Patricia Brenner's Stages of Nursing Expertise

A model that outlines the journey of a nurse as they gain expertise from personal experience and proper educational background (the novice to expert model)

“Knowing how” - concept of personal/concrete experience

“Knowing that” - concept of abstract principles

Reasoning involved:

Deductive Reasoning - “top down approach”

  • big picture comes to conclusion based on evidence (general idea to specific conclusion)
  • e.g. believing expert nurses are more knowledgeable than novice nurses → novice nurses need more training

Inductive Reasoning - “bottom up approach”

  • begins as observations then works its way up to theory/hypothesis
  • consider Q: “Ho do expert nurses perform compared to novices?” - essentially vie the actions of epert nurses (observations) and come to the conclusion “oh so this is what it takes to be a expert nurse”

5 Levels of Nursing Practice

Stage 1: novice

  • no professional experience
  • needs to be told hat to do in order to complete a task; inflexible

Stage 2: Advanced Beginner

  • has some experience
  • has idea of hat outcome of a situation should be
  • starts to form basic principles based on limited experience

Stage 3: Competent

  • begins to understand actions in terms of long-term goals
  • 2-3 years of experience
  • able to create a deliberate plan
  • organization and efficiency are improved
  • still lack prioritization; move slowly

Stage 4: Proficient

  • perceives situations as holes, rather than aspects
  • can anticipate client needs based on prior experience
  • sees “big picture” of hat’s going on
  • sees intricacy in situations

Stage 5: Expert

  • has intuitive grasp of situation
  • no longer relies on rules to govern decisions
  • has extensive experience
  • relies on a now very developed intuition
  • can see entire situation
  • expert level prioritization, no hesitance in actions
  • ability to analyze and problem-solve if things go awry

Summary:

The longer a nurse works the more they evolve from a novice nurse to an epert. Little by little they gain experience, knowledge, and become more confident, allowing them to make decisions based on prior experience, not solely following the textbook