# data[].attributes.body
Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982

# data[].attributes.attachment_link.readable_text
Biography and Career of Dr Patricia Benner

Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982

In the late 1960s, Benner worked in the nursing field. This included working as a Head Nurse of the Coronary Care Unit at the Kansas City General Hospital and an Intensive Care Staff Nurse at the Stanford University Hospital and Medical Center. From 1970 until 1975, she was a Research Associate at the University of California at San Francisco School of Nursing.

Following that, she was a Research Assistant to Richard S. Lazarus at the University of California at Berkeley. From 1979 until 1981, she was the Project Director at the San Francisco Consortium/University of San Francisco for a project achieving methods of intraprofessional consensus, assessment, and evaluation. Since 1982, Dr Benner has been working in research and teaching at the University of California at San Francisco School of Nursing.

Dr Benner has published nine books, including From Novice to Expert, Nursing Pathways for Patient Safety, and The Primacy of Caring. She has also published many articles. In 1995, she was awarded the 15th Helen Nahm Research Lecture Award from the University of California at San Francisco School of Nursing.

She is currently a professor emerita in the Department of Physiological Nursing at the University of California at San Francisco School of Nursing. Some of her works include:

Dr Patricia Benner's Contribution to Nursing Theory: From Novice to Expert Concept

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.

Dr Benner proposed that a nurse could gain knowledge and skills without actually learning a theory. She describes this as a nurse "knowing how" without "knowing that." She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience.

The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert.

1. A novice is a beginner with no experience. They are taught general rules to help perform tasks, and their rule-governed behavior is limited and inflexible. In other words, they are told what to do and simply follow instruction.

2. The advanced beginner shows acceptable performance, and has gained prior experience in actual nursing situations. This helps the nurse recognize recurring meaningful components so that principles, based on those experiences, begin to formulate in order to guide actions.

3. A competent nurse generally has two or three years' experience on the job in the same field. For example, two or three years in intensive care. The experience may also be similar day-to-day situations. These nurses are more aware of long-term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization.

4. A proficient nurse perceives and understands situations as whole parts. He or she has a more holistic understanding of nursing, which improves decision-making. These nurses learn from experiences what to expect in certain situations, as well as how to modify plans as needed.

5. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and an intuitive grasp of clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner's writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse.

These different levels of skills show changes in the three aspects of skilled performance: movement from relying on abstract principles to using past experiences to guide actions; change in the learner's perception of situations as whole parts rather than separate pieces; and passage from a detached observer to an involved performer, engaged in the situation rather than simply outside of it.

The levels reflect movement from reliance on past principles to the use of past experience and change in the perception of the situation as a complete whole with certain relevant parts. Each step builds on the previous step as principles are refined and expanded by experience and clinical expertise.

Benner's theory of From Novice to Expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients.
For more detailed information: From Novice to Expert Concept

# data[].attributes.attachment_link.description
Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982 In the late 1960s, Benner worked in the nursing field.

# data[].attributes.attachment_link.readable_text
Abstract

This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized. The NPPL helped create an empowering environment for continued nurse practitioner professional growth.

View full text

# data[].attributes.attachment_link.title
Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience

# data[].attributes.attachment_link.description
This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III.

# data[].attributes.body
1. Mentorship programs, simulation training
2. Leadership, administration, nursing practice, and research
3.  Foundation to preceptor programs
4. To develop career ladders, staff   development, and recognition/awards

# data[].attributes.body
The Novice to Expert theory is an explanatory, high middle-range theory. McEwen and Wills (2019) explain that middle-range theories guide the development of nursing practice.

# data[].attributes.body
Congruence with nursing standards:  P. Benner’s theory is consistent with nursing standards. Dr. Benner’s theory has been used extensively in nursing to increase nurse retention and develop experience with new nurse administrators and managers. The recognition alone that this theory has received and how it has been applied to nursing programs and hospitals around the world is amazing.

Congruence with current nursing interventions or therapeutics: Application of Patricia Benner’s theory include emergency room RN’s disaster preparedness (Schneider, 2019), nurse practitioners working on their career ladder in pediatrics, from practitioner to leadership (Evans et. al. 2016) and education of instructors with the use of HPS in nursing school (Thomas and Kellgren, 2017).

Evidence of empirical testing/research support/validity: Patricia Benner’s theory was introduced after she performed an observation and interview of clinical nursing practice situations (Benner 2001).   She claimed that nurses can perform the “knowing how” without the “knowing that”.  Basically, going from novice to expert allows the nurse to gain the concrete knowledge without having to learn the theory and concept behind the skills (Benner 2001).

Kiernan, L. C. (2018). Evaluating competence and confidence using simulation technology, utilized Benner’s theory to show that measurement of confidence increased 37.26% from beginning to end of program.

