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Bishwajit Mazumder
Nursing Instructor
Dhaka Nursing College, Dhaka
E. mail: mbishwa@rocketmail.com
Nursing Staffs Competencies Development and the Roll of Nurse
The term competency is often used to describe the knowledge to be able
perform at a particular task. According to Norman (1985) competency is more than
knowledge. It includes the understanding of knowledge, clinical, technical, and
communication skills, and the ability to problem solve through the use of clinical
judgment. Competence is the ability to perform a specific task, action or function
successfully. Competencies are used to create unique standards within disciplines and
specialties. This encompasses educators, learners, and practitioners. According to
Verma (2006), competencies in education create an environment that fosters
empowerment, accountability, and performance evaluation, which is consistent and
equitable. Black and Wolf (1990) describe competence as the ability to perform in
effective ways on different occasions including in differing and unexpected contexts
[cited in While, 1994]. However, even if performance can be measured, there is a lack
of evidence to suggest that good performance is always an adequate indicator of high
degrees of competence [Stedman 1985, cited in While 1994, 9].

Background and Significance:

The nurse manager role is currently seen as one of the hardest, most
complex roles in healthcare (Thrall, 2006). Sanders, Davidson, and Price (1996)

emphasize thatthe nurse manager is responsible for translating strategic goals and
objectives formulatedat the operational level into practice; thus, the position of nurse
manager requires anability to interpret general concepts and integrate them into
specific clinical andmanagement performance, while simultaneously determining and
monitoring outcomes. This nurse manager role is important because it is the direct
link between the administrative mission and vision, and the direct care provider. In
addition, the nursemanager role provides not only administrative and clinical
leadership, but also has 24- hour accountability for all patient care activities on the
unit (Beuchlin-Telutki, Bilak, Merrick, Reich, & Stein, 1993; Thrall, 2006). The role
of the nurse manager in the acutecare nursing area is pivotal in the development and
retention of staff, as well as overallunit productivity. In total, the nurse manager has
the responsibility to assure that themission of the organization is translated into
everyday practice, while assuring the qualityand efficiency of the daily operations of
their unit.
Changes in healthcare economics, advances in technology, and structural
operations indelivery systems have caused organizational transformation in healthcare
institutionsimpacting nurse managers (Kleinman, 2003). Nurse managers are
instrumental in role modeling and setting expectations for staff nurses regarding the
importance of highquality, transparent and patient-focused care. Additionally, they are
the conduit ofcommunication between upper management and the bedside staff,
providing keymessages and setting the culture for their units and organization. The
importance of this role cannot be underestimated in successful healthcare
organizations today.


Nursing competence is a complex conceptthat is difficult to define and

assess. Competenciesemphasize the knowledge, skills, andparticular type and level of
work. Technicalskill, while a component of competency, is in itself meaningless
without the knowledge of appropriate timing/frequency of and purpose for actions.
The National Council of State Boards of Nursing (NCSBN) defines competence as the

application of knowledge, and the interpersonal, decision-making and psychomotor

skills expected for the nurses practice role, within the context of public health,
welfare, and safety (NCSBN, 2009). Competence mayalso be defined as the formal
exhibition of askill, ability, or aptitude of a professional nurse.Competence
development is the method bywhich a nurse obtains, maintains, and refinespractice
knowledge, skills and abilities. Thisdevelopment can occur through formal
education,continuing education, or clinical practiceand is expected to continue
throughout thenurses career (NCSBN, 2009). Competence, as used in this document,
is defined as ongoing professional nursing competence according to level of
expertise, responsibility and domains of practice as evidenced by behavior based on
beliefs, attitudes and knowledge matched to and in the context of a set of expected
outcomes as defined by nursing scope of practice, policy, Code of Ethics, standards,
guidelines and benchmarks that assure safe performance of professional activities
(American Nurses Association, 2000; Whittaker, Carson and Smolenski, 2002).
Some authors believe that competencies can be learned but some are
inherited, that some competencies are skills that decrease when not used, and that
some occur on a continuum. Leaders of healthcare organizations are encouraged to
identify competencies that employees need to operate successfully in the work
environment. These competencies then can be used in selection, promotion, appraisal,
and career guidance in the organization (Garman, Johnson, 2006; OHearneRebholz,
2006; Verma, et.al 2009). Eraut (1994) defines competence as a generic term referring
to a persons overall capacity, while competency refers to specific capabilities, such as
leadership. These competencies are made up of the attributes of knowledge, skills and
attitudes.A definition of continuing competence is the ongoing ability of a registered
nurse to integrate and apply the knowledge, skills, judgment, and personal attributes
required to practice safely and ethically in a designated role and setting. Personal
attributes include but are not limited to attitudes, values and beliefs. Saskatchewan
Registered Nurses Association, (http://www.srna.org/registration/ccp.php, date
accessed 10/01/08).

