Presentation on Continuing Competency


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  • Through state regulation via statutes of the Nurse Practice Act, including licensure.
    Through the scope and standards of clinical nursing practice developed by professional nursing organizations.
    Through professional certification.
  • Nurses are asked to work outside of their specialty on a daily basis PROBLEMS WITH CERTIFICATION
    Lack of standardization among certifications
  • Highly individualized
    North Carolina requires a reflective practice approach
    Peer review and collegial feedback can aid in the process
  • Require a lot of thought and effort by the nurse
    Difficult to identify continuing competence in concrete and measurable ways
  • Compared to doctorate of engineering, 57000 awarded in last ten years alone
    Why develop DNP
    -the observation that advanced practice nursing is currently one of only a few health care disciplines that prepare their practitioners at the master’s rather than the doctoral level.
    -Most disciplines that prepare licensed independent practitioners (LIPs) such as podiatrists, psychologists, optometrists, pharmacists, osteopaths, medical doctors and dentists prepare them at the clinical doctoral level.
    -AACN “health system’s increasing demand for front-line primary care, and the accelerating drive towards managed care, prevention, and cost-efficancy and a driving need for nurses with advanced practice skills in this country”
    Inadequate numbers have knowledge and expertise to address persistent professional issues arising in health system
    Although the current masters and PhD programs in nursing are critical to the future of the profession and are evolving to keep pace with new demands, they do not fill the growing need for expert clinical teachers and clinicians. Informational shifts, demographic changes, growing disparities in healthcare delivery and access, and stakeholder expectations are all creating new demands on the nursing profession.
    The practice (also called clinical and professional) doctorate, with a focus on direct practice and healthcare leadership, offers nursing an exciting opportunity to meet these demands. Programs are already underway or being developed at several institutions, although problems and challenges such as standardization, regulation, and potential "devaluing" of existing programs have yet to be adequately resolved. The National Organization of Nurse Practitioner Faculties (NONPF), along with professional organization and educational institutional partners, supports the development of the practice doctorate and is committed to providing leadership to ensure quality educational outcomes. Nursing must develop a shared strategic vision to shape the rapidly moving practice doctorate initiative.
  • Will talk about the Position Statement from the AACN. Some people are skeptical/weary of this transition. Is it too difficult? Do we really need it?
  • Student enrollment doubled from 1,874 to 3,415
    -The Commission on Collegiate Nursing Education (CCNE), the leading accrediting agency for baccalaureate- and graduate-degree nursing programs in the U.S., began the process for accrediting DNP programs in Fall 2008.  To date, 62 DNP programs have initiated the accreditation process through CCNE.
  • These are the benefits of practice for DNP programs, outlined by the AACN.
    -Currently, advanced practice nurses, including Nurse Practitioners, Clinical Nurse Specialists, Nurse Mid-Wives, and Nurse Anesthetists, are typically prepared in master's degree programs, some of which carry a credit load equivalent to doctoral degrees in the other health professions.
  • So what exactly is the relationship between the masters, doctorate’s, and Phd? What pathways are available to pursue professional practice?
    -the combination of DNP-PhD is possible as well, like other practice doctorate programs.
    -Different entry points exist since the professional entry degree is a Bachelor’s or Master’s. the goal is to meet the 8 essentials of the DNP program outlined, so an individual’s process through the program may vary.
    -The DNP focuses on providing leadership for evidence based practice, the PhD is research-intensive.
  • Taken from Umass-Amhurst School of Nursing in their presentation of developing this program.
  • Another Interesting Difference is Resources: PhD candidates apply for dissertation funding, while DNP candidates are able to receive federal dollars.
  • These define the key elements of the doctorate nursing practice and addresses operational/transition issues.
  • School adopted recommendations with much less resistance than in past.
    Change to create DNP, controversy. Many adopting because realize nurses need to help change.
    NP established entry level competencies, and education and practice at doctorate level.
    7 levels of concern for CNS: issues about nursing profession, education, patient safety, economic issues, development and implementation of DNP and regulatory issues
  • The AACN addressed this, stating that master’s prepared nurses will be able to teach particular courses in the beginning transition stages. It is expected that all faculty will be doctorate prepared in the future.
