Rachelle, Brenna, David and Sabrina

Defining Competency

The Nursing profession is constantly evolving requiring the need for continued competency

To Err Is Human

Defining Competency

National Council of State Boards of Nursing defines continued competency as

“ The application of knowledge and interpersonal, decision-making, and psychomotor skills expected for nurse’s practice role, within the context of public health, welfare and safety.”

Debate of who should be responsible for Continued Education??

“Issue complicated by the fact that there are no national standards for defining, measuring or requiring continued competency”. ( p 305)

Should it be professional organizations, government or employers???

Tools used for Competency

Continuing education Recent practice

Periodic re-licensure Professional certification

Reflective practice and portfolios

Continuing Education

Usually defined as hours completed by a board approved program in order for license renewal. Every state differs on amount of hours required for renewal

Example of CE

Examples of CE in other states California 30 hours every two years Iowa 36 hours for a three year license

and 24 hours for licenses less than three years

New Jersey 30 hours every two years Oregon One-time, 7 hours course on

pain management

Pros and Cons of CE

Pros Cons

Professionalism Seat time does not guarantee learning

Commitment to maintaining competence

Difficult to agree on standards

Attention to patient safety and reduction in medical errors

Administrative and monitoring costs

Motivates employers to support CE

Concern about cost, access and quality of CE offerings

Raises the standard for CE for all nurses

Research inconclusive

Research supports positive effects of nursing practice

Difficult to measure outcomes

Periodic relicensure The NCLEX measures minimal

competence needed for entry into nursing

It has been suggested that nurses should be required to periodically retake the NCLEX or a similar test

Nurses, Doctors and Pharmacists have all been reluctant to implement relicensure as a means of assuring competence

Discussion Question

Why are professional health care organizations reluctant to support re-examination?

What are some consequences of mandating re-testing?

Why not? Possibility of not passing in large numbers Who will pay for it What test would be used Who would administer the test How often should it be requiredDid you know…. Physician’s Assistance are required to

pass a national certification exam and sit for recertification every six years to maintain their certification to practice.

What is the Differences Between Certification, and Licensure?

LicensureState/government defines a scope of practice,

grants permission for practice of a profession, and to use a particular title (restricted to license)

CertificationDefined by the American Board of Nursing

Specialties (2000) as the formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards

Certification

To achieve professional certification, nurses must meet eligibility criteria: • Years and types of work experience • Minimum educational levels• Active nursing licenses• Successful completion of a nationally

administered examination

Certifications last about 5 years; renewal normally based on CE requirements

Discussion Question

Should certification be required? Why or why not?

Benefits of Certification Research suggests certification:

Encourages a positive work environment and improved patient outcomes

Enhances nurse’s autonomyFacilitates collaboration in the workplaceEmpowers nursesValidates specialty knowledgeEnhances a feeling of personal accomplishment

and confidence in clinical abilitiesEnsures consistency in knowledge

Grief, C. (2007)Piazza, I., Donahue, M., Dykes, P., Griffin, M., & Fitzpatrick, J. (2006).

American Nurses Credentialing Center Largest and most prestigious nurse

credentialing organization in the US Became independent of the ANA in

1991 Over 250,000 ANCC-certified nurses Over 75,000 advanced practice

nurses Offers nursing certification in 26

different specialties (ANCC, 2009)(ANCC, 2009)

Accreditation Process for ANCC

Many Other Certifying Bodies ABNN (American Board of Neuroscience Nursing) ABCGN (American Board for Certification of Gastroenterology Nurses) ABPANC, Inc. (American Board of Perianesthesia Nursing Certification,

Inc.) ALNCCB (American Legal Nurse Consultant Certification Board) BCEN (Board of Certification for Emergency Nursing) CCI (Competency & Credentialing Institute) CCNA (Council on Certification of Nurse Anesthetists) INCC (Infusion Nurses Certification Corporation) MSNCB (Medical Surgical Nursing Certification Board) NBCHPN® (National Board of Certification for Hospice and Palliative

Nurses) NBCSN (National Board of Certification of School Nurses) ONCB® (Orthopaedic Nurses Certification Board) ONCC® (Oncology Nursing Certification Corporation) RNCB (Rehabilitation Nursing Certification Board) WOCNB (Wound, Ostomy, Continence Nursing Certification Board)

(list consists of ABNS approved certification programs)

o With so many different nursing certification credentials, and with certification programs often having very different standards, it may be difficult to draw valid conclusions about the value of a particular nursing certification

American Board of Nursing Specialties Incorporated in 1991 after three years of

dialogue within the nursing community to create uniformity in nursing certification

The only accrediting body specifically for nursing certification

Peer-review process used to accredit nursing certification programs

Renewal is required every 5 years(ABNS, 2008)

Discussion Question

Do most employers value professional certification? Do nurses?

Ways to Encourage Certification Tuition reimbursement and cash

incentives Make certification prep books available Display posters with benefits of

certification Paid time off to take exam Public recognition Pay raise

Reflective Practice• A process for the assessment of

one’s own practice to identify and seek learning opportunities to promote continued competence

New Brunswick’s Model (Canada)1. Self-assessment of nursing practice to

determine learning needs

2. Development and implementation of a learning plan to meet the identified learning needs

3. Evaluation of the effect of learning activities

Portfolios

Portfolios provide one means for the individual RN to be both reflective about his/her practice and to assess and/or demonstrate competence

Living document that demonstrates critical thinking, values, skills and reflection

Discussion Question

Could reflective practice/ portfolios replace CE as a requirement to ensure competence

Which is a better option for assuring competency? Recent practice Periodic relicensure Continuing education Professional certification Reflective practice and portfolios

Consider

The individual registered nurse has a professional obligation to maintain competence

2008 WA Draft of Continuing Competency The proposed “Continuing Competency Program”

would include documentation by each nurse of the following components:

Active nursing practice Self-reflection and assessment of current

knowledge, technical ability and learning needs A “Continuing competency development plan”

created by each nurse Timely implementation of the “Continuing

competency development plan” Evaluation of the “Continuing competency

development plan” including integration of new knowledge into practice.

