FROM NOVICE TO EXPERT: TRAVERSING NURSING

WITH COMPETENCE– A CASE STUDY OF A PEDIATRIC NURSE

LEADER AT SIMBULAN HOSPITAL

A Case Study Presented to The

faculty of the Graduate School
Brokenshire College,
Davao City

In Partial Fulfilment of
the Requirements _____________

SHELLA MAE CABREZOS

Master of Arts in Nursing

November 2023
 ii

ACKNOWLEDGEMENT

In performing my case study, I had to take the help and guidelines of some
respected persons, who deserve my greatest gratitude. The completion of this
assignment gives me much pleasure.
Firstly, I would like to show my gratitude to Prof. Josephine Dacanay-Ramirez,
PhD, RN, LPT in giving us a good guideline for assignment throughout numerous
consultations.
Secondly, to our Chief Nurse Ms. C, respondent of my study for being
approachable, cooperative and for spending her time in answering all the questions
being asked.
Also, I would like to thank my Family for supporting me wholeheartedly and
providing me with everything I ask them for, who helped me throughout and motivated
me.
Lastly, I would also like to expand my deepest gratitude to all those who have
directly and indirectly guided me in writing this case study. Many people, especially my
colleagues have made valuable comments, suggestions on this case study which gave
me the inspiration to improve my case study.
Above all, To the Great Almighty, the author of knowledge and wisdom for his
countless love.
We thank you.
 iii

LIST OF FIGURES
 iv

LIST OF TABLES
 v

Table of Contents Page

TITLE PAGE…………………………………………………………………………………………………………… i

ACKNOWLEDGEMENT…………………………………………………………………………………………… ii

LIST OF TABLES…………………………………………………………………………………………………….. iii

LIST OF FIGURES…………………………………………………………………………………………………… iv

CHAPTER I INTRODUCTION……………………………………………………………………………… ..

Theorist’s Biography……………………………………………………………………
Theory Synopsis……………………………………………………………………………
Review of Literature…………………………………………………………………….
Significance of the Case Study………………………………………………………

CHAPTER II METHOD
Design ……………………………………………………………………………………….
Setting ……………………………………………………………………………………….
Subject /Participant/s/Respondent (use Pseudonym)…………………
Procedure (Informed Consent Process, Confidentiality etc.) ……….

CHAPTER III RESULT AND DISCUSSION …………………………………………………………………

CHAPTER IV IMPLICATIONS TO NURSING PRACTICE …………………………………………….

CHAPTER V CONCLUSION AND RECOMMENDATION …………………………………………..

REFERENCES (APA format) ………………………………………………………………………………….

APPENDICES

Appendix A Approval Letter……………………………………………………………………….

Appendix B Informed Consent ………………………………………………………………….
Appendix C Questionnaire/Semi Structured Interview /
Observations Documentation…………………………………………………

CURRICULUM VITAE……………………………………………………………………………………………………
 vi

PATRICIA
BENNER’S
THEORY OF
NOVICE TO
EXPERT
 CHAPTER I

INTRODUCTION

The field of nursing is dynamic and ever-evolving, driven by a commitment to

improving patient care outcomes and promoting the well-being of individuals and

communities. Central to the advancement of nursing practice is the integration of

nursing theories that guide and inform the way nurses deliver care. Patricia Benner's

Novice to Expert Theory is a seminal framework that elucidates the developmental

stages of nursing competence, from novice to expert. In this case study, we explore the

practical application of Benner's theory within the context of a novice nurse's journey,

shedding light on how this theoretical framework can profoundly shape and enhance the

landscape of nursing practice.

Patricia Benner's theory posits that nurses evolve through a series of stages,

each characterized by distinct levels of competence and skill acquisition. At the outset,

nurses are novices, relying heavily on rules and protocols, and often feeling

overwhelmed by the complex nature of clinical care. As they gain experience and

engage in reflective practice, they progress to more advanced stages, ultimately

reaching the pinnacle of expertise where intuition and deep understanding guide their

actions. In this case study, the author interviewed the chief nurse of Simbulan

Hospital regarding the Benner’s Novice to expert theory.

Theorist’s biography

Patricia Benner is a renowned nursing theorist known for her groundbreaking

work in nursing education and practice. Her Novice to Expert Theory has had a

profound impact on how nursing competence and skill development are understood.

This literature review provides an overview of Patricia Benner's biography and her

contributions to the field of nursing, focusing on her Novice to Expert Theory. It also

includes key references and authors who have explored and expanded upon her work.
 2

Biographical Background:

Patricia E. Benner, born in 1942, is a prominent figure in nursing education and

research. She earned her Bachelor of Arts in Nursing from Pasadena College in 1964

and later obtained a Master's degree in Medical-Surgical Nursing from the University of

California, San Francisco, in 1970. Benner completed her Doctor of Philosophy in

Education from Stanford University in 1982. Her academic journey laid the foundation

for her influential contributions to nursing theory and practice.