  • AMA wants to make it a felony for non-physicians health care professionals to misrepresent themselves as a physician
    AMA thinks DNP should have to take same test to qualify for medical license
    AACN fought back and said that DNP should be certified through a nursing certifying body-AMA house of delegates also opposed this idea
    Nurses must be strong advocates of the profession…being apart of professional originations and continuing education opportunities
    “nursing must define nursing before others take away the freedom to practice.
  • Presentation on Continuing Competency

    1. 1. Rachelle, Brenna, David and Sabrina
    2. 2. Defining Competency  The Nursing profession is constantly evolving requiring the need for continued competency  To Err Is Human
    3. 3. Defining Competency  National Council of State Boards of Nursing defines continued competency as  “ The application of knowledge and interpersonal, decision-making, and psychomotor skills expected for nurse’s practice role, within the context of public health, welfare and safety.”
    4. 4. Debate of who should be responsible for Continued Education??  “Issue complicated by the fact that there are no national standards for defining, measuring or requiring continued competency”. ( p 305)  Should it be professional organizations, government or employers???
    5. 5. Tools used for Competency  Continuing education  Recent practice  Periodic re-licensure  Professional certification  Reflective practice and portfolios
    6. 6. Continuing Education  Usually defined as hours completed by a board approved program in order for license renewal. Every state differs on amount of hours required for renewal  Example of CE
    7. 7. Examples of CE in other states  California 30 hours every two years  Iowa 36 hours for a three year license and 24 hours for licenses less than three years  New Jersey 30 hours every two years  Oregon One-time, 7 hours course on pain management
    8. 8. Pros and Cons of CE Pros Cons Professionalism Seat time does not guarantee learning Commitment to maintaining competence Difficult to agree on standards Attention to patient safety and reduction in medical errors Administrative and monitoring costs Motivates employers to support CE Concern about cost, access and quality of CE offerings Raises the standard for CE for all nurses Research inconclusive Research supports positive effects of nursing practice Difficult to measure outcomes
    9. 9. Periodic relicensure  The NCLEX measures minimal competence needed for entry into nursing  It has been suggested that nurses should be required to periodically retake the NCLEX or a similar test  Nurses, Doctors and Pharmacists have all been reluctant to implement relicensure as a means of assuring competence
    10. 10. Discussion Question  Why are professional health care organizations reluctant to support re- examination?  What are some consequences of mandating re-testing?
    11. 11. Why not?  Possibility of not passing in large numbers  Who will pay for it  What test would be used  Who would administer the test  How often should it be required Did you know….  Physician’s Assistance are required to pass a national certification exam and sit for recertification every six years to maintain their certification to practice.
    12. 12. What is the Differences Between Certification, and Licensure?  Licensure State/government defines a scope of practice, grants permission for practice of a profession, and to use a particular title (restricted to license)  Certification Defined by the American Board of Nursing Specialties (2000) as the formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards
    13. 13. Certification  To achieve professional certification, nurses must meet eligibility criteria: • Years and types of work experience • Minimum educational levels • Active nursing licenses • Successful completion of a nationally administered examination  Certifications last about 5 years; renewal normally based on CE requirements
    14. 14. Discussion Question  Should certification be required? Why or why not?
    15. 15. Benefits of Certification  Research suggests certification: Encourages a positive work environment and improved patient outcomes Enhances nurse’s autonomy Facilitates collaboration in the workplace Empowers nurses Validates specialty knowledge Enhances a feeling of personal accomplishment and confidence in clinical abilities Ensures consistency in knowledge Grief, C. (2007) Piazza, I., Donahue, M., Dykes, P., Griffin, M., & Fitzpatrick, J. (2006).
