Theory applied to informatics – Novice to Expert cjni.net/journal Editorial – Fall 2010 by June Kaminski, RN MSN PhD(c), Editor in Chief I am often amazed by the consistent confusion and silence that arises when I ask nurses what nursing informatics related theories they use or are aware of. I can sense their minds searching for mysterious elusive theories that they conclude that they must have missed. Only a few realize that many theories that they are already familiar with have great applicability to nursing informatics. One such theory is the time honoured Novice to Expert theory. The Novice to Expert Theory, a construct theory first proposed by Hubert and Stuart Dreyfus (1980) as the Dreyfus Model of Skill Acquisition, and later applied and modified to nursing by Patricia Benner (1984) provides a very useful and important theory that clearly applies to nursing informatics. The Dreyfus brothers developed the model while working with scholars interested in comparing artificial intelligence development and expert computer system programming to the human mind and the development of expertise. Within the field of nursing informatics, this theory can be applied to: the development of nursing informatics skills, competencies, knowledge and expertise in nursing informatics specialists; the development of technological system competencies in practicing nurses working in an institution; the education of nursing students, from first year to graduation and; the transition from graduate nurse to expert nurse. The currently accepted five levels of development within the Novice to Expert theoretical model are illustrated in the image above, as presented by Benner (1984). They start from the 1/4 http://cjni.net/journal/?p=967 bottom rung at the Novice level and move upward through Advanced Beginner, Competent, Proficient, and Expert levels. Dreyfus and Dreyfus (1980) initially proposed the stages of: Novice, Competent, Proficient, Expertise and Mastery. In both configurations, each level builds on the level before it as the learner advances from a neophyte level then gains knowledge, skills, perceptions, intuition, wisdom and most important of all, experience in their given field of practice. Distinguishing Traits Both Dreyfus and Dreyfus and Benner estimated that it takes approximately five years to move through the five stages from novice to expert but also elaborated that not all novices become experts. Some people get ‘stuck’ at the competent or proficient stages. Two personal characteristics that distinguish the successful evolution to the expert level seem to be a) deliberate practice and b) the willingness to take risks, to go beyond the ‘norm’. Deliberate practice is a trait shown by people who use a personal, goal-oriented approach to skill and knowledge development – they devote themselves to engage in progressively higher, and ultimately expert performance. This requires years of sustained effort to continually improve the quali.

1. Theory applied to informatics – Novice to Expert
cjni.net/journal
Editorial – Fall 2010
by June Kaminski, RN MSN PhD(c), Editor in Chief
I am often amazed by the consistent confusion and silence that
arises when I ask nurses what
nursing informatics related theories they use or are aware of. I
can sense their minds
searching for mysterious elusive theories that they conclude that
they must have missed. Only
a few realize that many theories that they are already familiar
with have great applicability to
nursing informatics. One such theory is the time honoured
Novice to Expert theory.
The Novice to Expert Theory, a construct theory first proposed
by Hubert and Stuart Dreyfus
(1980) as the Dreyfus Model of Skill Acquisition, and later
applied and modified to nursing by
Patricia Benner (1984) provides a very useful and important
theory that clearly applies to
nursing informatics. The Dreyfus brothers developed the model
while working with scholars
interested in comparing artificial intelligence development and
expert computer system
programming to the human mind and the development of
expertise.
Within the field of nursing informatics, this theory can be
applied to:

2. the development of nursing informatics skills, competencies,
knowledge and expertise
in nursing informatics specialists;
the development of technological system competencies in
practicing nurses working in
an institution;
the education of nursing students, from first year to graduation
and;
the transition from graduate nurse to expert nurse.
The currently accepted five levels of development within the
Novice to Expert theoretical
model are illustrated in the image above, as presented by
Benner (1984). They start from the
1/4
http://cjni.net/journal/?p=967
bottom rung at the Novice level and move upward through
Advanced Beginner, Competent,
Proficient, and Expert levels. Dreyfus and Dreyfus (1980)
initially proposed the stages of:
Novice, Competent, Proficient, Expertise and Mastery. In both
configurations, each level
builds on the level before it as the learner advances from a
neophyte level then gains
knowledge, skills, perceptions, intuition, wisdom and most
important of all, experience in their
given field of practice.
Distinguishing Traits
Both Dreyfus and Dreyfus and Benner estimated that it takes

