Vous êtes sur la page 1sur 8

ce

article

Earn 2.3 Contact Hours

Competency in Nursing: A Concept Analysis


Donna D. Scott Tilley, PhD, RN

yielded 60 articles. Articles lacking application were not


abstract used. The reference lists of selected articles provided
Competency is a topic of great interest to educators and additional sources. In addition, landmark publications
administrators in practice disciplines, particularly health care such as the Institute of Medicine’s (IOM; 2003) Health
disciplines such as nursing. This article focuses on the role of Professions Education report were used.
competency in nursing. Through a concept analysis process, The method used for the concept analysis was taken
various elements of competency were assessed. The defin- from Walker and Avant (2004). Their seven-step process
ing attributes of competency are the application of skills in provides a structured way to analyze the concept of com-
all domains for the practice role, instruction that focuses on petency (Sidebar 1). The purpose of this analysis was to
specific outcomes or competencies, allowance for increasing provide a framework for tracking knowledge, skills, and
levels of competency, accountability of the learner, practice- attitudes throughout a career.
based learning, self-assessment, and individualized learn-
ing experiences. The learning environment for competency Findings
assurance involves the learner in assessment and account- Role of Competency
ability, provides practice-based learning opportunities, and The role of competency in education has grown dra-
individualizes learning experiences. matically as health care employers and educators have
J Contin Educ Nurs 2008;39(2):58-64. identified the gap between education and practice. The
IOM (2001) identified several challenges to health care
in the United States. To improve initial and ongoing

A lthough the concept of competency is relevant to


all health care disciplines, a common understanding
of what competency is does not exist. A comprehensive
professional education, the IOM called for educational
strategies to include a focus on competence. Addition-
ally, graduates are not typically prepared to care for
review of the literature regarding clinical competency by high-acuity patients with comorbidities and complex
Watson, Stimpson, Topping, and Porock (2002) yielded treatment regimens (IOM, 2003).
little consensus about a clear definition or measurement Gaps between educational preparation and actual
of the concept of competency. Indeed, educators and em- practice were attributed to factors such as a lack of
ployers of health care professionals often have disparate funding to update curricula and a limited focus on
views of competency (Whittaker, Smolenski, & Carson, teaching in academic health centers. The IOM outlined
2000). the following core competencies for health profession-
No mechanism exists for most health care facilities to als: work in interdisciplinary teams, provide patient-
ensure that practitioners remain up-to-date with current centered care, employ evidence-based practice, use
best practices. Schools of nursing throughout the United informatics, and apply quality improvement (IOM,
States struggle to determine the best ways to educate stu- 2003).
dents who demonstrate entry-level competencies. Em- Although the majority of literature about competence
ployers struggle to determine the best ways to validate in nursing education focuses on undergraduate educa-
entry-level competencies and determine specialty com- tion, assuring increasing levels of competency across the
petencies. educational continuum is important. Education at the

Methods Dr. Scott Tilley is Nursing Director, Texas Christian University, Fort
Worth, Texas.
A review of nursing, medical, public health, and edu-
The author discloses that she has no significant financial interests in
cational literature from the 5 years prior to January 2006 any product or class of products discussed directly or indirectly in this
was conducted. The keyword “competency” was used activity, including research support.
to search publications in English. The search engine CI- Address correspondence to Donna D. Scott Tilley, PhD, RN, Texas
NAHL yielded 187 articles and the search engine Ovid Christian University, TCU Box 298620, Fort Worth, TX 76129.

