Contributor: Lisa Kelly

In the fast-paced world of nursing, the journey from novice to expert is a critical path that every nurse must navigate. Patricia Benner’s theory of Novice to Expert offers an understanding of how nurses develop their skills and expertise over time. However, in today’s post-pandemic healthcare environment, as the nursing shortage continues to expand, new graduate bedside nurses are being expedited through these phases at an accelerated pace, which has severe implications for burnout and professional development.

I had the unique opportunity to witness this firsthand as the manager of a Student Nurse Technician program that generated a robust pipeline of new graduate staff to the organization. Rapid progression through Benner’s phases is not readily observed in a singular graduating cohort of nursing students. However, it was only a short time before I realized that the students from the previous semester’s graduating class were the newest class’s preceptors. The charge nurses they looked to for senior leadership? The graduates from the semester prior.

Understanding Benner’s Theory

Benner’s Novice to Expert theory describes the five stages of clinical competence: Novice, Advanced Beginner, Competent, Proficient, and Expert. According to Benner, nurses progress through these stages as they gain experience and develop a deeper understanding of their practice. This gradual progression allows nurses to build the skills, knowledge, and confidence needed to handle increasingly complex situations.

• Novice: A beginner with no experience in the role.
• Advanced Beginner: A nurse with some experience beginning to recognize recurring patterns.
• Competent: A nurse with 2-3 years of experience who can make decisions based on prior experience.
• Proficient: A nurse who sees the big picture and holistically understands situations.
• Expert: A nurse who intuitively understands complex situations and can provide high-level leadership.

Each stage builds on the previous one, and moving through these phases naturally is essential for developing a competent and resilient nurse.

The Impact of Rapid Advancement

In recent years, the push for nurses to advance from novice to expert at an accelerated pace has become more pronounced. New graduate RNs jump into charge nurse roles and decision-making positions shortly after completing their orientation. This rapid transition places significant demands on their developing skills and emotional resilience.

The instructional gap can be substantial when advanced beginners teach novice nurses, even when it does not feel like it to nurses in the lived experience. Advanced beginners, still in the early stages of their development, may need more depth of experience and insight to mentor novices effectively. This mismatch can lead to several issues:

• Inadequate Guidance: Advanced beginners may provide insufficient or incomplete guidance, hindering the novice’s development and increasing stress levels.
• Misaligned Expectations: Novices may struggle with the unrealistic expectations of advanced beginners, leading to feelings of inadequacy and burnout.
• Ineffective Coping Strategies: Novices taught by those still developing their coping mechanisms may not learn effective strategies for handling stressful situations, exacerbating their burnout.

The Burden of Early Leadership

New graduate RNs are often placed in charge nurse positions and asked to make complex decisions before fully developing the competencies outlined by Benner’s theory. Benner says competence is achieved after 2-3 years of practice. However, many new nurses are expected to assume leadership roles and make critical decisions shortly after their formal education.
This premature elevation can lead to several adverse outcomes:

• Increased Stress: New nurses face intense pressure balancing their learning curve with leadership demands.
• Burnout: High expectations and insufficient experience can contribute to high-stress levels and burnout.
• Inadequate Skill Development: Rushing through the stages of skill development limits the time nurses need to gain the expertise required for competent practice.

Perceived Competence and Leadership Trust

New nurses often perceive themselves as competent because their managers ask them to move into leadership roles. This early promotion can give them a false sense of readiness, leading them not to question their ability to take on these responsibilities. As nurses, especially new nurses, we trust our leaders to help determine when we are ready for the next level of advancement. When new nurses are placed in leadership roles prematurely, they may view this as a milestone of success or a badge of honor. As a profession, we package this as professional growth, support, and confidence in our new nurses rather than a reaction to the staffing shortage across the profession.

Early on, I will admit, I was proud of the graduates I had worked with who moved into leadership so quickly and praised them for their accomplishments. It did not feel like a professional stepping stone that raised any career red flags. After all, I remember being frustrated in my early nursing days with having to wait for what felt like forever for the opportunity to advance in my career.

Conversely, nurses who are not asked to move into charge or leadership roles may begin to question their abilities. These nurses might develop a lack of confidence despite progressing at a pace that was once considered the standard. This disparity can lead to feelings of inadequacy and self-doubt among those who are, in reality, advancing appropriately through the stages from novice to expert. As an outsider looking in at those nurses passed over for early advancement, I felt myself thinking, “That makes sense; they aren’t quite ready.”

Through the phases of Brenner’s model, expedited movement is incredibly easy to explain and create a supportive argument for.

This argument does not mean that these nurses aren’t incredibly capable professionals. In fact, they are some of the best nurses I have had the privilege of knowing. It is meant to raise awareness that as leaders, assigning competence to them too soon risks not allowing them to make mistakes and grow in the way nurses on a more standard progression are allowed.

The Long-Term Effects of Rushed Development

When nurses are moved through the stages of competence too quickly, they may not develop the skills needed to manage stress and adapt to complex clinical situations. This lack of preparation can lead to:

• Decreased Resilience: Nurses forced into advanced roles without adequate experience may struggle to pivot and adapt in stressful situations.
• Increased Burnout: Chronic stress and the inability to manage complex situations effectively can contribute to high levels of burnout, which can impact job satisfaction and patient care.
• This came full circle for me when, at the end of my time with the program, just 2 ½ years later, I began seeing my former Student Nurse Technicians sharing on social media their transitions away from the bedside and even their moves out of the nursing profession entirely.

Conclusion

Operating in the modern day, where speed has become a requirement in everyday living, the development of nurses may require intervention to slow down to speed up. Benner’s theory of novice to expert emphasizes that developing clinical competence is gradual. When nurses are pushed through this process too quickly, the results can be detrimental, leading to increased burnout and decreased job satisfaction. By recognizing and addressing the challenges associated with rapid advancement, healthcare organizations can work towards creating more supportive environments for nurses, fostering their development, and ultimately improving patient care.

As we navigate these challenges, we as a profession need to decide whether to honor the time-tested path from novice to expert, ensuring that nurses are given the space and support they need to develop their skills and resilience or work toward developing a new paradigm that addresses this updated progression over time in the post-COVID-19 environment.

References

Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley Publishing Company.

Kennedy, J., Astroth, K., Woith, W., Novotny, N. & Jenkins, S. (2021). New nurse graduates and rapidly changing clinical situations: the role of expert critical care nurse mentors. International Journal of Nursing Education Scholarship, 18(1), 20200131. https://doi.org/10.1515/ijnes-2020-0131

Nursology. (2020). Patricia Benner: From Novice to Expert. https://nursology.net/nurse-theories/from-novice-to-expert/

McMahon, M., & Gordon, S. (2017). “Burnout in Nursing: A Review of Theory, Research, and Practice.” Journal of Nursing Management.

About Lisa Kelly

I am Lisa Kelly, a dedicated nursing professional with 18 years of experience. My journey began as an Army Nurse Corps Officer, caring for patients in Med Surg and ICU settings stateside and in the Emergency Department in Iraq. After my military service, I continued my career with the Department of the Army and the Department of Veterans Affairs, exploring various roles from patient safety and healthcare quality leadership to managing a 130-person supplemental staffing workforce through the COVID-19 pandemic.

As a passionate advocate for nursing organizational culture and professional development, I have consistently championed the cause of helping nurses find their rightful roles within the profession. I currently work in healthcare staffing overseeing a team managing hundreds of travel nurses across all 50 states.

I am presently enrolled at Texas Woman’s University in the Ph.D. in Nursing Science program. My research interests are ever unfolding and I look forward to all the ways I can help move our profession forward.