Excerpt from the Core Curriculum for Clinical Coaching workbook:
Section Two: Novice to Expert
In this section, we will explore Patricia Benner's work as it relates to
understanding how nurses acquire
skills and apply clinical knowledge in their professional practice.
Her work focused on the Dreyfus model of skill acquisition and applied
it to nursing practice. The concern was not "how to do nursing" but,
rather, "how do nurses learn to do nursing?" She studied
the nature of nursing practice and how nurses gain expertise. She published From
Novice to Expert in 1984 and became a Fellow in the American Academy of
Nursing in 1985.
For more detail,
check out the Nurse Theorists web page -
Benner's work focused on our movement through
stages of:
Developing clinical competence
Creating a positive clinical environment
Levels of skills in nursing practice from novice to expert.
She applied the Dreyfus model to nursing practice and skill acquisition
Studied the nature of nursing practice and how nurses gain
expertise
Levels of Development and Execution
Novice
The novice has no experience
of situations in which they are expected to perform. Rules help them, but rules
are context free and independent of real life situations. Thus the rules tend
to be applied universally. Their
rule-governed behaviour is both extremely limited and inflexible. The novice has
no "life experience" to apply the rules. One becomes a novice again whenever
placed in an unfamiliar area of practice.
Key Concept: "just tell me
what and how, and I will do it"
Advanced
Beginner
Practice of the advanced beginner
is still rules- based, oriented towards completion of tasks and has difficulty
grasping the larger context of the situation. The focus of work is on nurse's
abilities instead of the needs of the client. Concern for good management of
skills and time is paramount. The
advanced beginner needs guidance and assistance from their preceptor. They have
coped with enough real situations to start noticing the recurring meaningful
components of the situation. This care provider is beginning to formulate
principles to guide actions that are based on experience.
Key
Concepts:
Competent
The competent practitioner has
been on the job 2 - 3 years (but time does NOT equal competence!!). They begin
to consciously see long-range goals. Deliberate planning is characteristic of
this skill level - and helps them achieve efficiency and organization. They
still lack the speed and efficiency of the proficient nurse but have a feeling
of mastery and the ability to cope with and manage the many contingencies of
clinical nursing. They can
differentiate between the aspects of the current situation, those in the future
and can select the aspects that are most important. They have a much keener
sense of responsibility but may have an unrealistic concept of what they can
handle.
Key
concepts:
Able to set goals
- Able to prioritize
Is comfortable with routine
- Becomes emotionally engaged
Functions with high level of
capability, but may be completely unable to cope with emergencies or unexpected
incidents
Proficient
The proficient nurse is able to
see the situation as a whole, in context, and can apply knowledge to clinical
practice. They can identify the
salient aspects and differentiate them from those that are less important. They
have confidence in their own knowledge and abilities with less focus on rules
and their time management. They can recognize when the expected normal picture
does not materialize.
Key
Concepts:
Expert
The expert no longer relies on an
analytic principle (rule, guide, maxim) to connect their understanding of the
situation to an appropriate action.
They have an intuitive grasp of each situation and go directly to the
salient point without wasteful consideration of alternative diagnoses and
solutions. The expert operates from a deep understanding of the total
situation. They do it "Because it
felt right; it looked good." The
expert is no longer aware of the features and rules and their performance
becomes fluid and flexible - highly proficient. They are highly skilled in
their analytical ability to see what is necessary for situations with which
they have no prior experience or when they have a wrong grasp of
situation. Their analytical
problem solving functions at its highest level and the focus on self and own
performance is diminished.
Key
Concepts
Reference: Benner, P. (1984). From novice to expert: Excellence and
power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.