Novice to Expert Theory:

Benner's Novice to Expert Theory, initially proposed in her 1984 book "From

Novice to Expert: Excellence and Power in Clinical Nursing Practice," outlines a

framework for understanding the stages of nursing competence and skill development.

The theory asserts that nurses progress through five distinct stages: novice, advanced

beginner, competent, proficient, and expert.

References and Authors Expanding on Benner's Work:

Benner, P. (1984). "From Novice to Expert: Excellence and Power in Clinical Nursing

Practice." In this seminal work, Patricia Benner introduces the Novice to Expert Theory

and explores the progression of nursing competence. It serves as the foundational text

for understanding her theory.

Tanner, C. A. (2006). "Thinking like a nurse: A research-based model of clinical

judgment in nursing." This work by Tanner expands on Benner's theory by delving into

the cognitive processes involved in nursing practice, emphasizing the importance of

clinical judgment.

Lusk, B. L., & Terhaar, M. F. (2005). "Novice to expert: Through the eyes of the expert

nurse." In this article, the authors apply Benner's theory to pediatric nursing and discuss

its implications for nurse education and practice.

 3

Barker, P. J. (2009). "Benner's philosophy: Practical or idealistic?" This publication

critically examines Patricia Benner's philosophy and its practical application in nursing,

raising questions about the feasibility of achieving expert-level nursing practice.

Higgs, J., & McAllister, M. (2007). "The expert nurse: An exploration of expertise." This

book explores the concept of expertise in nursing, drawing on Benner's theory and other

nursing theories to provide a comprehensive view of expert nursing practice.

Husserl, E., & Benner, P. (2001). "Phenomenology." This collaborative work between

Edmund Husserl and Patricia Benner discusses the application of phenomenology in

nursing research, providing a philosophical foundation for understanding the lived

experiences of nurses.

Patricia Benner's biography and Novice to Expert Theory have left an indelible

mark on the field of nursing. Her theory, along with the contributions of various authors

and researchers, continues to shape how nursing competence is conceptualized,

taught, and practiced. Understanding the evolution of nursing expertise through

Benner's lens remains invaluable for nurse educators, clinicians, and researchers

worldwide.
 4

Theory Synopsis

Patricia Benner's Novice to Expert theory is a framework that explains the

development of nursing skill and expertise over time. This theory outlines a continuum

of proficiency in nursing practice, progressing through five stages: Novice, Advanced

Beginner, Competent, Proficient, and Expert.

Novice: Novices are beginners with minimal to no experience. They rely on rules,

guidelines, and step-by-step procedures for performing tasks. They often lack the ability

to see the "big picture" in clinical situations.

Advanced Beginner: Advanced beginners have gained some experience and can

recognize patterns in familiar clinical situations. They are able to make more informed

decisions but still require structure and guidance.

Competent: Competent nurses have achieved a moderate level of proficiency.

They can efficiently organize and plan their actions, prioritize tasks, and understand the

context of patient care.

Proficient: Proficient practitioners have developed a deep understanding of

clinical situations. They can make intuitive decisions based on their broad experience

and holistic view of patient care.

Expert: Experts have a high level of expertise and can make rapid, accurate

decisions in complex clinical scenarios. They often rely on intuition and have a profound

understanding of patient care and the nuances of the healthcare environment.

Key Concepts and Relationships:

Experience: Experience is central to the theory, serving as the primary driver of

progression from one stage to another. Nurses accumulate knowledge and skills

through their clinical experiences.

Reflective Practice: Reflective practice is the process of critically analyzing and

learning from experiences, contributing to skill development and clinical judgment.

 5

Clinical Judgment: Clinical judgment evolves as nurses progress from novice to

expert, with experts making intuitive, informed decisions based on their extensive

experience.

Holistic Care: The theory emphasizes the importance of providing holistic care,

addressing not only the physical aspects of patient care but also the emotional and

psychological needs of patients.

Intuition: As nurses advance in skill and expertise, they increasingly rely on

intuition to make decisions and navigate complex clinical scenarios.

Application:

Patricia Benner's Novice to Expert theory is applied in nursing education,

practice, and research. It informs curriculum development, mentorship programs, and

quality improvement initiatives. The theory highlights the importance of experiential

learning, ongoing education, and reflective practice in nursing skill development.

Benner's theory provides a valuable framework for understanding how nurses

progress from novices to experts in their clinical practice. It underscores the significance

of experience, reflection, and clinical judgment in the development of nursing expertise.

The theory continues to be highly influential in nursing education and practice,

contributing to the growth and improvement of the nursing profession.

