The Benner Scale, named after the internationally renowned Dr. Patricia Benner, is widely accepted and arguably the most useful framework for assessing clinical competency at different stages of professional growth.
Dr. Benner proposes that expert nurses develop skills and understanding of patient care over time, not just through a proper educational background, but also through a multitude of experiences.
Rather than “how to be a nurse”, Dr. Benner focused on how nurses acquire nursing knowledge. This theorizes that one could gain knowledge and skills and “know how to do something”, without ever learning the other particular knowledge and insight that comes from the experience of actually doing or performing it. Beyond that, she values the experience gained in comparison of doing something once, to having done or performed such tasks a couple or several times.
Dr. Benner’s work was founded on the “Dreyfus Model of Skill Acquisition”. The Dreyfus brothers believed learning was experiential or “learned through experience” and also situation-based, and that a student had to pass through five very distinct stages in learning, from novice to expert.
Dr. Benner found that improved practice depended on experience and science, and developing those skills was a long and progressive process. She found when nurses engaged in various situation, and learned from them they developed “skills of involvement” with patients and family.
The Benner Model has also been relevant for ethical development of nurses since perception of ethical issues is also dependent on the nurses’ level of expertise. This model has been applied to several disciplines beyond clinical nursing, and understanding the five stages of clinical competence helps nurses support one another and appreciate that expertise in any field is a process learned over time.
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 particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms.
Those are the new grads 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.
These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Component nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners.
At this level, nurses can see situations as a whole, rather than just parts of it. Proficient nurses have learned from experience what events typically occur and are able to modify plans in response to different events.
Nurses who can recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, of when events don’t occur as expected.
Beginner nurse focus on tasks and follow a “to do” list. Expert nurses focus on the whole picture, even when completing singular tasks. They have a distinctive ability to notice subtle signs of a situation, such as a patient that is more difficult to stimulate than they been in prior visits.
The significance of this theory is that these levels reflect a movement of increased knowledge in a series of steps. Each step builds from the previous one, the nurse gains clinical experience, and knowledge is compounded. The result of this model is that the perception of what it means to be an “Expert Nurse” has changed.
The expert is no longer the highest paid nurse, but the nurse who provides the most superb nursing care.
CITATION:
Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education. Bulletin of Science, Technology & SocietyJune 2004 24: 188-199. Benner, P., & Wrubel, J. (1982a). Skilled clinical knowledge: The value of perceptual awareness. Part 1. Journal of Nursing Administration, 12(5), 11-14. Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. Benner’s From Novice to Expert – Nursing Theory (nursing-theory.org) |
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