Oshvandi et. al. 2016, used Benner’s theory to show that the novice to expert theory can be used as a predetermined clinical guideline for conducting all practices associated with nursing career.

Benner’s theory has been widely use by nursing educators, nursing researchers, and nursing administrators to increase the knowledge and confidence base of nurses.

Social relevance: Benner’s theory and levels of learning, from novice to expert, show a movement from past conceptual to past actual experience. It has a huge impact on our current nursing practice, administration, education and research.

Contribution to nursing: The use of Patricia Benner’s theory has altered the nursing profession’s views on what conditions are needed to become an expert. Meaning the nurse that has given the most experienced patient care has built the experience to perform independently and to act as a model for novice nurses.

Conclusions and implications:  Patricia Benner’s theory is beneficial for all nurses regardless of their educational level.  Benner’s theory has been proven to be successful for all levels of professionals.

# data[].attributes.body
Theory Description Patricia Benner’s Novice to Expert

Scope of theory: The Novice to Expert theory is an explanatory, high middle-range theory.

Purpose of theory: Explanatory theory, McEwen and Wills (2019) explain that middle-range theories guide the development of nursing practice

Origins of theory: Patricia Benner introduced her theory in 1984 after an observation and interview studio of clinical nursing practice situations from the perspective of new nurses and their preceptors (Benner, 2001).

Major concepts: Person, Health, and Situation (aka Environment).  “With experience and mastery, the skill is transformed.” (Benner, 2001)

Major theoretical propositions are as follows:

1.      Expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations” (Benner, 1984a, p.3).

2.      “Discovering assumptions, expectations, and sets can uncover an unexamined area of practical knowledge that can then be systematically studied and extended or refuted” (Benner, 1984a,p.8)

3.      Clinical knowledge develops over time and each clinician develops a personal repertoire of practice knowledge that can be shared in dialogue with other clinicians.

4.      Formal rules are limited, and discretionary judgment is needed in actual clinical situations

Major Assumptions:

1.      Theory is derived from Practice

2.      Human wisdom is more than rational calculation

3.      Theory frames issues and guides the practitioner in where to look and what to ask

4.      No practitioner can practice beyond experience

Context for Use: Nursing practice from student to experienced.  All levels of nurses with the introduction of new material.

# data[].attributes.body
According to Patricia Benner, 1982, 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
The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert.

1. A novice is a beginner with no experience. In other words, they are told what to do and simply follow instructions.

2. The advanced beginner shows acceptable performance and has gained prior experience in actual nursing situations.

3. A competent nurse generally has two or three years’ experience on the job in the same field.

4. A proficient nurse perceives and understands situations as whole parts.

5. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and determine actions.

# data[].attributes.attachment_link.readable_text
This paper details the application of Benner's Novice to Expert Model to simulation educator knowledge, skills, and attitude for academic and practice settings. Facilitator development in the use of simulation methods is gaining more attention and support. If simulation is to continue to advance as a discipline, a theoretical basis is needed. The Novice to Expert Model provides the necessary conceptual structure to guide simulation facilitator development and assist in understanding learning trajectory. This theory-based approach that defines and operationalizes the five stages of development provides guidance for development resources, educational programs, and infrastructure needed at various program levels.

References

Anderson, M., Bond, M. L., Holmes, T. L., Cason, C. L. (2012). Acquisition of simulation skills: Survey of users. Clinical Simulation in Nursing, 8(2), e59-e65. doi:
Google Scholar

Benner, P., Tanner, C. A. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87(1), 23-31
Google Scholar

Benner, P., Tanner, C. A., Chesla, C. A. (1997). The social fabric of nursing knowledge. American Journal of Nursing, 97(7), 16BBB-16DDD.
Google Scholar

Chinn, P. L., Kramer, M. K. (1999). Theory and nursing: Integrated knowledge development (5th ed.). New York, NY: Mosby.
Google Scholar

Decker, S. I. (2012). Simulation: Education and ethics. In Jeffries, P. R. (Ed.), Simulation in nursing education: From conceptualization to evaluation (pp. 21-33). New York, NY: National League for Nursing.
Google Scholar

Fawcett, J. (1992). The relationship of theory and research (3rd ed.). Philadelphia, PA; F. A. Davis.
Google Scholar

Hallmark, B. F., Thomas, C. M., Gantt, L. (2013). The educational practices construct of the National League for Nursing-Jeffries Simulation Framework: State of the science. Clinical Simulation in Nursing, 10(7), 345-352. doi: http://dx.doi.org/10.1016/j.ecns.2013.04.006.
Google Scholar

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., Jeffries, P. R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2, Suppl.), S3-S40. doi:
Google Scholar