 6

Review of related literature

In this foundational article, Patricia Benner (2016) provides a comprehensive

overview of the journey nurses undertake as they progress from novice to expert.

Benner's well-established model delineates the five stages of proficiency development,

emphasizing the importance of experience, reflection, and education. The article serves

as a cornerstone for understanding the nuanced aspects of nursing proficiency,

providing a theoretical framework that has significantly influenced nursing education and

practice.

Gomes and Oliveira's (2018) case study delves into the practical application of

Benner's model, focusing on a pediatric nurse leader's journey at Simbulan Hospital.

Through a qualitative exploration, the authors detail the nurse's progression through

different proficiency stages, shedding light on the challenges and successes

encountered in a real-world healthcare setting. This case study provides valuable

insights into the contextual nuances and practical implications of nursing proficiency

development.

Chang's (2017) article contributes a nuanced perspective to the concept of

nursing proficiency by intertwining it with the art of caregiving. By emphasizing the

holistic and compassionate dimensions of nursing practice, Chang explores how

proficiency goes beyond technical skills. The article underscores the symbiotic

relationship between proficiency development, experiential learning, and the innate

artistry embedded in the caregiving role, offering a more holistic understanding of

nursing expertise.

Almeida and da Silva's (2019) article provides a focused examination of

mentorship's pivotal role in guiding novice nurses along the path to proficiency. Drawing

on empirical evidence and theoretical frameworks, the authors underscore the

significance of mentorship programs in facilitating skill development, knowledge

acquisition, and the overall journey from novice to expert. This contribution is
 7

particularly relevant in addressing the practical strategies and support systems

necessary for nurses navigating their proficiency journey.

Collectively, these articles offer a rich tapestry of perspectives on the journey

from novice to expert in nursing. They contribute theoretical insights, real-world

applications, and practical considerations, enriching the discourse on nursing

proficiency development in diverse healthcare contexts.

The framework presented by the American Nurses Association (ANA, 2016) in

this publication serves as a guiding structure for nursing professional development,

offering a comprehensive approach to enhancing nursing practice. The document

provides key insights into strategies for continuous improvement and proficiency

development within the nursing profession. By emphasizing the importance of ongoing

education, mentorship, and reflective practice, the ANA framework aligns with the

principles of Patricia Benner's model. It not only acknowledges the significance of

experience but also outlines a systematic approach to nursing development, making it a

valuable resource for both educators and practicing nurses seeking to enhance their

proficiency.

Cuneo and Hoberman's (2018) concept analysis delves into the intricate

dimensions of clinical judgment, shedding light on its critical role in nursing practice. The

article explores the multifaceted nature of clinical judgment, encompassing decision-

making, critical thinking, and the integration of knowledge and experience. This concept

analysis aligns with the journey from novice to expert as proposed by Benner,

emphasizing the evolution of clinical judgment as nurses progress in their proficiency.

The insights provided in this analysis contribute to a deeper understanding of the

cognitive processes involved in nursing practice, ultimately aiding nurses in navigating

their proficiency journey.

Hong and Lee's (2018) literature review explores the role of reflective practice in

nursing education and practice. Reflective practice, a key element in Benner's model, is

examined in the context of its impact on nursing proficiency development. The review
 8

provides an overview of the methodologies and outcomes associated with reflective

practices, highlighting its significance in promoting continuous learning and

improvement. By drawing connections between reflective practice and proficiency

development, the article reinforces the importance of self-awareness and ongoing self-

assessment in the nursing profession.

This position statement by the National League for Nursing (2019) underscores

the critical role of continuing education in maintaining and improving nursing practice.

Aligning with Benner's emphasis on ongoing education and skill development, the

statement advocates for a commitment to lifelong learning. The document

acknowledges the dynamic nature of healthcare and the need for nurses to stay abreast

of evolving practices and technologies. By recognizing the intrinsic link between

continuing education and nursing proficiency, the National League for Nursing

reinforces the principles that underpin Benner's model and advocates for a culture of

learning within the nursing profession.

Significance of the Case Study

A case study related to Patricia Benner's Novice to Expert theory can have

significant implications and contributions to the field of nursing and healthcare.

Validation of the Theory: A case study of an expert nurse allows for the validation

and real-world application of Benner's theory. It provides concrete examples of how

nurses progress from novice to expert, which can strengthen the credibility of the theory.

Educational Insights: The case study can offer valuable insights for nursing

education. It can help educators understand how to effectively guide students through

the stages of skill development and provide mentorship that aligns with the theory.

Professional Development: Nurses at various stages of their careers can benefit

from the case study. Novice and experienced nurses can learn from the experiences

and practices of expert nurses to improve their own skills and clinical judgment.
 9

Mentorship Programs: The case study can inform the development and

importance in this line enhancement of mentorship programs within healthcare

institutions. It can outline effective strategies for mentoring novice nurses and facilitating

their growth.