3. approximately five years to move
through the five stages from novice to expert but also
elaborated that not all novices become
experts. Some people get ‘stuck’ at the competent or proficient
stages. Two personal
characteristics that distinguish the successful evolution to the
expert level seem to be
a) deliberate practice and
b) the willingness to take risks, to go beyond the ‘norm’.
Deliberate practice is a trait shown by people who use a
personal, goal-oriented approach to
skill and knowledge development – they devote themselves to
engage in progressively higher,
and ultimately expert performance. This requires years of
sustained effort to continually
improve the quality of their practice and performance within the
skill – in this case, in nursing
informatics skills. They feel personal satisfaction in confronting
challenges to achieve a high
standard of excellence within their field. They are not content to
acquire merely functional and
rudimentary skill levels – they want to shine, and join the ranks
of the experts in the field.
Taking Risks – This continuous climb to the expert level is not
without perceived ‘risks’ – it
requires people to move beyond the status quo of mere
competence through the levels of
Proficiency, then Expertise. This is a quality often seen in
Super Users and Champions within
the nursing informatics arena. To move to this level, many
different perspectives must be
digested and the zone of comfort can become threatening. Many

4. people do not like to stand
out from the rest, so do not risk the possibility of being
perceived as different or peculiar – nor
do they want to be regarded as thinking that they excel above
their peers. Yet, the true expert
must take this risk and continue to move up the ladder of skill
and knowledge acquisition
despite potential conflict within the nursing workplace.
Some common themes are evident as a person successfully
progresses through the novice to
expert levels:
As progression occurs, the person tends to move away from
relying on rules and explicit
knowledge to learning to trust and follow their intuition and
pattern matching.
Better cognitive filtering occurs, where problems are no longer
a huge confusing
collection of data but instead become a complete and unique
whole where some bits are
much more relevant than others.
The person also moves from being a detached observer of a
problem to an involved part
of the system itself, accepting responsibility for results, not just
for carrying out tasks.
2/4
Novice to Expert Levels
Each of the five levels of skill acquisition has distinguishing
behaviours and traits (Frisoli,
2007).

5. Novice
A novice does not know anything of the subject he/she is
approaching and has to memorize
its context-free features. The novice is then given rules for
determining an action on the basis
of these features. To improve, the novice needs monitoring,
either by self-observation or
instructional feedback. For example, a nurse learning to use a
new hospital information
system needs explicit instruction and ‘rules’ to learn to use the
computer interface and
manipulate the software.
Advanced Beginner
An advanced beginner is still dependent on rules, but as (s)he
gains more experience with real
life situations, (s)he begins to notice additional aspects that can
be applied to related
conditions.
Competent
At this stage, the competent person grasps all the relevant rules
and facts of the field and is,
for the first time, able to bring his/her own judgment to each
case. This is the stage of learning
that is often characterized by the term “problem solving.” A
competent level nurse would be
able to use a hospital information system with ease, and know
how to problem solve technical
difficulties or interpret conflicting data.
Proficient

6. The fourth stage is called fluency and is characterized by the
progress of the learner from the
step-by-step analysis and solving of the situation to the holistic
perception of the entirety of
the situation. The proficient hospital information system learner
would know how to interpret
data from all departmental information and provide guidance to
other disciplinary members as
needed.
Expert
An expert’s repertoire of experienced situations is so vast that
normally each specific situation
immediately dictates an intuitively appropriate action. After a
great deal of experience actually
using a system in everyday situations, the expert nurse
discovers that without his consciously
using any rules, situations simply elicit from him or her
appropriate responses. The proficient
performer, immersed in the world of his skillful activity, sees
what needs to be done, and
decides how to do it. The expert not only knows what needs to
be achieved, thanks to the well
refined ability to exercise situational discrimination, s/he knows
how to achieve his or her goal.
Change leaders and project managers would do well to consider
the Novice to Expert theory
as they plan implementation initiatives and other informatics
training opportunities. Learners
3/4

