Patricia Benner Novice to Expert is a study in having the 'know-how' and how to apply that knowledge. Dr. Benner believes in actual experience being a prerequisite to becoming an expert.
Patricia Benner is a big supporter of the belief that intuition derived from practical experience, plays a huge role in gaining the qualifications that make up 'expertise'. There has been a lot of data collected concerning intuition and its role in expert nursing.
Benner's theory of practice development demonstrates the way a nurse goes from a rule-based practice at the beginning, to the end result of becoming an expert. Not everyone agrees that expert practice being intuitive is the right notion. One expert practice definition is made up of 3 different types of intuitive practice, which are 'embodied', 'transitional', and 'cognitive'. It is believed that the development of these intuitive practices are dependent upon knowledge, then experience, and then reflective time.
While not all agree with the Patricia Benner nursing theory, it has definitely gained a considerable amount of interest from nursing educationalists. It shows promise in forming the basis for certain curricula being offered by some colleagues of nursing education. The quest is all about defining and explaining exactly what 'expert' means in regard to nursing.
Patricia Benner believes that nursing in various acute-care settings has now grown to be very complex. So much so that, it's not possible any longer to routinize it, or standardize it, or to delegate very much in regard to what a nurse does.
Before now, nursing care was very formalized, and nursing personnel has an 'interchangeability' that allowed for an easy nurse turnover.
However, with an increase in the acuity levels of patients, and shorter hospital stays, the demand for more technologically savvy nurses and specialized nursing has increased. Because of the complexity of nursing, and the increase in responsibilities, calls for a long-term commitment to ongoing career development. Thus, Patricia's view that there is a huge call for realizing the difference between an experienced nurse and a novice.
She works off of the 'Dreyfus Model of Skill Acquisition'. She views this as being a useful tool. It was created by 2 Berkeley, California professors. One was Stuart Dreyfus, who was a mathematician and a systems analyst; and the other was Huber Dreyfus, who was a philosopher. They acquired their knowledge by studying chess players and also pilots.
1. Novice
2. Advanced Beginner
3. Competent
4. Proficient
5. Expert
and these levels will reflect the changes in 2 general aspects concerned with skilled performance. The first aspect is a moving away from being reliant on abstract principles, and on to the using of past, solid experience as paradigms. The second is changing perception and understanding involved with a demand situation, to simplify how that situation is seen.
The Novice
A beginner has no experience in regard to situations in which they have to perform. That is the purpose of education. It is a preparation leading up to the experience. They learn about objective attributes, which are features describing the task, that they can recognize without having any situational experience.
There are common attributes shared by novices that include blood pressure, temperature, weight, intake/output, pulse, and various other measurable and objectifiable parameters involved with the condition of the patient.
According to 'Patricia Benner Novice to Expert', these novices also learn rules that guide their actions in respect to these various attributes.
One of the hardest difficulties for a novice to face, is to deal with their inability to make discretionary judgements. Because of their lack of experience in the situations they face, they are forced to rely on the rules to govern their performance. They are stuck in a situation that leaves them powerless to determine what tasks are the most relevant for a particular situation, and when it is necessary to make an exception to a rule.
Advanced Beginner
At this level a nurse is able to demonstrate performance that is fairly acceptable. They are someone who has had to cope with enough real life situations to be able to recall the aspects of former meaningful situational components. Patricia Benner notes that novices and advanced beginners are only able to take in very little of a situation, due to the fact that it is all too new and too strange to them.
Advanced Beginners, or the instructors of Advanced Beginners, are able to formulate guidelines that govern actions in regard to attributes and aspects. Those guidelines for actions integrate as many of the attributes and aspects possible, but tend to ignore the strangeness and newness of the experience. Therefore, they have a tendency to treat every attribute and every aspect with equal importance.
Novices and Advanced Beginners are intensely focused on following the rules. All their concentration is on rules and guidelines, sometimes robbing them of the flexibility needed for addressing an immediate call for a change in procedure. An experienced nurse is able to flow as needed, answering each challenge in a necessary order, even if it is not within the confines of the rules.
Competent
The competent nurses are typically the nurses who have two to three years of experience under their belt. They are beginning to see their careers in terms of their long-range goals. They have established a plan and developed a perspective.
The competency of nurses in this stage is evidenced by them seeing their actions through the long-range view. They are not yet as fast or flexible as the 'proficient' nurses, but they have acquired a feeling of mastery and an ability to manage and cope with various contingencies involved with clinical nursing.
This competent level is where many nurses wind up staying, mainly because of the fact that it is seen as being 'ideal' by supervisors. They are at the level where the routinization and standardization of procedures are managed well, which helps with the high nursing turnover. Most of the in-service education has been aimed at these nurses achieving the level of competency. Only a few of the in-service offerings get aimed at reaching the proficient level or the expert level of performance.
Proficient
The Patricia Benner Nursing Theory supports the view that with continued practice, a competent performer will move into the proficient stage. They are able to perceive a situation as a whole instead of in aspect terms, and their performance is now guided by maxims.
Experience can teach proficient nurses which typical events they can expect within a given situation. It also gives them intuition about how to modify their plans in order to respond properly to such events.
Due to the experience-base abilities of proficient nurses, they can now recognize whole situations, and know when an expected normal picture is not present within itself, with normal now being absent. The decision-making is now much less labored in terms of attributes and aspects.
Expert
According to Dr. Benner, at this level, a performer will no longer be reliant on analytical principles such as rules and guidelines, for connecting his/her understanding of a given situation, in order to take the appropriate action.
The expert nurse carries a huge background of experience, with an intuitive grasp of situations. They are able to zero in on the problem without wasting time on unfruitful possibilities in problem situations.
The expert operates out of a deep understanding of each situation, a lot like a chess master, who makes a move based on the fact that it simply 'felt right'.
Again, the Patricia Benner Nursing Theory is not accepted by all. However, it does hold to some basic truths in learning, education, and performance, that cannot be overlooked or ignored. It is an interesting study.