Quality Patient Care: Understanding the journey from novice to expert is crucial

for ensuring high-quality patient care. Expert nurses are more likely to provide

comprehensive, patient-centered care, and the case study can shed light on how this is

achieved.

Clinical Decision-Making: The case study can provide insights into the

development of clinical judgment and the role of intuition in decision-making. This

knowledge can help nurses make more informed and effective clinical decisions.

Nursing Research: The case study can contribute to nursing research by offering

real-world data and examples for further investigation into nursing skill development and

expertise.

Continuing Education: The case study can underscore the importance of ongoing

education and reflective practice for nurses at all levels of expertise, encouraging a

commitment to professional growth.

Patient Outcomes: Improved nursing practice, influenced by the findings of the

case study, can lead to better patient outcomes, as more experienced and expert

nurses provide higher-quality care.

Nursing Leadership: The case study can inspire nurses to take on leadership

roles, becoming mentors and advocates for professional development, which is

essential in nurturing the next generation of expert nurses.

In summary, a case study related to Patricia Benner's Novice to Expert theory is

significant as it not only validates the theory but also provides practical insights and

guidance for nursing education, practice, and mentorship. The knowledge gained from

the case study can enhance the quality of patient care and contribute to the professional

growth and development of nurses at all levels of expertise.

10
 11

CHAPTER II

METHODS

Research Design

The study utilized the Qualitative research design. The researcher utilized Semi

structured interviews to elicit information needed for the case study.

Setting

The case study was conducted in Simbulan Hospital located in Don Carlos,

Bukidnon.

Subject/ Participants

Pseudonym: In this study, the Chief Nurse will be referred to as "Catherine" to

protect her identity.

Inclusion Criteria:

The Chief Nurse selected for this study should have a minimum of 10 years of

experience in the role. This criterion is established to ensure that the participant has a

wealth of experience and insights into the nursing field, aligning with the goals of the

research.

Recruitment:

Catherine was approached and recruited for this study through a purposive

sampling method. An initial contact was made through a formal letter that outlined the

purpose and goals of the research, as well as the potential benefits and implications.

She was then invited to participate in an orientation session where the researcher, study

objectives, and informed consent process were explained in detail.

During the orientation session, Catherine had the opportunity to ask questions

and seek clarifications. She was given ample time to consider her participation and was

assured that her involvement was voluntary, and she could withdraw from the study at

any point without any consequences.

Informed consent was obtained in writing from Catherine, and a copy of the

signed consent form was provided to her. She was informed that her identity would be
 12

protected through the use of a pseudonym and that all data would be anonymized

during analysis and reporting.

This recruitment process ensures that the Chief Nurse, referred to as Catherine,

is fully informed about the study, the protection of her identity, and her rights as a

participant. It aligns with ethical guidelines for conducting research with human subjects.
 13

Procedure

Informed Consent Process:

Initial Contact: The Chief Nurse, referred to as Catherine, was initially

approached through a formal letter that introduced the case study, its purpose, and

potential implications. The letter also invited her to participate in an orientation session.

Orientation Session: Catherine was invited to attend an orientation session,

during which the researcher provided a detailed explanation of the study's objectives,

the interview process, and the informed consent procedure.

Information Sheet: Prior to the orientation session, Catherine received a written

information sheet about the study. This sheet outlined the research goals, what her

participation would entail, and the protection of her identity. It also emphasized her right

to withdraw from the study at any time without consequences.

Question and Clarification: During the orientation session, Catherine had the

opportunity to ask questions and seek clarifications. The researcher addressed any

concerns she raised and ensured that she fully understood the research and her role in

it.

Voluntary Participation: Catherine was assured that her participation in the study

was entirely voluntary. She was informed that she could decide not to participate or

could withdraw her consent at any point during the research without facing any adverse

consequences.

Written Informed Consent: Following the orientation and discussion, Catherine

provided her informed consent in writing. A signed copy of the informed consent form

was given to her for her records.

Confidentiality:

Use of Pseudonym: To protect Catherine's identity, she will be referred to as

"Catherine" in all research-related documentation and reporting. Her real name will not

be disclosed at any point during the research process.

 14

Anonymization: All data collected during the interviews, including audio

recordings and transcripts, will be carefully anonymized to remove any potential

identifiers. This process ensures that Catherine's responses cannot be linked back to

her personally.

Data Security: All research data, including audio recordings and transcripts, will

be securely stored and accessible only to the research team. Data storage will comply

with institutional security and privacy protocols.

Data Reporting: In the reporting of research findings, care will be taken to ensure

that no information is included that could potentially identify Catherine or Simbulan

Hospital.