Jeffries, P. R. (2015). The NLN Jeffries simulation theory. New York, NY: National League for Nursing.
Google Scholar

Jones, A. L., Reese, C. E., Shelton, D. P. (2013). National League for Nursing-Jeffries simulation framework state of the science project: The teacher construct. Clinical Simulation in Nursing, doi:1016/j.ecns.2013.10.008
Google Scholar

Kellgren, M., Manning, S., Sievers, L., Gamblin, V., Thomas, C., Rojas, D. (2016). Faculty development toolkit: Simulation resources. NLN Simulation Innovation and Resource Center. Available at http://sirc.nln.org/pluginfile.php/18733/mod_page/content/27/Faculty%20DevelopToolkit%20Final%20February%202016.pdf
Google Scholar

Rogers, B. L. (2005). Developing nursing knowledge: Philosophical traditions and influences. Philadelphia, PA: Lippincott Williams & Wilkins.
Google Scholar

Society for Simulation in Healthcare (SSH) . (2012). Certification standards and elements. Available at http://www.ssih.org/Portals/48/Certification/CHSE%20Standards.pdf
Google Scholar

Society for Simulation in Healthcare (SSH) . (2016). Suggested evidence of performance at the CHSE and CHSE-A levels for the certification standards and elements. Available at http://www.ssih.org/Portals/48/Certification/CHSE-A_Docs/CHSE-A%20Standards%20and%20Suggested%20Evidence.pdf
Google Scholar

Waxman, K. T., Telles, C. (2009). The use of Benner's framework in high-fidelity simulation faculty development: The Bay Area Simulation Collaborative model. Clinical Simulation in Nursing, 5(6), e231-e235. doi:
Google Scholar

Wilson, L., Wittman-Price, R. A. (2015). Review manual for the certified healthcare simulation educator (CHSE) exam. New York, NY: Springer.
Google Scholar

Young, P. K., Shellenbarger, T. (2012). Interpreting the NLN Jeffries Framework in the context of nurse educator preparation. Journal of Nursing Education, 51(8), 422-428.
Google Scholar

# data[].attributes.attachment_link.title
Benner's Novice to Expert Model: An Application for Simulation Facilitators - Christine M. Thomas, Molly Kellgren, 2017

# data[].attributes.attachment_link.description
This paper details the application of Benner's Novice to Expert Model to simulation educator knowledge, skills, and attitude for academic and practice settings. Facilitator development in the use of simulation methods is gaining more attention and support. If simulation is to continue to advance as a discipline, a theoretical basis is needed.

# data[].attributes.body
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.

# data[].attributes.body
Benner’s theory of From Novice to Expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients.

# data[].attributes.body
References

Benner's From Novice to Expert. Nursing Theory. (2020, October 17). https://nursing-theory.org/theories-and-models/from-novice-to-expert.php.

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.

Benner, P. (1984). The Dreyfus model of skill acquisition applied to nursing. Addison-Wesley Pub. Co.

Benner, P. (2001). From novice to expert: excellence and power in clinical nursing practice. Prentice Hall.

Evans, A., Loera, K., Harris, D., Carson, S., Boutros, L., & Okuhara, C. (2018, September 15). Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience. Journal of Pediatric Health Care. https://www.sciencedirect.com/science/article/pii/S0891524518301408?casa_token=05hk8-kI9rQAAAAA%3AjaehFxLsYnM7xcbEPY2VIGWsy7-nbhw4NPXzggkKKXgjxC7D6wpvEKDkHkXj8OXboSacawx4w68q.

Kiernan, L. C. (2018). Evaluating competence and confidence using simulation technology. Nursing, 48(10), 45–52. https://doi.org/10.1097/01.nurse.0000545022.36908.f3

Oshvandi, K., Moghadam, A. S., Khatiban, M., Cheraghi, F., Borzu, R., &amp; Moradi, Y.      (2016). On the application of novice to expert theory in nursing; a systematic review.      Journal of Chemical and Pharmaceutical Sciences, 9(4), 3014–3020.   https://doi.org/http://eprints.umsha.ac.ir/id/eprint/2304

Schneider, Brian Charles, "An Investigation of the Relationships Between and Among Disaster           Preparedness Knowledge, Perceived Use of Intuition, and Triage Decision Making of    Emergency Department Registered Nurses in Acute Care Hospitals Using Benner’s       Novice to Expert Theory" (2019). Seton Hall University Dissertations and Theses        (ETDs). 2667. https://scholarship.shu.edu/dissertations/2667

Thomas, C. M., & Kellgren, M. (2017). Benner’s Novice to Expert Model: An Application for Simulation Facilitators. Nursing Science Quarterly, 30(3), 227–234. https://doi.org/10.1177/0894318417708410