58 The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2


ce
article

Earn 2.3 Contact Hours

Sidebar 1 Sidebar 2
Concept Analysis Steps Competency outcomes and
l Select a concept performance assessment: Core
Competencies
l Determine the aims or purposes of the analysis
l Assessment and intervention
l Identify all the uses of the concept that can be discovered
l Communication
l Determine the defining attributes
l Critical thinking
l Identify a model case, borderline case, and contrary case
l Teaching
l Identify antecedents and consequences
l Human caring relationships
l Define empirical referents
l Management
Note. Data from Walker and Avant (2004).
l Leadership
l Knowledge integration skills
graduate level and beyond must be offered with increas- Note. Data from Lenburg (1999b).
ing competency as a goal.
Although education based on competency may be
agreed upon, determining which competencies are most 1990s as professional nursing organizations, consumer
critical, at what level they should be demonstrated, and advocacy groups, and a rapidly changing health care en-
how to teach them remains unclear. Evaluating cogni- vironment led nursing to continue its efforts to create
tive, affective, and psychomotor achievement of skills safe environments for patients. This movement was ac-
and knowledge that increase in complexity throughout celerated by the Pew Health Professions Commission’s
a career is challenging. reports (Pew Health Professions Commission, 1995) and
the Interprofessional Workgroup on Health Professions
Origin of the Concept of Competency Regulation (IWHPR; 1997) continuing competence
Competency is derived from the Middle French and summit in the mid-1990s.
Latin word competens. To be competent is to be proper In 1999, Lenburg (1999b) described the Competency
or rightly pertinent, to have requisite or adequate ability Outcomes and Performance Assessment (COPA) model,
or qualities, to be legally qualified or adequate, or to have which was applied in an academic setting but viewed as
the capacity to function or develop in a particular way equally applicable in the practice setting (Redman, Len-
(Merriam-Webster Online, n.d.). The National Coun- burg, & Hinton Walker, 1999). This model uses four
cil for State Boards of Nursing (NCSBN; 2005) defined guiding questions to create an organizing framework
competency as “the application of knowledge and the to assist in the transition to competency outcomes and
interpersonal, decision-making, and psychomotor skills performance assessment. Eight core competencies were
expected for the practice role, within the context of pub- identified (Sidebar 2). Evaluation is performed at didactic
lic health” (p. 81). McMullan et al. (2003) distinguished and clinical levels to promote accountability in the eight
between competence and competency, stating that com- core areas.
petence is focused on the description of the action or be- Also in 1999, the Accreditation Council for Graduate
havior, while competency is focused on the individual’s Medical Education (n.d.) endorsed general competen-
behavior that underpins the competent performance. cies for residents. This was the first step in the council’s
These terms are frequently used interchangeably. process of incorporating these competencies into its
Beginning in the early 1980s, many boards of nursing requirements. The general competencies identified for
began to explore the issue of competencies for graduating medical residents were patient care, medical knowledge,
nurses in their states. Several states developed essential practice-based learning and improvement, interpersonal
competencies of nursing program graduates. Typically, and communication skills, professionalism, and systems-
these competencies are specified by educational program based practice.
preparation (e.g., diploma, associate degree, and bach- Genomics, once considered a specialty area, is in-
elor’s degree). Most identify the knowledge, judgment, creasingly being recognized as a central science for all
skills, and professional values expected of graduates of health care professionals. With this in mind, a panel of
nursing programs. nurse leaders convened in 2005 to establish competen-
Continued competency became a topic of intense cies required for delivery of genetic and genomic fo-
and frequent discussion among nurses nationally in the cused nursing care. The essential competencies of pro-