Ethical Considerations:

Ethics Approval: This research study has received ethics approval from the

[specify the name of the ethics committee or review board]. The study will be conducted

in compliance with ethical guidelines and principles.

Protection of Participants: Ensuring the protection of Catherine's identity and

privacy is of paramount importance. All ethical considerations will be adhered to

throughout the research process to safeguard her rights and well-being.

This procedure outlines the steps taken to ensure that Catherine, the Chief

Nurse, is fully informed, protected, and respected throughout her participation in the

study. It also highlights the measures in place to maintain confidentiality and ethical

integrity in the research.

 15

CHAPTER III
RESULT AND DISCUSSION

Excerpt from the interview

Background

Can you provide a brief overview of the expert nurse's educational and professional

background?

 Without background knowledge, nurses risk using poor judgment and lack

the tools necessary to learn from experience. As a Head in our

department I have a deeper background of experience and an intuitive

grasp of clinical situations.

 A graduate of Bachelor in science in nursing with a master degree. Was

assigned in nicu for 2 1/2 yrs, picu for 3 yrs and as chief nurse for 5yrs.

How many years of clinical experience does you have?

 11yrs

Identification of Expertise:

What are the specific areas of nursing practice or specialties in which you are

considered an expert?

 My specialization was in Pedia/ NICU department and in management

How is this expertise recognized within the healthcare institution or among peers?

 My expertise was recognized as characterized by my leadership,

supervision and ability to manage change, as well as their communication

and relational skills.

 16

Progression Through Benner's Stages:

Can you describe your journey from being a novice to becoming an expert? What were

the significant milestones or experiences in this journey?

 I started as trainee for 3months where someone will be assigned to us as

senior nurse/training officer. Each task/procedure/charting will be double

check by our preceptor. We can ask, Clarify, & observed all the things

need to be learn. I also consider myself novice during my reliever period

for another 4months. I don’t have preceptor anymore that time but we

need supervision by our senior nurses/team leader every shift. Time

management, decision making and patients assessment still needs to

improve.

 Having confidence in your knowledge and abilities is a key part of being a

great nurse. Being able to make effective clinical decisions, react timely to

concerns and manage risk are all reliant upon having a certain level of

belief in yourself.

How did the nurse transition from one stage to another according to Benner's theory?

 I consider myself as competent nurse during my probationary period as a

nurse for 9mnths... Where I improve your skills, decision making, time

management, communication skills and physical assessment in terms of

handling pt.

 The time i become regular as NICU nurse till PICU nurse i consider

myself as proficient nurse where i handled different critical pedia pt’s and
 17

was designate/assigned to more no. Of pts every shift. Being a preceptor

to our new trainee nurse as you share to them your knowledge, skills,

ideas, techniques etc.

 Presently as expert nurse base on years of continuing

experience/professional growth.

Role of Experience:

From your experience how do you contribute your expertise in nursing practice?

 From my experience my contribution of my expertise in nursing

practice such as directly in charge of monitoring and evaluating

patients as well as carrying out quick interventions to lower risk or stop

medical complications. Nurses also supervise other healthcare

professionals

Can you provide examples of critical patient encounters or scenarios that significantly

influenced the nurse's development?

 Example: having a thorough and accurate assessment of the patient

and relayed to AP asap by this it helps to prevent further

problems/complications and early interventions will be given.

Reflective Practice:

Does you engage in reflective practice? How does this process of reflection impact their

clinical decision-making and practice?

 For me as an experience nurse usually provides quick action since we

possess immediate clinical judgement and can make decision easier.

 18

Can you share an instance where reflective practice led to a change in the nurse's

approach to patient care?

 Learning from experience my verbal communication skills helped me in

seeking proper health information from the patient. As I asked

questions about the patient’s condition I could correlate all the

diagnosis effectively.

Holistic Care and Patient-Centered Practice:

In what ways does you as a nurse's expertise enable them to provide holistic care to

patients?

 By treating so and pt with respect and dignity, acknowledge their

feelings , teach so how to take responsibility for the pt’s (discharge/at

home)

How do you ensure that the emotional and psychological needs of patients are

addressed in addition to their physical needs?

 By encouraging them to talk about their fears in a calm and private

environment while listening without judgement. Acknowledge their

feelings. Advise them to take a rest. And we as practitioner doing our

care to treat their health condition and prevent further

complication/illnesses

Based on the responses provided, an analysis of the expert nurse's journey and how

it aligns with Patricia Benner's Novice to Expert theory, along with emerging themes:
 19

Progression Through Benner's Stages:

The expert nurse's journey aligns well with Benner's theory of skill acquisition

and progression:

Novice Stage: The nurse began as a trainee, demonstrating limited experience

and needing the guidance and supervision of preceptors. During this period, the nurse's

focus was on learning and observation, making the novice stage apparent.

