The Group's views and Insights

Benner's Theory has created an impact on the profession in that it calls for professionalism and continuous improvement in nursing. Nurses are challenged to grow, mature and improve themselves in their work, to transition from being a novice to an expert. All these are ultimately geared towards improvement in the delivery of our care to our clients, who are, after all, the very reason of our profession.

-          Myron Mariano

Regardless of the country that we’re in, every nurse starts a new phase of learning. As one of the nurses working from one place to another, I’ve experienced to undergo preceptorship program during probationary period in every hospital I was newly engaged, in order for me to learn and adapt to the new environment, its policies and procedures, and standards of practice. After probationary period, I was evaluated through the delegated specified competencies, on how knowledgable and skilled I am to apply what was learned before and what was learned during the preceptorship program. Annually, we are being evaluated of our performance based on the skills and knowledge we have acquired through mandatory and voluntary educational seminars, trainings and most importantly how effectively executing clinical procedures. For now, I am engaging myself in continuing education and learning through encountering variety of situation and clinical experience on my current unit to advance and enhance my nursing practice.

– Mary Grace P. Moratillo

When I started working back in 2010, I was a NOVICE NICU staff nurse. I remembered when I had my first preterm delivery and my head nurse gave me an oxygen cannula and asked me to cut it because they were preparing a nasal CPAP set-up for oxygen delivery. I just stared at the cannula in my hand for about 10 seconds because I had no idea on what was going on and what I was supposed to do. Even though we were briefed about the different procedures being done inside the NICU, theory is still different with actual scenario. My head nurse grabbed the cannula from me and told me that I was slow. That moment, it dampened my spirit because of what she said, but it never stopped me from learning and trying my best. Fast forward to 2 years later, I became a senior staff. Since most of our senior staff has resigned already, the mentoring of the junior staff depends on us senior nurses. I can say that from that girl few years ago who does not know how to make a nasal CPAP set-up, I can now challenge my superior that even with my eyes closed I now know what to prepare and what to do when I have a preterm delivery. Truly, learning is essential for novice learners but it does not mean that you stop learning when you reach the top. The needs of our patient varies almost every second and frequently and in order for us to adapt to that change we must continue and enjoy learning.

-          Gerica Jufel Maravilla

Patricia Benner’s Theory of Novice to Expert truly applies to us nurses. The first moment we decided to study and enroll in nursing course, we became a novice. As we graduated from the course, we became an advance beginner who is very eager to learn more about our chosen field. As we practice our nursing profession, we became competent. Having an experience for two to three days in the job, we became familiar to the day to day situation. Then as time goes by, we deeply develop our nursing strategies. We learn from our experiences and understand what to expect in certain situations. We became Proficient. Finally, after all the hardships, trials and various situations we face in all aspects of our career, we tend to have intuitive grasp of clinical situations. With much more background experience, we perform more flexible and highly proficient. Thus, we became expert. So that’s how it explain, a nurse develop nursing skills and understand patient care over time through continuous education.

-          Jomedelle C. Sampulna

According to Dr. Benner, “The person is a self-interpreting being that is the person does not come into the world predefined but gets defined in the course of living a life.” As a nurse, we are the one responsible for our professionalism to grow, we are in charge to define who we are and what our purpose is as we continually learn, practice and develop our knowledge and skills. We will be defined on how we choose our path and how we live our lives. Being a school nurse for 2 years using Benner’s theory, I am considered to be on the 3^rd one which is the competent level wherein I am able to gain perspective from planning my own actions based on conscious, abstract, and analytical thinking and helps me to achieve greater efficiency and organization.

-          ALYANNA MARIE D. MARQUEZ

After graduation I have always this fear in me in landing a job. Though I am well aware of my capabilities and abilities but then I am not that confident enough because of new environment, new rules, and new people. So far, despite of my apprehensions, in the end, as time went by I know, I was able to deliver my job well, with efficiency and competence. In fact, recently, I undergone training and became a certified preceptor to our new trainee in my current hospital.

      In connection with this, I was able to relate it in Benner’s theory regarding the levels of nursing experience. From novice to advance beginner to competent to proficient to expert. Indeed, experience is a great teacher and learning does not happen only in the four walls of classroom. To become competent and expert to our field, it goes with experience. 

