Selecting examinable nursing core competencies: a Delphi project

LOCK L.R. (2011) Selecting examinable nursing core competencies: a Delphi project. International Nursing Review 58 , 347–353 Aim: To establish a set of core competencies that could be practically examined in a pre‐registration practical examination for Indonesian candidates completing their pre‐service education. Background: Indonesia is planning to institute a register for nurses to ensure a minimum standard of safe practice for new nurses completing their pre‐service education. A proposed route to registration includes the practical examination of a minimum set of core competencies. This Delphi project aimed to reduce 192 existing standard competencies to an examinable group of 12 core competences that all nurses registering in Indonesia must meet. Method: A modified Delphi method was used by 12 expert Indonesian nurses and a facilitator to determine which standard competencies should be considered core. Results: Five Delphi rounds were used. One hundred and ninety‐two standard competencies were reduced to a core set of 12. Selected competencies are assessable in a practical examination and can be used to determine a minimum level of safe practice for all nurses seeking to register at the completion of their pre‐service education. Conclusion: The expert panel met the project aim and provided a set of examinable competencies/activities that they consider will demonstrate the fundamental safety of new registered nurses. The subsequent responsibility for setting up a register for nurses in Indonesia now rests with the Indonesian Ministry of Health. The Indonesian National Nursing Association is working with the Ministry of Health to determine the route and criteria for registration in order to establish a common level of competence for nurses across the country exiting their pre‐service education.     

Development of competency inventory for registered nurses in the People's Republic of China: scale development

BACKGROUND: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN). METHODS: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. RESULTS: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001). CONCLUSION: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.     

血液净化专业护士核心能力的调查研究

目的：探讨血液净化中心专业护士的核心能力。方法：采用便利取样的方法选取10所医院68名血液净化中心的临床护理人员,采用护士一般人口情况调查表、中国注册护士核心能力量表进行调查。结果：血液净化中心的专业护士核心能力处于中等水平,得分最高的为人际关系,得分最低的是批判性思维能力。医院级别、护龄、学历、职称能影响核心能力。结论：临床护士核心能力有待于进一步提高,医院的护理管理者应该加强对临床护士的教育、培训和实践,以此提高护士核心能力。     

Jordanian perspectives on advanced nursing practice: an ethnography

Zahran Z., Curtis P., Lloyd‐Jones M. & Blackett T. (2012) Jordanian perspectives on advanced nursing practice: an ethnography. International Nursing Review 59 , 222–229 Aim: This study aimed to explore how different groups of participants perceived the concept of advanced nursing practice in Jordan. Background: In Jordan, there are postgraduate educational programmes offering a Master's degree in clinical nursing for registered nurses. Intended to prepare nurses to practise at an advanced level as potential clinical nurse specialists in critical care, community health nursing and maternal newborn nursing, little was known prior to this study about the development of advanced nursing roles for nurses in Jordan and the drivers behind their establishment. Methods: Using ethnographic design, narratives from semi‐structured interviews and non‐participant observation with participants from five Jordanian hospitals and two public universities were collected and analysed according to thematic analysis. Findings and discussion: Four themes emerged from the data: core competencies, specific practice area vs. generic practice, beneficiaries of advanced nursing practice and drivers for educational change. The findings are similar to those found in other countries and highlight the need for a consensual understanding between nurse educationalists, professional bodies and employers about what advanced nursing practice in Jordan should be, so that a common framework can be identified. Conclusion: Paralleling the lack of consistency in understanding of advanced nursing practice in the broader literature, participants described a number of different elements of advanced practice that are relevant to the specific context of contemporary Jordanian nursing.     

Preliminary outcomes of a local residency programme for new graduate registered nurses

kowalski s. & cross c.l. (2010) Journal of Nursing Management 18 , 96–104
Preliminary outcomes of a local residency programme for new graduate registered nurses
Aim  The present study reports preliminary findings regarding new graduate nurses participating in a year-long local residency programme at two hospitals in Las Vegas, NV.
Background  Nurse resident programmes are purported to increase the level of clinical competency and professional transition in new graduate registered nurses (RNs) and to decrease first-year turnover rates. The effectiveness of this programme was assessed using data of the first two cohorts participating in this new residency programme.
Method  Clinical competencies, anxiety, stress, professional transition and retention were measured on 55 nurse residents who have participated in the nurse residency programme.
Results  The findings indicate improved clinical competency throughout the programme, a decreased sense of threat, and improved communication and leadership skills. The first-year cohort's employment retention rate was 78%, and the second-year cohort is presently 96%.
Conclusions  The results of this study demonstrate the positive impact of a year-round residency programme for new graduate RNs.
Implications for nursing management  The need for a consistent nurse workforce demands that new graduates be transitioned into competent practitioners as soon as possible. Nurse residency programmes can provide this support and decrease replacement costs involved in high turnover.     

