Embodied dispositions or experience? Identifying new patterns of professional competence

Aim. This paper is a report of a study to explore nurses' competence as revealed during an admission assessment. Background. Studies of nursing competence and of models of competence have become virtually synonymous with the five-stage developmental model applied to nursing by Benner. However, the model has been criticized for its interpretation of intuition and also for the exclusion of the social elements and context of nursing practice. Method. The study was conducted in 2004. This paper draws on data from 12 structured non-participant observations of admission assessments in an orthopaedic ward by four nurses: two with <1 year' experience and two with more than 5 years' experience. Defined variables were observed using instantaneous and event sampling. The analysis was guided theoretically by the assumptions embedded in Benner's competence model and Bourdieu's theory of practice. Findings. Each nurse had unique patterns of practice that did not correspond to the level of competence expected in relation to their length of experience as a nurse. Nurses' competence seems to be situational rather than related to levels in the developmental model: in some observed variables, inexperience nurses acted as experts, while experienced nurses acted as advanced beginners, contrary to the expectations of Benner. Conclusion. The five-stage developmental competence model could not be verified empirically in this study. The findings suggest that further empirical research is needed to clarify the apparent links between situation and competence.