The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2 59


ce
article

Earn 2.3 Contact Hours

fessional responsibilities, professional practice domain, for new graduates, other states have opted to improve
referral activities, and provision of education, care, and the preparation of nurses for entry into practice through
support were identified. Each core competency has spe- other means (New Mexico Consortium for Nursing
cific behaviors by which it can be assessed. The Genom- Workforce Development, 1999; North Carolina Board
ics Consensus Panel recommends strategies to facilitate of Nursing, 2005). The Kentucky Board of Nursing
the development of the competencies to include long- (2006), after examining the congruence between educa-
term planning to incorporate genomic information to tion and practice, proposed the implementation of an in-
improve public health, faculty and practice nurses seek- tegrated practicum to be completed prior to graduation
ing continuing education or academic courses to update and a clinical internship to be completed immediately
their genetic and genomic knowledge, and collaboration following graduation.
with other disciplines (International Society of Nurse Certification by national agencies has historically
Geneticists, 2007). been a voluntary process, yet some states use certifica-
tion as an indicator of entry-level competency. However,
Uses of the Concept of Competency research is lacking to demonstrate that certification ex-
The NCSBN (2005) acknowledged the relevance of aminations are linked to competency or improved pa-
continued competency of nurses at all levels as an im- tient outcomes (Whittaker et al., 2000).
portant issue for all state boards of nursing. To apply the The performance-based development system is a
concept of competency to all practitioners at all levels of competency assessment system that uses video, audio,
practice, the NCSBN definition focused on the practice and written simulations to measure competency for
role within the context of public health. practice (del Bueno, 1990). del Bueno developed this as-
Competency-based education is defined by the Ac- sessment tool to standardize the orientation program for
creditation Council for Graduate Medical Education new hires. The performance-based development system
(n.d.) as an approach to instruction and assessment that measures critical thinking as well as interpersonal and
places primary emphasis on identifying and measuring technical skills in many practice settings.
specific learning outcomes or competencies. This ap- Competency Assessment in Initial Education. A com-
proach to instruction contrasts with more traditional petency-based approach to initial nursing education is
didactic methods of teaching and evaluation. Didactic not the norm for most prelicensure schools of nursing.
course evaluation uses objective testing strategies to de- Watson et al. (2002) noted the absence of a reliable and
termine cognitive achievements, whereas competency- valid method of competency-based training. Many pro-
based education uses demonstration of skills and knowl- grams issue a grade for didactic content mastery and a
edge to evaluate performance potential. pass–fail grade for clinical performance (Fordham, 2005).
Competency Assessment. Currently, in most states, a This practice further distances graduates from an expec-
nurse is determined to be competent when initially li- tation of an assessment of ongoing competence.
censed. Continued competency is assumed thereafter un- Evidence of fitness for practice can be demonstrated
less otherwise demonstrated. The dominant method to through the development of a practice portfolio (Ford-
assess a health care professional’s continued competency ham, 2005; Girot, 2000; McMullan et al., 2003). A port-
is traditional didactic continuing education (e.g., formal folio is a purposeful collection of traditional and nontra-
conferences, lectures, and dissemination of educational ditional work that represents student or nurse learning
materials; IOM, 2003). Little evidence exists that these activities, progress, and achievement over one’s academic
methods have any effect on clinicians’ behavior or pa- career (Scholes et al., 2004).
tients’ or systems’ health outcomes (IOM). State boards The development of a practice portfolio places the
of nursing are considering other ways to determine con- onus for learning and development with the individual.
tinued competency of practicing nurses. Indeed, the use of practice portfolios is based on prin-
Evaluating continued competency is a difficult pro- ciples of adult learning and active learning rather than
cess, primarily because the evaluation standards are not passive learning (McMullan et al., 2003). In addition to
yet clear for nursing. The NCSBN (2005) outlined several promoting active learning and individual accountabil-
options for a basis for evaluation: the current entry-level ity, portfolios are thought to promote development of
National Council Licensure Examination (NCLEX), critical-thinking skills. Although portfolios are widely
generalist core competency at each licensure level, fo- used and accepted by schools of nursing and offer many
cused areas of practice, essential emerging knowledge, or positives, their evaluation continues to be a subjective
some combination of these. process that is not easily amenable to standardization or
Whereas some states have differentiated competencies objective assessment (McMullan et al.). Ensuring equity

