Nursing is an art of caring which is more flourished by clinical experience and sound educational background (Benner 1982). As a nursing involves with patient centred approach, it needs a theory which can prove to be a strong scientific base for it. Benner explained expertise as a road with 5 stages which should be passed through by a Practitioner to become clinically skilled. Patricia Benner’s from Novice to Expert is known as one of the most important theory in the field of Nursing (Cash, 1995).
Experience and high degree of skills both are necessary components for nursing practice. The objective of this study is to explanation of Benner’s theory along with its stages and how it is relating to NMBA norms to practice nursing. The author will also explore that Benners work as applied to the nursing profession is adapted from validation and the Drefus model of skill acquisition. The author will also discuss a comparative analysis of novice versus advanced nurse.
Patricia Benner published her theory in 1982.
The theory was based on elementary units of advancing levels of nursing experience. The levels include 5 stages from novice to expert. Each level serves as a base for the next. If the nurses want to grow nurse in their selected field, they need to follow the elementary units. Theory explains that nurses require skills to become expert. Benner applied her work to the Dreyfus model of skill acquisition. That model was developed by Dreyfus and Dreyfus (1980), and Benner (1982). Moreover, she proposed that knowledge can be enhanced by practical knowledge and practical experience through research and one can gain knowledge without ever learning the theory (Journal of advanced nursing 18, 387-393).
She did research and published novice to expert in year 1982. Benner (1984) also recommends that nurses would have better learning by observation and learning from nurses who have immense experience in related field. Those act as their guide and having high level of cababilities (Benner 1982).
Novice, advanced beginner, competent, proficient, expert.
Novice (Student graduate who are learning to fly) ” She has just graduated from nursing school. They are the beginners having no experience of situations. Their nursing practice skills are limited. She is goal-oriented and can accomplish that given work without circumstantial experience. Example includes a nurse having years of experience in medicine transfers to surgical specialty. The once expert is the novice again in a different situations (Thomes J), (Benner et al., 1996).
Advanced Beginner (New graduate gaining height) – A nurse who has begun to accumulate situational experience according to Benner. They can carry out the slightly justifiable performance. They do not have the ability to conclude which task can be the prime or main concern. She will follow particular commands or rules and take no notice of other things. Example of this include a nurse asked to check blood pressure, she will carry out solely that, do not check for oxygen saturation of patient in respiratory distress (Thomes J), (Benner et al., 1996)
Competent (2-3 years in same setting- leaving the nest) ” According to Benner, they begins to see how nursing actions affect others including others and collegues. They are more relaxed in their patient approach as compared. They are not flexible enough to sort out the things but they can arrange systematically a patient care plan by evaluating his requirements. They are able to outline long term objectives. She is a resource nurse for novice and advanced beginner. Example includes a nurse normally inquiring for patient well being, checking side by side his pulse rate, drains and skin turgor (Thomes J), (Benner et al., 1996).
Proficient (3-5 years- On their own) ” According to Benner, this nurse has acquired what to presume in fixed circumstances, but can alter plan of care in response to evolving conditions. She perceives the situation as a whole and can plan long term goals. She will not get panic, if there is sudden change in scenario. For example, a patient who is talking normally, suddenly having seizure, up rolling of eyeballs, twitching of hands and became unresponsive. She will not wait for help or doctor’s order, activates EMR and start CPR, if there is no pulse. (Thomes J), (Benner et al., 1996)
Expert (Extensive, Soaring high- where to go?) ” She has acquired nursing skills that allow that nurse to be able identify a problem without wasteful thoughts of possible solutions to problems (Benner, 1982). She has vast knowledge experience, having instinct ability to interpret the things and can conclude important considerations. She would be an outstanding teacher accomodate knowledge to nurses who have not so much experience. For example a patient on dialysis sweating profusely, out of breath, back trouble along with agitation. Haemo dynamically he was stable but was restless. Dialysis closed and patient settled down but nurse was upset that something was surely not right with him. Same episode happened in next HD which then found dialyzer reaction (Thomes J), (Benner et al., 1996)
Advance practice nurse- APNs, as compared to novice and expert have a comprehensive and more multiplex practice. It includes specialization in a particular area by hands on and conceptual understanding which expanded through experience. For which a research was executed and patients separated into 2 categories. One category was taking care by expert and other was by APNs. The category looked after by APNs had more complex health concerns and were discharged with a number of gadgets than were patients in other category. But participants were more pleased by nursing care delivered by APNs as compared to other health care providers
Functions of Novice versus advanced nurse- Firstly they both are different in their clinical judgement. Novice determined by directions, recommendations and norms for clinical measures. They become affected by clinical conditions but eager to acquire new knowledge. She is theoretical, requires persistent instructions and assurance routinely. While APN is grouping of 4 characters: the NP, CNS, CNM, and CRNA. Their functions are- Counselling and teaching, Discussion, Research based practice, Supervision, Teamwork, Moral resolutions.
