Every year new nurses graduate from a nursing program and begin work in the clinical setting. As new nurses gain more insight and knowledge throughout their careers, they become seasoned nurses and mentors for the next generation. Patricia Benner discussed how even 30 years ago, long-term and ongoing career development was important in nursing due to the complexity and responsibility of nursing practice (Benner, 1982). Patricia Benner’s novice to expert model has been used to increase retention of nurses as well as to help build experience with new nurse managers and administrators. Fennimore and Wolf (2011) discuss how the retention of staff members is directly correlated to effective nursing leadership (p. 205). The purpose of this article is to reflect on Dr. Benner’s work, specifically with the novice to expert model, including the application of the model in the nursing leadership realm. Benner’s Novice to Expert
The novice to expert model was introduced into nursing by Dr. Patricia Benner in 1982 and discussed how nurses develop skills and understanding of patient care over time (“From novice to expert,” 2013). Dr. Benner’s novice to expert model was derived from the Dreyfus Model of Skill Acquisition and adapted to provide a more objective way for evaluating progress of nursing skills and subjects (Dale, Drews, Dimmitt, Hildebrandt, Hittle, & Tielsch-Goddard, 2013). The model essentially discusses how an individual begins in the novice stage and, as new skills and knowledge are gained, progresses through a number of stages to end in the expert realm. The five stages of proficiency in the novice to expert model are: novice, advanced beginner, competent, proficient, and expert (Benner, 1982).
The initial novice stage in the model is one in which the individual has had no previous experience with the situation at hand. This stage is where new nurses are taught simple, objective attributes that are easily identified. Applicability of the novice stage in the leadership realm is the first management job or experience an individual has and tends to be limited and inflexible, which requires further professional growth and development (Shirey, 2007). Benner (1982) discusses that since the novice has had no previous experience, there is an inability to use discretionary judgment (p. 403). The novice also struggles to decide which tasks are most relevant to accomplish since there are no concrete rules to regulate task performance or relevance in real-life situations (Benner, 1982).
As the novice gains knowledge, the individual progresses to the advanced beginner stage. Benner (1982) describes the advanced beginner as an individual who has been involved in enough real-world situations that the recurrent component is easily identified (p. 403). The main problem the advanced beginner faces is that, although the individual may have some clinical knowledge, the focus is on the rules and guidelines that have been taught. The advanced beginner needs assistance and support in the clinical area by setting priorities to ensure that important patient needs do not go unattended (Benner, 1982). An advanced beginner nurse leader has had some experience, but may need the influence and guidance of a mentor (Shirey, 2007). Shirey (2007) suggests that mentors dealing with protégés in this phase will help with setting priorities and provide constructive feedback (p. 168).
The third stage of the novice to expert model is the competent stage. The competent nurse or nurse manager is able to prioritize tasks at hand by utilizing past experiences. Benner (1982) describes the competent individual as someone who has been on the job two or three years and is able to see actions in terms of goals or plans (p. 404). The competent individual is able to work in an efficient and organized manner due to conscious, deliberate planning (Benner, 1982). The competent leader is one who lacks the multi-tasking talents and flexibility of proficient leaders, but is able to consciously plan using abstract and analytic principles that focus on long-term goals or plans (Shirey, 2007).
As the competent individual continues to progress, the proficient stage is entered. During this stage, the individual’s performance is guided by maxims due to seeing a situation in its entirety (Benner, 1982). Benner (1982) describes maxims as pieces of evidence that can provide direction to what is important in the situation (p. 405). The proficient nurse or administrator has a holistic understanding of the situation at hand, which allows for a more improved decision-making process (Shirey, 2007).
The fifth and final stage discussed in the novice to expert model is the expert stage. The expert individual has an extensive knowledge of situations that allows for confidence and an intuitive grasp of complex patient situations (Dale et al., 2013). Rules, guidelines, and maxims are no longer relied upon during the expert stage because the individual is able to grasp the situation and understand what needs to be accomplished at this point (Benner, 1982).
