1. Running Head: PATRICIA BENNER’S NOVICE TO EXPERT THEORY
1
Patricia Benner’s Novice to Expert Theory
Jezrel C. Oberes
Northern Negros State College of Science and Technology
Author Note
Jezrel C. Oberes, Graduate School, Northern Negros State College of Science and
Technology
This paper was prepared in partial fulfillment of the subject course MN 101 Advanced
Philosophical Theoretical Foundations in Nursing
Correspondence concerning this paper should be addressed to Jezrel C. Oberes, Graduate
School, Northern Negros State College of Science and Technology, Cadiz City Campus, Hda.
Hortencia, Brygy. Daga, Cadiz City.
2. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
2
Abstract
The purpose of this paper is to present and explore Patricia Benner’s Novice to expert theory. It
depicts the unique and similar attributes within the theory and concept as well as their utilization
within nursing practice, education, and leadership. It contains information on the academic
background of the theorist, the definition of the theory, and its significance to the different facets
involving the field of nursing. The articles involved in this paper include writings from
authorsAltmann, T. K. (2007), Dracup and Bryan-Brown (2004) and Wandel, J. C (2003). This
paper presents Benner’s theory with an intention of interpreting the theory in relation to the
progression of a nurse’s capacity or experience.
Keywords: Patricia Benner, novice to expert, nursing experience
3. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
3
Background of the Theorist
A noted nursing educator, Patricia Benner is a Professor Emerita in the Department of
Social and Behavioral Sciences at the University of California, San Francisco. She is a
former senior scholar at the Carnegie Foundation for the Advancement of Teaching, for
which she authored a study titled Educating Nurses: A Call for Radical Transformation. Her
book From Novice to Expert: Excellence and Power in Nursing Practice has been translated
into ten languages. Benner is a fellow of the American Academy of Nursing and was elected
an honorary fellow of the Royal College of Nursing. She is the recipient of the 2010
President's Award for Creativity and Innovation in Nursing Education.
Benner received her Bachelor of Arts in Nursing in Pasadena College, also known as
Point Loma College. She earned her Master’s Degree in Medical and Surgical Nursing at
University of California San Francisco (UCSF), and was able to accomplish her Doctorate
Degree in UCSF and UC Berkeley in 1970. Since 1979, she was able to conduct her
researches at the UC Berkeley. In 1982, she published the “Novice to Expert Theory”, from
which she was greatly recognized for.
Through her books and publications, she introduced the concept that expert nurses
develop skills and understanding of patient care over time through a sound educational base
as well as a multitude of experience. She proposed that one could gain knowledge and skill,
also known as “knowing how”, without ever learning the theory or the “knowing that”.
4. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
4
Concept and Definition of the Theory
Levels of skill acquisition
Patricia Benner conceptualizes in her writings that nursing skills as experience is a
prerequisite for becoming an expert. She discussed the five specific levels of nursing experience:
the Novice; the Advance Beginner; the Competent; the Proficient; and the Expert.
Novice.A novice is a beginner with no experience and is being taught the general rule to
help perform tasks. These rules are context-free, independent of specific cases and applied
universally. Their behavior is rule-governed, and is limited and inflexible.
Advance Beginner. An advance beginner demonstrates acceptable performance, gaining
prior experience in actual situations to recognize recurring meaningful components, and follows
principles that are based on experiences.
Competent.With a competent nurse, typically, there is a 2-3 year experience on the job
in the same area of in similar day-to-day situation. There is more awareness of long-term goals,
and gaining perspective from planning own actions based on conscious, abstract and analytical
thinking is being observed.
Proficient.A proficient nurse perceives and understands the situation as whole parts.
There is more holistic understanding which improves the decision-making process. There’s a 5year experience, and learning from experiences what to expect in certain situations and how to
modify plans are being observed.
5. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
5
Expert.The fifth level, an expert nurse, no longer relies in principles, rules or guidelines
to connect with situations and determine actions. More background experience is observed and
there’s an intuitive grasp of clinical situations. The performance is fluid, flexible and highly
proficient.
Metaparadigm in Nursing
Nursing
Patricia Benner described nursing as an “enabling condition of connection and
concern” (Marriner-Tomey, 1989, p192) which shows a high level of emotional involvement in
the nurse-client relationship. She viewed nursing practice as the care and study of the lived
experience of health, illness, and disease and the relationships among these three elements.
