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Competency The purpose of this concept analysis was to further explore uses of the concept and theoretically define how important the multidimensional aspects of competency are to the professional practice of nursing. Competency is essential to the profession of nursing, and providing a clear theoretical definition of competency is only the first step. The competency of all nurses and healthcare providers must be assessed to provide safe care, protect the public, and maintain the credibility of nurses. Standards must be established and adhered to both in practice and evaluation of competency.
The Oxford English Dictionary describes competency as the ability to deal with a subject, and as the “sufficiency of qualification” (OED, 1989). Merriam-Webster Online defines competence as “a sufficiency of means for the necessities and conveniences of life” and “having sufficient knowledge” to enable an action. In legal terms, competency refers to an individual who exhibits the ability to act prudently in give circumstances, including the ability to perform a job or an occupation, or to reason or make decisions (Dusky v. U. S. , 1960).
The meanings of competency are varied and include the ability of a person to perform a job (Woodruffe, 1993); skills that are developed in a pattern (Bradley & Huseman, 2003); a behavior or series of actions that can be demonstrated, observed, and assessed (Manley & Garbett, 2000) According to Walker and Avant (1995), defining attributes represent characteristics of a concept most frequently associated with the concept. These attributes appear repeatedly in references to the concept and are evident in both the theoretical and operational definitions making the concept unique and identifiable.
Defining attributes of competency in nursing that appear consistently in the literature are: (a) knowledge (b) actions (c) professional standards (d) internal regulation Review and analysis of literature exploring competency reveal an array of synonyms for the identified attributes. Variation in terms used to define and describe competency further illustrates the need for analysis to clarify the theoretical definition of competency. Synonyms of attributes ?Knowledge Information Teaching Training ?Actions Ability Patterns Processes Skill ?Professional standards
Criteria Requirements Qualification ?Internal regulation Accountability Attitude Autonomy Motivation model case. A model case as described by Walker and Avant (1995) is a “real life” example of how the concept is used and must include all attributes. The following case is an actual scenario and includes all of the critical attributes for the concept of competency. Nurse A is a registered nurse (RN) who graduated 5 years ago from a baccalaureate nursing program. Immediately after graduation, Nurse A began working on a medical–surgical unit with a patient ratio of 1:6.
The floor is well staffed and patient assignments are determined based on patient acuity. Upon admission, all patients are seen within 3 –5 min of arrival by an RN. Responsibilities of the RN at this time include obtaining a complete medical history and physical assessment for the patient. The physical assessment components are determined by the hospital practice standards committee to include specific body system function. Nurse A has demonstrated the necessary skills to obtain data, and in addition, can discern the presence of any abnormal findings.
Upon noting abnormal functions, Nurse A proceeds to investigate further with questions for the patient or by using advanced assessment skills to determine the significance of the assessment findings. Once the assessment is complete, Nurse A begins the process of clustering and analyzing data in order to develop a plan of care or as the patient’s condition may warrant take immediate action to prevent deterioration in the patient’s status. Contrary Case The following case does not represent competency because it lacks all of the defining attributes.
In this instance, Nurse B is an RN who has practiced for several years in the long-term care setting. The standard of care for the residents includes a physical assessment to be completed by the RN each week and/or as a resident’s condition warrants. Nurse B feels as if the time needed to conduct a full assessment could be better used in keeping up with paperwork and if the resident can ambulate in the hallway and participate in the weekly physical therapy activities, the assessment is not needed.
It is, however, documented on the resident’s permanent record that all systems were reviewed and found to be without abnormality. Nurse B illustrates an RN who has not demonstrated competency in performing the required assessment and has erred in judgment and actions required for a professional nurse. Consequences as characteristics present whenever the concept occurs. Antecedents provide additional insight about the attributes and illustrate the context in which the concept is used. The antecedents of competency include: The individual has completed the required educational preparation or acquired knowledge needed to demonstrate competency • Standards of action or behavior have been identified and relate to the educational theory • Accountability and responsibility for knowledge and actions are evident Consequences are the events or incidents that are a result of the occurrence of a concept. The consequences associated with competency include •safety of patients •high standards of patient care •application of core knowledge •internal motivation for continued learning 8.
Define empirical referents. Competent professionals have an understanding of their own limitations and are able to autonomously provide safe care according to defined responsibilities, professional standards, education, and qualifications. Competency promotes collaboration between the nurse and other healthcare team members in order to expand and integrate new knowledge and skills into their own practice. As evident in the literature, competency is essential to the profession of nursing, and providing a clear theoretical definition of competency is only the first step.
The competency of all nurses and healthcare providers must be assessed in order to provide safe care, protect the public, and maintain the credibility of nurses. Standards must be established and adhered to both in practice and evaluation of competency. Competency promotes collaboration between the nurse and other healthcare team members in order to expand and integrate new knowledge and skills into their own practice. Furthermore, the absence of competency results in serious medical errors, poor patient outcomes, and an inability to make sound decisions.
As evident in the literature, competency directly influences the quality of nursing care and all safety factors associated with it (AHQM, 2004; JCAHO, 2006; Whelan, 2006). References Agency for Healthcare Quality and Management (AHQM). (2004). Making health care safer is a critical analysis of patient safety practices. AHRQ evidence report/technology assessment no. 43, AHRQ Publication no. 01-E058. Rockville, MD: Health and Human Services. Bechtel, G. A. , Davidhizar, R. , & Bradshaw, M. J. (1999). Problem-based learning in a competency-based world. Nurse Education Today, 19(3), 182–187. Benner, P. (2001).
From novice to expert: Excellence and power in clinical nursing practice (Commemorative ed. ). Upper Saddle River, NJ: Prentice-Hall. Bradley, D. , & Huseman, S. (2003). Validating competency at the bedside. Journal for Nurses in Staff Development, 19(4), 165 –175. Bradshaw, A. (1997). Defining “competency” in nursing (part I): A policy review. Journal of Clinical Nursing, 6, 347–354. Meleis, A. (1997). Theoretical nursing development and progress (3rd ed. ). Philadelphia, PA: Lippincott Williams & Wilkins. Merriam-Webster Dictionary. (2005). Retrieved June 12, 2006, from Walker, L. O. , & Avant, K. C. (1995).
Strategies for theory (3rd ed. ) [Construction in nursing]. Norwalk, CT: Appleton and Lange. Watson, R. , Stimpson, A. , Topping, A. , & Porock, D. (2002). Clinical competence assessment in nursing: A systematic review of the literature. Journal of Advanced Nursing, 39(5), 421– 431. Whelan, L. (2006). Competency assessment of nursing staff. Orthopaedic Nursing, 25, 198 –202. Wiemann, J. M. , & Backlund, P. (1980). Current theory and research in communicative competence. Review of Educational Research, 50(1), 185 –199. Woodruffe, C. (1993). What is meant by a competency? Leadership & Organization Development Journal