Continuing competence in selected health care professions

Journal of Allied Health, Winter 2002 by Lundgren, Burden S, Houseman, Clare A

Registered Nurses

The National Council of State Boards of Nursing (NCSBN) was engaged in activities concerning continuing competence before the previously mentioned Pew Commission reports. Since 1985, NCSBN has published many reports addressing diverse issues in continuing competence.38 One of the Council's major contributions has been the development of a model for a professional portfolio for promoting professional development for all nurses and for regulatory boards to work with nurses who meet criteria that trigger an audit.39 Similar models have been developed by the Oklahoma Board of Nursing and the College of Nurses of Ontario. The models share certain common features: assessment of personal strengths and weaknesses, determining measurable strategies to improve practice, and personal accountability for achieving learning objectives and improving practice.40 Jasper" suggested, however, that the creation of individual portfolios also engenders common problems. Among these are a requirement for different types of education (e.g., self-reflection), a change in teacher/student roles (e.g., students set educational goals), costs of portfolio keeping and evaluation, validation issues, time requirements for nurses in keeping their profiles, and ethical issues (e.g., description of incidents relating to patients). Because consumers are often the forgotten component in discussions of continuing competence, the Alabama Board of Nursing authorized a project to determine public attitudes and expectations about the issue. One finding indicated that 89% of the public believes there is a need for nurses periodically to show competence.4"

The American Nurses Association (ANA) sees its role in continuing competence as threefold: 1) establishment of standards of practice and provision of the framework for the construction of the nurse-patient relationship, 2) development of tools to help practitioners assess and improve their performances, and 3) influencing statutes and regulations concerning safe nursing care within institutions. The ANA is collaborating with the NCSBN in the development of a joint model practice act that would address the issue of continuing competency and has convened an Expert Nurse Panel on Continued Competence. The Panel, which includes representatives from many nursing organizations (including NCSBN), is charged with developing research recommendations, defining the elements of continuing competence, and discussing the role of education in its measurement.43,44 However, the first assembly of the newly created United American Nurses, the ANA's labor union, has called for a delay, however, in all action for a proposed process to document continuing competence to allow staff nurses to have greater input.45

Issues in Continuing Competence

It is evident from the varied approaches described previously that the issue of continuing competence will be a challenge to health care professions for many years. Many issues must be addressed by all health care professions to deal with maintaining and improving the competency of their practitioners. Many health care professions have recognized their common interest in these issues. An Interprofessional Workshop has been meeting to address common regulatory interests since 1995. Continuing competence is now on their agenda.46 Four major issues that overarch all professional efforts in continuing competence are discussed subsequently.