Person
Benner stated that a “self-interpreting being, that is, the person does not come into the
world predefined but gets defined in the course of living a life. A person also has… an effortless
and non-reflective understanding of the self in the world. The person is viewed as a participant in
common meanings.” (Tomey, 2002 p173)
Benner believed that there are significant aspects that make up a person. She had conceptualized
the major aspects of understanding that the person must deal as:
1. The role of the situation
2. The role of the body.
3. The role of personal concerns.
4. The role of temporarility.
6. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
6
Health
Patricia Benner focused “on the lived experience of being healthy and ill.” She
defined health as what can be assessed, while well-being is the human experience of health or
wholeness. Well-being and being ill are recognized as different ways of being in the
world. Health is described as not just the absence of disease and illness. Also, a person may have
a disease and not experience illness because illness is the human experience of loss or
dysfunction, whereas disease is what can be assessed at the physical level.
Environment
Instead of using the term “environment”, Benner used the term “situation”, because it
suggests a social environment with social definition and meaning. She used the
phenomenological terms of “being situated’ and “situated meaning”, which are defined by the
person’s engaged interaction, interpretation an understanding of the situation.
Theoretical Assertion
Benner stated that theory is crucial to form the right questions to ask in a clinical
situation; theory directs the practitioner in looking for the problems and anticipating care needs.
There is always more to any situation than theory predicts. The skilled practice of nursing
exceeds the bounds of formal theory. Concrete experience provides learning about the exceptions
and shade of meaning in a situation. The knowledge embedded in practice discovers and
interprets theory, precede and extends theory, and synthesizes and adapts theory caring nursing
practice.
7. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
7
Acceptance by the Nursing Community
Practice
The model has been used to aid in the development of clinical ladders of promotion, new
graduate programs and clinical knowledge development seminars.
Education
Nursing educators have realized that learning needs at the early stages of clinical
knowledge development are different from those required at later researches.
Research
Her researches have been used in studying the impact of nursing and its seven domains in
every aspect of the profession. Nurses have a clear vision of the competencies requires in order
for them to climb up into the leadership ladder.
Administration
Benner (1984) provided the groundwork for reflecting on nursing practice in terms of
developing expertise of nurses in action. Effective nursing practice and leadership are “grounded
in the complexity of human relationships and therefore require systematic and careful thinking in
order to achieve successful outcomes” (STTI, 2005, pg. 6). Reflective practice enhances the
leadership capabilities of nurses through examination of their practice. Emden and Reid, found
that reflective practice helps to advance nursing theories at a conceptual level which leads to
changes at a professional, social and political level (as cited in STTI, 2005, pg. 8).
8. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
8
Analysis
Simplicity
Benner’s model is comparatively simple about the five stages of skill acquisition. It gives
a relative guide for classifying levels of nursing practice, from individual nurse descriptions and
observations to actual nursing practice. The interpretations are validated by agreement or by
general acceptance.
Clinical knowledge is relational and deals with local, specific, historical issues. Benner
uses narrative accounts of actual clinical situations and preserves that the model enablers the
reader to recognize similar intents and meanings, although the objective circumstances may be
quite different.
Generality
Benner’s model has universal characteristic for the reason that it is not restricted by age,
illness, health, or location of nursing practice. However, the characteristic of theoretical
universality involve properties of functionality for prediction that is not a part of this perspective.
The descriptive model of nursing practice has the potential for universal application as a
framework; however the descriptions are limited by dependence on the actual clinical nursing
situations from which they must be used. It depends on the understanding of the five levels of
competency and the ability to identify the characteristic intentions and meanings intrinsic at each
level of practice.
9. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
9
Empirical Precision
In terms of empirical precision, Benner’s model was tested using qualitative
methodologies. Succeeding researches suggest that the framework is applicable and useful in
providing knowledge of the description of nursing practice. The strength of Benner’s model is
that data-based research contributes to the science of nursing.
