Editor's Note

Dear Professionals,

Greetings from RGUHS Journal of Nursing Sciences. I take immense pleasure in presenting Vol. 8, issue 1, of RJNS June, 2018. The RGUHS editorial Board extends its gratitude to all the authors who have contributed articles for this issue. We encourage the nursing fraternity to contribute scientific papers to this journal and thus empower knowledge and nursing profession. The editorial of this issue focuses on upholding clinical competency in nursing

UPHOLDING CLINICAL COMPETENCY IN NURSING

introduction

In nursing, clinical competence is a central issue for patient care and a clear understanding of this concept is critical for nursing education and nursing discipline. Competencies areimportant because they provide a method of measurement to validate an individual has an ability or a skill. Is competence only limited to ensuring patient safety and rendering high quality of care?

Competency is derived from the Middle French and Latin word “competens”. To be competent is to be proper or rightly pertinent, to have requisite or adequate ability or qualities, to be legally qualified or adequate, or to have the capacity to function or develop in a particular way.

In many countries during 1980s, many boards of nursing began to explore the issue of competencies for graduating nurses in their states nursing councils and boards. They developed essential competencies of nursing program graduates. Typically, these competencies are specified by educational program preparation. Most identify the knowledge, judgment, skills, and professional values expected of graduates of nursing programs.

Definition

Competency is defined as “the attainment of knowledge, intellectual capacities, practice skills, integrity, and professional and ethical values required for safe, accountable and effective practice as a registered nurse or registered midwife”. Competence changes and develops over time. 

According to ANA (American Nurses Association) “assurance of competence is the responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders.”

Standard and Competence

What is the difference between standard and competency? 

• Standards reflect philosophical values; they remain stable.
• Competency statements, on the other hand, are revised as needed to incorporate advances in scientific knowledge and expectations for nursing practice. To demonstrate competency, the nurse must meet all competencies for the given standard.

New nurses establishcompetencies in the practice areas from the general standards presented to them in the course of their education in nursing schools and colleges which apply to all nurses. In speciality areas additional standards are applied.

A nurse’s level of competence is influenced by their educational preparation, frequency of clinical exposure and the duration of their experience, in particular, clinical settings. Competence is not static. A individual nurse is expected to continually re-evaluate her competence when faced with new practice situations. Each is accountable for her professional actions and, as such, they should refuse delegated or assigned roles or activities if they judge their competence to be limited. If they identify a competence deficit, they should take appropriate measures to gain competence.

Areas of Competency

There can be several areas of competencies. The key areas are as follows:

Professional  responsibilities: contains competencies that relate to professional, legal and ethical responsibilities. These include being accountable for one’s own actions and decisions within the nurse’s scope of practice.

Provision of nursing care: This area contains competencies related to assessment and provision of nursing care for health consumers when working under the direction of a nurse.

Interpersonal relationship: contains competencies related to interpersonal communication with health consumers, their families and other nursing and healthcare workers.

Quality improvement: It is working within interprofessional health care team and contributing to quality improvement.

Measures to Uphold Competencies

A Nurse can maintain and enhance competency through various medium as mentioned below 

Education: Continue education to give new perspectives and keep up-to-date on many changing healthcare needs and the expanding knowledge base. 

Conferences and Meetings: Attend conferences, where one can network with other nurses, learn from researchers, gain new information and learn about new procedures that can be implemented at the work place to improve patient care.Conferences and Meetings: Attend conferences, where one can network with other nurses, learn from researchers, gain new information and learn about new procedures that can be implemented at the work place to improve patient care.  

WebinarCourses and CNE modules: Complete courses via webinars and CNE modules from a reputable source. For instance, Sigma Theta Tau (International Honor Society of Nursing) offers webinar courses that members can access for free.

Seminars and Workshops: These programs are ideal for busy nurses who might not have the time to devote to potentially lengthy continuing education courses .

Technology: In today’s growing technological work scenario and it’s essential to be proactive in maintaining computer skills. Participating in onsite training programs whenever new equipment is introduced at work will ensure how to use the latest medical machinery.

Nursing journals: Read peer reviewed nursing and medical journals.

Certification: Become certified in the practice area. Certification programs and courses will enables nurses to demonstrate their specialty expertise and validate their knowledge. 

Reading: This includes journals, books and guidelines. Nowadays online journals usually include the option of searching sea of archived material, too

Textbooks: In the past an important learning tool but may not be as relevant or helpful as other more interactive and more practical methods.

Practical skill training courses: Basic life support skills must to be updated regularly via practical hands-on training with resuscitation dummies

Research: Research helps nurses determine effective best practices and improve patient care

Professional Organization: It is important to be member of a professional organization to stay current on changes that affect the practice

Competence Assessment

Assessments can be carried out by an experienced registered nurse who has recognised nursing knowledge and skills in the area of practice being assessed. She will work with the nurse or will have observed his or her practice for the purpose of making an assessment. 

The assessment should be based on a combination of strategies that include:

•  Direct observation of the nurse’s practice: Visual assessment, nurse manager, or other clinician/ educator as the individual performs specific tasks. 
• Interview to ascertain nursing care in different scenarios 
• Evidence provided by the nurse (including selfassessments, exemplars or examples of practice, documentation, and reports from other nurses and other health professionals). 
• Patient outcomes or surveys: Use of patients’ reports to evaluate nurses’ competencies 
• Objective Structured Clinical Examination (OSCE):Participation in a series of structured activities that test knowledge and skill in a variety of clinical areas; participants rotate through activities, one after the other; OSCEs allow participants to practice skills in a controlled setting 
• Portfolio/Records: Collection of evidence by the individual being assessed to demonstrate acquisition/maintenance of skills, knowledge, and attitudes; includes self-reflection and action plan development 
• Peer Review: Evaluation process whereby nurses assess and provide feedback regarding one another’s performance compared to established standards 
• Self -Assessment: Use of self-reflection to rate knowledge, skills, and performance. 

Assessments should be comprehensive and not based solely on observation of clinical procedures. The assessor is required to provide detailed comments for each competency, giving examples of the nurse’s practice that support the assessment. 

Role of Employer: While it is the responsibility of nurses to put in the effort and enhance their clinical competency, the support from the employers and the government can go a long way to encourage and help them maintain their level of competency. Employers are responsible for putting in place the mechanism that can help to promote the nurse’s credentials of the knowledge, skills and personal attributes they require in the nursing field. 

CONCLUSION

Nurses at all levels should be actively involved in determining the competencies they need to stay current. We have an ethical and legal responsibility to the public, ourselves, and the nursing profession to provide safe, timely, efficient, effective, equitable, and patient-centeredcare.