7. need particular types of guidance, depending on the level they
are currently at. Novices need
much different instruction and support than advanced beginners
need, and so on. The success
of your initiative ultimately depends on the end-users. Why not
apply this simple yet effective
theory to your nursing informatics practice?
REFERENCES
Benner, P. (1984). From novice to expert: Excellence and power
in clinical nursing. Menlo Park,
CA: Addison-Wesley.
Dreyfus, H. & Dreyfus, S. (1980). A Five-Stage Model of the
mental activities involved in direct
skill acquisition. Operations Research Center Report. University
of California, Berkeley.
Dreyfus, H. & Dreyfus, S. (1986). Mind over machine: the
power of human intuition and expertise
in the age of the computer. Oxford: Basil and Blackwell.
Frisoli, G. (2007). Adult Learning. Adult Learning and
Technology.
APA CITATION
Kaminski, J. (Fall, 2010). Theory applied to informatics –
Novice to Expert. CJNI: Canadian
Journal of Nursing Informatics, 5 (4), Editorial.
http://cjni.net/journal/?p=967
4/4

8. http://cjni.net/journal/?p=1117
http://cjni.net/journal/?p=959Theory applied to informatics –
Novice to ExpertEditorial – Fall 2010Distinguishing
TraitsNovice to Expert LevelsREFERENCESAPA CITATION
Benner’s stages of clinical competence - NSW Health, NaMO -
WOW Project tool 2011 Page 1
Benner's Stages of Clinical Competence
In the acquisition and development of a skill, a nurse passes
through five levels of
proficiency: novice, advanced beginner, competent, proficient,
and expert.
Stage 1: Novice
The Novice or beginner has no experience in the situations in
which they are expected to
perform. The Novice lacks confidence to demonstrate safe
practice and requires continual verbal
and physical cues. Practice is within a prolonged time period
and he/she is unable to use
discretionary judgement.
Stage 2: Advanced Beginner
Advanced Beginners demonstrate marginally acceptable
performance because the nurse has
had prior experience in actual situations. He/she is efficient and
skilful in parts of the practice
area, requiring occasional supportive cues. May/may not be

9. within a delayed time period.
Knowledge is developing.
Stage 3: Competent
Competence is demonstrated by the nurse who has been on the
job in the same or similar
situations for two or three years. The nurse is able to
demonstrate efficiency, is coordinated and
has confidence in his/her actions. For the Competent nurse, a
plan establishes a perspective,
and the plan is based on considerable conscious, abstract,
analytic contemplation of the
problem. The conscious, deliberate planning that is
characteristic of this skill level helps achieve
efficiency and organisation. Care is completed within a suitable
time frame without supporting
cues.
Stage 4: Proficient
The Proficient nurse perceives situations as wholes rather than
in terms of chopped up parts or
aspects. Proficient nurses understand a situation as a whole
because they perceive its meaning
in terms of long-term goals. The Proficient nurse learns from
experience what typical events to
expect in a given situation and how plans need to be modified in
response to these events. The
Proficient nurse can now recognise when the expected normal
picture does not materialise. This
holistic understanding improves the Proficient nurse's decision
making; it becomes less laboured
because the nurse now has a perspective on which of the many
existing attributes and aspects

10. in the present situation are the important ones.
Stage 5: The 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. His/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.
Benner, P. (1984). From novice to expert: Excellence and power
in clinical nursing practice.
Menlo Park: Addison-Wesley, pp. 13-34.
Benner's Stages of Clinical Competence
From Novice to Expert
Patricia E. Benner
This page was last updated on September 16, 2011
Introduction
· Dr Patricia Benner 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
experiences.
· She proposed that one could gain knowledge and skills
("knowing how") without ever learning the theory ("knowing

