Journal of Advanced Nursing, 1994, ZO,769-776

Expert: a discussion of the implications of the

concept as used in nursing
Melanie A Jasper BNurs BA RGNRM RHVDN Cert PGCEA
Seiuor Lecturer, School of Health Studies, Uruversityof Portsmouth, St James Hospital,
Locksway Road, MIlton, Portsmouth, Hampslure P048LD, England

Accepted for pubhcanon 26 January 1994

[oumal of Advanced Nursmg20, 769-776

Expert. a discussion of the imphcabons of the concept as used m nursing The
JASPERM A (1994)

concept 'expert' has become common in the nursing hterature since Benner's
(1984) work more than a decade ago Wrulst the term has a common meaning,
It IS apparent that when used m nursmg It refers to a multitude of attnbutes
and lacks clear definition ThIS paper uses the strategy for concept analysis
developed by Walker & Avant (1988) to seek an operational defimtion
for the concept of 'expert', and suggests the definmg attnbutes of possession of
a specialized body of knowledge and skill, extensive experience m a field of
practice, highly developed levels of pattern recogmtion, and acknowledgement
by others These are discussed in relation to nursmg practice and the
CIrcumstances under which the concept IS used Development of cases IS earned
out to exemphfy the concept, and the antecedents and consequences of the
attnbutes are discussed, suggesting that the concept lacks clarity, both m
conceptuahzanon, and m use A first definition of the concept IS posed to open
debate concernmg the relevance of the term for the future The conclusions
reached suggest that whilst an operational definition IS unlikely to be found,
because of the problems of defimtion and measurement, It IS possible, through
various strategies, to recognize expert practice and use It to further develop
nursing Furthermore, It IS likely to become mcreasmgly rmportant to recognize
and reward expert practitioners, given the political and economic constraints m
health care today
INTRODUCTION
Smce the pubhcanon of Benner's 'novice-to-expert' continuum a decade ago, It has become fashionable to talk of
'expert' practitioners in nursmg Indeed both in practice
(Benner 1984, Benner & Tanner 1987) and in education
(Gatley 1992, Meerabeau 1992) the level of attamment of
the expert IS seen as the pinnacle of achievement Wlulst
Toulmm (1972) states that concepts acqwre meanmg
through servmg 'relevant human purpose', current usage
m nursmg suggests that the definmon of' expert' ISfar from
clear Rodgers (1989) suggests that, m nursmg, 'expert' has
more complex connotations than when used m normal
language, but falls to clanfy the complexity If the 'expert'
practitioner ISto be used as a role model [Iarvis & GIbson

1985, Daloz 1986) mall spheres of nursmg, that ISpractice,

education, research and management, then It follows that
the cntena which quahfy expert practice need to be
defined For Instance, what IS meant by 'expenence' or
'excellence', when can It be said that a practitioner has
'specialist' knowledge, and what makes one pracnnoner
be regarded as an expert over and above her colleagues?
ThIS paper IS an attempt, in part, to answer these quesnons, and to respond to the challenge posed by Enghsh
(1993) when he stated
As the expert nurse 18 held In the Benner model to be a paragon
of excellence, and someone to be emulated, then an accurate
descnpnon of expertise 1S required

Walker & Avant's (1988) framework for concept enalysrs

769

MA

Jasper

is used to explore the attnbutes and definmg characterof 'expert', m an attempt to clanfy the use of the
word when refemng to nurses
IStlCS

USES OF THE CONCEPT 'EXPERT'

The first step In concept analysis IS to identify 'how' the
concept IS used In various sources

Dictlonary definibons and etymology

suggests that an mdrvidual leams how to manipulate SItuanons by USIng rules that are of Ius own makmg, or that
helshe operates at a level that IS different from those not
seen as 'expert'
Snmlarly, the obsolete usage of expert as 'destitute or
devoid of' IS the antithesis of the other charactensbcs,
suggestmg that an 'expert' has something missing, or does
not possess something However, concermng the charactenstics of expertise, many authors have identified that
experts do indeed lack the operational processes that other
pracnnoners use, and instead work to strategies of their
own making [Petrucci et al 1992, Benner 1984)