Factors that Impact on Competence:

Suffice it to say, competence does not exist in a vacuum. As the definition

implies a type of action, so must it have the ability to be acted on. There are several
factors that impact on competence, but some of the most prevalent that have been
identified include: mentoring, system and environmental issues, ethics, and the
evaluation of competence.
Mentorship is an extremely powerful tool that can help build competence, leadership
skills, self-awareness and morale (Prevosto, 2001). The United States military has
successfully used mentoring to promote competence for some time. Many business
organizations have used mentoring as well to foster competence in the workplace
(Phillips-Jones, 2004). In addition, Phillips-Jones (2004) notes that the strategy of
using mentoring groups or circles can help mentees accomplish two tasks: set
important development goals and build competence and character to reach those
goals. Having a mentor and/or coaching a learner can lead to the development of
competence and confidence in the learners own skills and abilities (Fumiano,2007).
Strategies have been identified for mentoring in the field of education from the
classroom to the online learning environment. Rayner, et. al. (2004) purport that
coaching is an important skill to add to a leaders repertoire of competence.
Mentoring and the related topic of coaching in health care environments have been
topics of research for some time. A study by Byrne and Keefe (2002) examined how
mentoring can be used to build research competence in nursing in various professional
and geographic settings. Competence, thus, can positively influenced by the use of a
mentor or mentoring groups. Mentoring continues to be an effective educational
strategy that develops and enhances competence.

System and Environmental Issues:

Demand for nurses has exceeded supply in certain types of patient care
specialties, such as critical care, cardiac, neonatal, and perioperative nursing (ANA,
2000). Indeed, demand has intensified for more baccalaureate-prepared nurses with
skills in critical thinking, case management, and health promotion skills across a

variety of inpatient and outpatient settings (Goode, et al., 2001). While there is a
demand for more nurses, it is implied that the nurses be competent to practice. An
essential aspect of nursing practice is the development and maintenance of
The current health care system needs not only more practicing nurses but
also competent practicing nurses. The American Nurses Association (ANA) through
the American Nurses Credentialing Center (ANCC) established the Magnet Hospital
Recognition Program to identify excellence in the provision of nursing services.
Currently, the Magnet Nursing Services designation is bestowed for four years and the
highest level of reward that can be accorded to organized nursing services in health
care organizations (ANCC, 2001). Nurse scientists have continued to evaluate magnet
hospitals. Recent studies have substantiated improved patient outcomes within
organizational environments that supportprofessional nursing practice. The Magnet
Nursing Services designation remains a valid marker of excellence in nursing care
(Aiken, Havens & Sloane, 2000).
The American Association of Colleges of Nursing (AACN) Task Force on Hallmarks
of the Professional Practice Setting (AACN White Paper, 2002) identified
characteristics of the practice setting that best support professional nursing practice
and allow baccalaureate and higher degree nurses to practice to their full potential.
Thus, the environment in which one works as well as the type of organizational
system in which one works and learns can affect the development of competence.
This stems from the literature on education and the learning environment. It also
translates the work of nurse researchers (Aiken, et.al.) who document the impact that
the environment has on the satisfaction of nurses at work. Learning and competence,
it seems, occur best in environments in which theemployee, in this case the nurse,
feels empowered and able to freely learn.
Ethics and competence involve two related aspects; first is the ethical nurse
who practices competently and second,there is a component of being ethically
competent. The development of ethical competence is of importance when it comes to

