Topic 8 DQ 1 Nursing Theorist: Patricia Benner Dr. Patricia Benner and her nursing theory Novice to Expert is one of the most widely used models that provides guidance as professional nurses progress through learning in clinical practice. Her framework identifies nurses’ needs at different stages of clinical competence. Her model outlines five different stages of skill acquisition; novice, advanced beginner, competent, proficient, and expert (McEwen & Wills, 2014) Benner’s theory “is not focused on how to be a nurse, rather on how nurses acquire nursing knowledge” (Benner, 1984, p. 22). This nursing theory explains that expert nurses progress through skills and understanding of patient care over time, with appropriate education, and clinical experiences. The foundation of the theory starts at the lowest stage, novice and proceeds to the next stages, building upon each other. The stages are not independent of each other but rather a ladder to the stage of expert. Each nurse and nursing leadership can use this in their own practice to evaluate themselves and where on the continuum of education and nursing experience they are at. Choice of Theorist Dr. Patricia Benner had her work first published in 1984, just 2 years after she finished her PhD from University of California at Berkley (McEwen & Wills, 2014).  Her model used the Dreyfus skill acquisition to nursing which was “developed by a mathematician and a philosopher” (McEwen & Wills, 2014, p. 222). The five stages are described as: Novice: The novice nurse enters the profession with no experience and requires guidance and continual support. Advanced beginner: The advanced beginner nurse is experiencing different patient experiences and learning by doing. This level thinks very concretely. Competent: A competent nurse is able to demonstrate analytical and abstract thinking. Typically, a nurse enters this stage after practicing for two years or more. Proficient:  A proficient nurse develops a better understanding of the clinical picture. Proficient nurses also are able to critically think and are able to determine care with the use of knowledge, skill, and intuition.            Expert:  The expert nurse is the highest level attainable. This nurse practices primarily by intuition and is “deeply connected to the clinical situation. Interventions are implemented based on a strong foundation of knowledge and years of clinical experience” (Benner, 1984, pp. 34-35). The group’s choice of Benner’s theory model was based on the familiarity with this theory and its application to practice. This theory can be easily described and incorporated into institutions. The progression to each level can be easily documented and assessed.  As a group progressing through these stages in our professional backgrounds and clinical experiences, the attainment of the level of expert has been very personal to each of us. Category of Theorist Benner’s theory falls in the classification of high middle range nursing the ...

1. Topic 8 DQ 1
Nursing Theorist: Patricia Benner
Dr. Patricia Benner and her nursing theory Novice to Expert is
one of the most widely used models that provides guidance as
professional nurses progress through learning in clinical
practice. Her framework identifies nurses’ needs at different
stages of clinical competence. Her model outlines five different
stages of skill acquisition; novice, advanced beginner,
competent, proficient, and expert (McEwen & Wills, 2014)
Benner’s theory “is not focused on how to be a nurse, rather on
how nurses acquire nursing knowledge” (Benner, 1984, p. 22).
This nursing theory explains that expert nurses progress through
skills and understanding of patient care over time, with
appropriate education, and clinical experiences. The foundation
of the theory starts at the lowest stage, novice and proceeds to
the next stages, building upon each other. The stages are not
independent of each other but rather a ladder to the stage of
expert. Each nurse and nursing leadership can use this in their
own practice to evaluate themselves and where on the
continuum of education and nursing experience they are at.
Choice of Theorist
Dr. Patricia Benner had her work first published in 1984, just 2
years after she finished her PhD from University of California
at Berkley (McEwen & Wills, 2014). Her model used the
Dreyfus skill acquisition to nursing which was “developed by a
mathematician and a philosopher” (McEwen & Wills, 2014, p.
222). The five stages are described as:
Novice: The novice nurse enters the profession with no
experience and requires guidance and continual support.
Advanced beginner: The advanced beginner nurse is
experiencing different patient experiences and learning by
doing. This level thinks very concretely.

