Dear Vicki, I was just dragging out an old paper I wrote in 1994.  Part of
it is about the work of P. Benner (1984)  "From Novice to Expert:
Excellence and Power  in Clinical Nursing Practice".  This dandy little
book explains how we move through 5 levels of skill acquisition.  (I think
I wrote about this before in archives).  The five levels are: novice,
advanced beginner, competent, proficient and expert.  We are all novices
with our first baby!  We want rule-governed behavior (x # of oz @ x hourly
intervals).  Same as being a novice in lactation.  The novice regards all
parts of a patient's care equally without regard for priorities.  Benner
states that this limited and inflexible behavior may give a novice a
functional framework, but rote behavior impedes progress (sound familiar?).


The advanced beginner continues to rely heavily on rules and guidelines,
but earlier experiences in various situations  help the advanced beginner
know when things are going wrong.  Benner believes the advanced beginner
also knows when, where and who to ask for help.

Competency stage usually begins after 2-3 years in a practice area.
Perspective and feelings of mastery are being gained.  The practitioner
lacks speed and flexibility.  (Sound familiar?)

Benner proposes that there is a major leap between competency and
proficiency.  "Only by dropping the rules can one become really
proficient."   (p.37)  :-) This should really begin to sound familiar!
Proficiency requires 3-5 years in an area.  The proficient practitioner
sees the patient as a whole, not parts - ie: a dyad, not mom here, baby
there!  This person has a deep perception of the "expected normal."  Deeper
understanding is developed thru repeated experiences with different
situations.

Finally, the expert approaches a situation from a holistic point of view.
The expert takes in the situation, automatically sorts out what is
important and imperative and what can slide.  She does this on an
unconcious level.  This is why many experts appear to focus in on a
situation by intuition.  Actually it is the experience gained thru many
repetitions of the same sort of situation that enables the expert to
operate on this level. (Benner, 1984)

This is so plain to  me in so many areas of our life. That's why we older
ones are wiser :-) more experience!  This is why we have such a broad range
of Q & As on Lactnet  and such a broad range of answers!  We all have to
start somewhere and build from there.  We all DID start somewhere and built
from there. That is why people need mentors and friends and all the help
they can get. This is how we grow and change and continue to learn.  (I
would also like to say that I think some people get stuck in a stage, for
whatever reason, and don't move on.  We all know some of these people - we
work with them everyday!)  And you don't have to have any magic initials
after your name to move along thru the stages.

So there is my New Year's epistle! Have a good day and a great year -
learning and moving on!  Sincerely, Pat in SNJ