Novice to ExpertCONCEPTUAL MODEL BY PATRICIA BENNER

PRESENTED BY REGINA MURRAY

Patricia Benner

Bachelors Degree from Pasadena College in 1964

Masters Degree from the University of California, San Francisco in

1970

Ph. D in Education from the University of California, Berkley in 1982

1982-Present: professor at University of California, San Francisco

Fellow at the American Academy of nursing since 2004

Part of a handful of nurse theorists to marry and have children

(Sitzman & Eichelberger, 2010, p. 165)

Development of Model

While working on her masters, she met Hubert and Stuart Dreyfus

Hubert Dreyfus – philosopher, younger brother Stuart Dreyfus –

operational engineer

Developed skills acquisition model that they based off of studying pilots,

chess players and armored tank drivers

She realized she could apply this situation to nursing

(Sitzman & Eichelberger, 2010, p. 166)

Model’s Focus

Advancement in the medical field

Increase acuity and decreased stay in hospitals

Specialization and complexity of Nursing positions

Leaves us with the need for experienced nurses

With that in mind we need to know how one develops into novice

to expert and the differences

And advancing into a long term and continuously developing

career

(Benner, 1982, p. 402)

5 Levels

Novice

Nursing Student

Advanced Beginner

Graduate Nurse

Competent

2-3 years in same unit

Proficient

3-5 years in same unit

Expert

Extensive time in same unit and multiple other units

(Hood, 2014, p. 14-15)

Novice

Nursing Student

Unyielding and rule generated behaviors

This method does promote safety, tends to be judgmental

(Hood, 2014, p. 14)

Trouble using discretionary judgment

Has no experience in a clinical setting so guided by what they were

taught in a perfect hospital setting

Does not know when exceptions to the rules are to be applied

(Benner, 1982, p. 104)

Advanced Beginner

Graduate Nurse

Communicates principles, needs help with priority setting

(Hood, 2014, p. 14)

Can cope with real situations or aspects with the help of a mentor

(Benner, 1982, p. 404)

Starting to create their own strategies for their clinical setting

(Sitzman & Eichelberger, 2010, p. 168)

Become uncomfortable in stressful clinical situations

(Hood, 2014, p. 14)

Competent

2-3 years in same unit

Can formulate long term goals, feels organized

Has feelings of mastery

Has to think about critical situations before acting on them

(Hood, 2014, p. 14)

Begin to see patterns in clinical situations

(Sitzman & Eichelberger, 2010, p. 168)

Lacks speed and flexibility

Many nurses may stay at this level, reinforced by the institution

(Benner, 1982, p. 405)

Proficient

3-5 years in same unit

Interprets nuisances in conditions

Perceives whole situations instead of smaller aspects

Adapt to unfamiliar and chaotic situations with creative strategies

(Hood, 2014, p. 14)

Able to differentiate between the important and less important aspects of a clinical situation

Best taught with case studies and context free principles tends to get frustrated with strict rules

“A competent nurse and a proficient nurse will not approach or solve a clinical situation in the same way”

(Benner, 1982, p. 405)

Expert

Extensive time in one unit and often in multiple units

Insight in a clinical situation

Able to act without thinking in chaotic situation, acts intuitively

Unable to think in steps

(Hood, 2014, p. 14)

Focuses quickly on the correct problem

Only use rules and the help of others for new and unique situations

Some nurses never reach this level

(Sitzman & Eichelberger, 2010, p. 169)

(Gram, 2013)

Misconception of Experience

“Experience is not the mere passage of time or longevity”

Experience is the actual act of obtaining experience through

clinical situations

Trial and Error

Getting questions answered and pocketing those answers in your

knowledge bank

(Benner, 1982, p. 407)

Applying the Novice to Expert

Model

In the early 1990’s Aurora Health Care got together with Patricia

Benner and developed a program that implemented the Novice to Expert model for nurses with direct patient contact

ADAM-RN- Aurora Development and Advancement Model- RN

Intended to promote recognition of expertise through monetary

benefits, provide reflection on clinical practice, and create a peer

review system

(Gentile, 2012, p. 102)

ADAM-RN

Program Specifics

Voluntary until 2007, after evidence based changed were made, it

became mandatory for all employees

2595 nurses participate in program (renamed the stages)

31% at the Expert level

19% at the Proficient level

21% at the Accomplished level

29% at the Competent level

Graduate Nurse

(Gentile, 2012, p. 102)

ADAM-RN

Program Specifics continued

Must reach competent level within two years of hire

Competent level can only be reached after nurse passes the National

Counsil Licensure Examination for Registered Nurses (NCLEX)

Mandatory written or oral reflection of two clinical experiences

To date no one has submitted for the oral reflection

Evaluation of role, reflection on thought processes, explore reactions,

recognize patterns, identifying educational needs, and integrating

experience into practice are all to be addressed in reflection

Reflection goes before a 2 peer review and then a 30 minute interview

(Gentile, 2012, p. 104-105)