Dictionanes consulted gave rune deflmtions for the word

'expert' These usages are summarized InTable 1 The dual
features of knowledge and/or skill, and expenence are
Nursing literature
imphed m all of these definitions except the fourth
Generally, these refer to positive attnbutes, such as An exammation of the use of 'expert' m the nursmg hteraattammg a higher level than other people (as in expert ture shows how elements of all these definitions are used,
WItness or passing a test), and m these attnbutes being mcludmg derivatives from the obsolete, or paradoxical
recognized by others (by classificatron, or achievmg a pre- definitions This ISextremely Important, m that the current
debate in nursing about 'expertise' often rejects attributes
scnbed level), so that a status IS gamed
The Latin roots of the word 'expert' are shown inTable 2 which are not measurable, yet It IS Just these attnbutes
As well as embracing the attnbutes of skill and experience, that appear to mark out the expert from the non-expert
the roots of the word also suggest that an expert IS 'sly, practitioner
Although the term 'expert' ISused frequently in the nurscunmng or subtle' - charactenstics not usually regarded
as positive However, this 'cunning' (perhaps as clever- mg hterature, It IS difficult to find any common defimtion
ness) may be a vital cntenon of 'expertise', in that It Some authors give no cntena at all (Crosby et a1 1990,
Mead 1991), whilst others define expertise m terms of
measurable parameters such as length of time m practice,
Table 1 Summary of dicnonary defimtions of 'expert'
pubhshed work, educational level and peer recognition,
1 A person who has skill and/or knowledge, gamed by
or a combination of these (Corcoran 1986, Holden &
expenence
Kbngner 1988, Fenton 1992)
2 One whose special knowledge or skill cause hun to be
Most sources however, agree that the expert nurse IS a
regarded as an authonty
person who displays advanced levels in skill and knowl3 One skilled m the study ofhandwntIng (expert WItness)
edge (Thompson et a1 1990, Woolery 1990), which have
4 Destitute or devoid of, free from (Obsolete usage)
been gamed through experience (GIlham 1991, Benner
5 Proved or approved by test
et al 1992, [arvis 1992), and as a result has the abihty to
6 HIghest classificanon grven to a member of the mihtary for
'move beyond analytical principles to connect understandskill in the use of arms
mg to appropriate practice' (Benner & Tanner 1987)
Sources Oxford Enghsh Dictionary (1961), Webster's
International Dicttonary (1963), Cassell's Compact Dictionary
(1963), Collins' Concise Drctionary (1988), Roget's Thesaurus
(1962)
Tabl.2

Roots of the word 'expert'

Latm

Meanmg

Sciens
Calhdus

KnOWIng, knowledge, acquamtance or skill

Expenenced, clever, dexterous, skilful, cunning,
subtle or sly
Expenenced, skilful, practical or expert
As a denvatIve ofpentus, means test out, or
expenment, expenence

Pentus
Expenn

Sources Partndge 1958. Oxford Enghsh Drctronary 1961,

Cassell's Compact LatIn/Enghsh Dictionary, SImpson 1963

170

TaCItknowledge 'mtuition'
Thus expert practice ISseen as more than Just the melding
of theory WIth practice in nursing (FIeld 1987, Sneed
1991), It IS charactenzed, for many authors, by a specific
mode of thmkmg which has evolved from the merger of
knowledge, skill and experience (Benner & Tanner 1987,
FIeld 1987) This appears to enable expert nurses to
develop 'heuristics' or 'a repertory of rules of thumb' (Nym
1988) which allows them to respond to situanons WIthout
having recourse to overt dragnostrc principles Benner &
Tanner (1987) suggest that this factor IS 'mtumon' Other
authors refer to this 'expert quality' m terms of 'perceptual
awareness' (FIeld 1987), 'know-how' (Gatley 1992), 'artistry' (Meerabeau 1991) and 'term associanon' (Broudy
et al 1964)
These are summarized by the concept coined by Polanyi

The concept of the expert m nUJ"6U18

(1958, 1961, cited in Gatley 1992) as 'tacit knowledge'
TIllBspecial quality that appears to distinguish experts
from non-experts seems to be mtangible and
Immeasurable