Shirey (2007) points out that skill acquisition is a more important predictor of competency than time in role (p. 168). The reason this is important is because when an individual is in a position for a length of time, others may view the person as competent or proficient, but the reality may be quite the opposite. Another important aspect to understand is that competent and proficient nurses will not approach or solve problems in the same way due to past experiences (Benner, 1982). Discussion
The novice to expert model has been used in many different areas of the nursing world including assisting with the development of nurse managers and administrators.
A study was released by Fennimore and Wolf (2011) from a hospital in Pittsburgh that initiated a program to assist in the preparation and education for nurse managers and administrators based on the novice to expert model by Dr. Patricia Benner. The program included leadership texts, articles, lectures, self-assessment tools and homework assignments related to budgetary and the business side of management (Fennimore & Wolf, 2011). Managers identified through evaluations and feedback that they appreciated tools given during the training which included identifying turnover trends, conducting behavioral interviews, and completing team assessments which identified work styles (Fennimore & Wolf, 2011).
Titzer, Shirey, and Hauck (2014) released an article in which Benner’s novice to expert model was described as an “effective framework for leadership development and competency measurement, mentoring programs, advanced nursing practice skill acquisition, and professional advancement ladders” (p. 38). The study conducted by Titzer et al. (2014) chose participants with management aspirations to attend a program that would enrich management knowledge through workshops, mentoring, and group activities (p. 40). The study found that participants who completed the program had increased leadership and management competencies at the end of the program (Titzer et al., 2014). The study also demonstrated that individuals who participated in the program had an increase in confidence with assuming a leadership position after the program had ended (Titzer et al., 2014). Practice Influence and Recommendations
The novice to expert model by Dr. Patricia Benner has had a significant impact on practices throughout the healthcare realm. The model allows for skill acquisition and knowledge to be gained as an individual progresses through each stage. The model also discusses important teaching strategies for each stage of the model. One example would be how an advanced beginner would benefit from a mentor since support is still needed with setting priorities and discovering what is most important (Benner, 1982).
Another recommendation for practice would be to implement professional development programs for nurse leaders. A potentially negative impact on role stress, work environments, patient outcomes, and turnover rates is seen when nurse leaders are not properly selected and prepared for positions (Titzer et al., 2014). Therefore, providing training and mentoring prior to being placed in a managerial or administrative position may lessen the burden associated with lack of training.ConclusionThe novice to expert model has been used in healthcare systems to develop mentor programs, leadership programs, increase nurse retention, and provide teaching aides for staff nurses. When developing leadership programs, utilizing mentorship along with self-assessment guides may allow for continued growth for current and future leaders of the healthcare industry. Effective leadership preparation and commitment can lead to enhanced staff retention as well as reduced turnover costs and improved quality outcomes (Fennimore & Wolf, 2011). Providing professional development based on Dr. Benner’s novice to expert model for nurse leaders allows healthcare systems to build confident, capable leaders who increase staff retention and contribute to quality, safe patient care. ReferencesBenner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.Dale, J. C., Drews, B., Dimmitt, P., Hildebrandt, E., Hittle, K., & Tielsch-Goddard, A. (2013). Novice to expert: The evolution of an advanced practice evaluation tool. Journal of Pediatric Health Care, 27(3), 195-201. //dx.doi.org/10.1016/j.pedhc.2011.12.004.Fennimore, L., & Wolf, G. (2011). Nurse manager leadership development: Leveraging the evidence and system-level support. Journal of Nursing Administration, 41(5), 204-210. //dx.doi.org/10.1097/NNA.0b013e3182171aff.From novice to expert: Patricia E. Benner. (2013). Retrieved from //currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html.Shirey, M. R. (2007). Competencies and tips for effective leadership: From novice to expert. Journal of Nursing Administration, 37(4), 167-170.
Titzer, J. L., Shirey, M. R., & Hauck, S. (2014). A nurse manager succession planning model with associated empirical outcomes. Journal of Nursing Administration, 44(1), 37-46. //dx.doi.org/10.1097/NNA.0000000000000019.