2. Competent: A competent nurse is able to demonstrate analytical
and abstract thinking. Typically, a nurse enters this stage after
practicing for two years or more.
Proficient: A proficient nurse develops a better understanding
of the clinical picture. Proficient nurses also are able to
critically think and are able to determine care with the use of
knowledge, skill, and intuition.
Expert: The expert nurse is the highest level attainable. This
nurse practices primarily by intuition and is “deeply connected
to the clinical situation. Interventions are implemented based on
a strong foundation of knowledge and years of clinical
experience” (Benner, 1984, pp. 34-35).
The group’s choice of Benner’s theory model was based on the
familiarity with this theory and its application to practice. This
theory can be easily described and incorporated into
institutions. The progression to each level can be easily
documented and assessed. As a group progressing through these
stages in our professional backgrounds and clinical experiences,
the attainment of the level of expert has been very personal to
each of us.
Category of Theorist
Benner’s theory falls in the classification of high middle range
nursing theory. This theory addresses the gap between the grand
theories and practice theories. Descriptions, explanations, and
predictions put forth in a middle-range theory are intended to
pose questions asked in practice theories (McEwen & Wills,
2014). These theories usually consist of fewer concepts and
allow for testing of nursing practice. Different from practice
theories, middle range theories are “more specific than grand
theory but abstract enough to support both generalization and
operationalization across a range of population; this sets it apart
from practice theory” (McEwen & Wills, 2014, p. 217).
Benner’s Model of Skill Acquisition is considered a high middle
range theory because it is a better-known and widely used

3. theory. Being labeled a high middle range theory is defined as
not containing the criteria for grand theory category.
Assumptions of Theory
One way that Benner (1982) describes nursing is that
nurses “through their education and experience, develop and
observe many ways to understand and cope with illness, as well
as many ways of experiencing illness, suffering pain, death, and
birth” (p. 406). While there is no specific definition for person
made by Benner, a person is referenced to as a patient and a
layperson having isolated experiences with health and illness
(Benner, 1982). Health is referenced throughout her work but
again, no specific definition, although she acknowledges that it
includes illness, pain, death, birth, and emotions. The
environment focused on by Benner is healthcare facilities and
where nurses care for patients. Benner recognizes that nurses
move on the Novice to Expert continuum depending on where in
their career they are at.
Major Concepts and Proposition of the Theory
The rising concerns of patients regarding the quality of
healthcare and their awareness about the relationship between
healthcare quality and the value of life has increased the
pressure on healthcare professionals. The primary dependence
of quality of healthcare or delivery of patient-centered care is
the direct responsibility of the nursing staff, which has been
defined as the main reason for rising stress in the nursing
industry. Such complications and complexities of the nursing
profession motivates significant percentage of nurses every year
to leave nursing profession, which is also the major reason for
increased turnover rate in the nursing industry. Accordingly, it
has been observed that many nurses change their profession
within the first year of their work experience due to the
increased amount of stress and workload (Trinkoff et al., 2013).
Another reason for the increased work burden on nurses is the
tiresome environment of the healthcare industry, which is
inflicted by continuous interaction of nurses with patients
suffering from traumas, untimely deaths, tragedies, and terrible

4. injuries. On the other hand, it has been assessed that nurses
become efficient over time, and are more likely to continue with
their careers after successful accomplishment of the first five
years in the nursing industry (Trinkoff et al., 2013). This is
aligned with the findings of the Benner’s from Novice to Expert
nursing theory that reveals the development and refinement of
nurses’ skills and knowledge on the basis of experience without
the exposure of nurses to new theories and advancements in the
field of nursing and healthcare (Gardner, 2012). For this reason,
it is revealed that the working environment of the nurses should
be improved in order to allow them to learn and become
efficient through experience, which is in line with the findings
of Benner’s nursing theory, and will help in the quality of care
in the longer run.
Benner’s nursing theory certifies that nurses are able to
upgrade their individual skills and expertise through experience
in the healthcare environment (Gardner, 2012). For this to
happen, nurses should give themselves time and leverage to
learn new skills and become more efficient for handling stress
and enhanced work burden, which is only possible through
increasing the quality of work environment for nurses. The work
environment of nurses is dependent on two factors; the first one
is the quality of the healthcare facility; and the second one is
the individual ability and capacity of nurses that allow them to
cope with the stressful environment of the healthcare industry.
It has been observed that there is a limit to improving the
quality of the healthcare facility as surgeries and treatments of
injured and ill patients are not an exciting experience for
healthcare professionals, which increases the significance of
inducing leadership attributes and focusing on team building to
motivate nurses. This is important for allowing nurses to give
themselves time and leverage to become use to the healthcare
environment, which is crucial for reducing their stress and
accordingly improving the quality of care in the longer run
(Twigg & McCullough, 2014). Moreover, enhancing leadership
and building stronger teams among nurses will enable the

