The Significance of the Theory

“These levels of learning, from novice to expert , reflect a movement from past abstract to past concrete experience.” It has a big impact on our current nursing practice, nursing administration, education and research.

 PRACTICE

"Nursing skills through experience are a prerequisite for becoming an expert nurse", explained by Benner's writings. This theory helps to develop skilled nursing practice through experience and encountering variety of situations. Exposure and experience in the clinical setting helps the nurses develop and gain more knowledge as well as the skills in providing efficient, competent and excellent care to the patient. For acquiring competence and expertise, one must gain knowledge through formal education combined with the experience we get from our everyday practice. It is the basis in constructing clinical competency, a tool used to assess competence of the staff nurse in providing quality patient care. In any healthcare organization, a newly hired nurse will start as a novice and undergoes a series of process, training, orientation and clinical exposure in the specific unit to acquire competence with the guidance of the mentor or preceptor.  The staff is being evaluated by using clinical competency tool. The standard of practice, and the policies and procedures in the specific unit will be acquainted and integrated to the staff through repetition of procedures as time passes by, thus make the staff more skillful, proficient and then later on become expert in delivering nursing practice. An example of that is the development of Initial Skills Assessment and Competency Evaluation. A specific example of it is the introduction of computer-generated nursing documentation, wherein nurses being novice at first in charting in computer, after series of training and day-to-day practice of charting in computer, the nurse integrated how to document properly and became used to it. Thus competence acquired over time through education and experiential learning.
ADMINISTRATION

This theory became the framework in synthesizing mentorship or preceptorship program in the healthcare organization. It is utilized to develop career ladder, a guide and a basis for the promotion and moving up in an organization. It is used as a method for recognition and rewards, to determine expert practitioners and recompense their work. It serves as a guide for staff development, to acquire expertise in practitioner, to have more knowledgable practitioner providing quality care. It is one of the useful frameworks in initiating clinical knowledge development seminar. It is the background which brought reflective practice into existence for enhancing leadership capabilities of nurses through examination of their practice. Examples cited are the creation of policy by the healthcare organization for Training and Development, Performance Management, Appraisal and Evaluation, Promotion of Employees and Preceptorship program. One specific example of this is the Magnet Hospital Framework. “The Magnet Recognition Program recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice.”

EDUCATION

                Benner’s stages of clinical competence describe nursing as a continuous learning experience until final level of competency is met, marked by knowing what to do in situations where no written plan is in place.

Nurses, before becoming full-fledged nurses, have to go to nursing school and study the concepts for 3 to 4 years to gain the knowledge. In the Philippines, students start with a general course in their first year taking mathematics, science and English subjects. They progress in their second year to their final year with nursing subjects such as fundamentals in nursing, maternal and child nursing, adult health nursing, community health nursing and nursing research. On their 2^nd or 3^rd year, they start their clinical duties on affiliated hospitals to correlate the nursing concepts learned in school and apply them in a real life, hospital setting. This is where they learn the reality of the “actual” hospital based versus the “theory” based scenario while being observed and taught by a senior nurse or their clinical instructor.

                After nurses graduate and successfully pass the licensure exam, they go into hospital duty to take on a concrete level of practicing the knowledge they learned in school. During this time, they are answerable to their own actions without the help of their clinical instructors. As they acquire a higher level of learning through experience, they are also required to increase their learning capacity for knowledge through enrolment in graduate school.

                As mandated by law (RA 9173), staffs need to undergo further studies in order to apply for a vacant position in the higher organizational level. The trend of enrolment to graduate school is more driven by professional growth through job promotion rather than professional growth through theoretical learning. In universities and colleges, they also require proof of continued studies and clinical experience in hiring clinical instructors.

                This shows that Benner’s theory on the stages of clinical competence corroborates the idea that as a nurse continuous to acquire knowledge through education and experience, the higher the level of experience and learning, the higher the demands for responsibility and accountability in the work place. Also, educators become more confident in dealing with students learning capabilities. They are able to create a modifiable teaching strategy to enable to adapt to the individual learning needs of the students.

RESEARCH

                Nursing, as an evolving science needs constant research development to re-evaluate certain clinical practices and theories that are currently in place if they could still be applied to the changing needs in healthcare delivery.

              Part of the difficulty is that although nurses perceive research positively, they either cannot access the information, or cannot judge the value of the studies which they find.
            People who have developed expertise in particular areas are, by definition, able to think effectively about problems in those areas. understanding expertise is important because it provides insights into the nature of thinking and problem solving. Research shows that it is not simply general abilities, such as memory or intelligence, nor the use of general strategies that differentiate experts from novices. Instead, experts have acquired extensive knowledge that affects what they notice and how they organize, represent, and interpret information in their environment. This, in turn, affects their abilities to remember, reason, and solve problems.
              In relation to Benner’s theory, expert researchers (Masters or Doctorate degree) could construct a more relatable topic to the chosen field of study. Most of the topics they consider for research are those that they have encountered during their clinical or theoretical experiences. This eventually leads to nursing research conducted to address certain demands in the changing and evolving health care delivery system.