Benner’s Stages of Nursing Expertise
Caring, Clinical Wisdom, and Ethics in Nursing
Karen A. Byczynski
“The nurse-patient 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.”
(Benner, 1984a)
Credentials and Background of the Theorist
Patricia Benner was born in Hampton, Virginia, and received her bachelor’s degree in Nursing from
Pasadena College in 1964, and later a master’s degree in Medical-Surgical Nursing from the University of
California, Berkeley. After completing her doctorate in 1982, she became an Associate Professor in the
Department of Physiological Nursing at the University of California, San Francisco. Dr. Benner is an
internationally known lecturer and researcher on health, and her work has influenced areas of clinical
practice as well as clinical ethics.
Dr. Patricia Benner is a nursing theorist who first developed a model for the stages of clinical
competence in her classic book “From Novice to Expert: Excellence and Power in Clinical Nursing
Practice”. Her model is one of the most useful frameworks for assessing nurses’ needs at different stages
of professional growth. She is the Chief Faculty Development Officer for Educating Nurses, the Director
of the Carnegie Foundation for the Advancement of Teaching National Nursing Education and honorary
fellow of the Royal College of Nursing.
Philosophical Sources of Patricia Benner
Benner acknowledges that her thinking in nursing was influenced greatly by Virginia Henderson. Benner
studies clinical nursing practice in an attempt to discover and describe the knowledge embedded in
nursing practice. She maintains that knowledge accrues over time in a practice discipline and is developed
through experiential learning, situated thinking, and reflection on particular practice situations. She refers
to this work as articulation research, defined as: “describing, illustrating, and giving language to taken-
for-granted areas of practical wisdom, skilled know-how, and notions of good practice” (Benner, Hooper-
Kyriakidis, & Stannard, 19999, p.5)
Purpose
Basic overview of nursing theory
Explanation of Patricia Benner’s work “From Novice to Expert” model
Relation of Benner’s work to current practices
From Novice to Expert Nursing Model
“Patricia Benner developed a concept known as “From Novice to Expert”. This concept explains that
nurses develop skills and an understanding of patient care over time from a combination of a strong
educational foundation and personal experiences.” Benner’s theory identifies five levels of nursing
experience: novice, advanced beginner, competent, proficient, and expert.
This nursing theory proposes that expert nurses develop skills and understanding of patient care over time
through a proper educational background as well as a multitude of experiences. Dr. Benner’s theory is not
focused on how to be a nurse, rather on how nurses acquire nursing knowledge – one could gain
knowledge and skills (“knowing how”), without ever learning the theory (“knowing that”). She used the
Dreyfus Model of Skill Acquisition as a foundation for her work. The Dreyfus model, described by
brothers Stuart and Hubert Dreyfus, is a model based on observations of chess players, Air Force pilots,
army commanders and tank drivers. The Dreyfus brothers believed learning was experiential (learning
through experience) as well as situation-based, and that a student had to pass through five very distinct
stages in learning, from novice to expert.
Benner’s Motivation for Novice to Expert
Nursing practice has been studied primarily from a sociological perspective as opposed to the
study of nursing practice itself
Nursing knowledge is accrued over time; it is embedded in expertise. Thoughts are based on the
Dreyfus model.
Knowledge has gone uncharted and unstudied because differences between practical and
theoretical knowledge have been misunderstood
Well charted nursing practice and observation are essential for theory development
Benner’s Philosophy
Benner “proposed that a nurse could gain knowledge and skills without actually learning a
theory” Described as “knowing how” without “knowing that”
Development of knowledge in nursing is “a combination of knowledge through research and
understanding through clinical experience”
Benner’s influences
Virginia Henderson
Benner has acknowledged that her “thinking has been influenced greatly by Virginia Henderson.”
Dreyfus model of Skill acquisition
Developed in 1980
Describes five levels of skill acquisition and development
Model showed advancement through the stages by changes in performance
Developed by studying chess players and pilots
Benner adapted the Dreyfus model for clinical nursing practice, basis for her work: Novice to
Expert.
Dreyfus vs. Benner
Dreyfus model including the 5 levels as of 1986 (moleseyhill.com) Benner’s Stages of Nursing
Proficiency
Novice to Expert
• Novice
• Advanced Beginner
• Competent
• Proficient
• Expert
The Novice
Ø Begins with no prior experience
Ø Taught rules to perform tasks
Ø Rule governed behavior is limited and inflexible
Ø Being a novice is not exclusive to students- any nurse entering a setting without prior
experience with that particular patient population may be limited to the novice level
The Advanced Beginner
Ø Can demonstrate marginally acceptable performance
Ø Has gained prior experience in actual nursing situations
Ø Formulation of guidelines or principles from prior experiences provide guidance in future
experiences
The Competent Nurse
Ø Has been on the job in similar situations for 2-3 years
Ø Aware of long-term goals-- gain perspective from planning their own actions
Ø Become more efficient and organized
The Proficient Nurse
Ø Perceives and understands situations as whole parts
Ø Views patients holistically
Ø Has learned what to expect in certain situations and how to modify plans as needed
The Expert Nurse
Ø No longer relies on principles, rules or guidelines to connect situations and determine
actions
Ø Performances are fluid, flexible, and highly proficient
Ø Expertise comes naturally
Benner’s Explanation of the Four Paradigms
• Nursing • Person • Health • Environment
Nursing
Ø Benner viewed nursing as the care and study of the lived experience and the relationship
of these three elements:
• Health
• Illness
• Disease
Person
Ø “…the person does not come into the world predefined but gets defined in the course of
living a life”
Ø Benner believed that there are significant aspects that make the being.