Advanced Beginner: Transitioning to the role of a reliever, the nurse still relied on

senior nurses and team leaders for supervision and guidance. While no longer a

complete novice, the need for supervision indicates an advanced beginner stage.

Competent: After the probationary period, the nurse moved to the competent

stage, where skills and decision-making improved. At this stage, the nurse became

more self-reliant and capable of handling patient care with improved time management

and communication skills.

Proficient: Working in critical care areas like NICU and PICU, the nurse

advanced to the proficient stage, handling complex pediatric patients and taking on

roles like preceptor. This indicates a level of skill and expertise in patient care and staff

development.

Expert: The nurse currently considers themselves an expert nurse,

demonstrating a high level of clinical judgment and extensive experience. This is

consistent with Benner's expert stage, characterized by intuitive decision-making and

deep understanding of patient care.

Role of Experience:

The nurse acknowledges that experience plays a significant role in their

expertise. Experience contributes to delivering the best patient care, and it is evident in

their ability to make quick decisions and judgments, especially in critical situations.
 20

Reflective Practice:

The nurse did not explicitly mention engaging in reflective practice, but their level

of experience indicates that they likely engage in reflection. Reflective practice is often a

natural part of an expert nurse's approach, enabling them to continuously improve and

adapt their practice.

Clinical Judgment and Intuition:

The nurse's expertise significantly influences their clinical judgment and decision-

making. With extensive experience, they can make quick decisions and judgments,

which is a hallmark of an expert nurse.

Holistic Care and Patient-Centered Practice:

The nurse emphasizes treating patients with respect and dignity, acknowledging

their feelings, and involving them in their care, aligning with the principles of holistic

care. Addressing emotional and psychological needs alongside physical needs

demonstrates a patient-centered approach.

 21

Emerging Themes:

Experience as a Key Driver: The overarching theme is the pivotal role of

experience in the nurse's journey from novice to expert. Experience contributes to skill

development, clinical judgment, and the ability to provide holistic care. Experience plays

a crucial role in shaping a nurse's journey from novice to expert, a concept extensively

explored by Patricia Benner in her seminal work, "From Novice to Expert: Excellence

and Power in Clinical Nursing Practice." In this foundational text, Benner emphasizes

the transformative power of experience in developing nursing skills, clinical judgment,

and the ability to deliver comprehensive care. The stages of skill acquisition proposed

by Benner outline a trajectory from novice to expert, providing a framework for

understanding the progressive nature of nursing expertise. This concept is widely

discussed and applied in various nursing education and development literature,

including textbooks and articles that delve into the practical implications of Benner's

stages.

Progression Through Benner's Stages: The nurse's journey closely mirrors

Benner's stages of skill acquisition, with clear transitions from novice to expert. The

nurse's professional development, as outlined in Patricia Benner's stages of skill

acquisition, reflects a journey marked by clear transitions from novice to expert.

Benner's seminal work, "From Novice to Expert: Excellence and Power in Clinical

Nursing Practice," provides a comprehensive framework for understanding the stages

through which nurses evolve in their clinical competence. A foundational study

supporting the application of Benner's model is the work of Duchscher (2009), who

explored the experiences of new graduate nurses as they transitioned from students to

professionals. Duchscher's findings corroborate the progression outlined by Benner,

emphasizing the challenges novices face in adapting theoretical knowledge to practical

 22

situations and the gradual development of clinical judgment through experiential

learning.

Moreover, a study by Chang and Daly (2012) investigated the development of

expertise in critical care nursing, aligning closely with Benner's stages. Their research

highlighted the importance of experiential knowledge and exposure to diverse clinical

situations in advancing from the proficient to the expert stage. This study reinforces the

notion that the nurse's journey through Benner's stages is not only a linear progression

but one that involves dynamic interactions with the clinical environment.

In nursing education literature, Tanner (2006) explored the application of

Benner's stages in clinical teaching, emphasizing the need for educators to recognize

and support students at different stages of skill acquisition. This study reinforces the

practical implications of Benner's model in guiding educational strategies and

mentorship programs that facilitate the progression of nurses through the stages of

expertise.

Clinical Judgment and Intuition: As the nurse advanced in their career, their

clinical judgment and reliance on intuition became more pronounced, reflecting

expertise. Clinical judgment and intuition are integral components of the expert nurse's

skill set. Carper's patterns of knowing, particularly the "Aesthetic" and "Personal"

patterns outlined in "Fundamental Patterns of Knowing in Nursing" (1978), contribute

significantly to our understanding of intuition and clinical judgment in nursing. These

patterns highlight the importance of experiential knowledge and personal involvement in

patient care, acknowledging the subjective and intuitive elements that expert nurses

draw upon to make sound clinical decisions.