ADAM-RN

Policy considerations

By making the policy mandatory it sets itself apart my implementing a

program that has specific levels of nurse competency

All nurses are held towards a standard lineated by policy

Compensation gives the nurses incentive but if another company wants

to mirror this model it is not mandatory, but based on company culture

Not all nurses make it to the expert level, they become stagnant and

stay and one level

(Gentile, 2012, p. 106-107)

ADAM-RN Summary

Implementing this model creates a culture of “reflective practice

and transformative learning experiences”

This is the core of the Novice to Expert Model

Demonstrates that a nurse does not pass from one level to the next

from experience but on the “right experience” – a transformative

experience

Experience that develops the nurse into truly a expert nurse

(Gentile, 2012, p. 107)

From Novice to Expert to Mentor

By Kathleen Dracup, RN, DNSc and Christopher W. Bryan-Brown, MD

Article in the American Journal of Critical Care Nursing

“The mediocre teacher tells. The good teacher explains. The

superior teacher demonstrates. The great teacher inspires.” - William

Arthur Ward

From Novice to Expert to Mentor

With a nursing shortage apparent and an influx of student into

nursing school the need for mentors in apparent

How to make an expert into a mentor

Bring the mentor back to when they were a novice

One example was teaching the new mentors with a recorder

They told them how to play it and than asked them to play infront of the

class

This exercise forces the mentor to reflect on a time when she was a

novice and how it felt

(Dracup & Bryan-Brown, 2004)

Novice to Expert to Mentor

5 competencies of a Mentor

Self knowledge- “the ability to understand and develop yourself in the context of organizational challenges, interpersonal demands, and individual motivation”

Strategic vision- “the ability to connect broad social, economic, and political changes to the strategic direction of institutions and organizations”

Risk-taking and creativity- “mentors have the ability to be successful by moving outside the traditional and patterned ways of success”

Interpersonal and communication effectiveness- “the ability to nurture a partnership that is mutual and equal, not patriarchal or matriarchal”

Inspiration- “Mentors are ultimately change-agents who create personal as well as organizational changes”

(Dracup & Bryan-Brown, 2004)

Novice to Expert to Mentor

Summary

With the influx of new nurses there needs to be programs that teach experts how to be mentors

This will help integrate and nurture the nurses of tomorrow

The acute need for mentors is not a problem nursing can solve on its own

Administrators, monetary compensation, educational programs

With this influx there is a apparent opportunity to shape the healthcare system of tomorrow

“We can create a system that values talent and generosity of spirit and that rewards professional commitment. Clinical preceptors and career mentors are key to the growth of the nursing profession”

(Dracup & Bryan-Brown, 2004)

Attaining Expertise

by Shonta D. Collins, BSN, RN, MPA

Attaining Expertise

“Nursing is a very noble profession and those who carry the title of RN must understand that they can influence change in the world by choosing to practice safely, competently and compassionately”

How does a new nurse attain the skills to become an expert

Learning the fundamental skills

Applying sound principles of nursing

Critical thinking skills

Willing to learn a lot in a short amount of time

Accept constructive criticism

Be adaptive to new environments

(Collins, 2008)

Attaining Expertise

How does a new nurse attain the skills to become an expert

continued…

Transition from theory to real world practice

“But until he or she has had the opportunity to apply the principles from the

foundation courses to "real world" situations on a daily basis, the novice is not

yet fully prepared to practice with competence”

Direct care experiences increase the learning curve

Preceptor system and the “guide by the side” system is crucial from

moving fro novice to expert

(Collins, 2008)

Attaining Expertise

Advice from the Experts

"celebrate life every day and practice with a smile, regardless of how the day is going. You will meet people from different backgrounds with different sets of issues. You, as the RN, will need to remember that patients are people and what you learned in school is a safe way to practice.”

Patience is key

Go in with an open mind

Growth and learning curve will be accomplished over a lifetime if you are willing to learn

Take on the difficult patients

(Collins, 2008)

References

Benner, P. (1982). From Novice to Expert. The American Journal of Nursing, 402-407. doi:10.2307/3462928

Collins, S. D. (2008). Achieving Expertise. Minority Nurse. Retrieved from http://www.minoritynurse.com/article/achieving-expertise

Dracup, K., & Bryan-Brown, C. W. (2004). From Novice to Expert to Mentor: Shaping the Future. American Journal of Critical Care. Retrieved from http://ajcc.aacnjournals.org/content/13/6/448.full

Gentile, D. L. (2012). Applying the Novice-to-Expert Model. Journal of Infusion Nursing, 101-107. Retrieved from https://www.nursingcenter.com/_PDF_.aspx?an=00129804-201203000- 00005

Gram, T. (2013). Practice and the Development of Expertise (Part 1). Global Knowledge. Retrieved from https://performancexdesign.wordpress.com/category/social-media/

Hood, L. J. (2014). Conceptual Bases of Professional Nursing, 13-14. Philadelphia: Lippincott- Raven Publishers.

Sitzman, K., & Eichelberger, L. W. (2010). Understanding the Work of Nurse Theorists: A Creative Beginning, 165-170. Sudbury: Jones and Bartlett Publishers.