being able to both reduce practice errors and retain nurses in health care. Ethics in
perioperative practice has become especially prominent as a focus on patient safety
has come to the forefront. Perioperative nurses have a tradition of promoting patient
safety by intervening to minimize the risks related to surgical infectionand injury
(Beyea, 2002). The action of intervening in high-risk situations may be motivated by
practice standards, professional duty, ethical values and beliefs. When surgical errors
happen, there is the responsibility or duty to report the errors and that is where the
ethical imperative enters into nursing practice. Ethical practice is important to nursing
as it underpins the fiber of the practice itself by providing an action guide for nurses.
With the increased awareness of medical malpractice in general, and surgical or
perioperative errors in particular, it has become imperative for nurses to be able to
speak out when errors, or the potential for errors, become evidenced. According to
Hettiarchy (2001), surgical errors often appear the worstthe end points insurgery
are often more concrete and immediate than in medicine survival or death, cure or
The American Nurses Association (ANA) Code of Ethics for Nurses with
Interpretive Statements (2001) third provision asserts that the nurse promotes,
advocates for, and strives to protect the health, safety, and rights of the patient. This
relates to the ANA Code statement that as an advocate for the patient, the nurse must
be alert to and take appropriate action regarding any instances of incompetent,
unethical, illegal, or impaired practice... (p.14). This provision specifically directs
nurses to take some type of action to support the rights of their patients.The concept
of ethics as an action guide is inherent in nursing practice and nursing practice
involves nurses having the power and knowledge to competently care for patients.In a
variety of studies, participants perceived themselves as patient advocates
(Lutzen&Nordin, 1994; Schroeter, 2004; Sellin, 1995; Snowball, 1996), but also felt a
sense of powerlessness at times in their ability to assist their patients (Erlen& Frost,
1991; Gaul, 1995). This sense of powerlessness as voiced by nurses was related to
their roles as nurses as well as a perceived lack of support by their nursing managers
or hospital administration (Schroeter, 2004).

Evaluation of Competence:

Qualification for practice is assured by licensing laws and by professional

standards. Familiar examples in nursing for assuring competency include: licensing
exams for practice entry, continuing education (CE) for renewal of practice license,
work-based orientation programs, and graduation from an accredited program of
study. It is traditionally assumed that licensure of health care professionals indicates
that they are minimally competent. Many nursing specialty organizations offer
examinations and other processes for certification, suggesting thatcertification is
associated with continued competency. Continuing education and testing provides a
limited picture of an individuals knowledge and/or skill acquisition in a limited area
at one point in time. Laws and rules are generally considered to uphold thelowest
minimum standard for practice. Licensing laws for example, protect patients from
harm, but do not hold professionals accountable to a skill level that promotes quality.
Competency is a complex construct that requires numerous measures. To practice
competently requires us to comply with external competence measures and to reflect
ethically about competence The methods by which competence is evaluated also must
be included in a review of the overall issue of competence. In order to ensure
competence in nursing practice, there must be reliable means by which this practice
can be assessed. Currently, there are many means used to evaluate competence. In
addition to examinations, there areother methods and frameworks utilized for
continuing competency assessment (Vandewater, 2004).

Competency indicator and assessment tools:

Existing reviews have identified numerous tools for assessment of

competence in nursing. However, no one comprehensive and effective measure has
been established. Indeed, in view of the lack of rigorous evidence, Watson concludes
that the literature does not currently support competence-based approaches to nurse
training. Few of the articles identified in the current review described approaches to
ensure validity and reliability of competence assessment tools with any degree of
rigor, mirroring findings reported elsewhere. There is general agreement in the

literature that assessment of competence should involve more than one indicator.
McGrath identifies that technical skills are easier to measure using standardized tools,
whereas non-technical skills require a level of judgment on the part of the assessor,
taking into account other factors that may not be considered using the assessment tool.
A number of authors have attempted to address the issue of how to measure nontechnical skills. However, Pearson highlights that, as more accommodation is made
for independent decision making, the more difficult it is to set specific criteria for
measurement of success.
There6 indicatoridentified a range of items that may be used as indicators for
competence in clinical nursing practice:

Continuing education , Portfolios , Examinations , Peer review (assessment)

Direct observation ,Self-assessment , Interview , Patient outcomes.

Each of these items is discussed in more detail later in this review.