Problems with competence assessment as it applies to student nurses

Nursing has enthusiastically embraced the concept of continuing competence as the key means of reassuring the public of the overall quality of the profession. There are many definitions of competence and a number of nursing regulatory bodies have put into operation, a definition which is reductionist rather then holistic in nature. Not surprisingly, and as a consequence many nurses, including nurse educators, think competence comprises a number of key competencies which can be isolated, accumulated and tallied. It is clear that both philosophically and practically these notions of competence have influenced the way that student nurses are currently educated. More specifically it is in preparation for their initial entry to practice that the approach to competence assessment of student nurses becomes problematic. In this paper it will be argued that the principles of continuing competence assessment, associated with the on going competence of experienced registered nurses, do not readily translate to students who are still in the process of learning. We suggest that solutions to this problem are three-fold and can be found by replicating for the student the conditions that apply to the assessment of continuing competence for registered nurses.     

Excellence in school nursing practice: developing a national perspective on school nurse competencies.

Developing a national position on competencies for school nurses can directly influence professional practice, which ultimately affects the well-being and academic success of students. Collaboration between national experts, such as school nurse educators and school nurse consultants, interested in moving this development forward is key. Closely aligning the work done by the Southern Regional Education Board Council on Collegiate Education for Nursing on entry-level competencies with the Standards of Professional School Nursing Practice provides a framework to carry the school nurse competency initiative forward. Continued competency development will provide guidance for the academic programs that design curricula to prepare school nurses and for the practice settings that hire school nurses.     

济南市三级医院护士核心能力的现状调查

目的调查济南市三级医院注册护士核心能力现状,分析人口学变量对护士核心能力的影响,为护士培训提供依据。方法应用一般资料调查表和注册护士核心能力量表,对济南市5所三级医院的513名护士进行问卷调查。结果护士核心能力总均分为(2.79±0.58)分。在各个维度中,评判性思维和科研得分最低,伦理和法律实践得分最高。工作年限、职称、工作满意度、婚姻状况、自评健康状况是其主要影响因素。结论济南市三级医院护士核心能力处于中等偏上水平,在护士培训中需注重评判性思维和科研能力的培养,并加强对年轻、未婚护士的培养,以提升护士的核心能力。     

A Delphi study to determine informatics competencies for nurses at four levels of practice

BACKGROUND: Despite its obvious need, a current, research-based list of informatics competencies for nurses is not available. OBJECTIVE: To produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice. METHODS: After a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America. RESULTS: Of the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds. DISCUSSION: The Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills.     

Defining the scope of practice of enrolled nurses in medication administration in Australia: a review of the legislation

Changing workforce patterns and changes in models of care delivery have renewed interest in the role of the enrolled nurse in Australia. A number of major reviews have confirmed the enrolled nurse as an integral member of the Australian health workforce and identified that the role of enrolled nurses is expanding in many practice settings. Medication administration is increasingly being delegated to enrolled nurses raising issues related to role, scope of practice, educational preparation, competence and delegation and supervision of nursing activities. Published reports and studies have identified a range of issues related to scope of practice nurses in Australia that have prompted the development of decision-making frameworks and a range of policies and guidelines to better define practice parameters. A review of the literature and documents available from various Australian nursing regulatory bodies related to medication administration by enrolled nurses was undertaken to determine the scope of practice of enrolled nurses in medication administration in Australia. The review confirmed that there is considerable variation in practice between jurisdictions, individual health care settings and on a daily basis in clinical practice. Despite the availability of a number of policy and practice guidelines, there is limited evidence on how they are used in clinical practice and the impact of variable policies on registered and enrolled nursing practice.     

Mandatory continuing professional education: what is the prognosis?