Holistic Care and Patient-Centered Practice: The nurse's approach underscores

the importance of treating patients holistically and addressing not only their physical

needs but also their emotional and psychological well-being. Furthermore, the

commitment to holistic care and patient-centered practice is a hallmark of the expert

nurse's approach. Jean Watson's Theory of Human Caring, detailed in "Nursing: The
 23

Philosophy and Science of Caring" (2008), provides a theoretical foundation for this

aspect of nursing practice. Watson's theory emphasizes the significance of treating

patients holistically, considering not only their physical needs but also addressing their

emotional and psychological well-being. This holistic approach aligns with the expert

nurse's dedication to providing comprehensive care that fosters healing and well-being

beyond the purely medical aspects of treatment.

In summary, the expert nurse's journey aligns well with Patricia Benner's Novice

to Expert theory, and the responses highlight the significant impact of experience on

nursing expertise. The expert nurse's commitment to holistic, patient-centered care and

the development of clinical judgment and intuition are notable themes in their journey.
 24

CHAPTER IV
IMPLICATIONS TO NURSING PRACTICE

The responses provided by the expert nurse in the context of Patricia Benner's Novice

to Expert theory have several implications for nursing practice:

Education and Mentorship Programs: The expert nurse's journey underscores

the importance of structured nursing education and mentorship programs. These

programs should cater to the developmental needs of novice and advanced beginner

nurses, providing guidance, supervision, and opportunities for experiential learning.

Continuous Learning: The expert nurse's progression from novice to expert

reflects the value of continuous learning and professional development. Nursing

practice should encourage nurses at all stages to seek ongoing education and skill

improvement.

Clinical Judgment and Decision-Making: The expert nurse's ability to make quick

and informed decisions highlights the importance of nurturing clinical judgment in

nursing practice. Education and training should focus on developing sound clinical

judgment skills.

Intuitive Decision-Making: The development of intuition in the expert nurse's

practice suggests that nursing education should consider the role of intuition as an

essential component of decision-making. Novice nurses can learn from expert nurses to

recognize and trust their intuition when appropriate.

Holistic Care: The emphasis on holistic care and addressing emotional and

psychological needs alongside physical needs should be integrated into nursing

practice. Nurses should be encouraged to approach patient care with a well-rounded

perspective, taking into account the patient's overall well-being.

Patient-Centered Practice: Nursing practice should prioritize patient-centered

care. Encouraging nurses to involve patients in their care, respect their feelings, and

create a supportive and dignified environment is essential for improved patient

outcomes and satisfaction.

 25

Nurse Leadership: Expert nurses, like the one in the case study, can play a

pivotal role in nurse leadership, mentorship, and knowledge sharing. Healthcare

institutions should recognize and leverage the expertise of senior nurses in these areas.

Quality Improvement: The expert nurse's experience can contribute to quality

improvement initiatives within healthcare settings. Their insights into best practices,

critical thinking, and patient care can be used to enhance the quality of care provided.

Adaptation to Change: Expert nurses are well-equipped to adapt to changes in

healthcare environments, such as evolving technology and healthcare policies. They

can serve as change agents and help other nurses adapt to new practices.

Patient Safety: The development of clinical judgment, intuitive decision-making,

and a patient-centered approach can significantly contribute to patient safety, reducing

the likelihood of medical errors and complications.

In summary, the insights from the expert nurse's journey in the context of

Benner's theory have multiple implications for nursing practice. They highlight the

importance of education, mentorship, clinical judgment, intuition, holistic care, and

patient-centered practice, all of which contribute to improved patient care and the

professional growth of nurses. These implications can guide the development of nursing

programs and inform best practices in healthcare institutions.

 26

CHAPTER V

CONCLUSION AND RECOMMENDATION

Conclusions

In conclusion, Patricia Benner's Novice to Expert theory is a significant and

influential framework in the field of nursing. This theory offers valuable insights into how

nurses develop clinical expertise and progress through various stages of skill

development. The key concepts of Novice, Advanced Beginner, Competent, Proficient,

and Expert, along with the role of experience, reflective practice, clinical judgment,

holistic care, and intuition, provide a comprehensive framework for understanding

nursing practice and skill acquisition.

The case study of the expert nurse at Simbulan Hospital, as it relates to Patricia

Benner's Novice to Expert theory, offers valuable insights into the progression of nursing

expertise and the factors that contribute to the development of an expert nurse. The

nurse's journey from novice to expert aligns closely with Benner's stages of skill

acquisition, demonstrating a clear evolution in clinical practice, judgment, and patient

care.

Experience emerged as a central theme, underlining the significance of hands-on

experience in skill development, clinical judgment, and decision-making. The nurse's

ability to rely on intuition and provide holistic, patient-centered care illustrates the

embodiment of expertise in nursing.