5. implementation of Benner’s theory, which reveals improvement
in nurses’ efficiency with increased work experience.
How Benner’s Theory is Used
Leadership has emerged as one of the most important
management traits in all types of industries, which increases the
overall efficiency of the workforce without incurring additional
costs to the organization (Twigg & McCullough, 2014). This is
based on the inspirational motivation of leaders that is induced
in their fellow nurses, subordinates and team members, which
allows them to work more diligently and with greater amount of
motivation. Also, leaders are able to identify the individual
strengths and weaknesses of their line employees and team
members, which is essential for aligning the individual skills
and expertise of employees with their job descriptions (Twigg &
McCullough, 2014). Such alignment is beneficial for reducing
the stress associated with the healthcare environment. This
results in a more comfortable environment for the nurses, which
allows them to keep on working as they enhance their individual
skills over a period of time. On the other hand, team building is
also a source of increasing motivation level of nurses.
Leadership and team building are easily implemented
simultaneously due to their common results that are inclined
towards increasing the motivation level of nurses. Accordingly,
it is revealed that in order to reap the benefits of Benner’s from
Novice to Expert nursing theory for improving the efficiency
and individual skills of nurses, it is essential to enhance
leadership and team building in the work environment of the
hospital (Gardner, 2012).
It has been observed that Benner’s theory emphasizes a
positive relationship between skills and experience of nurses
but the positive outcomes of increased work experience of
nurses are limited by the poor work environment and increased
stress faced by nurses in the healthcare environment (Gardner,
2012). Accordingly, leadership and team building are the key
attributes that should be used by the healthcare facility to
improve the quality of the work environment of the hospital, so

6. the management is able to reap positive outcomes of Benner’s
theory. The implementation of nursing leaders and strong
nursing teams will also minimize the turnover rates in the
nursing industry, which will further increase the quality of care
due to increased quality of workforce that is more experienced
and efficient without undergoing additional training for learning
new theories.
Theory Integration into Practice
In practice, when errors are made, nurses are provided staff
education to decrease the likelihood of the reoccurrence of such
errors. Unfortunately, staff education is often seen as a
discipline from higher authority, however, rather than a
punishment, a nurse should view these situations as a learning
experience and utilize it towards personal and professional
growth. A nurse taking the initiative is also vital to growth.
Attending staff training sessions and participating in
committees will guide nurses to stay current with research,
evidence-based practice, and policies and procedures of the
organization. All these are necessary to progress towards
Benner’s expert phase. Although Benner’s theory states that a
nurse becomes novice to expert through years of clinical
experiences, it does not mean that expert nurses do not lack
knowledge. A novice nurse will be most current with new
evidence-based practice, whereas more experienced nurses are
more likely to use patient care techniques that works best for
them.
Examples
The most current research shows that apple juice is more
efficient than orange juice with hypoglycemia, however, some
more experienced nurses continues to use orange juice. After
educating staff using the above example of hypoglycemia
treatment, a facility can evaluate the data of treatment provided
to patients to see if practice changes have occurred. This
evaluation aspect ensures that in addition to training, follow up
is used to reinforce the ideas. The ideal outcome would be that
the expert nurse, who may believe in her ways, uses the

