Nursing Competency: Definition, Structure and Development

Abstract

According to one concept analysis study, nursing competency can be divided into the following three theories: behaviorism, trait theory, and holism. Behaviorism refers to competency as an ability to perform individual core skills, and is evaluated by demonstration of those skills. Trait theory considers competency as individual traits necessary for effectively performing duties (knowledge, critical thinking skills, etc.). Holism views competency as a cluster of elements, including knowledge, skills, attitudes, thinking ability and values that are required in certain contexts. Nursing competency is generally viewed as a complex integration of knowledge including professional judgment, skills, values and attitude, indicating that holism is widely accepted. In nursing practice, nurses are required to apply their acquired knowledge, skills and innate individual traits to each situation and be able to adapt that knowledge and those skills to different circumstances Nursing Competency: Definition, Structure and Development.

There are two definitions of holistic, integrated nursing competency: 1) By analyzing a) graduation achievement goals as they relate to enhancing the development of nursing competency (the Conference for Nursing Education model),b) the International Competency Standards Framework for general nurses (International Council of Nurses) and c) the Scope and Standards of Nursing Practice (American Nurses Association), Nakayama et al. defined nursing competency as “the ability to take action by combining knowledge, skills, values, beliefs, and experience acquired as a nurse” and explained that competency can be viewed as an integrated performance reflecting the professional nurse’s feelings, thoughts and judgment; and 2) Takase and Teraoka defined nursing competency as a nurse’s ability to effectively demonstrate a set of attributes, such as personal characteristics, professional attitude, values, knowledge and skills and to fulfill his/her professional responsibility through practice. A competent person must possess these attributes, have the motivation and ability to utilize them and must effectively use them to provide safe, effective and professional nursing care to his/her patient Nursing Competency: Definition, Structure and Development.

These definitions were developed by referencing international standards and literature reviews of the concept of nursing competency using domestic and international databases, clearly describing the structure of nursing and also leading to the development of evaluation methods. Therefore, they will play important roles in future research on nursing competency.

On the other hand, in order for more nurses to evaluate and enhance their own nursing competencies in their practice, it is important to develop definitions of nursing competency and competency levels that are simple and easy to understand. The Japanese Nurses Association has been developing a standardized clinical ladder for nurses. As a result, the Association developed nursing competency indices that could be used across all areas of nursing practice. These nationally standardized indices were created to help nurses objectively evaluate their competencies, use them in different practice settings and situations and enhance the quality of nursing care. The Association defines core nursing competency as “the ability to perform clinical nursing care that is based on the nurse’s ethical thinking and accurate nursing skills and that is provided to meet the needs of the cared.” It also developed a rubric showing four core competencies for nurses (the abilities to understand needs, provide care, work collaboratively, and support decision-making) as a clinical ladder, with five levels for each competency as follows: I) following basic nursing care procedures and practicing nursing with needed advice; II) practicing nursing independently based on a standard nursing care plan; III) practicing individual nursing suited to care recipients; IV) practicing nursing using predictive judgment with a broad perspective; and V) in more complex situations, practicing nursing by selecting the best means for care recipients and increasing QOL. Since the rubric shows objectives (including performance objectives) for each level, it helps many nurses evaluate their own skills, thus enhancing their competencies Nursing Competency: Definition, Structure and Development.

To acquire nursing competency, nurses must possess the skills and personal traits necessary to effectively perform their duties while integrating multiple elements including knowledge, techniques, attitude, thinking ability and values that are required in specific contexts. There are three categories into which these elements can be divided: personal traits necessary for nursing, professional attitudes and behaviors, and the ability to provide care based on professional knowledge and skills. Personal traits include affection, understanding, self-control, critical thinking and problem-solving ability. Nursing Competency: Definition, Structure and Development Professional attitudes and behaviors involve the following performance standards: taking up professional responsibilities, being autonomous, being aware of one’s own limitations, providing explanations, respecting patient rights, promoting continuous learning and maintaining up-to-date knowledge and skills. Providing care based on professional knowledge and skills includes the ability to collaborate with other healthcare professionals, develop intrapersonal relationships, educate and instruct, manage nursing care, ensure safety and quality of nursing and expand the capacity of nursing.

Thus, nursing competency attributes include a wide variety of abilities, and nursing competency can be referred to as performance traits explicitly demonstrated by a competent nurse who possesses these abilities.

COMPONENTS OF NURSING COMPETENCY

In order to make nursing competency measurable, since it is a holistic and integrated concept, many researchers seek to identify its main components. Matsutani et al. analyzed the definitions, attributes, elements and structure of nursing competency by reviewing articles in English about nursing competency. The present review produced a definition of nursing competency that included the ability to integrate knowledge and skills under particular situations or settings and traits that included core abilities necessary for ethical and effective nursing practice. Nursing competency is a holistic and integrated concept, which is constructed from complex activities. It is defined as a performance competency, which meets the standards expected from potential competencies. In addition, Matsutani et al. categorized nursing competency into seven elements subsisting within three major components: i) the ability to understand people [1) applying knowledge and 2) building intrapersonal relationships]; ii) the ability to provide people-centered care [3) providing nursing care, 4) practicing ethically, and 5) collaborating with other professionals]; and iii) the ability to improve nursing quality [6) expanding their professional capacity, and 7) ensuring the delivery of high-quality nursing]. Matsutani et al. presented a diagram showing people-centered, collaborative relationships among the three participants involved in creating healthy living: people who require nursing care, healthcare and welfare professionals, and nurses who play important roles in the fields of healthcare and welfare. This schematization of nursing competency is very useful Nursing Competency: Definition, Structure and Development.

