Going from Novice to Expert in Nursing

Nursing graduates are so excited to have finally made it through nursing school! Then they study and study some more to pass the most important test of their life – NCLEX. Thankfully, they pass. Now it is time to start their career with their first nursing job. After classroom orientation for a week or two, the new nurse is assigned to work on the unit taking care of real clients. Hopefully, the new nurse will have a preceptor. Within a couple of days, the new nurse is depressed and has gone into reality shock. Comments like “I did not learn anything I need to know about being a nurse in nursing school,” “Nursing school only taught me how to pass NCLEX,” “I am so frustrated! I don’t know anything!”

Have you heard these words? Have you said them? You are not alone. But here is what you need to understand. When a new graduate gets out of nursing school, that new nurse is a novice nurse. In other words, you know how to be a safe nurse. The key is also knowing when you do not know something and how to seek out the correct answer to that issue. How? Look at the policy and procedure manual. Rely on your preceptor or supervisor. You cannot know everything as a novice nurse. But you must practice safely.

During nursing school, the student is considered to be a novice nurse. It takes up to five years for that new nurse to become an expert nurse. Dr. Patricia Benner first introduced the concept of becoming an expert nurse in 1982. This concept revolves around the understanding that expert nurses develop skills and understanding of client care over time and through a sound educational base as well as a large number of experiences.

Novice Nurse to Expert Nurse

According to Benner (1982), there are five levels of nursing experience:

1. Novice Nurse

The novice nurse has no prior experience. This would be the nursing student. During nursing school, general rules are taught to assist the nursing student in performing tasks. These rules are context-free and can be applied universally. Flexibility in clinical behavior is limited or absent. The novice has a very limited ability to predict what might happen in a particular client situation. Signs and symptoms, such as changes in mental status, can only be recognized after a novice nurse has had experience with clients with similar symptoms. The novice nurse says, “Tell me what to do and I will do it.”

2. Advanced Beginner Nurse

The advanced beginner nurse is the new graduate working at his or her first nursing job. This nurse can demonstrate acceptable performance and has acquired some prior experience in actual situations. Now the nurse can recognize recurring meaningful parts of each situation. The knowledge and the know-how are there, but the nurse still lacks comprehensive experience. The nurse starts to develop principles based on these experiences that guide actions. Beginner nurses focus on tasks and follow a "to do" list (Benner, 1982).

3. The Competent Nurse

The competent nurse generally develops within 2-3 years of experience on the same job, in the same area, or in similar day to day situations. This nurse has gained some mastery, but still lacks the speed and flexibility of the proficient nurse. The competent nurse can rely on advanced planning and organizational skills acquired. This nurse is more aware of long-term goals and has a greater perspective on achieving maximum efficiency and organization. The competent nurse recognizes patterns and the nature of clinical situations more quickly and accurately than the advanced beginner nurse. Actions are based on conscious, abstract, and analytical thinking.

4. The Proficient Nurse

The proficient nurse understands situations as whole parts. There is a more holistic understanding of clients that helps to improve the nurse’s decision-making skills. This nurse has learned from experiences what to expect in certain situations and how to modify plans.

5. The Expert Nurse

The expert nurse recognizes demands and resources in situations and is able to achieve goals. This nurse knows what needs to be done and no longer relies exclusively on rules to guide actions under certain situations. There is an intuitive grasp of the situation based on deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. The expert nurse focuses on the whole picture even when performing tasks and is able to recognize subtle signs of a situation such as a client that is a little harder to arouse than in previous encounters. Analytical tools are used only when they have no experience with an event, or when events don't occur as expected (Benner, 1982).

What does this mean for the new graduate Nurse? Understand that you are not an expert nurse. It takes up to five years to reach this level of nursing understanding. Nursing school taught you the rules and principles of nursing to follow. You did learn a lot. Now you have to apply those rules and principles. It will take time to gather many more experiences than you gained while in school. As you gain mastery, you will become more proficient in your nursing skills, and knowledge. You will gradually notice that you are focusing on the whole rather than the part of client care. Your decision-making skills will improve and you will no longer have to rely on analytical tools to guide your practice.

The point is: Do not give up! Give yourself the time you need to become an expert nurse. Nursing involves life-long learning, so accept where you are at this moment in time and keep learning!

Reference Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.

September 24

Debra S. McDonough, RN, MSN, EdD