Ø She conceptualized these as the roles of:
• the situation
• the body
• personal concerns
• temporality
Health
Ø Benner focused “on the lived experience of being healthy and being ill”
Ø Health can be assessed Well-being is the human experience of health or wholeness
Ø Illness is the human experience of loss or dysfunction
Environment
Ø Benner uses the term situation rather than environment.
Ø “Personal interpretation of the situation is bounded by the way the individual is in it.”
Ø A person’s past, present, and future influences their current situation
Relationship of Paradigms to Benner’s Model
- The culmination of the four paradigms of nursing create experiences that nurses utilize to
advance through the stages of Benner’s model From Novice to Expert
Using Benner’s Model in Practice
Examples of use in practice:
• Preceptorship
• Orientation processes
• Nursing educational programs
• Professional advancement ladders
• Interdepartmental job changes (e.g. medical-surgical nurse transitioning to an intensive care
unit)
Benner in Action
American Association of Critical-Care Nurses (AACN) Synergy Model
Ø Developed as a basis for nursing practice
Ø Development utilized use of Benner’s Novice to Expert stages of development
Ø Combines nursing competencies with characteristics of patients to “enhance optimal
patient outcomes” (Kaplow, 2002)
Ø Patient outcomes will be different at the different levels of the nurse’s expertise.
Clinical Ladder Programs
Ø Most are based on stages of clinical competence of Benner’s (Murphy, 2012)
Ø Intention of the ladder is to retain experienced nurses • Greater rewards at the expert
levels than the novice level
Benner’s Stages of Nursing Expertise
Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in
the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might
happen in a particular patient situation. Signs and symptoms, such as changes in mental status, can only
be recognized after a novice nurse has had experience with patients with similar symptoms.
Stage 2 Advanced Beginner: Those are the new graduates in their first jobs; nurses have had more
experiences that enable them to recognize recurrent, meaningful components of a situation. They have the
knowledge and the know-how but not enough in-depth experience.
Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some
mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns
and nature of clinical situations more quickly and accurately than advanced beginners.
Stage 4 Proficient: At this level, nurses are capable to see situations as “wholes” rather than parts.
Proficient nurses learn from experience what events typically occur and are able to modify plans in
response to different events.
Conclusion
This model can be applied to all areas of nursing. It looks at the education and development of a
nurse and how they become an expert. Patricia Benner examined how nurses learn to nurse
(Nursingtimes.net, 2010)
References:
American Association of Critical-Care Nurses (2013). Retrieved from www.aacn.org Benner, P.,
(2001).
From novice to expert: Excellence and power in clinical nursing practice (Commemorative
edition).
New Jersey: Prentice Hall Health. Black, B.P. (2011).
Becoming a nurse: Defining nursing and socialization into professional practice.
In K.K. Chitty & B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp.
126-145). Maryland Heights, MO: Saunders Elsevier. Dreyfus, S. E., & Dreyfus, H. L. (1980).
A five-stage model of the mental activities involved in directed skill acquisition (Operations
Research Center Rep. No. ORC-80-2). Kaplow, R. (2002).
The synergy model in practice applying the synergy model to nursing education. Critical Care
Nurse, 22(3), 77-81. Murphy, D. (2012, September/October).
Novice to expert: clinical ladder programs as a recruitment and retention tool.
Ohio Nurses Review., 16-17. Retrieved from www.ohnurses.org Nursingtimes.net [website].
(2010, March). Nursing Times. Retrieved from http://www.nursingtimes.net/whats-new-in-
nursing/hall-of-fame/patricia-benner-us-nurse-theorist-and-author-of-from-novice-to-
expert/5012095.article Nursing Theory. (2011).
Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursing-
theory.org/nursing-theorists/Patricia-Benner.php Nursing Theories. (2013).
Patricia Benner: Metaparadigm in nursing. Retrieved from http://nursingtheories.info/patricia-
benner-metaparadigm-in-nursing/ Nursing Theories: a companion to nursing theories and models
website. (2012). Retrieved from www.currentnursing.com/nursing_theory Tomey, A., &
Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.
Case Study #1
Sally had the opportunity to be a nurse extern at a hospital on a busy medical-surgical unit while
she finished her undergraduate studies. With this opportunity, Sally stated that she had the
chance to become comfortable in a nursing role, and was able to relate nursing practice to the
theory that she was learning in class. After graduation, Sally became an RN in the Neonatal ICU.
Given her recent nursing experience, which of Benner’s stages is Sally practicing at as a
Neonatal RN?
Case Study #2
You and Ginger have been nurses together for the last five years. You have both worked on the
Orthopedic unit since graduating nursing school. You both easily perform the required nursing
duties, seem to have “that nursing sense” about when something is going downhill, and act as
charge nurses on the unit. Ginger is reluctant to act as a preceptor to newer nurses stating that “I
still need to work on my organization before trying to help others learn the way.” You have acted
and excelled as a preceptor with excellent feedback. What stages of Benner’s model would you
place yourself and Ginger?