'~esses'ofexperUse

T..... 3 Nurses' deftmbons of 'expert' A total of 13 nunMII were

asked, both smgly and m a group dIscusalon, to glve definitions,

and their cntena for the word 'expert' The numbers m
parentheses relate to how many people mentioned each aiterion
Expenenced person (10)
Speciahst (9)

To provide an operational deflnmon of 'expertlse' It may

Achieved knowledge (ll)
be necessary to move beyond the anecdotal, qualitative
Very skilled in what they do (11)
methodology used by Benner et al (Benner 1984, Benner Understandmg (4)
et al 1987, 1991) to the use of cntena which are more Recognized by others (9)
tangible

Systems engineers demonstrate a contrasting approach

by focusing on the behaviour and lOgICof the expert, rather
than on the less readily definable 'qualities' of expertise
Thompson et al (1990) suggest that attempts to find defimuons of 'expertise' are fruitless m that the defirunons
will not provide measurable phenomena, mstead they
descnbe 'network theory' which attempts to measure patterns of stimulation m the brain Schvaneveldt et aJ (1985)
conclude that
a charactensbc of expertise IS not a more complex structure, but
rather, experts tend to identify the Important, cnncal mformabon
and assocrations, yielding a SImpler network

Woolery (1990) suggests that expertise IS a process of

learnmg, identified by the three phases of cogmtion,
association and automancrty, and that this results m 'performance Without COnsCIOUaSwareness of the knowledge
being used' (Woolery 1990) This ISsimilar to the approach
taken by Scbvaneveldt et al , and Thompson et al , m that
It focuses on measurable cogmtrve processes
Both the quahtauve and quanntatrve approaches appear
to idennfy a common characteristic of expert practice, the
first school idennfies this as 'mtuinon', whilst the second
calls It 'networking', both acknowledge It as 'pattern
recogmtion'
Common uses of ,expert' as defined by nurses
Colleagues m vanous fields of nursing were asked for their
of an expert The common elements of special
skills m their area of practice, recogmtion by other practmoners, and 'something wluch enabled them to nse above
the rest of the herd' were identified Table 3 summanzes
the features idenufied by nurses
definmons

THE DEFINING

ATTR.IBUTES

Walker 8t Avant (1988) suggest that de6.mng attnbutes are

those that must be present for a pure example of the concept to exist Table 4 summanzes the defimng attnbutes of
'expert' developed by the present author from the sources
mentioned above
The de6.mng attnbutes are now discussed m greater
detail

Know what they're doing more than other people (4)

Able to reflect on what they're dOlD8 (2)
Quahficanons (2)
General consensus (2)
Title perceived as expert (8)
Better than anyone else (7)
Something special (6)
Ability to analyse problems (2)
ASSigned by media (group drscussion)
Always gets thmgs right (3)
Degree of refinement of extraordmary proportIons (1)
Undefinable quality (7)
Respected by others (4)
Perceived by others as havmg knowledge and sIolis of a
particular subject Speciality (6)

Table 4 Definmg attributes of the concept 'expert'

1
2
3
4

Possession of a specialized body of knowledge or sloll

Extensive expenence In that field of practice
HIghly developed levels of pattern recogninon
Acknowledgement by others

A specialized body of knowledge and/or skill, and

extensive experience
Although sources differ m the combmatlon of cntena
used, all recogmze the expert as possessing 8 high level of
knowledge and skill Some authors use educational quahfications as evidence of this, for Instance, the holdmg of 8
Bachelor or Master's degree (Holden 8t Khngner 1988,
Fenton 1992), others use expenennal cntena such as
number of years m practice (Corcoran 1986, Benner et al
1992) All recogmze that expertise cannot be measured
through one cntenon alone, I e an academic knowledge
base venfied through quahfications 18 Insufficlent m Itself
to earn the label of expert To gam this accolade, a nurse
must 'prove' herself to be an excellent chmcian (GlllIam
1991, Rodnguez 1992)
On reflection, 1t appears that this level of knowledge
must be more than the everyday practitioner knows (defininons I, 2, 3, 5 and 6 m Table 1) and must be 'know-how'
as well as 'know-that', I e knowledge that 18 applicable to,
and denved from practice (Gatley 1992) TIns 'know-how'
171

