Novice to expert: The value of nursing expertise

It seems like a no-brainer: one needs experience to become an expert. Obviously, right? This is why nursing students rotate through clinical experiences, new graduate nurses complete a residency program, and seasoned nurses cross-train when switching specialties.

Our understanding of this comes from the work done by Dr. Patricia Benner, a nurse and theorist. Her pioneering work, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, was published in 1984 in the American Journal of Nursing,

Her article put forth the idea that nursing expertise comes from developed skills and understanding of patient care over time through a solid educational foundation and varied experiences. While Dr. Benner’s research was originally refined with critical care nurses, it has applicability in all nursing settings and specialties.

Dr. Benner theorized five stages of clinical competence: novice, advanced beginner, competent, proficient, and expert. Each stage builds upon the last as skills are honed, concepts that were once abstract become concrete and tangible, and clinical experience is gained.

Here’s a brief snapshot of the five stages. It is useful to think of these stages in terms of the skills and concepts mastered at each stage instead of the years of nursing. A nurse who has stayed in one specialty for their entire career can reach the expert stage in that specialty faster than a nurse who has worked in many different care settings. A nurse can be an expert in one specialty area of nursing and a novice in another.

Novice

This nurse has little to no previous experience. Nursing students or nurse techs often fit into this category. Because the nurse has no previous experience informing their current practice, they are unable to use discretionary judgment. The novice nurse may also struggle with prioritization and time management and will benefit from concrete rules to support professional growth and development.

Advanced Beginner

This nurse has enough experience to recognize repeated conditions or situations they have seen before, but not enough to synthesize that information into a larger picture. Think of a new graduate nurse who recently completed their residency and is now beginning to work independently on the patient care unit. They can complete nursing tasks but still need help identifying changes in patient condition or understanding how an abnormal lab value fits into the greater clinical picture. They have some clinical knowledge but need support to prioritize clinical tasks throughout the shift.

Competent

The competent nurse now has some skills and experience under their belt. They can utilize deliberate planning to ensure their work is efficient and organized. However, they lack the flexibility and multi-tasking skills of proficient nurses. These nurses can formulate a plan for their shift and work effectively to execute that plan but often need assistance with a patient status change, unexpected admission, or other unanticipated situation that causes their plan to go awry. They benefit from a mentor, charge nurse, or more experienced colleague to help them get back on track and regroup.

Proficient

These nurses are characterized by mastery and confidence. They can synthesize information to anticipate, adjust, and respond in the moment as different situations occur.

The nurse can see the whole patient situation, not just individual clinical issues. They are highly skilled and work independently without close supervision. Proficient nurses often serve as mentors or preceptors to advanced beginners or competent nurses. They themselves would benefit from mentoring or coaching by an expert nurse to grow professionally.

Expert

These nurses are all about nuance. They have a deep understanding of the intricacies of nursing practice. The expert nurse uses their vast experience and clinical skills to anticipate and intuit subtle changes in patient conditions or clinical situations, even when performing nursing tasks. Think of the nurse who parks the crash cart outside the patient’s room because they “just have a gut feeling.” They know how to prioritize and get things done. These nurses are excellent mentors to competent and proficient nurses but may be frustrated working with novice or advanced beginner nurses. Expert nurses benefit from continuing to grow their knowledge and experience through different clinical situations, educational opportunities, and mentoring and coaching.

Benner’s work has been used in the development of nursing education programs, clinical ladders, leadership development programs, and more. Where do you land? Which stage do you see the most in your work environment? How might you use Benner’s continuum to facilitate your continued development in nursing practice?