing Theory, 2011)
Photo courtesy

16. The Proficient Nurse
Perceives and understands situations as whole parts
Views patients holistically
Has learned what to expect in certain situations and how to modify plans as needed
(Nursing Theory, 2011)

17. The Expert Nurse
No longer relies on principles, rules or guidelines to connect situations and determine actions
Performances are fluid, flexible, and highly proficient
Expertise comes naturally
(Black 2011, p. 137)
(Nursing Theory, 2011)

18. Benner’s Explanation of the Four Paradigms
Nursing
Person
Health
Environment
Photo courtesy

19. Nursing
Benner viewed nursing as the care and study of the lived experience and the relationship of these three elements:
Health
Illness
Disease
Photo courtesy
(Nursing Theories, 2013)

20. Person
“…the person does not come into the world predefined but gets defined in the course of living a life”
Benner believed that there are significant aspects that make the being. She conceptualized these as the roles of:
the situation
the body
personal concerns
temporality
Photo courtesy
(Nursing Theories, 2013)

21. Health
Benner focused “on the lived experience of being healthy and being ill”
Health can be assessed
Well-being is the human experience of health or wholeness
Illness is the human experience of loss or dysfunction
(Tomey & Alligood, 2006, p. 151)
Photo courtesy

22. Environment
Benner uses the term situation rather than environment. “Personal interpretation of the situation is bounded by the way the individual is in it.” A person’s past, present, and future influences their current situation
Photo courtesy
(Tomey & Alligood, 2006, p. 151)

23. Relationship of Paradigms to Benner’s Model
The culmination of the four paradigms of nursing create experiences that nurses utilize to advance through the stages of Benner’s model From Novice to Expert
Photo courtesy
Photo courtesy

24. Using Benner’s Model in Practice
Examples of use in practice:
Preceptorship
Orientation processes
Nursing educational programs
Professional advancement ladders
Interdepartmental job changes (e.g. medical-surgical nurse transitioning to an intensive care unit)

25. American Association of Critical-Care Nurses (AACN)
Benner in Action
American Association of Critical-Care Nurses (AACN)
Synergy Model
Developed as a basis for nursing practice
Development utilized use of Benner’s Novice to Expert stages of development
Combines nursing competencies with characteristics of patients to “enhance optimal patient outcomes” (Kaplow, 2002)
Patient outcomes will be different at the different levels of the nurse’s expertise.
(photo courtesy AACN.org)

26. Benner in Action Clinical Ladder Programs
Most are based on stages of clinical competence of Benner’s (Murphy, 2012)
Intention of the ladder is to retain experienced nurses
Greater rewards at the expert levels than the novice level

27. Conclusion
This model can be applied to all areas of nursing. It looks at the education and development of a nurse and how they become an expert. Patricia Benner examined how nurses learn to nurse (Nursingtimes.net, 2010)
Photo courtesy
Photo courtesy

28. References
American Association of Critical-Care Nurses (2013). Retrieved from Benner, P., (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative edition). New Jersey: Prentice Hall Health. Black, B.P. (2011). Becoming a nurse: Defining nursing and socialization into professional practice. In K.K. Chitty & B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp ). Maryland Heights, MO: Saunders Elsevier. Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill acquisition (Operations Research Center Rep. No. ORC-80-2). Kaplow, R. (2002). The synergy model in practice applying the synergy model to nursing education. Critical Care Nurse, 22(3),

29. References
Murphy, D. (2012, September/October). Novice to expert: clinical ladder programs as a recruitment and retention tool. Ohio Nurses Review., Retrieved from
Nursingtimes.net [website]. (2010, March). Nursing Times. Retrieved from
Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from theory.org/nursing-theorists/Patricia-Benner.php
Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved from
Nursing Theories: a companion to nursing theories and models website. (2012). Retrieved from
Tomey, A., & Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.

30. Case Study #1
Sally had the opportunity to be a nurse extern at a hospital on a busy medical-surgical unit while she finished her undergraduate studies. With this opportunity, Sally stated that she had the chance to become comfortable in a nursing role, and was able to relate nursing practice to the theory that she was learning in class. After graduation, Sally became an RN in the Neonatal ICU. Given her recent nursing experience, which of Benner’s stages is Sally practicing at as a Neonatal RN?

31. Case Study #2
You and Ginger have been nurses together for the last five years. You have both worked on the Orthopedic unit since graduating nursing school. You both easily perform the required nursing duties, seem to have “that nursing sense” about when something is going downhill, and act as charge nurses on the unit. Ginger is reluctant to act as a preceptor to newer nurses stating that “I still need to work on my organization before trying to help others learn the way.” You have acted and excelled as a preceptor with excellent feedback. What stages of Benner’s model would you place yourself and Ginger?