Benner's theory of novice to expert

Topic 8 DQ 1

Nursing Theorist: Patricia Benner

Dr. Patricia Benner and her nursing theory Novice to Expert is one of the most widely used models that provides guidance as professional nurses progress through learning in clinical practice. Her framework identifies nurses’ needs at different stages of clinical competence. Her model outlines five different stages of skill acquisition; novice, advanced beginner, competent, proficient, and expert (McEwen & Wills, 2014) Benner’s theory “is not focused on how to be a nurse, rather on how nurses acquire nursing knowledge” (Benner, 1984, p. 22).

This nursing theory explains that expert nurses progress through skills and understanding of patient care over time, with appropriate education, and clinical experiences. The foundation of the theory starts at the lowest stage, novice and proceeds to the next stages, building upon each other. The stages are not independent of each other but rather a ladder to the stage of expert. Each nurse and nursing leadership can use this in their own practice to evaluate themselves and where on the continuum of education and nursing experience they are at.

Choice of Theorist

Dr. Patricia Benner had her work first published in 1984, just 2 years after she finished her PhD from University of California at Berkley (McEwen & Wills, 2014). Her model used the Dreyfus skill acquisition to nursing which was “developed by a mathematician and a philosopher” (McEwen & Wills, 2014, p. 222). The five stages are described as:

Novice: The novice nurse enters the profession with no experience and requires guidance and continual support.

Advanced beginner: The advanced beginner nurse is experiencing different patient experiences and learning by doing. This level thinks very concretely.

Competent: A competent nurse is able to demonstrate analytical and abstract thinking. Typically, a nurse enters this stage after practicing for two years or more.

Proficient: A proficient nurse develops a better understanding of the clinical picture. Proficient nurses also are able to critically think and are able to determine care with the use of knowledge, skill, and intuition.

Expert: The expert nurse is the highest level attainable. This nurse practices primarily by intuition and is “deeply connected to the clinical situation. Interventions are implemented based on a strong foundation of knowledge and years of clinical experience” (Benner, 1984, pp. 34-35).

The group’s choice of Benner’s theory model was based on the familiarity with this theory and its application to practice. This theory can be easily described and incorporated into institutions. The progression to each level can be easily documented and assessed. As a group progressing through these stages in our professional backgrounds and clinical experiences, the attainment of the level of expert has been very personal to each of us.

Category of Theorist

Benner’s theory falls in the classification of high middle range nursing theory. This theory addresses the gap between the grand theories and practice theories. Descriptions, explanations, and predictions put forth in a middle-range theory are intended to pose questions asked in practice theories (McEwen & Wills, 2014). These theories usually consist of fewer concepts and allow for testing of nursing practice. Different from practice theories, middle range theories are “more specific than grand theory but abstract enough to support both generalization and operationalization across a range of population; this sets it apart from practice theory” (McEwen & Wills, 2014, p. 217). Benner’s Model of Skill Acquisition is considered a high middle range theory because it is a better-known and widely used theory. Being labeled a high middle range theory is defined as not containing the criteria for grand theory category.

Assumptions of Theory

One way that Benner (1982) describes nursing is that nurses “through their education and experience, develop and observe many ways to understand and cope with illness, as well as many ways of experiencing illness, suffering pain, death, and birth” (p. 406). While there is no specific definition for person made by Benner, a person is referenced to as a patient and a layperson having isolated experiences with health and illness (Benner, 1982). Health is referenced throughout her work but again, no specific definition, although she acknowledges that it includes illness, pain, death, birth, and emotions. The environment focused on by Benner is healthcare facilities and where nurses care for patients. Benner recognizes that nurses move on the Novice to Expert continuum depending on where in their career they are at.

Major Concepts and Proposition of the Theory

The rising concerns of patients regarding the quality of healthcare and their awareness about the relationship between healthcare quality and the value of life has increased the pressure on healthcare professionals. The primary dependence of quality of healthcare or delivery of patient-centered care is the direct responsibility of the nursing staff, which has been defined as the main reason for rising stress in the nursing industry. Such complications and complexities of the nursing profession motivates significant percentage of nurses every year to leave nursing profession, which is also the major reason for increased turnover rate in the nursing industry. Accordingly, it has been observed that many nurses change their profession within the first year of their work experience due to the increased amount of stress and workload (Trinkoff et al., 2013). Another reason for the increased work burden on nurses is the tiresome environment of the healthcare industry, which is inflicted by continuous interaction of nurses with patients suffering from traumas, untimely deaths, tragedies, and terrible injuries. On the other hand, it has been assessed that nurses become efficient over time, and are more likely to continue with their careers after successful accomplishment of the first five years in the nursing industry (Trinkoff et al., 2013). This is aligned with the findings of the Benner’s from Novice to Expert nursing theory that reveals the development and refinement of nurses’ skills and knowledge on the basis of experience without the exposure of nurses to new theories and advancements in the field of nursing and healthcare (Gardner, 2012). For this reason, it is revealed that the working environment of the nurses should be improved in order to allow them to learn and become efficient through experience, which is in line with the findings of Benner’s nursing theory, and will help in the quality of care in the longer run.

