Core Competencies for Professional Nurses
The concept of core competency arose in the 1990s. A core competency can be defined as “a defined level of expertise that is essential or fundamental to a particular job; the primary area of expertise; specialty; the expertise that allows an organization or individual to beat its competitors” (Dictionary.com, n.d.). In professional nursing, core competencies are fundamental knowledge, abilities, and skills that enable nurses to provide safe, effective care to other persons in health care settings. In many health care settings, professional nurses are expected to display competence in a particular area of practice on an annual basis. Frequently, nursing staff development departments design and deploy activities to verify that nurses possess a certain level of competence with the knowledge and skills appropriate to their clinical practice areas.
In 1973, the American Nurses Association (ANA) published the first Standards of Nursing Profession. The goal was to develop a generic list of standards for professional nurses that would apply across practice settings. The standards primarily focused upon nursing process (assessment, diagnosis, planning, implementation, and evaluation) which at the time articulated a thinking model for all nurses to use in clinical practice. As time passed, the original standards of nursing practice have evolved into the Scope and Standards of Nursing that outline all key elements of professional nursing practice including nursing process and key competencies (knowledge and skills) for meeting each standard of professional practice. Although the competencies are designated, the execution of each competency may be context dependent. For example, Standard 3 Outcome Identification and Standard 4 Planning specify that the patient, significant others, and other health team members should be involved in determining the desired outcomes and how to achieve them (ANA, 2015c). If the patient is unconscious or has been legally declared mentally incompetent, then the patient is unable to be an active participant in the determination of care goals and planned actions to attain them.
By the 1990s, the ANA recognized the need to develop standards of practice for nursing specialty areas and collaborated with the nursing specialty organization to develop context-based scope and standards or practice including those for school faith community, psychiatric–mental health, transplant, holistic, pediatric, forensic, hospice and palliative care nursing, and nursing administration. The ANA’s (2015c) third edition of the Nursing: Scope and Standards of Practice, contains 6 standards addressing nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) and 11 standards related to professional performance (ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, practice quality, professional practice evaluation, resource utilization, and environmental health) (ANA, 2015a). Disposing used needles and sharp implements (e.g., needles, disposable scissors) into hard, impermeable boxes labeled “biohazard” is an example of a competency related to environmental health. In 1990s, the Institute of Medicine (IOM) published a series of reports outlining safety and quality concerns within the American health care system. The Robert Wood Johnson Foundation provided funding to Linda Cronenwett, PhD as principal investigator and the American Association of Colleges of Nursing (AACN) for the Quality Safety Education for Nursing Initiative to develop strategies for nursing practice and education for continuously improving and enhancing safety in health care delivery. During the first phase of the project, the following six core competencies were identified for professional nursing: “patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety” (QSEN Institute, 2014, para 4). Along with identifying the competencies, the initiative developed sets of knowledge, skills, and attitudes for each of them. The project initially addressed pre-licensure nursing education, but eventually was expanded to address graduate nursing education (QSEN Institute, 2014).
In March 2006, the Massachusetts (MA) Department of Higher Education and the MA Organization of Nurse Executives held a workshop Creativity and Connections: Building the Framework for the Future of Nursing Education and Practice that was attended by 32 key stakeholders in nursing education and practice. An outcome of the workshop was the formation of a subcommittee to develop a set of core professional nursing competencies to facilitate a seamless continuum for progression in nursing education. Between 2006 and 2009, the committee reviewed the best practices, standards and initiatives education progression to create a list of nursing competencies for each level of nursing education. Results of the review were compiled into a set of 10 core competencies that were then compared to outcomes required for associate degree and baccalaureate degree program accrediting agencies. Funded by the MA Department of Higher Education and the Johnson and Johnson Promise of Nursing for the MA Nursing School Grant Program, the Nurse of the Future Competency Committee identified 10 core competencies that are essential for professional nursing practice known as The Nurse of the Future Nursing Core Competencies© (Fig. 1.2). The identified competencies are patient-centered care, professionalism, leadership, systems-based practice, information and technology, communication, teamwork and collaboration, safety, quality improvement, and evidence-based practice (Massachusetts Action Coalition, 2014; Massachusetts Dept. of Higher Education, 2010). Similar to QSEN competencies, each one of The Nurse of the Future Nursing Core Competencies© contain specific knowledge, skills, and attitudes for nurses to display. The identified competencies include the hallmarks of baccalaureate education: systems-based thinking, evidence-based practice, and nursing leadership (AACN, 2008). Table 1.1 links the Hood Professional Contributions Model with The Nurse of the Future Nursing Core Competencies©. Caring, compassion, commitment, and confidence are the key attitudes that provide the affective domain of professional nursing practice. Caring and compassion denote the nurse’s genuine concern for others and a desire to help them. When a nurse displays confidence in what is being done as a professional, recipients of nursing care, other health care team members, and the public perceive that the nurse possesses the knowledge, skill, and attitude for effective role performance. Competence ascertains that nurses are capable of performing skills (cognitive, clinical, and communication) effectively to provide safe, optimal care. Complex systems, chaos, and change describe the clinical practice environments of professional nurses.
FIGURE 1.2 Massachusetts Nurse of the Future Nursing Core Competencies Graphic.
TABLE 1.1 Hood’s Professional Nursing Contributions Model and the Nurse of the Future Nursing Core Competencies© Linkages