11. that").
· She further explains that the development of knowledge in
applied disciplines such as medicine and nursing is composed of
the extension of practical knowledge (know how) through
research and the characterization and understanding of the
"know how" of clinical experience.
· She coneptualizes in her writing about nursing skills as
experience is a prerequisite for becoming an expert.
ABOUT THE THEORIST
· Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita
at the University of California, San Francisco.
· BA in Nursing - Pasadena College/Point Loma College
· MS in Med/Surg nursing from UCSF
· PhD -1982 from UC Berkeley
· 1970s - Research at UCSF and UC Berkeley
· Has taught and done research at UCSF since 1979
· Published 9 books and numerous articles
· Published ‘Novice to Expert Theory’ in 1982
· Received Book of the Year from AJN in 1984,1990,1996, 2000
· Her web address is at: http://www.PatriciaBenner.com
· Her profile can be obtained at
http://nurseweb.ucsf.edu/www/ix-fd.shtml
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
Novice
· Beginner with no experience
· Taught general rules to help perform tasks
· Rules are: context-free, independent of specific cases, and
applied universally
· Rule-governed behavior is limited and inflexible
· Ex. “Tell me what I need to do and I’ll do it.”

12. Advanced Beginner
· Demonstrates acceptable performance
· Has gained prior experience in actual situations to recognize
recurring meaningful components
· Principles, based on experiences, begin to be formulated to
guide actions
Competent
· Typically a nurse with 2-3 years experience on the job in the
same area or in similar day-to-day situations
· More aware of long-term goals
· Gains perspective from planning own actions based on
conscious, abstract, and analytical thinking and helps to achieve
greater efficiency and organization
Proficient
· Perceives and understands situations as whole parts
· More holistic understanding improves decision-making
· Learns from experiences what to expect in certain situations
and how to modify plans
Expert
· No longer relies on principles, rules, or guidelines to connect
situations and determine actions
· Much more background of experience
· Has intuitive grasp of clinical situations
· Performance is now fluid, flexible, and highly-proficient
Different levels of skills reflect changes in 3 aspects of skilled
performance:
1. Movement from relying on abstract principles to using past
concrete experiences to guide actions
2. Change in learner’s perception of situations as whole parts
rather than in separate pieces
3. Passage from a detached observer to an involved performer,
no longer outside the situation but now actively engaged in
participation
SIGNIFICANCE OF THE THEORY
· These levels reflect movement from reliance on past abstract
principles to the use of past concrete experience as paradigms

13. and change in perception of situation as a 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 profession's understanding of what it
means to be an expert, placing this designation not on 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.
CONCLUSION
· Nursing practice guided by the human becoming theory live
the processes of the Parse practice methodology illuminating
meaning, synchronizing rhythms, and mobilizing transcendence
· Research guided by the human becoming theory sheds light on
the meaning of universal humanly lived experiences such as
hope, taking life day-by-day, grieving, suffering, and time
passing
RESEARCH ON BENNER'S THEORY
1. Towards an alternative to Benner's theory of expert intuition
in nursing: a discussion paper
2. An evaluation of the seminal work of Patricia Benner: theory
or philosophy?
3. A response by P. Benner to K. Cash, "Benner and expertise in
nursing: a critique"
4. Benner and expertise in nursing: a critique
5. Intuition as a function of the expert nurse: a critique of
Benner's novice to expert model
REFERENCES
1. Dracup and Bryan-Brown. From Novice to Expert to Mentor
Shaping the Future - American Journal of Critical Care.
2004;13: 448-450.
2. Jane Corrigan Wandel. The Institute for Nursing Healthcare

14. Leadership Conference: Reflections on the Impact of Patricia
Benner's Work. Medscape Nurses. 2003;5(2). Accessed on 5-04-
2010 from http://www.medscape.com/viewarticle/462607
BIBILIOGRAPHY
1. Benner, P. (1982). From novice to expert.American Journal
of Nursing, 82(3), 402-407
2. Benner, P., & Wrubel, J. (1982a). Skilled clinical knowledge:
The value of perceptual awareness. Part 1.Journal of Nursing
Administration, 12(5), 11-14.
3. Benner, P., & Wrubel, J. (1982b). Skilled clinical knowledge:
The value of perceptualawareness. Part 2.Journal of Nursing
Administration, 12(6), 28-33.
4. Benner, P. (1984). From novice to expert: Excellence and
power in clinical nursingpractice. Menlo Park, CA: Addison-
Wesley.