Transition Slide…

In 2004: almost 3 million total nursesjust over 40,000 obtained doctorate degree5.8% of these doctorate prepared nurses focused on clinical practice (NSSRN, 2004)

What’s all this DNP talk about?

On October 25, 2004, the members of the American Association of Colleges of Nursing

(AACN) endorsed the Position Statement on the Practice Doctorate in Nursing. AACN members voted to move the current level of preparation

for advanced nursing practice from the master’s degree to the doctorate level by the 2015.

A few facts… As of April 2009:

92 current DNP programs enrolling students

102 programs in the planning stages

From 2007-2008 student enrollment doubled

62 institutions have initiated accreditation to date

(AACN)

The DNP Position Statement Development of needed advanced competencies for

increasingly complex practice, faculty, and leadership roles Enhanced knowledge to improve nursing practice and

patient outcomes Enhanced leadership skills to strengthen practice and health

care delivery Better match of program requirements and credits and time

with the credential earned Provision of an advanced educational credential for those

who require advanced practice knowledge but do not need or want a strong research focus (e.g., practice faculty)

Enhanced ability to attract individuals to nursing from non-nursing backgrounds

Increased supply of faculty for practice instruction.(AACN,

2004, p.4)

Why do you think so few nurses are willing to pursue a doctoral degree?

Don’t want to do researchResearch study conducted talks about the “dread

of research” in that nurses say research has been presented to them in “boring” classes that don’t stimulate their interest

Salaries not kept pace with clinical setting.BSN $73,000 vs faculty with masters or higher

only making $58,000 (AACN,2005b)Time$

Relationships, relationships, relationships… Ultimately the terminal degree options will fall

into 2 pathways:Professional entry degree to DNP degreeProfessional entry degree to PhD degree

The practice arena vs. scientific investigation

Doctor of Nursing Practice (DNP) Program

Post Baccalaureate

Baccalaureate2nd Bachelors

Foundation Core

Family NP Public Health Leadership

Residency/Capstone

DNP

RN to BSN

*Multiple entry points possible

Cognates/Electives

Psych NP

The Big Transition

The AACN provides numerous tools to make the DNP transition a realityToolkitsRoadmap task forces

○ Faculty Issues○ Program Issues

The 8 Essentials

“Building the bridge as you walk on it…”

The 8 Essentials I. Scientific Underpinnings for Practice II. Organizational and Systems Leadership for Quality

Improvement and Systems Thinking III. Clinical Scholarship and Analytical Methods for

Evidence-Based Practice IV. Information Systems/Technology and Patient Care

Technology for the Improvement and Transformation of Health Care

V. Health Care Policy for Advocacy in Health Care VI. Interprofessional Collaboration for Improving Patient

and Population Health Outcomes VII. Clinical Prevention and Population Health for

Improving the Nation’s Health VIII. Advanced Nursing Practice (AACN, 2004, p.8)

How difficult with it be for APRN programs to meet the 2015 deadline recommended by AACN?

What organizations think about change NONPF (Nurse practitioners)-

Supports DNP, not deadline to prepare graduates Should a new deadlines be placed? NACNS (clinical nurse specialist)- list 7 key areas of concern,

but will partner with other organizations to develop doctrate level CNS cirriculum

Nurse-midwives- see DNP as an option, but not a requirement. Resisted change in past and now only in 2010 enforcing master

level entry for practice ACNM states “regardless of terminal degree, are safe, cost-

effective providers of maternity and women’s health care” Nurse Anesthetists-in support but want deadline to extend to

2025, after extensive research at practice doctorates

Up For Discussion

The AACN mentioned a main benefit of the DNP programs was to “increase supply of faculty for practice instruction” (AACN, 2004).

If there is already a shortage of instructors for entry level programs, how do we have resources to teach at the doctorate level?

Dr. Nurse???

AMA wants limitations on the use of the term “doctor”, restricting it to only physicians, dentist, and podiatrists.

concerned with pt safety issues- however, there is no evidence to support position

Wants DNP to practice as apart of medical team and under supervision of physician who has final authority and responsibility for the patient.

References(2009). About ANCC. Retrieved from

http://www.nursecredentialing.org/FunctionalCategory/AboutANCC.aspx on November 13, 2009

(2008). American board of nursing specialties: ABNS. Retrieved from http://nursingcertification.org/index.html on November 13, 2009

Grief, C. (2007). The perceived value of BCEN certification... Board of Certification for Emergency Nursing. JEN: Journal of Emergency Nursing, 33(3), 214-216. Retrieved from CINAHL with Full Text database.

Piazza, I., Donahue, M., Dykes, P., Griffin, M., & Fitzpatrick, J. (2006). Differences in perceptions of empowerment among nationally certified and noncertified nurses. Journal of Nursing Administration, 36(5), 277-283. Retrieved from CINAHL with Full Text database.

Huston, C.J. (2010). Professional issues in nursing: Challenges and opportunities, 2nd ed. Philadelphia: Lippincott Williams &

Wilkins.Washington State Department of Health Nursing Commission (2008).

Demonstrating continued competency (Rev 7/2008).AACN Position Statement on the Practice Doctorate in Nursing (2004).

American Association of Colleges in Nursing. Retrieved on November 15, 2009 from www.aacn.org.