The Assertions, Strengths and Limitations of the Theory

The Theoretical Assertions

Benner (1984a) stated that there’s always more to any situation than theory predicts. The skilled practice of nursing exceeds the bounds of formal theory. Concrete experience facilitates learning about the exceptions and shades of meaning in a situation. The knowledge embedded in practice can lead to discovering and interpreting theory, precedes and extends theory, and synthesized and adapts theory in caring nursing practice. Some of the relationship statements included in Benner’s work follow:

·         “Discovering assumptions, expectations, and sets can uncover an unexamined area of practical knowledge that can then be systematically studied and extended or refuted” (Benner, 1984a,p.8)

·         Clinical knowledge is embedded in perceptions rather that precepts.

·         Perceptual awareness is central to good nursing judgment and… (for the expert) begins with vague hunches and global assessments that initially bypass critical analysis; conceptual clarity follows more often than in precedes” (Benner, 1984a, p.8)

·         Formal rules are limited and discretionary judgment is needed in actual clinical situations

·         Clinical knowledge develops over time and each clinician develops a personal repertoire of practice knowledge that can be shared in dialogue with other clinicians.

·         Expertise develops when the clinician tests and refines propositions, hypotheses, and principle based expectations in actual practice situations” (Benner, 1984a, p.3).

The Strengths of the Theory

One of the greatest strengths of Benner’s theory is that it focuses on the behavior of nurses depending on their level of understanding with nursing practice – novice, advanced beginner, competent, proficient, expert. Her theory highlights the importance of clinical experience in developing expertise. As observed today, her theory is widely used as it provides a foundation to use for assigning clinical competence. 

Limitations of the Theory

Benner’s theory proposes that the road from novice to expert nurse encompasses five stages (novice, advance beginner, competent, proficient, and expert). However, these stages are poorly defined in the literature, and some of the evidence from nursing practice presented to support their existence is weak.  

In addition, the criteria used for assigning nurses to stages (number of years of experience and supervisors’ judgements) are not reliable and in fact have been shown to not always correlate with expertise.

Moreover, establishing the reality of stages is a difficult matter, requiring a wealth of quantitative data, which are lacking in this case.

Also, the very status of these stages is unclear. If they are meant to imply that individuals can be categorized in one stage, there are plenty of evidences showing that individuals, while fluent in one sub-field, may perform much less fluidly in another sub-field of the same domain.