Molly Burns

NSG 456
First Block Journal #1

Summary of Major Points

From Novice to Expert by Patricia Benner identified the fact that a presence of
different levels of proficiency exist in the nursing field. The author used the Dreyfus
Model of Skill Acquisition that was originally developed by two professors at the
University of California, Berkely to define the progression of these levels of
expertise. The model describes that through the process of developing a skill, one
progresses through 5 distinct levels of proficiency: novice, advanced beginner,
competent, proficient, and expert.
The article goes on to define each of the specific approaches to practice that
determine an individuals level of progression, but the most relevant comparison to
my experience in the nursing field thus far is that of the novice and the expert.
Benner explains that a novice nurse relies fully on abstract principles, rules, and
specific algorithms when providing patient care. A novice lacks the ability to provide
discretionary judgement, has difficulty prioritizing, and is not readily able to identify
exceptions to the rules that they were taught in nursing school. On the other hand,
an expert has a vast wealth of concrete experience and provides a more holistic
approach to patient care. They have progressed past the step-by-step thinking
process, and are better able to identify the most important aspects of the patients
situation and needs. Expertise is achieved not by simply the passage of time, but by
refining ones previous approaches and means by which they apply theory to
practice (Benner, 1982).
Description
In reflecting on my Capstone experience thus far, I am able to identify these
differences in proficiency levels among my preceptor and I. However, I am not able
to relate it to one specific occurrence, but rather to the general difference in the
way we each approach providing care to our patients. For example, a typical shift
begins with my preceptor and I receiving report, and then sitting down at the
nurses station to organize our thoughts and establish an initial plan for the day.
During this time, my preceptor typically peruses our patients charts and makes a
few small notes on her clip board, while I make extensive check lists and write out
all of the interventions that are due. When in a patients room, my preceptor is able
to gain so much more information from a quick head-to-toe assessment than I am.
While it seems as though she is socializing while just taking a quick glance at the
patient, she is really making observations that I would never have picked up on. She

seems to take the approach of really looking at the patient and what they
individually have going on at the moment, while I am more focused on completing
the list of interventions scheduled based on the prompts the computer charting
system provides.
My preceptor does an incredible job of quizzing me as we work through our shift.
She asks me why we are administering specific medications, what I think should be
the priority concern with each patient, and various other things to get me thinking
in the mindset of a seasoned nurse. When coming up with answers for these
questions, I find myself thinking back to my classroom time. I struggle to remember
bits of Professor Lees pharmacology lectures, Professor Lams concept maps, or Dr.
Donovans algorithms. In sifting through all of the information I have been taught
over the years, it usually takes me a while to come up with an answer. It is apparent
that my thinking and approach to these questions are based heavily on classroom
material, while hers are based on experience. She can give me a rationale to her
approach by providing me with a stories of past clinical experiences and their
outcomes while all I have to say to back up my answer is thats what I was told in
school.
Abstract Conceptualization
This article identifies a large difference between a novice and an expert nurse as
being a differing level of experience. This immense difference in amount of time
spent in clinical situations is what causes their approaches to care to be so different,
and I have been able to identify the validity of this idea in my Capstone
experiences.
My preceptor has been practicing for over 15 years and has worked in a wide
variety of settings. She, therefore, is able to waste less time, be flexible with her
approaches, and identify times in which the rules may not apply unlike a novice
such as myself. Since her approach to practice has become second nature, she
often has difficulty explaining to me why she does things the way she does or how
she learned to take a specific approach, much like the article describes. The type of
care that I am able to provide to my patients is, on the other hand, directly
correlated to my lack of experience. As the article states, novices often struggle due
to their inability to draw from past clinical experiences. A vast majority of the
knowledge that I have gained has come from the classroom setting. I have been
taught step by step procedures and approaches to general medical situations.
However, my clinical experience is lacking which is my current greatest limitation.
As the article describes, as a novice nurse, I have little hands on experience to draw
upon when providing care, making me less flexible, adaptable, and able to make
appropriate judgement calls. Overall, I find the descriptions of each level of
proficiency in this article to be completely relevant to what I have experienced in
my time with my preceptor.

Active Experimentation
The contents of this article in combination with my Capstone experiences will be
extremely beneficial to me both professionally and personally. Now that I have a
better understanding of the differences between the levels of proficiency, I can work
toward implementing my patient care in a manner in which a more experienced
nurse would. I have a greater understanding of my limitations as a novice nurse,
and am now better able to identify ways to overcome those. I plan to gain as much
clinical experience as possible in order to grow into a more effective, well rounded,
experienced nurse.
Also, this article provided me with a much needed boost of confidence. In my
Capstone experience so far, I feel as though I havent known a lot of answers to
questions I have been asked and have generally felt ill prepared for the experience.
However, after reading this article, I understand that I am a novice nurse and all
other young nurses out there are in a similar situation as me. I realize now that time
in the classroom can only teach one so much, and it is hands on clinical experience
that will guide me toward excellence in this career. Being able to identify the
different aspects of what makes my preceptor an expert will better help me to
achieve that level of proficiency someday.