Patricia Benner developed the high middle range theory model of skill acquisition in nursing.

Patricia Benner developed the high middle range theory model of skill acquisition in nursing. This theory is rated toward the high middle due to the broadness of the content, but not a grand theory as it suggests to define a component of nursing practice. This theory suggests that nurses range from novice to expert in skill and experience. Benner recognizes education and theory as a basis for nursing skill, but the practice itself exceeds the bounds of formal theory. (Tomey & Alligood, 2009)

Benner formed her philosophy around the work of the Dreyfus Brothers. Benner used the Dreyfus skill acquisition model and molded it into clinical nursing practice. The stages are broken down into novice, advanced beginner, competent, proficient, and expert. Each stage is builds upon itself until a nurse becomes an expert.

This explanatory theory describes that the novice nurse can develop into an expert by learning through experience and applying that to future practice. “Expertise develops when the clinician test and refines propositions, hypotheses, and principle based expectations in actual practice situations.” (McEwen & Wills, 2014, p. 232). Brenner’s model has been used in education, management, and precepting. It suggests that the expert nurse isn’t the highest paid with the most prestigious title, it is the one with greatest experience and care. “An expert nurse caring for the same patient would complete the same tasks but not be caught up in the technical details. The expert integrates knowledge of cardiovascular physiology and pathophysiology to assess symptoms and guide patient care.” (Dracup & Bryan-Brown, 2004)

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This theory is used on a daily basis in my area of practice. Working in the post anesthesia unit, you are they eyes and the ears of the surgeon. You have to rely on clinical skill and past experience to care for these patients that can decline rapidly. We care for some high acuity patients in an outpatient setting. If the patient is recovering from a transurethral resection of the prostate, experience suggests that you monitor the patient’s heart rate closely. They have an urge to bare down to urinate and vasovagal. Also, for pain management the traditional narcotic route doesn’t work the best. The more bladder specific medications such as levsin and pyridium have a tendency to work better. This experience has made me an expert nurse at my current job and I have served as a preceptor on many occasions.

Dracup, K., Bryan-Brown, C. (2004, November.) From Novice to Expert to Mentor: Shaping the Future. American Journal of Critical Care. Retrieved from

McEwen, M. & Wills, E. (2014). Theoretical Basis for Nursing (4th Ed.); Lipincott Williams and Wilkins ISBN 9781451190311

Tomey, A., Alligood M. (2009). Nursing Theorists and Their Work. (7th ed.) St. Louis, MO: Mosby ISBN-10: 0323056415

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