• Subject Name : Nursing

The Impact of The Advanced Practice Nursing Role

Introduction to Benner's Theory from Novice to Expert Nursing Practise

The main coordinators in the health care sector are nurse they bridge the gap between doctor instruction and patient care that is important to deliver quality care. Nurses clinical practise directly reflect over the health status of the patient that increase their credibility (Silva et al., 2018). The Benner’s theory indicates that an individual acquires new skills and knowledge from pioneer to expert stage. The theory indicates that nurse acquires clinical skills, clinical competency and nursing knowledge from theoretical training to clinical practice (ÖZDEMİR, 2019). The clinical competency is important in the nursing profession and Benner theory discusses how nurse acquires the clinical competency during their clinical practice. The essay will outline the Benner theory and different aspect concerning the clinical practice of the nurse. This will also include novice vs. advance nurse followed by the NMBA standards for nursing practise.

Benner’s Theory Outline

One of the philosophical bases of nursing was laid down by Benner’s theory that constructed on the principle that practical skills and knowledge need to be expanding constantly. The theory indicates that experience and proficiency are two important clinical skills that are to be acquired by the nurse during practice. The Benner’s theory divided the road map for the nursing professional lifetime into five sections that include novice to the advanced beginner that is followed by competent after which it is proficient and end at expert. These different sections are the skills and knowledge development stage of the nurses concerning the clinical practice (Oshvandi et al., 2016). The findings were supported by Murray et al. (2019) by adding that Benner’s theory has been adapted from Skills Acquisition model of Dreyfus that is utilized to frame the stages of the clinical competency of the nurse. Benner’s theory is considered to be a framework that is important for the professional skills development that is important for the care procedure in nurses. The theory indicates that nurse during their professional experience transient their skills concerning their clinical practice. Each section of the framework add the experience and learning to the individual practise that is important to improve the clinical expertise. It also indicates that expertise cannot be defined from the post it is directly reflected from the quality of nursing care at the indvidual level. The theories indicate that position did not help to gain the clinical expertise but it is gained through the clinical experiences. Benner’s theory is important in the nursing profession to improve the competency with the patient that is important to deliver quality care.

Clinical Competency Stages

Clinical competency is the functional ability and efficiency that are related to the skills and knowledge that improve quality of care. There are different stages of the clinical competency that nurse goes through their professional practice to improve the skills. Clinical competency is important in the nursing profession to improve the case process concerning the scope of practice (Manoochehri et al., 2015). The first stage of the clinical competency is considered to be novices discuss the nursing student having no experience and she is being instructed to perform the normal task. The behaviour of the novice is rule-governed, limited and inflexible that indicates restricted work. The advanced beginners are considered to be having prior experience with acceptable performance and they follow the set principle concerning their clinical experiences (Thomas & Kellgren, 2017). 

The third stage is of competent nurse that included the nurse with 3-4 year of experiences concerning the same settings. They are considered to be aware of their long term goal and they gain understanding concerning their consciousness or analytical thinking. The next stage is proficient includes the nurse having an understanding concerning the whole situation that is important for the holistic framework. They are expected to work as per the situation that is important to normalise the expected outcome. The last stage is the expert nurse that includes nurses having strong background experiences without relying on the principle, rules and guidelines. Their performance is considered to be flexible and highly proficient to deliver the quality care. Benner's theory is important to segregate the different nurses concerning their level of the clinical competency skills that are important to understand their professional’s roles (Fraley, 2016).

Advanced Practise

Advanced practise in health care includes the involvement of the health care professionals of master level. They are considered to have the right skills and knowledge concerning the requirement of expanded role within the scope of practice. The advanced practice is preferred due to the new model it follows to transform the treatment process for patient concerning the quality care. The main aim of advanced care is to improve the services by utilizing the holistic approach that includes continuous support, traditional boundaries and working in the scope of practice. The advanced care utilizes the prevention methods of cares that is more personalized and responds faster to the need of patient (Woo et al., 2017).

 Four pillars are the backbone of the advanced practise that includes appropriate clinical practise that can address the specific need of the patient to provide person-centred care. Facilitating learning is another aspect that increases the reflective learning habit of professionals which is important to deliver quality care. The next pillar is leadership that is important to work in collaboration and delivering quality care by utilizing the teamwork spirit. The last is evidence and research-based to improve the clinical practice by using the bets and new method to address the issue of the patient. The advanced role is based on the improved health care services that are focusing on the patient need to improve the health status of the patient (Jakimowicz et al., 2017).