Approaches to development of competency indicators:

Provides a brief summary of the methods and results of articles identified in
the current review that described the development of competency indicators. Where
validity, reliability or other outcomes were assessed, a brief overview of the results is
provided. A common methodological theme across all articles that described the
development of competency indicators was broad consultation with the relevant
professional group followed by refinement and expert review.
Pilot and validity testing outcomes :
Key findings from each of the identified articles are described in Table 3. A
brief summary is provided below, highlighting similarities and common issues
identified. Some of these issues are discussed in more detail in later sections about
individual indicators.
Number of competencies:
Some authors described the need to reduce the number of competencies
included in their assessment tool as a result of pilot testing.

Language of competencies:
Clarifying the language used to avoid confusion and ambiguity was a
common outcome of pilot testing.

The time required to use the tool was flagged as a potential barrier to its
implementation by some authors.
Lessons learned by competence indicator developers :
A number of findings from the studies identified may serve as valuable
lessons for groups planning to develop and evaluate competence indicators and
assessment tools. Key points are listed below:

a. When developing competence indicators, include input from the relevant

professional group to ensure the indicators are meaningful and relevant.

b. When measuring the effects of competence indicators, consider not only

individual staff satisfaction but patient and unit outcomes.

Approaches to development of competency indicators :

Provides a brief summary of the methods and results of articles identified in

the current review that described the development of competency indicators. Where
validity, reliability or other outcomes were assessed, a brief overview of the results is
provided. A common methodological theme across all articles that described the
development of competency indicators was broad consultation with the relevant
professional group followed by refinement and expert review.

a. The nature of competence insight; confusion about the distinction

between core and higher levels of competence


b. Measurement of competence indicators of continuing competence are not

easy to define and go beyond measurement of basic skills; no degree of valid
inference about continuing competence is possible using a single indicator
c. Regency of practice infers currency of knowledge and skills but insufficient
inference of competence or safety
d. Continuing professional development has the potential to improve
reflective skill, knowledge and psychomotor skills and stimulate activity but
alone is not a reliable inference of competence
e. Participation in research, committees and quality assurance programs
infers currency and involvement in practice and the desire to develop
professionally but does not infer competence
f. Writing in health journals may only infer competence in particular areas
not broad continuing competence

Role of Nurse Manager:

Demonstrates professional conduct, practices in accordance with the
Nursing Practice Standards, the Code of Ethics for Registered Nurses and legislative
requirements, and demonstrates that the primary duty is to the client to ensure
consistently safe, competent, ethical registered nursing care.
A. Competencies : Professional Responsibility and Accountability
1. Nurse manager is accountable and accepts responsibility for own actions and
decisions, including personal safety.
2. Recognizes limitations of practice and seeks assistance as necessary.
3. Articulates the role and responsibilities of a registered nurse as a member of the
health-care team.
4. Represents a professional image of nursing.
5. Demonstrates leadership in providing client care by promoting healthy and
culturally competent work environments.
6. Displays initiative, a beginning confidence, self awareness, and encourages
collaborative interactions within the nursing and health-care team.


7. Demonstrates critical inquiry processes in relation to new knowledge and

technologies that change, enhance or support nursing practice.
8. Exercises professional judgment when using agency policies and procedures or
when practicing in the absence of agency policies and procedures.
9. Organizes own workload and develops time-management skills for meeting
10. Demonstrates responsibility in completing assigned work and communicating
about work completed and not completed.
11. Uses basic conflict resolution strategies in which situations of conflict are
transformed into healthier interpersonal interactions.
12. Demonstrates an understanding of the concept of duty to report unsafe practice in
the context of professional self-regulation.
13. Protects clients through recognizing and reporting unsafe practices when client or
staff safety and well-being are potentially or actually compromised.
14. Questions, as necessary, and is prepared to challenge and take action, as necessary,
on questionable orders, decisions or actions made by other health-care team
15. Questions, recognizes and reports errors (own and others) and takes action to
minimize harm arising from adverse events.
16. Identifies, reports and takes action on actual and potential safety risks to clients,
themselves or others.
This category has two sections:
x. Specialized Body of Knowledge
xx. Competent Application of Knowledge
x. Specialized Body of Knowledge
Draws on diverse sources of knowledge and ways of knowing, which
includes the integration of nursing knowledge along with knowledge from the


