Excellence and Power in Clinical Nursing Practice by Patricia Benner - Essay Example

Research Paper: Patricia Benner (Insert July 31 Patricia Benner has had an enormous influence on contemporary nursing theory, practice, and the education of nurses. Her 1984 book, From novice to expert – Excellence and Power in Clinical Nursing Practice, set out a framework for the development of nurses, from graduation to expert level, and shifted the emphasis in nursing from theory to clinical experience. Part 1 Patricia Benner is currently a Professor in the Department of Physiological Nursing in the School of Nursing at the University of California, San Francisco. She graduated with a Bachelor’s degree in nursing from Pasadena College, California, and a Master’s degree in surgical nursing from the University of California. Benner went on to work as nurse for several years, including a period in an intensive care unit, an emergency room, as a staff nurse, and in home care. She then returned to academia, as a researcher at the University of California. In 1984, she authored the work which set out the basic principles of her influential theories – From novice to expert – Excellence and Power in Clinical Nursing Practice. Benner had become very interested in the Dreyfus model of skills acquisition, and, in this work, adapted this to nursing. Her main intention in doing so was to answer the question ‘how do nurses learn to do nursing?’ (enursescribe.com). This book was based on 21 sets of interviews Benner had conducted with newly-graduated nurses and their preceptors. Additionally, Benner interviewed or observed some 51 experienced clinical nurses, a further 11 newly-graduated nurses, and 5 senior nursing students, hoping ‘to further delineate and describe characteristics of nurse performance at different levels of education and experience’ (Benner, 1996, p.xiv). Among Benner’s many other works are the 1996 book Expertise in Nursing Practice: Caring, Clinical Judgement, and Ethics, with Christine Tanner and Catherine Chesla, and Caregiving, with Suzanne Gordon and Nel Nodding, published in the same year. Her work has had an enormous influence on nursing training and practice, and already in 1985, the year after the publication of From novice to expert, she was elected to the fellowship of the American Academy of Nursing. Benner has also been elected an honorary fellow of the Royal College of Nursing. This influence has also spread well beyond the United States. For example, Benner’s work has provided the basis for a redesigned system of nursing practice and education in three states in Australia (earthlink.net). Benner proposed that a graduate nurses becomes an expert nurse by developing knowledge, understanding and clinical skills over time. This is a process which draws on a wide experience, and a sound grasp of nursing theories are not enough. She therefore suggested that a newly-graduated nurse was in fact able to acquire advanced skills and knowledge – what she termed ‘knowing how’ – without ever learning the abstract theory – ‘knowing that’ - behind those skills (Dracup and Bryan-Brown, 2004, p.448). Taking the Dreyfus model as her foundation, she set out a ladder by which a nurse becomes an expert nurse. Stuart and Hubert Dreyfus (1980) described their model thus: ‘In acquiring a skill by means of instruction and experience, the student normally passes through five developmental stages which we designate novice, competence, proficiency, expertise and mastery’ (4). Fig. 1. Benner’s adaptation of the Dreyfus Model Source: http://nursingpedagogy.com/benner.jpg As a nurse advances up through these levels, he/she increasingly comes to rely on the knowledge and skills he/she has acquired from her ever-widening practical experience, and is less and less rigidly tied to the abstract principles which formed a great part of his or her academic education in nursing. Stuart and Hubert Dreyfus (2004) had already set this out in their on work on general skill acquisition: ‘as the student becomes skilled he depends lesson abstract principles and more on concrete experience’ (p.4). Benner was able to draw on her considerable experience of both practical nursing, and academia, to recognise that great clinical care cannot be the result merely of the application of academic theories, often formulated by those with little recent experience of practical nursing. Rather, theories should be developed in response to practical experience (currentnursing.com). After all, excellent care is delivered on the hospital ward, and not in a university faculty. Benner has also influenced the conception of what it takes to be an ‘expert nurse’. In