7. evidence to change her practice and becomes better at treating
hypoglycemia. Another outcome is that a novice nurse, who
may previously called the doctor for advice, tries this
intervention first and assesses the patient’s response. In such
situations, learning is always an on-going process in which
novice can learn from experts, and vice-versa. Nurses can use
Benner’s theory to evaluate themselves and leadership can use
her model to insure training and education is thorough.
Conclusion
In conclusion, Benner’s theory of Novice to Expert guides our
nursing care regardless of the field of nursing. Although
education is important, it is only the base of what we truly need
to learn. Most of our learning is accomplished from hands on
experience. Benner states that theories are not always
necessary to gain knowledge and skills (Benner, 1984). The
knowledge we gain through trial and error from our clinical
experiences is what promotes growth and expertise. A novice
nurse simply follows directions and bases patient care on class
acquired knowledge. A nurse with more years of experience
will guide his or her practice on previous experience. For
example, a novice nurse will contact the doctor for a blood
pressure of 84/52 if the orders indicate to do so, however for a
nurse with more experience, they are more likely to assess for
dehydration, check patient’s baseline, push fluids, and re-check
post interventions. A nurse with more expertise will contact the
doctor after nursing interventions fail. Expert nurses more
often recognize trends and reports accordingly to avoid critical
conditions in patients. Unfortunately, even nurses in expert
phase make errors that lead to patients in distress.

8. References
Benner, P., (1982). From novice to expert. The American
Journal of Nursing, 82(3), 403-407. doi:10.2307/3462928
Benner, P. (1984). From novice to expert: Excellence and power
in clinical nursing practice. Menlo Park: Addison-Wesley
Gardner, L. (2012). From novice to expert: Benner's legacy for
nurse education. Nurse Education Today, 32(4), 339-340.
Retrieved
fromhttp://dx.doi.org.lopes.idm.oclc.org/10.1016/j.nedt.2011.11
.011
McEwen, M., & Wills, E.M. (2014). Theoretical basis for
nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health:
Lippincott Williams & Wilkins.
Trinkoff, A. M., Han, K., Storr, C. L., Lerner, N., Johantgen,
M., & Gartrell, K. (2013). Turnover, staffing, skill mix, and
resident outcomes in a national sample of US nursing
homes. Journal of Nursing Administration, 43(12), 630-636.

9. doi:10.1097/NNA.0000000000000004
Twigg, D., & McCullough, K. (2014). Nurse retention: a review
of strategies to create and enhance positive practice
environments in clinical settings. International Journal of
Nursing Studies, 51(1), 85-92.
doi:10.1016/j.ijnurstu.2013.05.015
Topic 8 DQ 2
Patricia Benner’s Model of Skill Acquisition utilizes five stages
of development include novice, advanced beginner, competent,
proficient, and expert (McEwen & Wills, 2014). Benner’s model
describes the importance of retaining and rewarding nurses for
achieving expert status. As nurse’s transition from one level to
the next, they evolve in their practice, which benefits patient
care. This will also trickle down and lead to further professional
development of the staff (McEwen & Wills, 2014). Per Benner,
you learn from different situations and then transmit that
information to others. “Expertise develops when the clinician
tests that refines propositions, hypothesis, and practice-based
expectation in actual practice situations” (McEwen & Wills,
2014, p. 232). A mix of novice to expert nurses is the norm on
most units today. The expert nurses lead the less experienced
nurses. However, the novice nurses also have an important
place. They can bring with them new ideas and reinfuse the
excitement of the more experienced nurses.
Benner’s model can be used in all areas of nursing. Examples of
this include education, management, and preceptorship. Using
Benner’s model, education can be tailored to the individual.
“Benner’s Novice to Expert concept provided the stimulus to
recognize the need for in-depth specialty knowledge and skill
development for medical-surgical nurses to provide optimum
patient care to current and recently hired nurses for the vascular
and plastics medical-surgical unit” (Marzen-Groller, 2007, p.
86). Although this study dealt with vascular surgery nurses, this

10. method is applicable to all fields of nursing. Providing
knowledge decreases anxiety and increases self-confidence.
This can further increase patient and staff satisfaction and
retention.
References
Marzen-Groller, K.D. (2007). Article: Orienting nurses to a
vascular nursing specialty. Journal of Vascular Nursing
25(4):85-89. Doi:10.1016/j.jvn.2007.09.003
McEwen, M., & Wills, E.M. (2014). Theoretical bases for
nursing (fourth Edition). Philadelphia, PA: Wolters Kluwer
Health: Lippincott Williams & Wilkins