Benner’s stages of Nursing Expertise and Philosophies

Important Principles

Novice
- The person has no background experience of the situation in which he or she is
involved.
- This level applies to the students of Nursing, but Benner has suggested that
nurses at higher levels of skills in one area of practice could be classified at the
novice level if placed in an area or situation completely foreign to them such as
moving from general medical-surgical adult care to neonatal intensive care units.

Advanced Beginner
- Nurses at this level are guided by rules and are oriented by task completion.
- They have difficulty grasping the current patient situation in terms of the larger
perspective.
- Nurses at this stage view clinical situations as a test of their abilities and the
demands of the situation placed on them rather than in terms of patient needs
and responses.
- Advanced beginners feel highly responsible for managing patient care, yet they
still rely on help from those who are more experienced.
- Benner places most newly graduated nurses at this level.

Competent
- This stage is typified by considerable conscious and deliberate planning that
determines which aspects of current and future situations are important and
which can be ignored.
- Consistency, predictability, and time management are important in competent
performance.
- A sense of mastery is acquired through planning and predictability.
- This stage is most pivotal in clinical learning, because the learner must begin to
recognize patterns and determine which elements of the situation warrant
attention and which can be ignored. Also considered to be the most pivotal in the
formation of the everyday ethical component of the nurse.
- To become proficient, the competent performer must allow the situation to guide
responses.
 - Anxiety is now more tailored to the situation than it was at the novice or
advanced beginner stage, when a general anxiety exists over learning and
performing well without making mistakes.

Proficient
- The performer perceives the situation as a whole (the total picture) rather than in
terms of aspects, and the performance is guided by maxim.
- The performance of the nurses is guided by deep understanding.
- The proficient level is a qualitative leap beyond the competent. Now the
performer recognizes the most salient aspects and has an intuitive grasp of the
situation based on background understanding.
- They no longer rely on preset goals for organization, and they demonstrate
increased confidence in their knowledge and abilities.
- This stage there is much more involvement with the patient and family.
Transition into expertise.

Expert
- They complete the task without technical difficulties
- Nurses integrate knowledge to guide care
- They have an intuitive understanding and skills a situation
- There is a qualitative change as the expert performer “knows the patient,”
meaning knowing typical patterns of responses and knowing the patient as a
person.
- Expert nurse has the ability to recognize patterns on the basis of deep
experiential background.

Key aspects of Expert Practice

● Demonstrating a clinical grasp and resource-based practice
● Possessing embodied know-how
● Seeing the big picture
● Seeing the unexpected

Aspects of a situation
The aspects are the recurring meaningful situational components recognized and
understood in context because the nurse has previous experience
Attributes of a situation
The attributes are measurable properties of a situation that can be explained without
previous experience in the situation.

Major concepts
Competency - area of skilled performance identified by its meaning.
Domain - area of practice having a number of competencies with similar intents,
functions, and meanings.
Exemplar - an example of a clinical situation that conveys one or more intents,
meanings, functions, or outcomes.
Experience - an active process of refining and changing preconceived theories,
notions, and ideas towards actual situations.
Maxim - a skilled performance that requires a certain level of experience to recognize
the implications of the instructions.
Paradigm case - clinical experience that stands out and alters the way the nurse will
perceive and understand future clinical situations.
Salience - a perceptual stance or embodies knowledge whereby aspects of a situation
stand out as more or less important.
Ethical comportment - it involves engagement in a particular situation and entails a
sense of membership in the relevant professional group. Clinical and ethical judgments
are inseparable and must be guided by being with and understanding the human
concerns and possibilities in concrete situations.
Hermeneutics - means interpretative. Refers to studying meaningful human
phenomena in a careful and detailed manner as free as possible from prior theoretical
assumptions, based instead on practical understanding.

Use of Empirical Evidence

Benner directed the AMICAE project to develop evaluation methods for

participating schools of nursing and hospitals in the San Francisco area. It was an
interpretive, descriptive study that led to the use of Dreyfus’ five levels of competency
to describe skill acquisition in clinical nursing practice. The interpretive method,
according to Benner, seeks a rich description of nursing practice from observation and
narrative accounts of actual nursing practice in order to give text for interpretation
(hermeneutics).
 The domains and competencies of nursing practice were provided by Benner as
an open-ended interpretive framework for better understanding the knowledge
embodied in nursing practice. Domains and competencies should be developed for
usage in each institution through the study of clinical practice in each specific site
because clinical knowledge is socially rooted, relational, and dialogical.

Metaparadigm of the theory

Nursing

- Caring relationship, caring is primary, nursing as a caring practice.

- Caring is primary because caring sets up the possibility of giving help and
receiving help.
- Nursing is viewed as a caring practice whose science is guided by the moral art
and ethics of care and responsibility.
- Nursing is not only about care but the responsibility in giving the best treatment
possible towards your patient. Building a relationship is important because a
strong connection will make a person feel secured and safe which would
definitely help you as a nurse to deal with your patients’ situation and health
experience.
- Benner & Wrubel (1989) understand nursing practice as the care and study of
the lived experience of health, illness, and disease and the relationships among
these three elements.

Person

● The role of the situation

● The role of the body
● The role of personal concerns
● The role of temporality

Together this aspects of the person makes up the person of the world

“A person is a self-interpreting being, that is, the person does not come into the
world predefined but gets defined in the course of living a life. A person has an
effortless and non reflective life understanding of the self in the world” - Benner &
Wrubel (1989)
 - This means that as you live your life you will find your purpose in this world.
- Embodied/Embodiment – is the capacity of the body to respond to meaningful
situations.

Health

- What can be assessed. Well-being: human experience of health or wholeness.

Well-being and being ill are distinct ways of being in the world.

- Health is described as not just the absence of disease and illness a person may
have a disease and not experience illness. Because illness is the human
experience of loss or dysfunction while disease is what can be assessed at the
physical level.

Situation

- It conveys a social environment with social definition and meaningfulness.

- “Personal interpretation of the situation is bounded by the way the individual is
in it”
- This means that each person’s past, present, and future which includes his or her
own personal meaning, habits, and perspective influences the current situation.