Patricia Benner

§ Model on Novice to Expert

§ “The nurse-patient relationship is not a uniform, professionalized blueprint but rather a
kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane
moments of life.”
§ Credentials and Background of the Philosopher
§ Patricia Benner was born in Hampton, Virginia, and spent her childhood in California, where she
received her early and professional education. Majoring in nursing, she obtained a baccalaureate
of arts degree from Pasadena College in 1964. In 1970, she earned a master’s degree in nursing,
with major emphasis in medical- surgical nursing, from the University of California, San
Francisco (UCSF) School of Nursing. Her PhD in stress, coping, and health was conferred in
1982 at the University of California, Berkeley, and her dissertation was published in 1984
(Benner, 1984b).
§ Benner has a wide range of clinical experience, including positions in acute medicalsurgical,
critical care, and home health care.
§ The standards of education and practice for the profession are determined by the members of the
profession, rather than by outsiders. The education of the professional involves a complete
socialization process, more far reaching in its social and attitudinal aspects and its technical
features than is usually required in other kinds of occupations.
§ Socialization can be defined simply as the process by which people (a) learn to become members
of groups and society and (b) learn the social rules defining relationships into which they will
enter. Socialization involves learning to behave, feel, and see the world in a manner similar to
other persons occupying the same role as oneself (Hardy & Conway, 1988, p. 261). The goal of
professional socialization is to instill in individuals the norms, values, attitudes, and behaviors
deemed essential for survival of the profession.
§ Various models of the socialization process have been developed. Benner’s model (2001)
describes five levels of proficiency in nursing based on the Dreyfus general model of skill
acquisition.
§ The five stages, which have implications for teaching and learning, are novice, advanced
beginner, competent, proficient, and expert. Benner writes that experience is essential for the
development of professional expertise
§ Benner’s Stages of Nursing Expertise
§ STAGE I: NOVICE o No experience (e.g., nursing student). Performance is limited, in-
flexible, and governed by context-free rules and regulations rather than experience.
§ STAGE II: ADVANCED BEGINNER o Demonstrates marginally acceptable performance.
Recognizes the meaningful “aspects” of a real situation. Has experienced enough real situations to
make judgments about them.
§ STAGE III: COMPETENT o Has 2 or 3 years of experience. Demonstrates organizational and
planning abilities. Differentiates important factors from less important aspects of care.
Coordinates multiple complex care demands.
§ STAGE IV: PROFICIENT o Has 3 to 5 years of experience. Perceives situations as wholes
rather than in terms of parts, as in Stage II. Uses maxims as guides for what to consider in a
situation. Has holistic understanding of the client, which improves decision making. Focuses on
long-term goals.
§ STAGE V: EXPERT o Performance is fluid, flexible, and highly proficient; no longer re-
quires rules, guidelines, or maxims to connect an understanding of the situation to appropriate
action. Demonstrates highly skilled intuitive and analytic ability in new situations. Is inclined to
take a certain action because “it felt right.”
§ One of the most powerful mechanisms of professional socialization is interaction with fellow
students. Within this student culture, students collectively set the level and direction of their
scholastic efforts. They develop perspectives about the situation in which they are involved, the
goals they are trying to achieve, and the kinds of activities that are expedient and proper, and they
establish a set of practices congruent with all of these. Students become bound together by
feelings of mutual cooperation, support, and solidarity.
§ The National Student Nurses Association (NSNA) helps link nursing students with nursing
leadership groups. This organization exposes student nurses to issues impacting the nursing
profession while promoting collegiality and leadership qualities.
§ The primacy of caring is a model proposed by Patricia Benner and Judith Wrubel (1989). Caring
is central to nursing and creates possibilities for coping, enables possibilities for connecting with
and concern for others, and allows for giving and receiving help (Chinn and Kramer, 2011).
§ Caring means that persons, events, projects, and things matter to people. It presents a connection
and represents a wide range of involvement (e.g., caring about one’s family, one’s friendships,
and one’s patients).
§ Benner and Wrubel see the personal concern as an inherent feature of nursing practice. In caring
for one’s patients, nurses help patients recover by noticing interventions that are successful and
that guide future caregiving.