MA

Jasper

ISthe knowledge gathered through a penod of expenence

m one field (deftnmons 2, 3 and 6 m Table 1) Authors do
not agree as to a necessary length for this expenence the
range m the hterature reviewed covered a time span of
between 18 months (Corcoran 1986) to 5 years (Benner
et aJ 1992) Nor IS there any certain measure of what the
expenence consists of, and what expenence counts as
vahd

The expert, by defimtion, possesses knowledge andlor

skill beyond that possessed by the non-expert However,
the specific content of that knowledge or skill appears to
be indefinable, and 'experts appear to "know more and
more about less and less'" (Ashworth 1991) The knowledge becomes mcreasmgly specialized as further expertise
ISgamed, and consequently the expert 'IS able to do thmgs
the rest of us cannot' (Johnson 1983, CIted 10 Woolery
1990) WIth preCISIOnand efficiency Thus the attribute of
'experience' ISmextncably hnked to that of the knowledge
base, because the expert possesses extensive practical as
well as theoretical knowledge
Experts not only possess specialized knowledge, they
also generate new knowledge because 'expertise creates
the possibihty that allows an otherwise Improbable outcome to evolve' (Tofias 1989) Thus although experts may
be able to share their knowledge It may not be possible to
define what It IS, or predict what It may be m the future
However, this knowledge ISaccessible If the expert herself IS consulted, and this has Important nnphcanons for
nurse education For development beyond the purely
'competent' level, to achrevmg proficiency and expertise,
a gradation of knowledge and skill IS necessary Some
authors have developed programmes to educate advanced
practinoners, With formahzed assessment schedules dehneatmg accomphshments at expert level (Gatley 1992,
Rodriguez 1992) The Enghsh National Board (ENB)have
introduced a higher award as an attempt to hnk academic
advancement With practical achievements in the cluneal
area Both of these depend upon the availabihty of experts
m practice for mentorship, With the underlying assumption that expertise Will develop through expenential
learmng
However, even If the knowledge base of the expert ISto
be mcreasmgly recogmzed through the development of
high level practice skills, the question of recogmzmg
expert practice still remains Many nurses may possess a
speciahst knowledge base, or have practised a long time
10 a particular specialty, but not all nurses possessmg these
two features Will be regarded as expert This suggests that
there IS an additional cntenon which IS perceived as
cntical for recogmtion of the expert

Pattem recognition
It IS the progreSSIOnof the cntena

of knowledge and
experience mto the charactensnc of pattern recogmnon
772

that IS seen as the 'special' cbaractensbc of an expert

(Benner 1984, Thompson et aJ 1990, Woolery 1990) This
ISalso evident in the dictionary deflnmons, m the case of
'expert Witness' or 'mihtary expert', both of whom use the
base of their highly developed skills to transfer to other
smular situations An important feature to acknowledge
here ISthat an 'expert' can only function within his framework of 'pattern recognmon' when he IS within his own
specialist area, 1e his knowledge base IS not transferable
outside of this (Benner 1987)
Crucial to this attnbute ISthe development of'mtumve'
patterns of funcnomng which allow for rapid decisionmaking leading to appropnate action The mark of the
expert IS the capacity to trunk m 'wholes' due to the
sophistrcation of the mtemahzation of knowledge and
skills This incorporates elements of the obsolete deflmtion
(no 4 m Table 1) m the notion that the expert IS 'devoid
of: or 'free from' the rules that the rest of us use to make
decisions Kitson et a1 (1993) support this notion in
identifymg the different ways in which experts and other
practitioners denve cntena for the management of postoperative pam rehef Hohstic thmkmg becomes the donnnant mode of operation for the expert, rather than the
recourse to first principles charactenstic at Benner's (1984)
other stages