Each year registered nurses apply for registration renewal. The Nursing and Midwifery Board of Australia stipulate all nurses and midwives are expected to take responsibility and accountability for participating in continuing professional development (CPD) as a declaration that their practice is current, safe and competent. The code of professional conduct and Australian Nursing and Midwifery Council (ANMC) competencies governing registered nurses and midwives, outline the professional and personal responsibility nurses hold in order to maintain clinical competence; which may be achieved through continuing nurse education and professional development. As the health care industry shifts focus to keep up with changes in technology, economics, demographics and culture, the nursing profession must respond accordingly.With the implementation of a national registration scheme in Australia, this paper provides a review of the literature relating to mandatory CPD and how CPD may assist nurses to respond to the changing needs of the health care system and its consumers, to ensure the best possible health outcomes. Suggestions of possible avenues of research into the concept of CPD are also offered.     

Sustained nurse home visiting in early childhood: exploring Australian nursing competencies

Abstract There is strong evidence that a comprehensive model of sustained nurse home visiting (SNHV) in early childhood can improve child and family outcomes for vulnerable and at-risk families. There is also evidence that nurse home visitors experience challenges in delivering SNHV. This article aims to identify the nursing competencies needed for delivering a comprehensive model of SNHV and highlight the areas where further competency development is required. Qualitative analysis compared the content and language of published registered generalist and child and family nursing competency statements for Australian nurses with the work experiences of a team of community-based nurses delivering SNHV. Development of competencies is needed in the areas of (a) enhanced knowledge of child development, social determinants of health, and broader outcomes for individuals and populations; (b) advanced skills in fine observation, anticipatory guidance, negotiating, modelling and experimentation, holistic case management, and working in interdisciplinary teams; and (c) attitudinal competency for working "with" and supporting risk taking. The current published competencies for general and child and family nurses do not encompass the different and advanced competencies required for performing SNHV. Competency development and associated nurse training and support are needed for delivery of quality SHNV services.     

Educational needs of psychiatric nurses for continuing competency

BACKGROUND: Practice setting diversification has created an increased need for psychiatric nurses to assume more independent roles, while at the same time being able to demonstrate the corresponding degree of competency to practice. Psychiatric nurses were invited to share their perceptions concerning changes occurring in mental health care, proactive strategies for participating in these changes, and educational opportunities to ensure continuing competency to practice. METHOD: Focus groups were conducted with psychiatric nurses located in various Regional Health Authorities in southern and central regions of Manitoba, Canada. RESULTS: Research findings suggest that psychiatric nurses are primarily concerned with balancing the requirement to demonstrate continuing competence to practice with the challenges associated with the evolving mental healthcare system. CONCLUSION: If the requirement for continuing competence is to be reasonable and achievable, it will be essential that the program generate insight into the necessity for such a program to be implemented and acquire support among the registered psychiatric nurse membership.     

Relating new graduate nurse competence to frequency of use

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.     

A case study - Implementing a registered nurse professional recognition program across a Queensland hospital and health service

Ongoing advancement and documentation of professional development is required to maintain nursing registration and competency to practise in Australia and many other countries. All Australian registered nurses are required to undertake a minimum of 20 h of continuing professional development annually and demonstrate competence to practice; this is a criterion for nursing registration. Many health care organisations nationally and internationally develop programs to support such processes, assisting nurses to formally document their ongoing education and commitment to best practice, and clearly demonstrate their ongoing continuing professional development. Such programs align with the MAGNET ® principles of providing structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. This study describes the implementation, evaluation and impact of the registered nurse professional recognition program undertaken by one Hospital and Health Service in South East Queensland using Donabedian's structure, process outcome framework. The registered nurse professional recognition program was implemented to invest in and develop the nursing workforce by providing an opportunity for registered nurses to assess and document their professional skills, knowledge and expertise that are critical to the provision of safe and cost-effective patient and family-centred care.     

沈阳某三甲医院护士规范化培训模式改进的效果研究

目的 探讨护士规范化培训模式改进在护士规范化培训中的应用效果。方法 选取沈阳市某三甲医院临床护士764人为研究对象,以护士核心能力为基准进行规范化培训模式改进,包括重新设置课程内容、培训方案、考核方案、培训师选拔标准和质量监控方案,并将该模式应用于护士规范化培训。采用中国注册护士核心能力量表调查改进模式实施前后护士的核心能力。结果 实施改进培训模式后,护士的核心能力总均分高于实施前(t=-43.766,P<0.001)。结论 改进的规范化培训模式可以提高护士的核心能力。     

Preliminary clinical nursing leadership competency model: a qualitative study from Thailand

This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model.