CONCEPTUAL FRAMEWORK

Patricia Benner explained that before the acquisition and development of a skill, a nurse passes through five levels of proficiency with respect to his/her clinical context. Each stage, according to Fisoli (2007), possesses a distinguishable behavior relative to its succeeding phase:  (1) Novice; (2) Advanced Beginner; (3) Competent; (4) Proficient; and (5) Expert.

Novice- is the first stage wherein the nurse has a very limited skills set and is still transitioning from the theoretical to the practical realm. In order to accomplish a task, nurses on this stage, need clear instructions and constant supervision; rules are rudimentary in establishing their clinical practice during this stage. 

Advanced Beginner- is a phase wherein experience is gradually assimilating to their skills set, although, nurses at this stage, are still dependent on rules.

Competent- is the stage wherein the nurse has gained mastery of pertinent rules and concepts needed in his clinical construct. This is an important period where nurses are able to exercise their own clinical judgment in the situation. Some references address this stage as “problem-solving” stage.

Proficient- is a phase where fluency in terms of clinical proficiency is observed. Analysis and problem solving of the bigger picture dominates in practice.

Expert- is a stage reached by nurses with vast amounts of experience assisting them to intuitively come up with important clinical judgment and decision. They do this without consciously utilizing rules and more importantly has a goal in mind when carrying out tasks.