Expert systems
The use of computers With 'expert systems' attempts to
harness the knowledge and skills of the 'expert' practmoner as adjuncts to decision-makmg (Thompson et a1
1990, Woolery 1990) Woolley (1991a) even claims that
these 'are computer applications capable of making mtelhgent decisrons, based upon speciahst knowledge of a
particular area of expertise'
Moreover, the use of expert systems IS an attempt to
access the process of expert decision-makmg rather than
the more nebulous quahues that other authors examme
However, can these systems really be expert? Although
created from expert knowledge and decision-making, they
do not satisfy the defining cntenon of 'expertise' relating
to pattern recognmon, If this ISaccepted as encompassmg
the hohsnc nature of decision-makmg At present the systems relate to speciflc areas of care such as pressure area
care (Woolley 1991b) rather than to the holistic approach
charactenstic of expert nurses
Thompson et a1 (1990) suggest that expertise IS charactenzed by 'the creation of a network of concept nodes,
interconnected by relanonal lmks, resulting m the 'abihty
to accurately perform the required mental or physical
acnvrty rapidly and With the fewest number of cues'
Wrulst experts may be able to access this knowledge, It IS
difficult to elucidate the process of accessing (FIeld 1987,
JarVIS1992) Some authors suggest that experts find It
difficult to analyse the processes that they have used
(Lalnff 1990) m decisron-making, and Dreyfus & Dreyfus

The concept of the expert

(1977, cited m Rodnguez 1992) claun that 'If asked to

explaIn something, they will mvent rational reasons that
were not actually present when they made the decision'
This suggests that reported knowledge may be unreliable
m terms of clanfymg what expert practice mvolves As
expert systems depend on this reported knowledge, It IS
likely that the databases do not represent 'expert' knowledge at all Thus, systems will also not possess the attnbute
of 'expenence' which contnbutes to the development of
pattern recognition
This identifies a lack of precision m the use of the term
'expert' m relation to computer systems WIth the rapid
mtroductIon of computenzed patient management systems, mcludmg care plannmg, mto ward environments It
IS likely that true expertise will be replaced by systems
purportmg to be expert

Recognition by others
The fourth entenon of recognmon by others may mitially
appear contentious However, m all the defimnons given
in Table 1 It can be seen that the label of expertise has to
satisfy some externally validated entenon There 18 the
need to 'prove' a knowledge or skill (definmon 1), this
proof must be determmed and Judged as relevant by other
people, whether by formal means such as exammatlon
(definmon 5) or by observation and reputation [defimnon
2) In order to practise as an expert, a person needs to be
so acknowledged by others, e g as an 'expert Witness'
(deflnmons 2 and 3), or as m the mihtary deflnmon
(defimtlon 6)
Moreover, this recogmtion needs to be by people who
are quahfied to make that Judgement, 1e by peers, or by
other experts m snmlar or related fields For instance,
awards are made, and tests adnnmstered by others WIth
sumlar skills, knowledge and expenence are vahdated by
those quahfied to make such a Judgement, and WItnesses
or authonnes are recommended by others according to
proven expertise
Thus nursmg experts need to be recognized both from
outside and within the profession In order for nursmg
knowledge to be developed It IS crucial for expert practitioners to be idennfled and their knowledge used to
expand the boundanes of care It IS from within the profeSSIOnthat the label of expert Will be afforded, for It IS
only smnlarly quahfied nurses who Willbe able to identify
the true expert
However, It IS crucial that professions external to nursmg also recogruze those identified as 'expert' by their
peers, in terms of credibility of research and practice
knowledge developed For a profession that has traditionally been subservient to medicine, and which has only
recently moved mto higher education and started to
develop Its own knowledge base, this IS not easy to
accomplish

In nUl'BJII8

The most visible entena for expertise appear to be the

practical abihties which are grounded m a knowledge
base As all other entena denve from these, It IS not only
Important to possess these cepabihues, but It IS vital that
these are witnessed and labelled as expert by others
Wmlst many experts will be extremely high profile nurses,
pubhshmg research and engaged m other scholarly
activity, most will be secure m their chrucal practice It IS
these who provide the vast source of expert knowledge for
the profession, as role models and educators for future
generations of nurses The creation of chnrcal nurse
specialist (CNS) posts offers the first idennfiable structure
for the formal recognition of experts
These are also the nurses that other professionals would
see as experts, those who practise their skills on a regular
basis and are respected for this In partlcular this reeogninon comes from doctors and paramedical staff who
depend on nursing skills as part of the care delivery team
Wmlst It IS questionable whether other prcfessronals
would themselves be able to idennfy experts m nursing.
It IS Important that they recogruze as experts those
acknowledged as such from within the profession, as this
will vahdate the development of nursing as a profession
in Its OWll nght
For professional development to conunue, both these
types of recogmnon of expert pracntioners will be
necessary

