by June Kaminski, RN MSN PhD(c), Editor in Chief
I am often amazed by the consistent confusion and silence that arises when I ask nurses what nursing informatics related theories they use or are aware of. I can sense their minds searching for mysterious elusive theories that they conclude that they must have missed. Only a few realize that many theories that they are already familiar with have great applicability to nursing informatics. One such theory is the time honoured Novice to Expert theory.
The Novice to Expert Theory, a construct theory first proposed by Hubert and Stuart Dreyfus (1980) as the Dreyfus Model of Skill Acquisition, and later applied and modified to nursing by Patricia Benner (1984) provides a very useful and important theory that clearly applies to nursing informatics. The Dreyfus brothers developed the model while working with scholars interested in comparing artificial intelligence development and expert computer system programming to the human mind and the development of expertise.
Within the field of nursing informatics, this theory can be applied to:
The currently accepted five levels of development within the Novice to Expert theoretical model are illustrated in the image above, as presented by Benner (1984). They start from the bottom rung at the Novice level and move upward through Advanced Beginner, Competent, Proficient, and Expert levels. Dreyfus and Dreyfus (1980) initially proposed the stages of: Novice, Competent, Proficient, Expertise and Mastery. In both configurations, each level builds on the level before it as the learner advances from a neophyte level then gains knowledge, skills, perceptions, intuition, wisdom and most important of all, experience in their given field of practice.
Both Dreyfus and Dreyfus and Benner estimated that it takes approximately five years to move through the five stages from novice to expert but also elaborated that not all novices become experts. Some people get ‘stuck’ at the competent or proficient stages. Two personal characteristics that distinguish the successful evolution to the expert level seem to be
a) deliberate practice and
b) the willingness to take risks, to go beyond the ‘norm’.
Deliberate practice is a trait shown by people who use a personal, goal-oriented approach to skill and knowledge development – they devote themselves to engage in progressively higher, and ultimately expert performance. This requires years of sustained effort to continually improve the quality of their practice and performance within the skill – in this case, in nursing informatics skills. They feel personal satisfaction in confronting challenges to achieve a high standard of excellence within their field. They are not content to acquire merely functional and rudimentary skill levels – they want to shine, and join the ranks of the experts in the field.
Taking Risks - This continuous climb to the expert level is not without perceived ‘risks’ – it requires people to move beyond the status quo of mere competence through the levels of Proficiency, then Expertise. This is a quality often seen in Super Users and Champions within the nursing informatics arena. To move to this level, many different perspectives must be digested and the zone of comfort can become threatening. Many people do not like to stand out from the rest, so do not risk the possibility of being perceived as different or peculiar – nor do they want to be regarded as thinking that they excel above their peers. Yet, the true expert must take this risk and continue to move up the ladder of skill and knowledge acquisition despite potential conflict within the nursing workplace.
Some common themes are evident as a person successfully progresses through the novice to expert levels:
Each of the five levels of skill acquisition has distinguishing behaviours and traits (Frisoli, 2007).
A novice does not know anything of the subject he/she is approaching and has to memorize its context-free features. The novice is then given rules for determining an action on the basis of these features. To improve, the novice needs monitoring, either by self-observation or instructional feedback. For example, a nurse learning to use a new hospital information system needs explicit instruction and ‘rules’ to learn to use the computer interface and manipulate the software.
An advanced beginner is still dependent on rules, but as (s)he gains more experience with real life situations, (s)he begins to notice additional aspects that can be applied to related conditions.
At this stage, the competent person grasps all the relevant rules and facts of the field and is, for the first time, able to bring his/her own judgment to each case. This is the stage of learning that is often characterized by the term “problem solving.” A competent level nurse would be able to use a hospital information system with ease, and know how to problem solve technical difficulties or interpret conflicting data.
The fourth stage is called fluency and is characterized by the progress of the learner from the step-by-step analysis and solving of the situation to the holistic perception of the entirety of the situation. The proficient hospital information system learner would know how to interpret data from all departmental information and provide guidance to other disciplinary members as needed.
An expert’s repertoire of experienced situations is so vast that normally each specific situation immediately dictates an intuitively appropriate action. After a great deal of experience actually using a system in everyday situations, the expert nurse discovers that without his consciously using any rules, situations simply elicit from him or her appropriate responses. The proficient performer, immersed in the world of his skillful activity, sees what needs to be done, and decides how to do it. The expert not only knows what needs to be achieved, thanks to the well refined ability to exercise situational discrimination, s/he knows how to achieve his or her goal.
Change leaders and project managers would do well to consider the Novice to Expert theory as they plan implementation initiatives and other informatics training opportunities. Learners need particular types of guidance, depending on the level they are currently at. Novices need much different instruction and support than advanced beginners need, and so on. The success of your initiative ultimately depends on the end-users. Why not apply this simple yet effective theory to your nursing informatics practice?
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing. Menlo Park, CA: Addison-Wesley.
Dreyfus, H. & Dreyfus, S. (1980). A Five-Stage Model of the mental activities involved in direct skill acquisition. Operations Research Center Report. University of California, Berkeley.
Dreyfus, H. & Dreyfus, S. (1986). Mind over machine: the power of human intuition and expertise in the age of the computer. Oxford: Basil and Blackwell.
Frisoli, G. (2007). Adult Learning. Adult Learning and Technology.
Kaminski, J. (Fall, 2010). Theory applied to informatics – Novice to Expert. CJNI: Canadian Journal of Nursing Informatics, 5 (4), Editorial. http://cjni.net/journal/?p=967