Benner’s nursing theory certifies that nurses are able to upgrade their individual skills and expertise through experience in the healthcare environment (Gardner, 2012). For this to happen, nurses should give themselves time and leverage to learn new skills and become more efficient for handling stress and enhanced work burden, which is only possible through increasing the quality of work environment for nurses. The work environment of nurses is dependent on two factors; the first one is the quality of the healthcare facility; and the second one is the individual ability and capacity of nurses that allow them to cope with the stressful environment of the healthcare industry. It has been observed that there is a limit to improving the quality of the healthcare facility as surgeries and treatments of injured and ill patients are not an exciting experience for healthcare professionals, which increases the significance of inducing leadership attributes and focusing on team building to motivate nurses. This is important for allowing nurses to give themselves time and leverage to become use to the healthcare environment, which is crucial for reducing their stress and accordingly improving the quality of care in the longer run (Twigg & McCullough, 2014). Moreover, enhancing leadership and building stronger teams among nurses will enable the implementation of Benner’s theory, which reveals improvement in nurses’ efficiency with increased work experience.

How Benner’s Theory is Used

Leadership has emerged as one of the most important management traits in all types of industries, which increases the overall efficiency of the workforce without incurring additional costs to the organization (Twigg & McCullough, 2014). This is based on the inspirational motivation of leaders that is induced in their fellow nurses, subordinates and team members, which allows them to work more diligently and with greater amount of motivation. Also, leaders are able to identify the individual strengths and weaknesses of their line employees and team members, which is essential for aligning the individual skills and expertise of employees with their job descriptions (Twigg & McCullough, 2014). Such alignment is beneficial for reducing the stress associated with the healthcare environment. This results in a more comfortable environment for the nurses, which allows them to keep on working as they enhance their individual skills over a period of time. On the other hand, team building is also a source of increasing motivation level of nurses. Leadership and team building are easily implemented simultaneously due to their common results that are inclined towards increasing the motivation level of nurses. Accordingly, it is revealed that in order to reap the benefits of Benner’s from Novice to Expert nursing theory for improving the efficiency and individual skills of nurses, it is essential to enhance leadership and team building in the work environment of the hospital (Gardner, 2012).

It has been observed that Benner’s theory emphasizes a positive relationship between skills and experience of nurses but the positive outcomes of increased work experience of nurses are limited by the poor work environment and increased stress faced by nurses in the healthcare environment (Gardner, 2012). Accordingly, leadership and team building are the key attributes that should be used by the healthcare facility to improve the quality of the work environment of the hospital, so the management is able to reap positive outcomes of Benner’s theory. The implementation of nursing leaders and strong nursing teams will also minimize the turnover rates in the nursing industry, which will further increase the quality of care due to increased quality of workforce that is more experienced and efficient without undergoing additional training for learning new theories.

Theory Integration into Practice

In practice, when errors are made, nurses are provided staff education to decrease the likelihood of the reoccurrence of such errors. Unfortunately, staff education is often seen as a discipline from higher authority, however, rather than a punishment, a nurse should view these situations as a learning experience and utilize it towards personal and professional growth. A nurse taking the initiative is also vital to growth. Attending staff training sessions and participating in committees will guide nurses to stay current with research, evidence-based practice, and policies and procedures of the organization. All these are necessary to progress towards Benner’s expert phase. Although Benner’s theory states that a nurse becomes novice to expert through years of clinical experiences, it does not mean that expert nurses do not lack knowledge. A novice nurse will be most current with new evidence-based practice, whereas more experienced nurses are more likely to use patient care techniques that works best for them.

Examples

The most current research shows that apple juice is more efficient than orange juice with hypoglycemia, however, some more experienced nurses continues to use orange juice. After educating staff using the above example of hypoglycemia treatment, a facility can evaluate the data of treatment provided to patients to see if practice changes have occurred. This evaluation aspect ensures that in addition to training, follow up is used to reinforce the ideas. The ideal outcome would be that the expert nurse, who may believe in her ways, uses the evidence to change her practice and becomes better at treating hypoglycemia. Another outcome is that a novice nurse, who may previously called the doctor for advice, tries this intervention first and assesses the patient’s response. In such situations, learning is always an on-going process in which novice can learn from experts, and vice-versa. Nurses can use Benner’s theory to evaluate themselves and leadership can use her model to insure training and education is thorough.

Conclusion

In conclusion, Benner’s theory of Novice to Expert guides our nursing care regardless of the field of nursing. Although education is important, it is only the base of what we truly need to learn. Most of our learning is accomplished from hands on experience. Benner states that theories are not always necessary to gain knowledge and skills (Benner, 1984). The knowledge we gain through trial and error from our clinical experiences is what promotes growth and expertise. A novice nurse simply follows directions and bases patient care on class acquired knowledge. A nurse with more years of experience will guide his or her practice on previous experience. For example, a novice nurse will contact the doctor for a blood pressure of 84/52 if the orders indicate to do so, however for a nurse with more experience, they are more likely to assess for dehydration, check patient’s baseline, push fluids, and re-check post interventions. A nurse with more expertise will contact the doctor after nursing interventions fail. Expert nurses more often recognize trends and reports accordingly to avoid critical conditions in patients. Unfortunately, even nurses in expert phase make errors that lead to patients in distress.

References

Benner, P., (1982). From novice to expert. The American Journal of Nursing, 82(3), 403-407. doi:10.2307/3462928

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley

Gardner, L. (2012). From novice to expert: Benner's legacy for nurse education. Nurse Education Today, 32(4), 339-340. Retrieved fromhttp://dx.doi.org.lopes.idm.oclc.org/10.1016/j.nedt.2011.11.011

McEwen, M., & Wills, E.M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health: Lippincott Williams & Wilkins.

Trinkoff, A. M., Han, K., Storr, C. L., Lerner, N., Johantgen, M., & Gartrell, K. (2013). Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes. Journal of Nursing Administration, 43(12), 630-636. doi:10.1097/NNA.0000000000000004

Twigg, D., & McCullough, K. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. doi:10.1016/j.ijnurstu.2013.05.015