    16. 16. American Nurses Credentialing Center  Largest and most prestigious nurse credentialing organization in the US  Became independent of the ANA in 1991  Over 250,000 ANCC-certified nurses  Over 75,000 advanced practice nurses  Offers nursing certification in 26 different specialties (ANCC, 2009) (ANCC, 2009)
    17. 17. Accreditation Process for ANCC
    18. 18. Many Other Certifying Bodies  ABNN (American Board of Neuroscience Nursing)  ABCGN (American Board for Certification of Gastroenterology Nurses)  ABPANC, Inc. (American Board of Perianesthesia Nursing Certification, Inc.)  ALNCCB (American Legal Nurse Consultant Certification Board)  BCEN (Board of Certification for Emergency Nursing)  CCI (Competency & Credentialing Institute)  CCNA (Council on Certification of Nurse Anesthetists)  INCC (Infusion Nurses Certification Corporation)  MSNCB (Medical Surgical Nursing Certification Board)  NBCHPN® (National Board of Certification for Hospice and Palliative Nurses)  NBCSN (National Board of Certification of School Nurses)  ONCB® (Orthopaedic Nurses Certification Board)  ONCC® (Oncology Nursing Certification Corporation)  RNCB (Rehabilitation Nursing Certification Board)  WOCNB (Wound, Ostomy, Continence Nursing Certification Board) (list consists of ABNS approved certification programs)
    19. 19. o With so many different nursing certification credentials, and with certification programs often having very different standards, it may be difficult to draw valid conclusions about the value of a particular nursing certification
    20. 20. American Board of Nursing Specialties  Incorporated in 1991 after three years of dialogue within the nursing community to create uniformity in nursing certification  The only accrediting body specifically for nursing certification  Peer-review process used to accredit nursing certification programs  Renewal is required every 5 years (ABNS, 2008)
    21. 21. Discussion Question  Do most employers value professional certification? Do nurses?
    22. 22. Ways to Encourage Certification  Tuition reimbursement and cash incentives  Make certification prep books available  Display posters with benefits of certification  Paid time off to take exam  Public recognition  Pay raise
    23. 23. Reflective Practice • A process for the assessment of one’s own practice to identify and seek learning opportunities to promote continued competence
    24. 24. New Brunswick’s Model (Canada) 1. Self-assessment of nursing practice to determine learning needs 2. Development and implementation of a learning plan to meet the identified learning needs 3. Evaluation of the effect of learning activities
    25. 25. Portfolios  Portfolios provide one means for the individual RN to be both reflective about his/her practice and to assess and/or demonstrate competence  Living document that demonstrates critical thinking, values, skills and reflection
    26. 26. Discussion Question  Could reflective practice/ portfolios replace CE as a requirement to ensure competence
    27. 27. Which is a better option for assuring competency?  Recent practice  Periodic relicensure  Continuing education  Professional certification  Reflective practice and portfolios
    28. 28. Consider  The individual registered nurse has a professional obligation to maintain competence
    29. 29. 2008 WA Draft of Continuing Competency  The proposed “Continuing Competency Program” would include documentation by each nurse of the following components:  Active nursing practice  Self-reflection and assessment of current knowledge, technical ability and learning needs  A “Continuing competency development plan” created by each nurse  Timely implementation of the “Continuing competency development plan”  Evaluation of the “Continuing competency development plan” including integration of new knowledge into practice.
    30. 30. Transition Slide…
    31. 31. In 2004: almost 3 million total nurses just over 40,000 obtained doctorate degree 5.8% of these doctorate prepared nurses focused on clinical practice (NSSRN, 2004)
    32. 32. What’s all this DNP talk about? On October 25, 2004, the members of the American Association of Colleges of Nursing (AACN) endorsed the Position Statement on the Practice Doctorate in Nursing. AACN members voted to move the current level of preparation for advanced nursing practice from the master’s degree to the doctorate level by the 2015.
    33. 33. A few facts…  As of April 2009: 92 current DNP programs enrolling students 102 programs in the planning stages From 2007-2008 student enrollment doubled 62 institutions have initiated accreditation to date (AACN)
    34. 34. The DNP Position Statement  Development of needed advanced competencies for increasingly complex practice, faculty, and leadership roles  Enhanced knowledge to improve nursing practice and patient outcomes  Enhanced leadership skills to strengthen practice and health care delivery  Better match of program requirements and credits and time with the credential earned  Provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g., practice faculty)  Enhanced ability to attract individuals to nursing from non- nursing backgrounds  Increased supply of faculty for practice instruction. (AACN, 2004, p.4)
    35. 35. Why do you think so few nurses are willing to pursue a doctoral degree?