Novice vs. Advanced Nurse

The different functions that are associated with the novice nurse are a simple task that can be easy and instructive. The simple functions that are associated with novice nurse include determining the fluids balance, monitoring the patient morning weight and daily intake or output of the patient. The novice nurses have no experience thus they cannot diagnose any mental or physical illness they are expected to follow the instruction of the seniors to improve the care process (Nyikuri et al., 2020). One the other hand advanced nurse is considered to have experience but they also require a mentor to complete the work. They are involved in maintaining the patient record concerning the instruction. They also document the response of the patient concerning the treatment to modify the care treatment. They also perform the interpretation of the lab results, performing diagnosis and physical examination. They also follow the instruction of the senior nurse but they have more freedom then novice to perform care and take the decision (Nyikuri et al., 2020). Both of the nurses involved in the patient care but the advanced beginner nurses are more competent and experienced concerning the patient care when compared to the novice as they are the beginners in the care. The role of both of them differs from each other as novice nurse are considered to just assist the registered nurse and follow the instruction to understand and improve the clinical skills. Advanced nurse are more independent and they can perform care under their mentor but by using their experiences also.

Benner’s Theory Relevancy with NMBA Standard

The Nursing and Midwifery Board (2017) proposed the standard of practice to improve the working pattern of the nurses that help to justify the professional role. The professional standard includes code of conduct, the standard of practise and code of ethics. The standards of practice are different for registered and enrolled nurse concerning their professional role. The registered nurse standards are framed as per the expert stage of the clinical competency so that they can deliver the quality care to the patient. Enrolled nurse standard of practice is framed as per the novice stage of the clinical competency. The registered nurse standards are framed as per their authority to solely involve in the care with authority to take some clinical decision. Enrolled nurse standards are framed following their partnership with the registered nurse during the care and how they should follow the registered nurse instruction.

Conclusion on Benner's Theory from Novice to Expert Nursing Practise

The study can be concluded by discussing the importance of cultural competency in care and Benner’s theory is framed following the level of skills of the nurses. Benner’s theory divided the nurses into five stages concerning their level of the clinical competency to improve their role in care. The novice and advanced nurse function differ greatly due to the experience advanced nurse have with little more independency when compared to the novice nurse. The novice nurses are considered to be the beginners thus they are expected just to follow the instruction of the senior nurse. The standard of practice proposed by the Nursing and Midwifery board are concerning the clinical competency of the registered and enrolled nurse. The different level of clinical competency expressed by both the nurse directly influences the framing of the standard of practice that is important for quality care.

References for Benner's Theory from Novice to Expert Nursing Practise

Fraley, T. E. (2016). Transitioning novice nurses to expert nurses in progressive telemetry care. Nursing Theses and Capstone Projects. 245.1-47.

Jakimowicz, M., Williams, D., & Stankiewicz, G. (2017). A systematic review of experiences of advanced practice nursing in general practice. BMC Nursing, 16(6), 1-12. DOI:10.1186/s12912-016-0198-7 

Manoochehri, H., Imani, E., Atashzadeh-Shoorideh, F., & Alavi-Majd, A. (2015). Competence of novice nurses: Role of clinical work during studying. Journal of Medicine and Life8(Spec Iss 4), 32–38.

Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchscher’s theory: Providing the framework for understanding new graduate nurses’ transition to practice. Nurse Education in Practice, 34, 199–203. DOI: 10.1016/j.nepr.2018.12.003 

Nursing and Midwifery Board. (2017). Professional Standard. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nyikuri, M., Kumar, P., English, M., & Jones, C. (2020). "I train and mentor, they take them": A qualitative study of nurses' perspectives of neonatal nursing expertise and its development in Kenyan hospitals. Nursing Open7(3), 711–719.  DOI: 10.1002/nop2.442

Oshvandi, K., Moghadam, A. S., Khatiban, M., Cheraghi, F., Borzu, R., & Moradi, Y. (2016). On the application of novice to expert theory in nursing; a systematic review. Journal of Chemical and Pharmaceutical Science, 9(4), 3014-3020.

ÖZDEMİR, N. G. (2019). The development of nurses' individualized care perceptions and practices: Benner's novice to expert model perspective. International Journal of Caring Sciences, 12(2), 1279-1285.

Silva, R. B. D., Brault, I., Pineault, R., Chouinard, M. C., Prud'homme, A., & D'Amour, D. (2018). Nursing practice in primary care and patients' experience of care. Journal of Primary Care & Community Health9, 1-7.  DOI: 10.1177/2150131917747186

Thomas, C. M., & Kellgren, M. (2017). Benner’s novice to expert model: an application for simulation facilitators. Nursing Science Quarterly, 30(3), 227–234. DOI: 10.1177/0894318417708410 

Woo, B., Lee, J., & Tam, W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human Resources for Health15(63), 1-22. DOI: 10.1186/s12960-017-0237-9

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