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Competency of Nursing Practice

The overarching goal and expectation of any profession is to practice in a competent manner, but what does this mean to your specific practice?  The generic meaning of competency in the dictionary is defined as, “the ability to do something successfully and efficiently.”  In nursing practice, this meaning paints a very broad stroke. By examining and honing your competency, it will increase your success and aid in the ability to prove your competency in practice if ever called into question.

Let’s start by looking at American Nurses Association expectations of competency in nursing practice.  Nurses in the US take the NCLEX after graduating from an approved nursing program.  This is initially how licensure is obtained, but does this truly prove competency?  The short answer is no. It proves you have the knowledge to pass a test, and your nursing program attests that you fulfilled the obligations necessary to graduate.  The American Nurses Association (ANA) defines competency as “an expected level of performance that integrates knowledge, skills, abilities and judgment.”   They further expand, stating, “Knowledge is the cognitive aspect of competence, incorporating thinking and understanding of the nurse’s role and responsibilities.”  Because the ANA serves all states in the US, this definition is left purposefully broad to allow states the autonomy to create their own expectations and definitions of practice.

When looking at the Oregon State Board of Nursing (OSBN), the governing body of nursing practice in Oregon, the definition of competency begins to fill in the wide gaps left by ANA.  OSBN breaks down competency into multiple Standard of Practice categories, each of which contain subsections. It can be daunting, and you may be overwhelmed when you open the link to Scope and Standards of Practice. 851-045-0030 .  You, as the licensed nurse, are expected to “self- regulate” your practice. You are responsible to know and adhere to your scope, you are expected to know the current standards of practice and function within those standards, and there is an expectation that you remove yourself when unable to practice with skill and safety. 

Many employers assist in maintaining their employees’ knowledge of current general practice by requiring annual competency completion (i.e., websites like Healthstream or other electronic educational platforms).  This is one way that employers protect themselves by proving they are providing the competency standards for general professional practice, but how does this protect the individual practicing nurse?  Well, it depends. Do you have access to the proof of completion of those modules?  Do you practice within the definitions of those standards, and if you have to deviate, are you charting and able to explain the deviation?  This is part of clinical decision making/clinical judgement but being able to explain and articulate those deviations are extremely important if you need to defend your practice.  Are you in a specialized practice of nursing that has a certification?  Do you have that certification, and if not, what education are you completing to prove that you are competent within that specialty? 

Certification is the easiest way to prove competency. When you belong to an organization, it holds you accountable to complete the education required.  When you pay your dues and submit proof of the completion of their requirements (for example, 50 CEUs over 3 years) they are acknowledging that you have up-to-date education which allows you to practice according to their standards.  There are other perks to certification, but this is the easiest way to prove competency.  If you don’t have a certification, does that mean you aren’t competent?  Of course not, but you still need to be able to prove your competency if ever called into question by a board of nursing.  It is beneficial to have proof of classes, continuing education, conferences, and webinars, etc., to prove that you are current in your knowledge of standards. Taking a class five years ago does not support your competency claim.  Healthcare evolves quickly, and it is important to maintain current knowledge in your field, not only for patient safety, but to prove you are sustaining standards of practice.

Another way to prove competency is to belong to a professional organization which participates and publishes changes in practice and research and can offer continuing education.  For example, an ER nurse may not be CEN certified, but she/he belongs to the Emergency Nurses Association, which has access to research journals and conferences, and a quarterly update on any changes in standards of practice as it pertained to emergency nursing.

In the next blog we will look at specific examples of competency or lack thereof, and we will further explore ways to surmount barriers to competency.