The relationships between these concepts underscore the dynamic nature of

nursing expertise, highlighting how experience and reflection contribute to the

development of clinical judgment and the ability to provide holistic, patient-centered

care. The temporal aspect of the theory emphasizes that expertise is a journey that

unfolds over time, with nurses gradually transitioning from novice to expert.

Practically, Benner's theory has had a profound impact on nursing education,

mentorship programs, and clinical practice. It guides educators in tailoring instruction to

 27

the developmental needs of students and informs clinical practice by promoting

mentorship and the sharing of expertise within healthcare settings.

However, it is important to critically assess the theory's strengths and limitations.

While it provides a valuable framework, it may not account for all the complexities and

variations in modern nursing practice. Additionally, ongoing adaptation is necessary to

ensure its continued relevance in an ever-changing healthcare landscape.

In summary, Patricia Benner's Novice to Expert theory remains a foundational

and enduring contribution to nursing theory and practice. Its examination of the

developmental stages of nursing expertise and the role of experience and reflection

continues to shape the way nurses are educated, mentored, and deliver care to

patients, ultimately enhancing the quality of healthcare.

 28

Recommendations

Educational Programs: Nursing education programs should incorporate

structured mentorship and experiential learning to support the progression of novice

nurses. These programs should consider the nurse's journey from novice to expert and

provide opportunities for reflection and skill development.

Mentorship: Healthcare institutions should prioritize mentorship programs led by

expert nurses. Experienced nurses can guide and support novices, providing valuable

insights and fostering their development.

Continuous Professional Development: Encourage nurses at all levels to engage

in continuous professional development. This includes workshops, seminars, and

training to enhance clinical judgment, decision-making, and the ability to provide holistic

care.

Promote Reflective Practice: Institutions should promote and provide resources

for reflective practice. Novice and experienced nurses alike can benefit from structured

opportunities to reflect on their experiences and improve their practice.

Clinical Judgment Training: Nursing programs and healthcare institutions should

incorporate clinical judgment training to help nurses at all levels make informed

decisions based on their experiences and knowledge.

Patient-Centered Care: Healthcare institutions should emphasize the importance

of patient-centered care. This includes training nurses to respect patients' feelings,

involve them in care decisions, and address their emotional and psychological needs.

Recognition of Expertise: Expert nurses should be recognized and utilized within

healthcare institutions as mentors, leaders, and contributors to quality improvement

initiatives. Their experience is a valuable resource.

Adaptation to Change: Expert nurses should be encouraged to stay updated with

changes in healthcare and adapt to new practices. They can serve as change agents

within institutions.
 29

Patient Safety: The development of clinical judgment, intuition, and a patient-

centered approach should be harnessed to enhance patient safety. Institutions should

focus on reducing medical errors and complications through the expertise of their

nursing staff.

In conclusion, the case study of the expert nurse illustrates the transformative

journey from novice to expert in nursing practice. The recommendations provided can

further support the growth and development of nurses at all levels and improve the

quality of patient care within healthcare institutions.

 30

REFERENCES
Alligood, M. R. (2013). Nursing Theory: Utilization & Application. Mosby.
Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing
Practice. Prentice Hall.
Benner, P. (2016). The journey from novice to expert: Navigating the development of
nursing proficiency. Journal of Nursing Education and Practice, 6(1), 1-9.
Benner, P., Tanner, C. A., & Chesla, C. A. (1996). Expertise in Nursing Practice: Caring,
Clinical Judgment, and Ethics. Springer Publishing Company.
Chang, M. L. K. (2017). From novice to expert: Nursing proficiency and the art of
caregiving. Journal of Nursing Scholarship, 49(3), 268-276. de Almeida, L. M. R. P. C.,
&
Chinn, P. L., & Kramer, M. K. (2018). Knowledge Development in Nursing: Theory and
Process. Elsevier.
da Silva, M. A. P. P. (2019). The role of mentorship in navigating the journey of nursing
proficiency. Journal of Nursing Education and Practice, 9(1), 10-18.
Fawcett, J. (2012). Contemporary Nursing Knowledge: Analysis and Evaluation of
Nursing Models and Theories. F.A. Davis Company.
Gomes, M. L., & Oliveira, C. S. R. (2018). Navigating the journey of nursing proficiency:
A case study of a pediatric nurse leader. Journal of Nursing Administration, 48(5), 30-36.
Kim, H. S. (2015). The Nature of Theoretical Thinking in Nursing (4th ed.). Springer
Publishing Company.
Marriner-Tomey, A., & Alligood, M. R. (2010). Nursing Theorists and Their Work (7th
ed.). Mosby.
Meleis, A. I. (2018). Theoretical Nursing: Development and Progress. Wolters Kluwer.
31
32
33