How Clinical Competencies Effect Nursing Educators
What Is Clinical Competency in the View of Banner
Benner (1982) defined nursing competence as the ability to perform a task with desirable outcomes under the varied circumstances of the real world. Benner (1984) famously placed competence in the middle of a continuum, ranging from novice to advanced beginner, to competent, to proficient, to expert. Competent practitioners are under stood to be able to consciously plan their activities, but can lack flexibility and speed (Benner, 1984) Chapman (1999) defined competence as being more concerned with what people can do rather than with what they know.
Similarly,
competence-based training and education are believed to have concentrated on
what people can do as opposed to what they know and not on the learning process
itself, with emphasis on observable and measurable outcomes, requiring a
consistent standard of practice (Winskill, 2000 )
Clinical Competencies for Nurses Educators
Competence is much more than an
array of skills attained by the clinician. The interface of professional skills
with knowledge, attitudes, and values works in tandem with the cognitive and
emotional intellect in nursing practice. Other critical qualities involved in
competent practice include motivation, personal insight, explanatory capacity,
maturity, and self-assessment ability (Axley, 2008).
The importance of clinical
competence must not be underestimated. One study explored competence levels of
nurse's working in accident and emergency departments in Ireland. Findings
demonstrated a positive correlation between level of perceived competence and
frequency of practice, and a positive relationship between competence and
frequency of activities, as well as competence and years of experience
(McCarthy, Cornally, O'Mahoney, White, & Weathers, 2013)
Advantages and Disadvantages of Clinical Competencies in Nursing Education
There is a wealth of literature on
clinical competence, particularly on the advantages and disadvantages as a
measure of practice ability: Nurse managers and educators have been
increasingly required to demonstrate that a process is in place to assess,
validate, audit, and maintain or improve the competence of staff on an annual
basis. Recommended competencies have included the following: provision of
patient centered care; collaboration as a member of an interdisciplinary team;
understanding of how to access, interpret and synthesize information, and use
of evidence to guide nursing practice and clinical decision making (Billings,
2008).
Lejonqvist, Eriksson, and Meretoja (2012) conducted a study by exploring the views of clinical staff, students, and nurse educators. They found clinical competence was evident in practice as encountering, knowing performing, maturing. and improving. These authors discuss the core of nursing as the ethical foundation of clinical competence. The ethical foundation includes nurse patient relationships, the aim of doing good, and maintaining the dignity of the patient.
Clinical competence becomes
evident in thought, words, and actions, thus constituting the culture of
nursing Competence is believed to be the essence of nursing expertise and is
grounded in meaning that it is transferable between contexts (Lejonqvist et
al., 2012). Another view on competence considers the relationship with
accountability to self. There is evidence that competence is related to
continuous learning, professional career advancement, actively adopting
self-care strategies, and taking control of work and life (Meretoja &
Koponen, 2012)
While some discuss the complexities
of competence development, others argue competence-based nursing is
reductionist. There is consensus that the perception of nurse competence as a
task-based activity is redundant, and a holistic framework is more appropriate
(Cowan, Norman, & Coopamah, 2005) One study found that an individual
nurse's education level and years of experience influence level of expertise,
thus enhancing the probability of becoming a competent expert (McHugh &
Lake, 2010).
The importance of competence should not be underestimated. It is most evident in terms of quality of care and patient safety. Ensuring patient safety is considered a major principle of clinical competence together with problem-solving competence, critical thinking ability, and the capacity to anticipate factors, which may impact on patient care outcomes (Axley, 2008). The absence of competence may lead to clinical errors resulting in serious consequences or harm for patients (Axley, 2008).
Nurses are fundamental in the systematic identification, assessment, and
implementation of good care for patients, as well as recognizing potential
adverse events. It is, therefore, essential that the acquisition and maintenance
of competence for nurses is mandatory, particularly given the fast-evolving
health care settings (Ponte, Kruger, DeMarco, Hanley, & Conlin, 2004)
Educators and clinical managers should therefore safely guard patients by
leading nurses in a culture of lifelong learning, which is critical in the
maintenance of competence and safe practice.
Impact of Clinical Competencies Nursing Education
Nursing requires a combination of
knowledge, performance, skills, and attitudes; Hence, a holistic definition of
competence is a requisite. This holistic approach could then underpin the
development of competence standards and associated tools required for
assessment (Cowan et al., 2005).
Nurse educators and managers must be challenged to promote learning that builds competence, capability, and resilience. The ever-changing health care environment requires competent frontline clinical staff; Thus, nurse educators need to prepare nurses to manage practice improvement and change. Collaboration between educators and clinicians is key to positively influencing current competent, safe practice. Competence planning and monitoring of programs needs to consider a broad view of nursing, encompassing factors such as ethos, ethics, peer review, self-assessment, and the cultural context.
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