Nakayama et al. studied and organized processes for developing and evaluating nursing competency by collecting longitudinal and cross-sectional data on nursing competency from university graduate nurses who worked in hospital settings to discern the developmental processes that surrounded their competencies. They examined conceptual definitions and nursing competency frameworks through literature review of domestic and foreign articles and subsequently developed a competency structure with four concepts and 13 competencies. Further, Nakayama et al. created a list of questions for evaluating these competencies and developed a tentative measurement system called the Clinical Nursing Competence Self-Assessment Scale (CNCSS). The CNCSS measures the following four competency concepts: basic nursing abilities (basic responsibilities, ethical practice and supportive relationships); the ability to provide care that addresses individual needs (clinical judgment, planned nursing implementation, evaluation of care, and health promotion); the ability to modify care environment and collaboration systems [risk management, care coordination and nursing care management (fulfillment of responsibilities)] and the ability to devote time toward professional development in nursing practice (enhancement of professionalism, improvement of nursing quality, and continuous learning). This scale enabled the assessment of university graduate nurses’ competencies and was initially used for nurses with 1–5 years of experience. However, the scale was later deemed useful for accurately measuring nursing competency in nurses with > 5 years of experience Nursing Competency: Definition, Structure and Development.

Takase and Teraoka conducted a concept analysis of nursing competency through a literature review of foreign articles published between 2000 and 2009. They then developed a scale based on the resultant definitions and attributes of nursing competency and presented the components of this scale. The following ten attributes represent the characteristics of nursing competency addressed: personal characteristics; cognitive ability; orientation to ethical/legal practice; engagement in professional development; collaboration with other healthcare professionals; providing teaching or coaching to patients and staff; demonstrating management skills; ensuring quality and safety in care; establishing interpersonal relationships with patients and nursing staff; and managing nursing care.

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In addition, Takase and Teraoka developed the Holistic Nursing Competence Scale (HNCS) based on the definitions and attributes of nursing competency that are mentioned above, which consisted of 36 items with a five-factor structure that were retained to form the HNCS. These factors illustrate nurses’ general aptitude and their competencies in staff education and management, ethical practice, provision of nursing care and professional development. This scale consists of 36 items and allows for the easy administration of periodic clinical nursing competency evaluations. The attributes of nursing competency identified through concept analysis are reflected onto the scale items without deviation from their original meanings. Therefore, HNCS can be considered as a holistic scale. Since this scale holds high reliability and validity, it is believed to be useful for clinical application Nursing Competency: Definition, Structure and Development.

To train nurses who can function in a wide range of facilities and settings, provide educational support and help maintain stable nursing workforce, the Japanese Nurses Association has been developing a “nursing clinical ladder (Japanese Nurses Association version)” as a nationally standardized index. This index is designed to be used in any nursing practice setting, and thus its use is not limited to the facilities with which individual nurses are affiliated. The nursing clinical ladder i) develops a standardized nursing competency index, applicable for all nurses regardless of practice setting and background and supports their competency development; ii) assures and secures nursing quality by properly evaluating nursing competencies, and iii) provides safe and trusted nursing care to patients and service users. The clinical ladder is a system that shows nursing competency throughout different phases, displays target abilities for each phase and indicates nurses’ abilities according to their achievement levels. It enables nurses to assess their own competency levels for self-improvement and can also be used for staff development Nursing Competency: Definition, Structure and Development.

A core competency of nursing is “the ability to practice nursing that meets the needs of clients cared for using logical thinking and accurate nursing skills.” The nursing competency structure consists of four abilities: the ability to understand needs, the ability to provide care, the ability to collaborate and the ability to support decision-making. These four abilities are closely related and utilized in all types of nursing practice settings.

As shown previously, nursing competency has various definitions, and different components have been indicated. Therefore, future studies are needed to clarify the relationships that exist among the components that support each nursing competency and in what order each element is acquired. Furthermore, it is important to develop nursing competency training methods, evaluate their effectiveness and conduct further research, which contributes to improving nursing quality Nursing Competency: Definition, Structure and Development

CONCLUSION

Nursing competency is a core ability that is required for fulfilling nursing responsibilities. Therefore, it is important to clearly define nursing competency in order to establish a foundation for nursing education curriculum. It is also important to identify the developmental process of nursing competency for continuous professional development after obtaining a nursing license. However, while competencies are important in improving the quality of nursing, the concept of nursing competency has not been fully developed. Nursing Competency: Definition, Structure and Development Thus, challenges remain in establishing the definition and structure of nursing competency, competency levels necessary for nursing professionals, training methods and so on. Therefore, further investigation is needed to establish a full concept of nursing competency.