the process she laid out for becoming an expert, the emphasis is on giving the best care possible, and being able to give better and better care as one gains experience. Therefore, rather than being the best-paid or most senior nurse in a clinic or hospital, Benner’s expert was the one who was able to deploy a vast clinical experience in order to provide excellent care. It is clear that Benner was doing something novel, and that her research marked a key change in conceptions about nursing education and practice. As Dracup and Bryan-Brown (2004) acknowledge, ‘Until the publication of Benner’s research, which focused on critical care nurses, this characterization of the learning process had gone largely undefined’ (p.448). Part 2 Benner was describing what she saw as nursing students developing ‘nursing connoisseurship’ – a ‘hallmark of growing expertise within nursing culture’ (nursingpedagogy.com). As Benner (1984) herself put it, students, as they moved through the different levels on the skill acquisition ladder, learn to recognise ‘the context, meanings, characteristics, and outcomes of their connoisseurship’ (p.5). Dracup and Bryan-Brown (2004) began their article with a quotation taken from William Arthur Ward: ‘The mediocre teacher tells us. The good teacher explains. The superior teacher demonstrates. The great teacher inspires’ (p.448). Benner’s expert nurse goes about all of her duties in a professional manner. She carefully observes technical details and measurements, but is not bound by them alone, and does not get caught up only with technical detail. The expert can also bring their clinical experience to bear in assessing the condition of patients, and what action should be taken. For Benner (1996), at ‘the heart of all good clinical judgement and clinical wisdom lies experiential learning from particular cases’ (p.xv). Benner’s expert nurse is also able to successfully integrate the different theoretical and practical elements of what they have learnt into a coherent code of excellent practice – ‘the expert is able to integrate various aspects of patient are into a meaningful whole’ (Dracup and Bryan-Brown, 2004, p.449). As Benner (1996) put it, ‘experiential learning requires the stance of an engaged learner, rather than the stance of an expert in techne who skilfully applies well-established knowledge in prespecified clear circumstances’ (p.xvi). Such a nurse holds their background knowledge ‘in a fluid or semipermeable way’ (p.xvii). Therefore, in following Benner’s advice, a nurse would asses, diagnose, plan, implement and evaluate in a flexible and adaptable manner, drawing on both theory and experience, with the latter guiding the former rather than vice versa. Such a nurse would thus be very responsive to changing circumstances. Part 3 It is difficult to argue with the conclusion that ‘The importance of this work is hard to overestimate’ (nursingtimes.net). Benner shifted the emphasis in nursing back to clinical experience, and provided a framework in which it was possible for newly-graduated nurses to learn how to provide the highest levels of care. She has therefore played a key part in putting nursing theory and academic work in perspective – as an important tool, but not the most important tool of the expert nurse. Novice nurses who follow her system are able to become truly great nurses. This has been recognised by public health authorities worldwide, which have adopted her advice in prescribing courses of education for nurses. Benner (1996) herself recognised that her 1984 book had ‘helped in the development of internship and orientation programs for the newly graduated nurse as well as clinical development programs for the more experienced nurse’ (p.xiii). References Benner, P. (1984). From novice to expert – Excellence and Power in Clinical Nursing Practice. Menlow Park: Addison-Wesley. Benner, P., Tanner, C. & Chesla, C. (1996). Expertise in Nursing Practice: Caring, Clinical Judgement and Ethics. New York: Springer. Dracup, K. & Bryan-Brown, C. W. (2004). “From Novice to Expert to Mentor: Shaping the Future”. American Journal of Critical Care 13 (2004): pps.448-450. “Nurse Theorists: Patricia Benner”, n.d. Nurse Scribe. Available from: [Accessed July 29 2010]. “Patricia Benner”, n.d. Earthlink. Available from: [Accessed July 29 2010]. “Patricia Benner’s From Novice to Expert” (2010). Nursing Theories. Available from: [Accessed July 29 2010]. “Patricia Benner – US nurse theorist and author of From Novice to Expert” (2010). Nursing Times. Available from: [Accessed July 29 2010]. “Pedagogical Evolution”, n.d. Nursing Pedagogy. Available from: [Accessed July 29 2010]. Read More