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Dr. Patricia E. Benner was the first nursing theorist to apply the Dreyfus model of
skill acquisition to the nursing profession. Her nursing theory was new to the profession.
Dreyfus presented his theory in 1980 as a basis to determine where an employee is
skill-wise in their profession and when they are ready to move up to the next level
of competency. In 1984, Dr. Benner published her book, From Novice to Expert, which
changed the way expertise and teaching was applied to nursing.
Today, Dr. Benner is currently a professor emeritus at the University of California
at San Francisco in the Department of Social and Behavioral Sciences. Dr. Benner has
published nine books, but is still best known for her theories on leadership and expertise
in nursing.
Dr. Benner's theory made clear once and for all that nursing expertise was not about
who made the most money in their field or who held positions of leadership. Rather
competence was based primarily on experience in the profession.
The Dreyfus model took four characteristics of knowledge and applied them to skill
acquisition. It looked at:
- Recollection - situational or non-situational
- Recognition - decomposed or holistic
- Decision - analytical or intuitive
- Awareness - monitoring or absorbed
Each characteristic had a range from top to bottom. As an example, a person who
has great recollection skills will use complete situations from the past in their
work rather than non-situational approaches. Using these four characteristics, he
then developed five layers of expertise, each one including the four characteristics.
These are:
- Novice - non-situational recollection, decomposed recognition, analytical decision and monitoring awareness
- Competence - situational recollection, decomposed recognition, analytical decision and monitoring awareness
- Proficiency - situational recollection, holistic recognition, analytical decision and monitoring awareness
- Expertise - situational recollection, holistic recognition, intuitive decision and monitoring awareness
- Mastery - situational recollection, holistic recognition, intuitive decision and absorbed awareness
Dr. Benner applied this idea to the nursing profession to use as a gauge for looking at
the competency of nurses and the effectiveness of training. As with the Dreyfus Theory,
the primary way to acquire increased competency in the nursing profession was with
actual on the job experience. Dr. Benner came up with the following five levels of
nursing:
- Novice - Performs work by following rules and a few basic procedures learned in school or on the job. This is a "tell me what to do and I will do it" situation.
- Advanced Beginner - Demonstrates knowledge of all basic skills. Has a number of past situations that can be drawn on to help with new experiences in the field. Begins to develop a personal structure of guidelines in the profession.
- Competent - Generally a nurse with 2 to 3 years of experience in the same area. Has situational recognition and can form holistic views of any situation. Begins to look at long-range planning for situations in the profession and plans work on own initiative.
- Proficient - Able to add intuition to decision making in the profession. Able to easily switch to an assortment of skills and knowledge depending on the situation. Assists with long-term planning and decisions in their area of nursing.
- Expert - Performance is fluid, almost automatic. No longer relies on individual parts or thinking, but is able to look at the profession as a whole and plan their work. Planning and decision making has become automatic and is successful.
Dr. Benner also categorized three additional changes that occur as nurses mature in
their profession. These changes are:
- Moving from relying on abstract principles to using past experiences to dictate actions.
- Change in nurse's perception of a situation as a whole rather than individual pieces.
- No longer a detached observer, but the nurse becomes an active participant in their profession.
Dr. Benner's theories led to a change in the profession from depending on research
and theorists to promote change and improvement in nursing to the profession relying
more on the nurses who are actually working in the field. Many theories were not always
very workable when put into place, and involving both researchers and active nurses
results in changes that are more successful. Dr. Benner showed that research and
working nurses are not isolated from one another, but actually two parts of the same
coin.
The increased involvement of working nurses in the profession leads to a more human
based nursing profession. Once nurses reach the expert level, the nurses tend to focus
on the complete patient, not just the reason for the patient being in the hospital or
under treatment by the nurse.
Dr. Patricia Benner's Novice to Expert theory has withstood the test of time. Dr.
Benner continues to lecture on leadership and expertise in the profession. Her Novice
to Expert theory is used by the profession to assist nurses in moving up to the next
skill level. Eventually, all nurses should be able to achieve the mastery level with
proper support. Patricia Benner Novice to Expert has become an integral part of the
nursing profession.
Publications related to Patricia Benner's From Novice to Expert Theory
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