Patricia Benner

Nurse Theorist
A blog power point assignment in partial
fulfillment of the requirements for NU
602 Advanced Role Theory in the
College of Nursing University of North
Alabama
Patricia Benner: An Influential
Nurse in the Development of
the Profession of Nursing
• Patricia Benner’s research and
theory work provides the profession
of nursing with what we now know as
the Novice to Expert model, also
known as Benner’s Stages of Clinical
Competence. Benner’s work as
applied to the nursing profession is
adapted from the Dreyfus Model of
Skill Acquisition.
Skill Acquisition
• “The utility of the
concept of skill
acquisition lies in
helping the teacher
understand how to
assist the learner
in advancing to the
next level” (McClure,
2005)
The Dreyfus Model of Skill
Acquisition is shown on the
next slide:
(Dreyfus, 2008).
acquisition were conducted over a period of 21
years. Nurses with a range of experience and
reported skill fullness were interviewed. Each study
used nurses' narrative accounts of actual clinical
situations. A subsample of participants were
observed and interviewed at work. These studies
extend the understanding of the Dreyfus model to
complex, underdetermined and fast paced
practices. The skill of involvement and the
development of moral agency are linked with the
development of expertise, and change as the
practitioner becomes more skillful. Nurses who had
some difficulty with understanding the ends of
practice and difficulty with their skills of
interpersonal and problem engagement did not
progress to the level of expert. Taken together,
these studies demonstrate the usefulness of the
Dreyfus model for understanding the learning needs
and styles of learning at different levels of skill
Patricia Benner Honored

• In 2003, the
Institute for
Nursing Healthcare
Leadership
celebrated the 20th
anniversary of
Benner’s work.
“Introduced at the podium as ‘the person who
taught the world how to listen to the voice of the
nurse’, Benner discussed the importance of
attending to the expertise embedded in clinical
nursing practice. For nursing practice to flourish,
she said, nurses must deepen their understanding
of the important knowledge that develops during
clinical work. Citing the often-discussed ‘theory to
practice gap’ in which elements of science do not
move into practice, she discussed the ‘practice to
theory’ gap in which clinicians fail to recognize and
develop the knowledge that can only be gained in
the world of experience.”
(Wandel, 2003).
 Benner’s accomplishments
• Benner’s
accomplishments are
many, in addition to
being a faculty
member at UC San
Francisco, she has
authored nine books
and numerous
articles, she is an
internationally known
lecturer and
researcher on health,
stress, and coping,
skill acquisition and
ethics.
The impetus for Ms. Benner’s
involvement in nursing and her
important research is summarized on
her website:
• “In a highly changing health care environment,
the core of the hospital, the core of the hospital is
patient care and the core of the core is the
practice of the nurses who are with patients on a
24-hour basis. Whether the hospital finds itself in
a time of strong or lean financial resources, or a
time of nursing shortage or surplus, the key
question is whether, in this era of highly acute
patients, there are nurses who have an
excellence of practice that can directly affect how
a patient progresses to discharge and reduce
unnecessary recidivism.”
• (Benner, 2009).
Benner’s work in applying the
Dreyfus Model of Skill
Acquisition has produced the
following five stages of nursing
expertise:
Stage 1: Novice
• “Beginners have no
experience of the
situations in which
they are expected
to perform.” (Benner,
1984).
These inexperienced nurses function at the
level of instruction from nursing school.
They are unable to make the leap from the
classroom lecture to individual patients.
Often, they apply rules learned in nursing
school to all patients and are unable to
discern individual patient needs. These
nurses are usually new graduates, or those
nurses who return to the workplace after a
long absence and are re-educated in
refresher programs.
Stage 2: Advanced Beginner
• “Advanced beginners
are those who can
demonstrate
marginally acceptable
performance, those
who have coped with
enough real situations
to note or to have
pointed out to them
by a mentor, the
recurring meaningful
situations
components.” (Benner,
1984).
Advanced beginners are able
to translate some didactic and
clinical learning principles to
individual patients, but often
lack the real life experiences
that differentiate individual
patients.
Stage 3: Competent
• “Competence, typified
by the nurse who has
been on the job in the
same or similar
situations two or three
years, develops when
the nurse begins to
see his or her actions
in terms of long-range
goals or plans of which
he or she is
consciously aware.”
(Benner, 1984).
Competent nurses are able to plan and
care for patients on an individual basis
following a plan of care or the lead of a
more experienced nurse. Competent
nurses are able to provide safe care,
but are not looked upon as formal or
informal leaders. Their decision-
making abilities usually consist of
individual circumstances and rarely
are they able to see how one situation
affects the ‘big picture’.
Stage 4: Proficient
• “The proficient
performer perceives
situations as wholes
rather than in terms of
chopped up parts or
aspects, and
performance is guided
by maxims. Proficient
nurses understand a
situation as whole
because they perceive
its meaning in terms
of long term goals.”
(Benner, 1984).
The proficient nurse frequently is able to
assume charge nurse duties and lead a
group of nurses in clinical practice. They are
frequently able to manage care of several
patients without direct supervision. These
nurses provide formal and informal
leadership to the nursing unit, and are often
the nurse that is called upon by the less
experienced nurse to provide assistance.
Stage 5: Expert
• “The expert performer no
longer relies on an analytic
principle to connect his or
her understanding of the
situation to an appropriate
action. The expert nurse,
with an enormous
background of experience,
now has an intuitive grasp
of each situation and
zeroes in on the accurate
region of the problem
without wasteful
consideration of a large
range of unfruitful,
alternative diagnoses and
solutions.” (Benner, 1984).
The expert performs their duties without
thinking; they react automatically to
situations and are often ‘thinking ahead’
during a situation. They frequently are
formal leaders and are called upon to
provide clinical expertise to other staff
members. Many times experts are able to
function seemingly ‘without thinking’ as
their abilities seen to others to come as
second nature.
 Modern Theorists
• Benner is a relatively
modern theorist, with
her work having been
done in the early
1980’s. Since that
time health care has
seen the advent of
DRG’s, managed care,
an increase in the
acuity of patients in
the hospital related to
early discharge and
bounce back
admissions.
 Hospital Survival
• Her theory of expert
nurses is critical today as
the profession begins to
realize the aging of the
members of its workforce
and the increasing age of
the population who will
require more nursing
services. Her theory is
applicable today, as it was
at its publication, and
provides us with a
foundation to use for
assigning clinical
competence, a tool to use
to assess competence in
the staff nurse.