Derivable Consequences
The usefulness of Benner’s model gives a general framework for identifying, defining
and describing clinical nursing practice. She uses a phenomenological approach to express and
obtain meaning and abilities from interactions in life situation. The implication of Benner’s
research findings lies on her conclusion that “a nurse’s clinical knowledge is relevant to the
extent to which its manifestation is nursing skill makes a difference in patient care and patient
outcome.”
Application of theory
One example of a structured faculty development plan based on the novice-to-expert
framework is the Bay Area Simulation Collaborative (BASC) faculty development plan. The
BASC is a group of more than 100 member schools and hospitals, totaling more than 600 faculty
andhospital educators from both service and academia in the 10 counties of the San Francisco
Bay Area. The California Institute for Nursing and Health Care (CINHC), in Berkeley, leads the
BASC, which was funded through a grant from the Gordon and Betty Moore Foundation.
CINHC was developed to increase educational capacity in schools of nursing, increase
diversity in the nursing workforce, and develop leadership. The 3-year BASC project is designed
10. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
10
to train and teach nursing faculty andhospital educators in the concepts of simulation. The
BASCis also designed to develop clinical simulation scenarios for use among its members.
Finally, the project implements a research and evaluation agenda to demonstrate that simulation
makes a difference in the critical thinking skills of nursing students.
The faculty development plan was designed by the BASC operating committee and
program director. The goal is to train a large number of expert clinicians and nursing faculty in
the Bay Area, and the plan is built on the novice-to-expertmodel. In this plan, the faculty
member in Level 1 training (basic technical skills) is in the novice stage, Level 2 (simulation
methodology) is the advanced beginner stage, Level 3 (apprenticeship) is the competence stage,
and Level 4 (train the trainer) is the proficient and expert stage. Ultimately, a train-the-trainer
model will allow the BASC to have its own qualified instructors to teach others.
To date more than 400 clinical educators and nursing faculty have been trained in the San
Francisco Bay Area. More than 200 have been trained at the basic level (Level 1), more than 100
at the intermediate level (Level 2), more than 100 in debriefing, and six have completed the
apprentice program and have demonstrated competency in being a simulation instructor. As for
Level 4, there are currently 10 instructors that are trainers. As a result of the success of the
BASC, the work is being leveraged to create a Southern California Simulation Collaborative and
will include replication of the faculty development plan.
11. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
11
Conclusion
Practical knowledge is essential to knowledge development and professional growth of
nursing. Reflection in practice is a tool that can be used by nurses to find deeper meaning within
practical experience as a means to advance practice as well as to enhance one’s skill level. Every
clinical situation is an opportunity for learning. Through reflection and experience, a nurse can
achieve a profound understanding of themselves and the practice of nursing and ultimately
improve patient care outcomes.
From a nurse educator perspective, both the novice to expert theory and reflective
practice can be substantially advantageous in teaching and learning strategies. Guided reflection
can foster students’ knowledge development, confidence, and self-awareness which in turn will
help to advance their level of skill acquisition. Thus understanding the skill level of the student is
essential to facilitate successful learning
12. PATRICIA BENNER’S NOVICE TO EXPERT THEORY
12
References
Altmann, T. K. (2007). An evaluation of the seminal work of Patricia Benner: Theory or
philosophy? Contemporary Nurse. Volume 25, Issue 1-2, May – June, 122.
Dracup and Bryan-Brown.(2004) From Novice to Expert to Mentor Shaping the Future American Journal of Critical Care. 13: 448-450.
Sigma Theta Tau International. (2005). The scholarship of reflective practice. Retrieved
from www.nursingsociety.org/aboutus/.../resource_reflective.doc
The Use of Benner’s Framework in High-fidelity Simulation Faculty Development The Bay Area
Simulation Collaborative Model. (2009) Retrieved September 20, 2013,
fromhttp://akoaotearoa.ac.nz/download/ng/file/group-6261/kt-waxman---article-ofinterest.pdf
Tomey, A.M. &Alligood, M.R (2002).Nursing Theorists and Their Work.Fifth Edition.From
Novice to Expert: Excellence and Power in Clinical Nursing Practice. 165 – 179
Wandel, J. C..(2003)The Institute for Nursing Healthcare Leadership Conference: Reflections on
the Impact of Patricia Benner's Work. Medscape Nurses. 5(2). Accessed on 5-04-2010