sciences, humanities, research, ethics, spirituality, relational practice and critical

inquiry. Competencies : Specialized Body of Knowledge
1.Nurse manager has a knowledge base from nursing and other disciplines concerning
current health-care issues, (e.g., the health-care needs of older people,
aboriginal health, health promotion, pain prevention and management, end-oflife care, addictions, blood borne pathogens, traumatic stress syndrome and
chronic disease management).
2. His knowledge based about human growth, development and role transitions for
people of all ages and genders, especially how these impact various states of
health and wellness.
3.His knowledge based in the health sciences including physiology, pathophysiology,
pharmacology, microbiology, epidemiology, genetics and immunology.
4. His knowledge base concerning the growth and development of groups and/or
communities, and population health perspectives.
5. He/ she hastheoretical and practical knowledge of relational practice and
understands that relational practice is the foundation for all nursing practice.
6. Nurse manager demonstrates awareness about emerging community disasters and
global health issues.
xx. Competent Application of Knowledge:
Demonstrates competence in the provision of nursing care. The competency
statements in this section are grouped into four areas. While the presentation of these
competency statements appears linear in nature, the actuality of providing nursing
care reflects a critical inquiry process that embraces all competency statements.

Area 1: On-going Holistic Assessment

Area 2: Collaborates with Clients to Develop Plans of Care
Area 3: Provides Registered Nursing Care:
Area 4: On-going Evaluation of Client Care

a. Area 1: On-going Holistic Assessment:


Incorporates critical inquiry and relational practice to conduct an organized and

comprehensive assessment that emphasizes client input and the determinants of


Competencies: On-going holistic assessment

1. Nurses manager uses appropriate assessment tools and techniques in consultation
with clients and other health-care team members.
2. He/she engages clients in an assessment of the following: physical, emotional,
spiritual, cognitive, developmental, environmental, social and information or
learning needs, along with their perception of health.
3. He/ she collects information on client status using assessment skills of observation,
interview, history taking, interpretation of laboratory data and physical
assessment, including inspection, palpation, auscultation and percussion.
4.He/ she uses anticipatory planning to guide an on-going assessment of client health
status and health-care needs.
5. Nurse manager analyzes and interprets data obtained in client assessments to draw
conclusions about client health status.

b. Area 2: Collaborates with Clients to Develop Plans of Care

Plans nursing care appropriate for clients within the context of critical
inquiry, relational and caring approaches. Draws on knowledge from nursing, health
sciences and other related disciplines as well as knowledge from practice experiences,
clients' knowledge and preferences, and factors within the health-care setting,
including client and staff safety, when developing the plans of care.
Competencies: Collaborates with clients to develop plans of care
1.Nurse manager uses a critical inquiry process to support professional judgment and
reasoned decision-making to develop plans of care.
2. He/ she uses principles of primary health care in developing plans of care.
3.He/ she facilitates the appropriate involvement of clients in identifying their
preferred health outcomes.
5. Anticipates potential health problems or issues and their consequences for clients.


6. Anticipates potential staff safety concerns and initiates appropriate action.

7.Nurse manager explores and develops a range of possible alternatives and
approaches for care with clients.
c. Area 3: Provides Registered Nursing Care:
Uses multiple sources of knowledge (knowledge from nursing science,
health sciences other related disciplines, practice knowledge, clients' knowledge and
preferences, and factors within the health-care setting) to consistently provide
individualized nursing care for people of all ages and genders across a variety of
settings (acute, continuing and community) in situations related to:
i. Health promotion, prevention and population health
ii. Altered health status including acute and chronic health conditions and
rehabilitative care
iii. Hospice, palliative and end-of-life care
Competencies: Provides Registered Nursing Care
1. Nurse manager provides nursing care that is informed by a variety of models
relevant to health and healing (e.g., nursing theories, family theories,
communication and learning theories, systems theory, cultural theories,
community development and population health theories).
2. Incorporates evidence from research, clinical practice, client preference, staff safety
and other available resources to make decisions about client care.
3. Provides culturally competent nursing care.
4. Supports clients through developmental and role transitions from birth to death.
5. Manages multiple nursing interventions for clients with co-morbidities and
complex, rapidly changing health status.
6. Applies principles of population health by collaborating to implement strategies to
prevent illness and injury (e.g., immunization, communicable disease control
measures, violence, abuse, neglect, addictive behaviors, risks of mental health