60 The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2


ce
article

Earn 2.3 Contact Hours

and consistency in evaluation is a key concern with the Academy of Nurse Practitioners certification renewal
use of portfolios (Scholes et al., 2004). process requires documentation of clinical practice as
Krenz (2003) suggested using nursing outcomes clas- a nurse practitioner, and continuing education (Yoder-
sification as the foundation for a competency-based un- Wise, 2006). The American Nurses Credentialing Center
dergraduate curriculum. Krenz used discipline-specific accepts practice hours, continuing nursing education,
outcomes in curriculum revision to write competency academic education, presentations, publications, and
statements that reflected what nursing students were to preceptorship for certification renewal (Yoder-Wise).
achieve in care implementation. Analysis of this curricu- Portfolios, widely used to evaluate competence in
lum development determined that it provided clarity and initial education programs, are gaining popularity as a
direction to the curriculum. tool for documenting ongoing competency in practice.
Similar to the COPA model, Reising and Devich (2004) Web-based systems for tracking competencies for pro-
suggested assessing progressively difficult skill sets in suc- fessionals in practice are available and gaining popular-
cessive semesters of a baccalaureate nursing program as a ity. Software for this inexpensive and portable method
way to evaluate competency. Consistent evaluation criteria of maintaining records related to ongoing competency
across all courses should include critical thinking and pri- activities continues to be developed (Hobbs, 2005).
ority setting, health assessment, psychomotor skills, and
communication, including patient teaching and documen- Defining Attributes of Competency
tation. As with other methods of competency assessment, In their review of the literature regarding competency
lack of evaluation consistency was a drawback identified in nursing education, Watson et al. (2002) found that in 22
by students and faculty. Student anxiety, not necessarily a of 61 articles on the topic, authors did not define the term
disadvantage of other methods of assessment, was a sig- competency. The NCSBN (2005) elucidated the reasons
nificant drawback as well (Reising & Devich). why there is no clear solution to evaluating competency.
In addition to competency assessment for students, The reasons for the lack of clarity in defining competency
competency assessment in ongoing and advanced prac- include that competency is multifaceted and difficult to
tice is becoming more common. measure; the volume of nurses in practice makes it diffi-
Competency Assessment in Ongoing Practice. The IOM cult to identify feasible and meaningful, yet cost-effective,
(2003) recommended that all licensed health professionals regulatory approaches; agreement is lacking about who
be required to periodically demonstrate their ability to should be responsible for continued competency; nursing
deliver patient care as defined by the core competencies careers are widely divergent with various levels of practice;
for health professionals. These competencies were to be and there is an inherent evolution of practice from the new,
measured directly through technical competence, patient entry-level graduate to the experienced nurse (Bargagliotti,
assessment, evaluation of patient outcomes, and other Luttrell, & Lenburg, 1999).
evidence-based assessment methods. Further, the IOM The barriers to clarity outlined by the NCSBN are
recommended that certification bodies require certificate compounded by the fact that there are currently two
holders to maintain competence throughout their careers common uses for the concept of competency: maintain-
by periodically demonstrating their ability to deliver care ing ongoing competency in practice and preparing for
reflecting the core competencies. initial licensure (Sidebar 3).
Currently, the most common method of demon-
strating continued competence for licensure renewal is Cases of a competency focus in
continuing education (NCSBN, 2005). Continuing edu- education
cation is required for license renewal by 25 registered A Model Case
nurse boards and 24 licensed vocational nurse boards. A model case provides an example of the concept that
Of these, 12 boards require specific subject matter as a demonstrates all defining attributes of the concept, or a
part of licensure maintenance (NCSBN). Other boards pure exemplar (Walker & Avant, 2004). For an example
require a specific number of continuing education or of a model case, consider the following actual nursing
practice hours. For renewal of an inactive license, many school curriculum.
boards require a refresher course and some require a Alverno College is known for its innovative focus
competency examination (NCSBN). Advanced practice on the learner. This college was among the first to use
nurses may also be required to seek specific content (Yo- a web-based diagnostic digital portfolio to allow nurs-
der-Wise, 2006). ing students to track their learning progress through
Advanced practice nurses have a similar model for their years of study (Alverno College, n.d.). As students
demonstrating ongoing competence. The American receive feedback from faculty, external assessors, and

