Continuing competence in selected health care professions

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

In a minimum competence scheme, basic responsibility falls to the state regulatory process. If the public goal of continuing competence is to eliminate performance below the minimum acceptable practice level, mechanisms currently in place (e.g., complaint and disciplinary processes) are designed to address this need. If the goal is not simply to maintain competence, but to increase it, responsibility for improvement becomes broader, falling not only on the state regulatory board but also on the work setting and the individual practitioner. The College of Nurses of Ontario (Canada) differentiates three approaches to continuing competence. The competence assessment component places responsibility on the regulatory arm to ensure that nurses' practices meet legal and professional expectations. The College evaluates the competence of members, registers nurses who meet criteria, and investigates and acts as appropriate when nurses' practice is below standard.61 Nurses themselves are to engage in reflective practice. This methodology requires nurses to annually identify areas to improve to retain their competence in the changing health care environment.62 The College offers many options for nurses to fulfill this requirement. The third component is practice setting consultation which uses a model developed by the College to support and encourage agencies to develop and maintain the characteristics (e.g., communication systems, organizational supports, professional development system) needed to promote quality of care.63 The Practice Setting Consultation Program involves 10,000 nurses at almost 40 sites.64

The NCSBN identifies an additional player in terms of accountability. The NCSBN` maintains that educators bear a part of responsibility for continuing competence by:

Incorporating standards into the curriculum

Promoting integration of standards by the student

Evaluating student performance based on standards

Providing the first role model for students as to the expectation of lifelong learning and professional accountability

Economics of Continuing Competence

The costs of ensuring competence in the end are borne by the consumer. The administrative costs (e.g., remediation programs) necessary to enforce continuing competence requirements are relatively easy to evaluate. Administrative costs may be only a small component of the price, however, for increased stipulations for licensure. In a lengthy study of professional regulation, the Manitoba Law Reform Commission67 argued that licensure itself diminishes competition, drives up the costs of services, and reduces access to care. The addition of continuing competence requirements to the already high costs of licensure can only exacerbate the situation:

High standards for entry or continuing practice force practitioners to invest in their own education and training. In order to recoup this investment, practitioners will tend to charge higher prices than would have been the case if obtaining or maintaining a license had been less costly-To the extent that high entry and practice standards erect a barrier to the service, they undermine the purpose of a licensing regime and may, in fact, be counterproductive.66