Patricia Benner Nurse Theorist A blog power point assignment in partial fulfillment of the requirements for NU 602 Advanced Role Theory in the College of Nursing University of North Alabama
Patricia Benner: An Influential Nurse in the Development of the Profession of Nursing
Patricia Benner’s research and theory work provides the profession of nursing with what we now know as the Novice to Expert model, also known as Benner’s Stages of Clinical Competence. Benner’s work as applied to the nursing profession is adapted from the Dreyfus Model of Skill Acquisition.
“ The utility of the concept of skill acquisition lies in helping the teacher understand how to assist the learner in advancing to the next level” (McClure, 2005)
The Dreyfus Model of Skill Acquisition is shown on the next slide: (Dreyfus, 2008).
“ Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 years. Nurses with a range of experience and reported skill fullness were interviewed. Each study used nurses' narrative accounts of actual clinical situations. A subsample of participants were observed and interviewed at work. These studies extend the understanding of the Dreyfus model to complex, underdetermined and fast paced practices. The skill of involvement and the development of moral agency are linked with the development of expertise, and change as the practitioner becomes more skillful. Nurses who had some difficulty with understanding the ends of practice and difficulty with their skills of interpersonal and problem engagement did not progress to the level of expert. Taken together, these studies demonstrate the usefulness of the Dreyfus model for understanding the learning needs and styles of learning at different levels of skill acquisition.” (Benner, 2004).
Patricia Benner Honored
In 2003, the Institute for Nursing Healthcare Leadership celebrated the 20 th anniversary of Benner’s work.
“ Introduced at the podium as ‘the person who taught the world how to listen to the voice of the nurse’, Benner discussed the importance of attending to the expertise embedded in clinical nursing practice. For nursing practice to flourish, she said, nurses must deepen their understanding of the important knowledge that develops during clinical work. Citing the often-discussed ‘theory to practice gap’ in which elements of science do not move into practice, she discussed the ‘practice to theory’ gap in which clinicians fail to recognize and develop the knowledge that can only be gained in the world of experience.” (Wandel, 2003).
Benner’s accomplishments are many, in addition to being a faculty member at UC San Francisco, she has authored nine books and numerous articles, she is an internationally known lecturer and researcher on health, stress, and coping, skill acquisition and ethics.
The impetus for Ms. Benner’s involvement in nursing and her important research is summarized on her website:
“ In a highly changing health care environment, the core of the hospital, the core of the hospital is patient care and the core of the core is the practice of the nurses who are with patients on a 24-hour basis. Whether the hospital finds itself in a time of strong or lean financial resources, or a time of nursing shortage or surplus, the key question is whether, in this era of highly acute patients, there are nurses who have an excellence of practice that can directly affect how a patient progresses to discharge and reduce unnecessary recidivism.”
Benner’s work in applying the Dreyfus Model of Skill Acquisition has produced the following five stages of nursing expertise:
Stage 1: Novice
“ Beginners have no experience of the situations in which they are expected to perform.” (Benner, 1984).
These inexperienced nurses function at the level of instruction from nursing school. They are unable to make the leap from the classroom lecture to individual patients. Often, they apply rules learned in nursing school to all patients and are unable to discern individual patient needs. These nurses are usually new graduates, or those nurses who return to the workplace after a long absence and are re-educated in refresher programs.
Stage 2: Advanced Beginner
“ Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note or to have pointed out to them by a mentor, the recurring meaningful situations components.” (Benner, 1984).
Advanced beginners are able to translate some didactic and clinical learning principles to individual patients, but often lack the real life experiences that differentiate individual patients.
Stage 3: Competent
“ Competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware.” (Benner, 1984).
Competent nurses are able to plan and care for patients on an individual basis following a plan of care or the lead of a more experienced nurse. Competent nurses are able to provide safe care, but are not looked upon as formal or informal leaders. Their decision-making abilities usually consist of individual circumstances and rarely are they able to see how one situation affects the ‘big picture’.
Stage 4: Proficient
“ The proficient performer perceives situations as wholes rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as whole because they perceive its meaning in terms of long term goals.” (Benner, 1984).
The proficient nurse frequently is able to assume charge nurse duties and lead a group of nurses in clinical practice. They are frequently able to manage care of several patients without direct supervision. These nurses provide formal and informal leadership to the nursing unit, and are often the nurse that is called upon by the less experienced nurse to provide assistance.
Stage 5: Expert
“ The expert performer no longer relies on an analytic principle to connect his or her understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now 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.” (Benner, 1984).
The expert performs their duties without thinking; they react automatically to situations and are often ‘thinking ahead’ during a situation. They frequently are formal leaders and are called upon to provide clinical expertise to other staff members. Many times experts are able to function seemingly ‘without thinking’ as their abilities seen to others to come as second nature.
Benner is a relatively modern theorist, with her work having been done in the early 1980’s. Since that time health care has seen the advent of DRG’s, managed care, an increase in the acuity of patients in the hospital related to early discharge and bounce back admissions.
Her theory of expert nurses is critical today as the profession begins to realize the aging of the members of its workforce and the increasing age of the population who will require more nursing services. Her theory is applicable today, as it was at its publication, and provides us with a foundation to use for assigning clinical competence, a tool to use to assess competence in the staff nurse.