The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2 61


ce
article

Earn 2.3 Contact Hours

and evaluation process used by Alverno College repre-


Sidebar 3 sents a model case that incorporates the defining attri-
Defining Attributes of Competency in butes of competency-based education.
Nursing and Nursing Education
Characteristics of education focused on competency A Borderline Case
A borderline case is an example of a case in which
Lenburg (1999a)
some, but not all, defining attributes of the concept are
An intentional shift from traditional patterns of informa- demonstrated (Walker & Avant, 2004). Borderline cases
tion giving to actively engaging students in real time
are inconsistent in some way with one or more of the de-
Collaborative learning, based on developing and ex-
panding assessment, critical thinking, communication,
fining attributes of the concept. For a borderline case of
and leadership competency assessment in nursing education, consider
Accreditation Council for Graduate Medical Education the following actual example.
(n.d.) A registered nurse to bachelor of science in nursing
Explicit and clearly aligned with expected competencies program at a large Southwestern university is a web-
Criteria driven, focused on accountability in reaching
based program that individualizes degree plans and clini-
benchmarks and, ultimately, competence cal experiences. Students start portfolio construction at
Grounded in “real-life” experiences
the beginning of the curriculum and maintain a current
portfolio throughout. Courses are specifically designed
Focused on fostering learners’ ability to self-assess
for registered nurses and advanced placement or gradu-
Individualized and providing more opportunities for ate course substitution based on previous experience is
independent study
encouraged. Testing is not a component of any course,
Defining attributes of competency in nursing and nursing
education
but each course does require students to write at least one
paper with clearly defined criteria. Although the program
Application of knowledge, interpersonal, decision-making,
and psychomotor skills expected for the practice role is considered strong and innovative, it represents a bor-
derline case of a competency focus in education because
Instruction and assessment that places primary emphasis
on identifying and measuring specific learning outcomes it is missing defining attributes (i.e., a focus on fostering
or competencies learners’ ability to self-assess and provision of opportuni-
Allowance for increasing levels of competency for increas- ties for independent study).
ingly complex care
Criteria driven, focused on accountability in reaching A Contrary Case
benchmarks and, ultimately, competence A contrary case is one in which none of the defin-
Grounded in “real-life” experiences ing attributes are met, or a case that is “not the concept”
Focused on fostering learners’ ability to self-assess (Walker & Avant, 2004). For a contrary case of a com-
petency focus in education, consider the following con-
Individualized and providing more opportunities for
independent study structed example.
School A is a traditional didactic-based program in
which testing classroom content is the primary method
peers, they are able to look for patterns in their own aca- of evaluation. Students attend classroom instruction ex-
demic work to continue development in areas indicated clusively for the first 2 years of the 4-year program. The
and be autonomous learners. Clearly defined competen- second half of the program includes a clinical component
cies provide a guideline, and students must demonstrate that requires students to perform nursing skills that must
mastery of lower-level competencies before moving into be completed before the end of the program. Students can
higher-level content. Students are expected to demon- either pass or fail the clinical component of each course,
strate integration and mastery of knowledge, interper- and detailed feedback is not provided regarding their clin-
sonal, decision-making, and psychomotor skills. The ical performance. All defining attributes of competency
diagnostic digital portfolio is built on Alverno’s student are absent in this imaginary nursing program.
assessment-as-learning process, making it more trans-
parent to the student and others who seek to understand Antecedents and Consequences
this important educational program. It also provides ac- Antecedents are events that must occur prior to the
tual, accessible performance data with which graduates occurrence of the concept. Consequences are the events
can create an electronic résumé for potential employers that occur as a result of the occurrence of the concept, or
or for graduate schools (Alverno College). The teaching the outcomes of a concept (Walker & Avant, 2004).