-          Dessire Lou Molina

We go through Benner’s Novice to Expert continuously as we grow and develop in our profession as nurses. I remembered my first week of training in NICU after being a general pediatric nurse for more than a year: my preterm patient just turned from pink to blue in just a span of seconds, my initial reaction was to have an apneic episode together with that baby! Now, after more than 3 years of being a NICU nurse, those occurrences are all a part of a normal day at work. I’m already used it. Am I saying that it gets easier? Not necessarily, but now I know what to do in such situations. I think as we go along the process, we do not just develop our nursing and critical thinking skills, we also become more competent, committed and compassionate in our chosen practice.

-          Katherine Mariano

NACPE. That’s the first thing that comes to my mind whenever I hear the name Benner. It’s an acronym for her popular skill acquisition model which is comprised of the following stages: novice, advanced beginner, competent, proficient and expert. NACPE is all I knew about Benner until we started creating this blog. I learned that it is her most cited concept but not the one she discussed most about. Benner primarily talked about the seven domains of nursing practice which are formulated through interview and actual observation of nurses-on-duty. We can use this to reflect on the nursing functions we have developed the most and the nursing functions we need to improve.

I find the theory From Novice to Expert highly acceptable. However, we should recognize that we can only advance in this ladder if we are exposed to a rich nursing experience. Hence, the length of experience described by Benner on each stage may not be true for all nurses. Another thought, the five stages can be interpreted as the general competence of nurses but it does not necessarily mean that a competent nurse, for example, will perform in a competent manner to all nursing skills. He or she may move up or down the ladder for certain skills. As one nursing research cited in this blog has suggested, individual human capacity must be considered.

As someone who works for quality and patient safety, I can attest that gross errors are more likely to be committed by the novice nurses hence, the need for a structured mentoring and orientation programs. Being an expert nurse though does not make you infallible for errors because human nature exists in the complex systems of our healthcare setting.

-          Dan Nathaniel Ordoño

All of us started as a novice. Unaware of making critical decisions. Scared and nervous. Such innocent neophytes.

I even remember when I started working, I was too scared to speak. Overwhelmed with the hospital’s environment, and the fast-paced clinicians, I was afraid to commit mistakes. So I took it slowly. I grabbed the opportunity during the orientation period to gather bits and pieces of confidence I can find. Then only while doing what I learned, while applying the nursing skills I studied in school, did I became comfortable.

As what Patricia Benner believes in her nursing theory that with enough educational background and tons of experience will we become experts in our own fields.

-          Kristinna Camille T. Miguel

The Theory of Patricia Benner is quite essential in the nursing profession. A newly registered nurse begins his nursing career as a novice and through years of experience and continuous learning, he will retire as an expert. Nursing professionals in clinical, education or in research applies and values this theory. However, the stages of expertise does not tell how competent a nurse is.Therefore,every nurse must keep on learning to remain competent and an expert.

--  Daphne Joanne A. Muñoz

Can you still remember your first trip going to school way back in college? Or your first trip going to a place that you are not familiar? How about doing a thing for the first time? Your first RLE exposure? Can you still remember the feeling?

I can still remember an incident during my RLE days in one of the government hospitals in Tondo. There was a patient having an episode of seizure and was brought to ER. The doctor ordered for diazepam and I don’t know what to do. My clinical instructors were always there to help me. They were there to tell me what to do and how to do things. From proper way of taking vital signs, bed making, IV cannula insertion, first assist in OR, etc.

Practicing as a registered nurse was never easy, it was difficult at first.  I asked questions to my senior nurse if I don’t know things. I asked help if there were procedures that are not familiar to me. There were times that I would check the patient’s name and the medication for several times before giving it to the patient, thinking that I would make an error. You have to be familiar with the policies and procedures of the hospital. As time goes, I gained confidence in everything I do in the clinical settings. I learned how to manage my time in the area. I learned how to prioritize the needs of my patients. I developed my decision making skills during emergency.

I have been practicing my profession for 6 years now. I can’t say that I already know everything because I must accept that every day, I learn new things from my colleagues, educators, and patients.

Let us compare Benner’s theory to a little boy learning how to walk. His mother was there during his first step and always there to help and assist him in every step that he makes. Until he starts walking on his own, but still, his mother was there making sure that he is safe. Then the time comes that the little boy can walk without the help of anyone and started to run.

Now, remember your first day at work. That early morning you were riding the bus going to the hospital to report on your first day. And now that you are already working in that hospital for several years, is the feeling still the same?

