In the past, graduation from a nursing program and passage of licensure examinations presumed competency of practitioners throughout their careers. Those days are indeed past and nursing has recently acknowledged that this is no longer realistic in today's practice arena with the rapid change in health care and explosion of nursing knowledge worldwide. Nurses must maintain competency in practice by updating their knowledge to assure quality care. Likewise, nurse educators are challenged to develop new methods to assure initial competence of their graduates. Health care institutions are demanding more than ever that educators assure competency as outcomes of their educational institutions. This issue of the Online Journal of Issues in Nursing presents five introductory articles which examine the question of how to evaluate and validate nursing competence to meet increasingly complex societal demands for health care.
Carrie B. Lenburg, EdD, RN, FAAN is a leader in the area of continuing competence and much of her thinking is presented throughout this issue. Dr. Lenburg acknowledges that members of the nursing profession are concerned with methods necessary to validate competent performance and hold varied opinions regarding these methods. She has categorized the major issues of competency as philosophical, conceptual, organizational, administrative or legal. The idea of insuring nursing competence is addressed within this framework throughout the five articles.
In Redesigning Expectations for Initial and Continuing Competence for Contemporary Nursing Practice, Dr. Lenburg provides an overview of the development of the idea of continuing competence which focused on questions revolving around the level of competence of practicing nurses and methods needed to insure that competency is maintained. Dr Lenburg examines the gap in expectations between the reality of health care practice and the expectations of faculty of nursing and calls for the collaboration of these groups to develop needed changes. Following the discussion of rationale for addressing the issue of competency-based education, Dr. Lenburg concludes the article by presenting a method for validating and assuring nurse competence.
The second article is titled The Framework, Concepts and Methods of the Competency Outcomes and Performance Assessment (COPA) Model by Carrie B. Lenburg, EdD, RN, FAAN. Dr. Lenburg offers an exciting and innovative model for nursing education. The COPA Model is detailed as a holistic, integrated system having a conceptual framework of competency-based education and practice. Dr. Lenburg discusses the four guiding questions used to create her organizing framework and presents specific examples of content and critical elements necessary for competency outcomes. This Model provides a thought provoking redesign for practice based nursing education grounded in learner focused learning strategies and innovative ideas for faculty/student interaction.
Richard W. Redman, PhD, RN, Carrie B. Lenburg, EdD, RN, FAAN, and Patricia Hinton Walker, PhD, RN, FAAN in the third article of the issue, Competency Assessment: Methods for Development and Implementation in Nursing Education and Practice, present the University of Colorado's experience in implementing a competency-based, outcomes-focused curriculum in all four levels of their educational program. This article addresses a needs assessment from nurse stakeholders, as well as the development of a curricular framework, assessment methods, and faculty preparation at each level of the educational program. Emphasis is placed on the process of evaluating student performance as a means of assessing competency using Lenburg's Competency Outcomes and Performance Assessment Model.
Assuring Continued Competence '” Policy Questions and Approaches: How Should the Profession Respond? speaks to the development of policy to address the issue of competent practice through public, private, and organizational regulations, guidelines and studies. Policy matters such as the correlation between continued competence and certification; the question of who is responsible for requiring demonstrations of competency; and legal and practical issues of measurement are discussed. This article also includes the American Nurses Credentialing Center task force's definitions for competency-related terms. The authors, Winifred Carson, JD, Susan Whittaker, MSN, RN, and Mary Smolenski, EdD, RN,CS, present a comprehensive look at the development and current understanding of competence in relation to policy in the United States. This article is still in development and will be posted shortly. (Note: not published until June 30, 2000)
The fifth article of the issue, Reducing Threats to the Implementation of a Competency-Based Performance Assessment System by Tony Bargagliotti, DNSc, RN, Marjorie Luttrell, PhD, RN, and Carrie B. Lenburg, EdD, RN, FAAN, examines the threats inherent in the transition from traditional process evaluation to a competency-based assessment system for nursing stakeholders. Key constituents in the process of evaluation are identified with emphasis on nursing education. Strategies identified as essential to reduction of anxiety during competency-based assessment for students include: standardizing evaluation forms; advanced knowledge of specific, clear evaluation criteria; adequate practice opportunities; and opportunities for re-test if needed. This article examines the paradigm shift and faculty commitment to a competency based assessment system.
As previously noted, this issue reflects much of the thinking derived from Dr. Lenburg's leadership in the area of continuing competence in nursing and nursing education. However, the OJIN staff strongly believes that it is essential to provide varied points of view on all topics. Therefore, as with all OJIN publications, authors are encouraged to submit manuscripts that reflect different perspectives on the issues discussed.
Article published Sept. 30, 1999