62 The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2


ce
article

Earn 2.3 Contact Hours

Antecedents for competency are educational pro-


grams, students, faculty or teachers of nurses, and key points
practicing nurses. The literature review suggested that
Competency in Nursing
willingness to use innovative approaches to nursing edu- Scott Tilley, D. D. (2008). Competency in Nursing: A Concept
cation and assessment of ongoing readiness for practice Analysis. The Journal of Continuing Education in Nursing, 39(2),
is also an antecedent. 58-64.
Consequences of competency remain largely undeter-
mined and untested. The current literature implies that a
consequence of a focus on competency in education is 1 Competence is focused on the description of the action or
behavior, whereas competency is focused on the individual’s
behavior underpinning the competent performance.
a narrowing of the gap between education and practice,
leading to improved patient outcomes, clinical judgment,
and accountability and self-assessment of learners.
2 Little evidence exists that commonly used continuing educa-
tion methods have any effect on clinicians’ behavior or patient/
systems health outcomes.
Empirical Referents
Empirical referents are processes by which the con-
cept of competency can be measured (Walker & Avant,
2004). Measuring the gap between education and prac-
3 The current literature about competency implies that a conse-
quence of a focus on competency in education is a narrowing
of the gap between education and practice, leading to im-
tice continues to challenge researchers, educators, and proved patient outcomes, clinical judgment, and accountability
practice administrators. Watson et al. (2002) demon- of learners.
strated a lack of reliable and valid methods for evaluat-
ing competency, particularly in education. As measure-
ment tools are developed and selected, ensuring that needed. Initial competency measurement is critical, but
they are comprehensive, reliable, valid, and free of bias it needs to be determined at what point in an individual’s
is important. career measurement of competency moves from general
The current trend of using portfolios to demonstrate competence to specialized competency. Determining
ongoing competency lacks a clear empirical referent for who is responsible for developing guidelines and assur-
competency. Development of processes by which port- ing initial and ongoing competency is another important
folios can be standardized and evaluated is required be- issue. This responsibility could lie with the individual, a
fore portfolios will provide measurable outcomes. professional association, an employer, a board of nurs-
Krenz (2003) suggested using the nursing outcomes ing, or credentialing entities. The American Nurses As-
classification as the foundation of a competency-based sociation has stated that assurance of continuing compe-
undergraduate curriculum. Competency statements that tency is the shared responsibility of these various entities
reflect what nursing students are to achieve in care im- (Whittaker et al., 2000).
plementation are a step closer to objective measurement As methods for assessing and teaching from a com-
of outcomes. petency-based framework continue to be developed, it
Assessing progressively difficult skill sets in succes- is important for these issues to be considered. A flex-
sive semesters of a baccalaureate nursing program pro- ible, efficient, and effective framework will be required
vides a comprehensive solution to measurement (Reising to assess the broad range of nursing functions (Lenburg,
& Devich, 2004). However, inconsistency in evaluation 1999a). A model must be developed that provides for
is a drawback to this subjective method, as is student safety of care to patients, incorporates choice for nurses
anxiety (Reising & Devich). to document or demonstrate their competency, and is
cost-effective and practical.
Conclusion Certification, portfolios, electronic tracking of com-
Competency is an exciting and challenging concept in petencies, and progressive skills testing are useful. Fur-
education that may address gaps between education and ther research in this arena is required. Bridging the gap
practice. The best methods to teach and evaluate using a between practice and education requires innovation by
competency model remain unclear and in need of more nurse educators in collaboration with practice partners.
research.
There is a lack of consensus about several important References
issues surrounding competency. A clear and consistent Accreditation Council for Graduate Medical Education. (n.d.). Out-
come project: Minimum program requirements language. Retrieved
definition of competency is an important step. Deter-
January 4, 2008, from www.acgme.org/outcome/comp/compMin.
mination of at what point to measure competency is asp