-          Cristine Joyce Marin

The theory that Benner had conceptualized known as the Theory of Skills Acquisition symbolizes a hierarchy of application in the profession of nursing. Her theory had made me come into realization of what I had experienced when I was just starting up to the time that I became a Senior nurse. Each nurse must go through all these levels, from being a novice before he can be called an expert in that certain field. You can’t proceed to the next level unless you have acquired the necessary skills expected from you in that certain level. Thorough trainings, updates and mentoring and willingness as well as acceptance on the part of the nurse are the pillars of achieving each level. Benner’s theory plays a vital role in helping nurse managers on how to deal or handle nurses, how to delegate tasks and how to effectively yield an efficient nursing care. Through her theory, nurse managers may be able to understand that skills are acquired not just in a click of a hand.

-          Mary Joy Micabalo

Dr. Benner’s Competency Theory has changed the meaning of being an Expert Nurse with having the highest paying job to somebody who provides exquisite Nursing Care.  I think this theory suits perfectly to determining competency.  As we all know, once you practice Nursing, it becomes a completely different story from what we have learned from our classrooms and this is something we only learn through our experience as a professional.  In fact, I, together with some of my select colleagues, are focusing on Medication Errors as this is obviously a very big and common issue.  Regardless of tenure, position, title or salary, Nurses are expected to have expertise in Medication Administration.  Currently, we are using Dr. Benner’s Theory into creating a program which aims to identify our Nurses’ competency in Medication Administration.  The goal of this program is to eliminate or lessen Medication Errors and to produce Expert RN’s in all aspects of Medication Administration.

-          Pamela Marie P. Mondonedo

 

In Benner’s theory, the expertise of a nurse will vary depending on their area of assignment. Nurses who are experienced in taking care of patients with kidney problems and nurses who are experienced in taking care of patients with heart problems may assess a patient’s current health condition differently. This concept explains that nurses develop skills from his/her personal experiences in a specific clinical area and his/her advancement in the novice to expert level of expertise is dependent on the experiences available to them.

- Vina Omictin 

The theory that Benner had conceptualized known as the Theory of Skills Acquisition symbolizes a hierarchy of application in the profession of nursing. Her theory had made me come into realization of what I had experienced when I was just starting up to the time that I became a Senior nurse. Each nurse must go through all these levels, from being a novice before he can be called an expert in that certain field. You can’t proceed to the next level unless you have acquired the necessary skills expected from you in that certain level. Thorough trainings, updates and mentoring and willingness as well as acceptance on the part of the nurse are the pillars of achieving each level. Benner’s theory plays a vital role in helping nurse managers on how to deal or handle nurses, how to delegate tasks and how to effectively yield an efficient nursing care. Through her theory, nurse managers may be able to understand that skills are acquired not just in a click of a hand.

  
-- Mary Joy Micabalo

        As we all know, there’s a scarcity of nurses and health care professionals here in the Middle East especially here in the Kingdom of Bahrain.  In the hospital where I am working now, we develop a curriculum together with the help of the Education and Training Department to encourage Bahraini young men and women to be part and undergo education to become a Patient Care Assistants. The hospital itself with the help of their Ministry of Education, selected young individuals to have a free education in order for them to help and serve their fellow countrymen healthy, sick and dying individuals. This Patient Care Assistant Program (PCAP) embodies to teach and train Bahrainis as nurse assistants in providing assistance to patients in their activities of daily living. It’s a 22-month program consisting of 5 modules based on the Roper-Logan-Tierney theory.

         The Clinical Nurse Educators will provide a Preceptor Workshops to all Senior Nurses in each unit/department. These preceptors are an experienced nurse who is eager and has the desire to teach. He/She ensures that the orientee is competent in the nursing practice and supports each staff member transition from novice to expert in the clinical area. Meanwhile, the Clinical Nurse Specialist will facilitate classroom discussion, providing theoretical framework and analysis, and integrating curriculum grades of the PCAP students. Once PCAP students are in the field of practicum, the Preceptors will monitor and guide them in complying their competency skills checklist.  The preceptor creates an environment conducive for learning and allows orientee to meet the required orientation goals and outcomes. Communication between the preceptor and orientee is vital by providing positive and negative feedback in regards of his/her performance. Eventually, at the end of the orientation,  the preceptor will evaluate with the guidance of Clinical Support Nurse to assessed the evidence of achievement of all competencies we’re fully met.

          In conclusion, as the years goes by, basically the learner knows how to take vitals signs to a non-critically ill patients (novice) to know and document the early warning scores(expert) which is detrimental for the nursing assistant to inform the nurse immediately for reassessment and re-evaluation. As what Patricia Benner says, “Movement from detached observer to involved performer”.  

  -     Raymund Christopher R.  Ondona