7. Collaborates with clients to achieve mutually agreed upon health outcomes within
the context of care.
8. Develops and implements learning plans to meet identified client learning needs.
9. Assists clients to identify and access health and other resources in their
communities (e.g., other health disciplines, community health services, support
groups, home care, relaxation therapy, meditation and information resources).
10. Provides supportive care to clients with chronic and persistent health challenges
(e.g., mental health/addictions, dementia, cardiovascular conditions and diabetes).
11. Implements preventive strategies related to the safe and appropriate use and
administration of medication.
12. Implements preventive and therapeutic interventions safely (e.g., positioning,
managing intravenous therapies, drainage tubes, skin and wound care).
13. Applies evidence-informed practices of pain prevention and management with
clients in various states of health and illness using pharmacological and nonpharmacological measures.
14. Prepares the client for diagnostic procedures and treatments, provides postdiagnostic care, performs procedures, interprets findings and provides follow-up
care as appropriate.
15. Provides nursing care to meet hospice/palliative/end-of-life care needs (e.g.,
symptom control, spiritual care, advocacy, support for clients and significant
d. Area 4: On-going Evaluation of Client Care
Collaborates with clients and members of the health-care team while
conducting an on-going organized and comprehensive evaluation to inform future
care planning.
Competencies : On-going evaluation of client care
1.Nurse manager uses a critical inquiry process to evaluate client care in a timely


2. Monitors the effectiveness of client care in collaboration and consultation with the
client and other members of the health-care team.
3. Verifies that clients have essential information and skills.
4. Reports and documents client care and the ongoing evaluation of that care in a
clear, concise, accurate and timely manner.
C. Ethical Practice:
Competencies : Ethical Practice
1. Nurse manager establishes and maintains a caring environment that supports
clients to achieve optimal health outcomes, goals to manage illness or a
peaceful death.
2. Identifies effect of own values, beliefs and experiences concerning relationships
with clients, and uses this self-awareness to support offering culturally
competent client care.
3. Establishes and maintains appropriate professional boundaries with clients and
other team members, including maintaining the distinction between social
interaction and therapeutic relationships.
4. Engages in relational practice with clients through a variety of approaches that
demonstrates caring behaviors appropriate for clients (e.g., speech, touch,
active listening, reflecting, empathy, disclosure, confrontation, counseling).
5. Promotes a safe environment for clients, themselves and other health-care worker
that addresses the unique needs of clients within the context of care and uses a
culturally competent approach to nursing care.
6. Accepts and provides care for all clients, respectful of diverse health/illness status
or diagnosis, or experiences, beliefs, and health practices.
7. Supports clients in making informed decisions about their health care and then
respects those decisions.
8. Advocates for clients or their representatives when they are unable to advocate for


D. Service to the public:

Understands the concept of public protection and the duty to practice
registered nursing in collaboration with clients and other members of the health-care
team to provide and improve health-care services in the best interests of the public.
Competencies : Service to the public
1. Nurse manager enacts the principle that the primary purpose of the registered
nurse is to practice in the best interests of the public and to protect the public from
2. Demonstrates awareness of the impact of organizational culture on the provision of
health care and acts to enhance the presence of a culturally competent practice
3. Participates and contributes to nursing and health-care team development by:
(a) Building partnerships with health-care team members based on respect for
the unique and shared competencies of each member
(b) Recognizing that ones own values and assumptions affect positive team
(c) Contributing nursing perspectives on issues being addressed by other
health-care team members
(d) Knowing and supporting the full scope of practice of various team

4. Collaborates with health-care team members to respond to changes in the healthcare system by:
(a) Recognizing and analyzing changes that affect own practice and client care
(b) Developing strategies to manage changes affecting ones practice and
client care
(c) Implementing changes developed by others when appropriate
5. Uses established communication protocols within and across health-care agencies
and with other service sectors.