Thinks critically and analyses nursing practice- Professional nursing competence defined by Benner (1984) as stages of skill acquisition (Novice to Expert stages) serves as conceptual framework for this study. Critical thinking is innate surrounded by nursing practice (Carleen A. Maynard, p-12). Discoveries do support Benner’s (1984) claim that nurses inclined to acquire expertise and awareness firstly through steps based on experience. Experimental fraction results in critical thinking potential. Advanced beginner has begun to figure out the rationale for tasks executed- the eternally evasive “critical thinking skills” are in vision (Carleen A. Maynard,P-17)
Professional evolution authorizes nurses to strengthen skill and proceed across the level of accomplishment as narrated by Benner (1984).
Benner advocates nurses depends on previous experience and nurses must intensify their clinical state. She highlights apprehension evolution via experience but does not abandon analytical thinking. Critical thinking is required at all skill levels.
Advanced clinical assessment, involvement and ultimate bio film elimination therapies, eventually refining patient consequences. Benner skill acquisition model enlightened the expansion of this project (Stevenson, 2018)Develop a plan for nursing practice.
Provides safe, appropriate and responsive quality nursing practice.
Experience and skillfulness both are connected but dissimilar ideas. We interpret experience, also based on Benner (1984), as both time in practice and self reflection that enables fixed formulation and belief to be established, refined in actual circumstances. Solely experiencing patient conditions and situations is not experience; rather experience involves nurses reflecting on encountered circumstances to improve their moment to moment decision making at an unconscious, instinctive level (Benner, 1984)
Transition is the variation from one condition to other which causes alteration in the lives of individual (nurse) and others (patients). (Schum-acher & MELEIS, 1994, P.119). Freshly graduate nurses undertaking the profession because of growing demand of nurses and expanding requirements of health care (Barney, 2002; Purnell, Horner, Gonzalez & Westman, 2001; Shields, 2004). This part of transition exhibits remarkable alterations in their perception and they adapt with new position and accountability. This was claimed by Dearmun (2000), and Duchscher (2001) that in first 3 months, recently graduates realize huge dissimilarity in academic and experimental knowledge. These novel graduate passes via stages of doing, being and knowing (Judy Boychuk Duchscher
This is the orientation period of professional stage for new nurses which is of 3-4 months. Patients are not alloted to them. They are on probationary title of graduate nurse. They just have to follow commands and are enclosed to directions (Judy Boychuk Duchscher)
Post orientation is next 4-5 months, they undertake improvement in their thinking, understanding and expertise. They lack certainity in their potential and feel unsafe for their practice. (Judy Boychuk Duchscher)
After 12 months of practice, they acquied comparatively balanced state of relief and faith with their position, duty and regimen. Their growth can be seen in answering questions and assisting others in their task (Judy Boychuk Duchscher)
Novice to Expert theory can be used as a fixed clinical recommendation for regulating all practices linked with nursing care. Hands on skill is crucial for professional development of a nurse. She goes through diverse challenges to become expert from a novice. Author also concluded with help of examples and articles that via experience and self reflection a nurse can boost patient care outcomes.
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