DEVELOPMENT OF CASES
Once the definmg attnbutes of a concept have been identified, Walker & Avant (1988) suggest that these are tested
by the 'development of cases' This IS Important m terms
of identifying what IS and what IS not an incidence of the
concept (Walker & Avant 1988) TIDsexercise helps to vahdate the definmg attnbutes of the concept by the use of
cases which exemplify the attnbutes

The model case

Kelly Jones IS a chmcal nurse specialist m breast care who has
10 years' expenence in the field Followmg her basic nurse traming, she has tramed as a midwife, and taken special courses in
care of the dymg and oncology, culmmatmg m a Master's degree
in counselling She practises withm her area on a dally basis,
lectures and carries out research In her field, and IS consulted by
others for her specialist knowledge In particular, Kelly IS asked
to support panents newly diagnosed as havmg cancer, because
she IS recogmsed as 'always knowmg what to say'
This case mcludes all the definmg attnbutes covenng
speciahst knowledge base developed both formally and
mformally, expenence built up over years m the same Job,

773

MA./asper
pattern recogmtion demonstrated as 'knowmg what to say'
WIth a particular group of patients, and recognrtion
by others evidenced by requests for teachmg and

consultation

The borderline case

Sheila Moms has practised as tnple worker on a remote Island
for 15 years She 18 the only nurse present on the island, and
provides all the pnmary health care functions within her role
She has basic quahficatrons In nursing, midwifery and health VISitmg, and has taken correspondence courses to keep her nursmg
knowledge up to date She IS known to her panents and clients
as 'a good nurse' and she IS respected for 'always knowing what
to do In an emergency'
This IS a borderhne case because although the cntena
of expenence and pattern recogmtion are present, specialrst knowledge and the acknowledgement of expertise by
peers IS rmssmg, although her chents do recogmze her

skills

The contrary case

Io Bradley 18 17 years old and started her Jobas a nursing auxiliary
on a maternity ward 3 days ago She left school WIth no formal
qualifications, and has no expenence of pregnant women, looking
after babies, or childbirth She relies totally on others to tell her
what to do, and cames out mstrucnons exactly

The contrary case states what the concept IS not The

person descnbed has neither knowledge, nor experience,
she rehes on direct instructions for each task and thus
demonstrates no pattern recognition In dependmg on
others she IS not recognized as havmg any special skills
Therefore, this case demonstrates none of the characterIStICSof expert practice

ANTECEDENTS AND CONSEQUENCES

The process of idennfymg the antecedents and consequences of the concept [Table 5) helps to further refine the
definmg attnbutes by ensuring that there IS a clear mVISIon
between what falls into each category
The antecedents need to exist pnor to the development
of expertise The expert needs to have basic quahficanons
m an appropriate area of practice, on which to build her
knowledge and skills She needs to be facihtated by her
own self-confidence to act on her mtuition, based on pattern recognition If this does not develop then the nurse
WIll be unable to support her Judgements to other professionals, or to act fully on her own mmanve The nurse
needs to be exposed to workmg With colleagues who are
able to give feedback, and who are qualified to make a
Judgement about her practice In order to develop pattern
recognition, the nurse needs to build up expenences in a
single environment
The label of 'expert' becomes self-reinforcing, m that
colleagues WIll draw on expertise once It IS established
This in turn builds reputations as experts become more
VISible when they are consulted by others, and are used
as a role model for students and other practmoners If the
expertise IS not remforced then the label Will become
extinct, With loss of credibihty and loss of reputation m
the field
The idennficanon of antecedents and consequences has
been particularly difficult m this case because the boundanes for attnbutes such as 'knowledge' and 'expenence'
are not discrete

A FIRST DEFINITION
On the baSIS of the preVIOUSanalysis a definition of expert

might be
a nurse who has developed the capacity for pattern recogmtion

Related cases
Table 5 Antecedents and consequences of the concept of 'expert'
These are rdentified by Walker & Avant (1988). as
'mstances of concepts that are related to the concept bemg
studied but that do not contam the cntical attributes'
Some concepts related to 'expert' are professional, specialISt, consultant, proficient, master and practitioner All of
these contam some of the definmg attributes for 'expert'
but not all of them