6. Uses safety measures to protect self and colleagues from injury or potentially
abusive situations (e.g., aggressive clients, appropriate disposal of sharps,
lifting devices, low staffing levels, increasing workload and acuity of care).
7. Manages physical resources to provide effective and efficient care (e.g., equipment,
supplies, medication, linen).
8. Demonstrates an awareness of healthy public policy and social justice.
E. Self-Regulation
Demonstrates an understanding of professional self-regulation by
developing and enhancing own competence, ensuring consistently safe practice, and
ensuring and maintaining own fitness to practice.
Competencies : Professional Self-Regulation
1. Understands the mandate of CARNA as the regulatory body and professional
association for registered nurses and the mandates of professional associations
and unions.
2. Demonstrates knowledge of the registered nursing profession as a self-regulating
and autonomous profession mandated by provincial legislation to protect the
3. Understands the significance of the concept of fitness to practice in the context of
individual self-regulation and public protection.
4. Identifies and implements activities that maintain ones fitness to practice.
5. Develops support networks with RN colleagues, other health-care team members
and community supports.
6. Understands the concept of continuing competence, its role in self-regulation at the
individual and professional levels, and its significance for public protection.
7. Demonstrates continuing competence by:
(a) Committing to life-long learning
(b) Assessing ones practice to identify individual learning needs


(c) Obtaining feedback from peers and other sources to augment ones
assessment and develop a learning plan
(d) Seeking and using new knowledge that may enhance, support or influence
competency in practice

Competency Issues for Future Consideration

Will competencies need to be redefined in the future? A Robert Wood
Johnson Foundation funded group on ? Quality and Safety Education for Nurses
(QSEN, 2007) was designed to address these gaps in competency development and
education. Before teaching strategies could be developed, however, the quality and
safety education for nurses (QSEN) faculty needed to identify specifically what was
to be achieved. The ultimate goal of this team was to describe competencies that
would apply to all registered nurses. The quality and safety education for nurses
( QSEN) report outlined the definitions of competencies to be shared with the
profession with the hope that nursing, through its professional organizations, can
benefit from the work. If nursing constituencies find their competency definitions
clear and compelling, over time the competencies may serve as guides to curricular
development for formal academic programs, transition to practice and continuing
education programs. In addition, the definitions can provide a framework for
regulatory bodies that set standards for licensure, certification, and accreditation of
nursing education programs (QSEN, 2007).

Professional competence and healthcare quality improvement are priorities
within the patient safety movement that has developed over the last decade.Healthcare
providers have been called uponto become more accountable for the quality ofthe care
they provide. To meet this challenge, nurses are accountable for attaining knowledge
and competency that reflects current nursing practice. Registered nurses are
accountable for supervising, teaching, and evaluating those who perform or are
preparing to perform nursing functions and for providing for the maintenance of


safe and effective nursing care, whether rendered directly or indirectlyCompetencies

emphasize the knowledge, skills, and behaviors that are required for success in a
particular type and level of work. Technical skill, while a component of competency,
is in itself meaningless without the knowledge of appropriate timing/frequency of and
purpose for actions.In addition, nursing managers are held responsible for assessing
the capabilities and competence of personnel in relation to client status and plan of
nursing care and for delegating responsibility or assigning nursing care functions to
qualified personnel. Nursing administrators are further held accountable for ensuring
a mechanism is in place to validate the qualifications, knowledge, and skills of
nursing personnel; providing educational opportunities related to expected nursing
performance; and ensuring the implementation of a system for periodic performance
evaluation of staff.

1. Kugler E.C.(2012), Validation of nursing competence : What does it mean?
2. Chase L.E.(2010), Nurse manager competencies
3. Pillay R.(2009), Perceived competencies of the nurse manager: A
comparative analysis of the public and private sectors I South Africa
4. Harper C. M. (009). Critical analysis of the discourse of competencies in
professional nursing practice
5. College and Association of registered nurses of Alberta (2006) Entry
practice competencies for registered nurses profession .
6. Evans A. (2000), Competencies assessment in nursing
7. Schroeter K. (2008), Competencies Literature review
8. Stefl M.E.,(2008), Common competencies for all health care manager: The
health care leadership alliance model
9. College of nurses of Ontario(2011), Entry practices competencies