The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2 63


ce
article

Earn 2.3 Contact Hours

Alverno College. (n.d.). Alverno’s diagnostic digital profile. Retrieved J., et al. (2003). Portfolios and assessment of competence: A review
January 4, 2008, from www.alverno.edu/academics/ddp.html of the literature. Journal of Advanced Nursing, 41(3), 283-294.
Bargagliotti, T., Luttrell, M., & Lenburg, C. B. (1999). Reducing threats Merriam-Webster Online. (n.d.). Retrieved January 4, 2008, from www.
to the implementation of a competency-based performance assess- m-w.com/dictionary/competent
ment system. Retrieved January 9, 2008, from www.nursingworld. National Council for State Boards of Nursing. (2005). Business book:
org/ojin/topic10/tpc10_5.htm NCSBN 2005 annual meeting. Chicago, IL: Author.
del Bueno, D. J. (1990). Experience, education, and nurses’ ability to New Mexico Consortium for Nursing Workforce Development.
make clinical judgments. Nursing & Health Care, 11(6), 290-294. (1999). Standards for differentiated competencies of the nursing
Fordham, A. J. (2005). Using a competency based approach in nurse workforce at the time of entry/advanced beginner. Albuquerque,
education. Nursing Standard, 19(31), 41-48. NM: Author.
Girot, E. A. (2000). Assessment of graduates and diplomates in practice North Carolina Board of Nursing. (2005). Continuing competence. Ra-
in the UK: Are we measuring the same level of competence? Jour- leigh, NC: Author.
nal of Clinical Nursing, 9(3), 330-336. Pew Health Professions Commission. (1995). Performing health care
Hobbs, D. (2005). Tracking clinical competencies on the web. Radio- workforce regulation: Policy considerations for the 21st century. San
logic Technology, 76(5), 345-349. Francisco: University of California San Francisco Center for the
Institute of Medicine. (2001). Crossing the quality chasm: A new health Health Professions.
system for the 21st century. Washington, DC: Author. Redman, R. W., Lenburg, C. B., & Hinton Walker, P. (1999). Com-
Institute of Medicine. (2003). Health professions education: A bridge to petency assessment: Methods for development and implementa-
quality. Washington, DC: Author. tion in nursing education. Retrieved January 4, 2008, from www.
International Society of Nurse Geneticists. (2007). Genetics/genomics nursingworld.org/ojin
nursing: Scope and standards of practice. Philadelphia: Author. Reising, D., & Devich, L. (2004). Comprehensive practicum evaluation
Interprofessional Workgroup on Health Professions Regulation. across a nursing program. Nursing Education Perspectives, 25(3),
(1997). Continued competency summit: Assessing the issues, meth- 114-119.
ods, and realities for health care professions. Course materials: A Scholes, J., Webb, C., Gray, M., Endacott, R., Miller, C., Jasper, M., et
compendium of conference handouts. al. (2004). Making portfolios work in practice. Journal of Advanced
Kentucky Board of Nursing. (2006). Entry into practice: A regulatory Nursing, 46(6), 595-603.
initiative. Retrieved January 22, 2006, from http://kbn.ky.gov/ Walker, L., & Avant, K. (2004). Strategies for theory construction in
education/pon/entry nursing (4th ed.). Norwalk, CT: Appleton & Lange.
Krenz, M. (2003). The use of NOC to direct a competency based cur- Watson, R., Stimpson, A., Topping, A., & Porock, D. (2002). Clinical
riculum. International Journal of Nursing Terminologies and Clas- competence assessment in nursing: Review of the literature. Journal
sifications, 14(Suppl. 4), S59. of Advanced Nursing, 39(5), 421-431.
Lenburg, C. (1999a). Redesigning expectations for initial and continu- Whittaker, S., Smolenski, M., & Carson, W. (2000). Assuring continued
ing competence for contemporary nursing practice. Retrieved Janu- competence: Policy questions and approaches. How should a profes-
ary 4, 2008, from www.nursingworld.org/ojin sion respond? Retrieved January 4, 2008, from www.nursingworld.
Lenburg, C. (1999b). The framework, concepts and methods of the org/ojin
competency outcomes and performance assessment (COPA) model. Yoder-Wise, P. (2006). State and certifying boards/associations: CE and
Retrieved January 4, 2008, from www.nursingworld.org/ojin competency requirements. The Journal of Continuing Education in
McMullan, M., Endacott, R., Gray, M., Jasper, M., Miller, C., Scholes, Nursing, 37(1), 3.

64 The Journal of Continuing Education in Nursing · February 2008 · Vol 39, No 2