Illegitimate case
The fourth defimtion in Table 1, 'destitute or devoid of',
IS seen as an illegitimate case because It IS an example of
the term that IS used Improperly, 1 e not withm the framework of the defining attributes
774

The antecedents of 'expert' are

confidence m oneself and one's decision-making
skills,
2 working With colleagues,
3 exposure to a single environment withm which skills and
knowledge can develop,
4 holding appropnate basic qualifications m the chosen area
and the opporturuty to develop these
1 having

The consequences ofbecommg an 'expert' are

1 accordance of high status withm the professron,
2 consultation by others,
3 use as a role model

The concept of the expert

through high level knowledge and skill, and extensive expenence
III

a speciahst field, and who

IS

idennfled as such by her peers

It IS acknowledged that acceptance of this defimnon

IS dependent upon acceptance of the defining attributes,
In parbcular that of 'pattern recognition' Clearly
Enghsh (1993) who stimulated this attempt at defimtion,
would not agree With the entenon, as he concludes
The procedures that nurses carry out shall require a foundation
in empmcal research Cluneal assessment must be equally based
on exphcit cntena, and such cntena are not provided in the
'hunches' of Benner's experts

It IS hoped that this first attempt at a defirution Will

provoke further discussion and analysis In order to
develop our understanding

THE CREATION OF EMPIRICAL REFERENTS

The use of ernpmcal referents IS a strategy for measuring
the concept In this case, work In the development of artificial mtelhgence, such as networking theones may prove
of immense value In differentiatmg, In practical terms,
between experts and their colleagues Other referents
might be found through the search for consensus
amongst nurses for defimng cntena, or through specific
competencies used for skrll-mix purposes

In nursmg

essential If the nursing profession ISto survive In fact, the

appropnate use of the expert nurse could herald more
effiCientand cost-effective health care
ThIS analysis has, It IS felt, taken the first steps on the
road to clanfymg the concept of expert, accordmg to a
previously tested and respected framework WhIlst It IS
disappomting that this first analysis has not YIelded an
operancnal defiruuon of the concept, It has certainly been
a worthwhile exercise for the author m defining the boundaries within which the expert might function
It has also raised the ISsue of the nebulous apphcanon
of the term 'expert', perncularly where It IS used In cases
where all four definmg cntena are not present For
instance, can a umversity lecturer m nursing practice be
regarded as an expert If she does not practise m a
specialized field and possess both practical and theoretical
knowledge over and above that of her service colleagues?
It ISdifficult to prevent personal behefs and values from
creeping into the analysis, although It IS hoped that by
justifymg both the conclusions reached and the rejection
of some components, and by presenting the evidence of
the steps taken, that any bias IS reduced to a rmmmum
The author would welcome contmumg dialogue With
others WIth similar interests, m the hope of sharing Ideas
and broadening understanding
References

DISCUSSION
Although the term 'expert' IS used commonly m nursing
practice and the nursing hterature, It ISapparent from this
analysis and subsequent dISCUSSIOthat the term IS
ambiguous and difficult to clanfy The attribution of
expertise remains hnked to subjective cntena and reputation, With all of the defining attnbutes (knowledge,
expenence, pattern recogmtion and recognition by others)
having loosely defined parameters However, as the term
continues to be used In practice, It ISessential that cntena
emerge that can be used to recognize the existence of
expertise and those who demonstrate It Formal mechanIsms for this are being developed, such as, in professional
education, the creation of departments of nursing In institutes of higher education, and minatrves such as the
Enghsh National Board (ENB 1990) higher award and
United KIngdom Central Council (UKCC 1990) profile
Other developments, such as analyses of skill-mix, cluneal
grading and speciahst nurse roles Will all contnbute to a
clanflcation of specific and general cntena relating to
expertise

In

nursing

Factors influential In the development of nursing, such

as the changing economic climate, Bntish Government
pohcy regarding the National Health Service, changing
demography, and the need for cost-effective health care,
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