    36. 36.  Don’t want to do research Research study conducted talks about the “dread of research” in that nurses say research has been presented to them in “boring” classes that don’t stimulate their interest  Salaries not kept pace with clinical setting. BSN $73,000 vs faculty with masters or higher only making $58,000 (AACN,2005b) Time $
    37. 37. Relationships, relationships, relationships…  Ultimately the terminal degree options will fall into 2 pathways: Professional entry degree to DNP degree Professional entry degree to PhD degree The practice arena vs. scientific investigation
    38. 38. Doctor of Nursing Practice (DNP) Program Post Baccalaureate Baccalaureate2nd Bachelors Foundation Core Family NP Public Health Leadership Residency/Capstone DNP RN to BSN *Multiple entry points possible Cognates/Electives Psych NP
    39. 39. The Big Transition  The AACN provides numerous tools to make the DNP transition a reality Toolkits Roadmap task forces ○ Faculty Issues ○ Program Issues The 8 Essentials “Building the bridge as you walk on it…”
    40. 40. The 8 Essentials  I. Scientific Underpinnings for Practice  II. Organizational and Systems Leadership for Quality Improvement and Systems Thinking  III. Clinical Scholarship and Analytical Methods for Evidence-Based Practice  IV. Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care  V. Health Care Policy for Advocacy in Health Care  VI. Interprofessional Collaboration for Improving Patient and Population Health Outcomes  VII. Clinical Prevention and Population Health for Improving the Nation’s Health  VIII. Advanced Nursing Practice (AACN, 2004, p.8)
    41. 41. How difficult with it be for APRN programs to meet the 2015 deadline recommended by AACN?
    42. 42. What organizations think about change  NONPF (Nurse practitioners)-  Supports DNP, not deadline to prepare graduates  Should a new deadlines be placed?  NACNS (clinical nurse specialist)- list 7 key areas of concern, but will partner with other organizations to develop doctrate level CNS cirriculum  Nurse-midwives- see DNP as an option, but not a requirement.  Resisted change in past and now only in 2010 enforcing master level entry for practice  ACNM states “regardless of terminal degree, are safe, cost- effective providers of maternity and women’s health care”  Nurse Anesthetists-in support but want deadline to extend to 2025, after extensive research at practice doctorates
    43. 43. Up For Discussion The AACN mentioned a main benefit of the DNP programs was to “increase supply of faculty for practice instruction” (AACN, 2004).  If there is already a shortage of instructors for entry level programs, how do we have resources to teach at the doctorate level?
    44. 44. Dr. Nurse???  AMA wants limitations on the use of the term “doctor”, restricting it to only physicians, dentist, and podiatrists.  concerned with pt safety issues- however, there is no evidence to support position  Wants DNP to practice as apart of medical team and under supervision of physician who has final authority and responsibility for the patient.
    45. 45. References (2009). About ANCC. Retrieved from spx on November 13, 2009 (2008). American board of nursing specialties: ABNS. Retrieved from on November 13, 2009 Grief, C. (2007). The perceived value of BCEN certification... Board of Certification for Emergency Nursing. JEN: Journal of Emergency Nursing, 33(3), 214-216. Retrieved from CINAHL with Full Text database. Piazza, I., Donahue, M., Dykes, P., Griffin, M., & Fitzpatrick, J. (2006). Differences in perceptions of empowerment among nationally certified and noncertified nurses. Journal of Nursing Administration, 36(5), 277-283. Retrieved from CINAHL with Full Text database. Huston, C.J. (2010). Professional issues in nursing: Challenges and opportunities, 2nd ed. Philadelphia: Lippincott Williams & Wilkins. Washington State Department of Health Nursing Commission (2008). Demonstrating continued competency (Rev 7/2008). AACN Position Statement on the Practice Doctorate in Nursing (2004). American Association of Colleges in Nursing. Retrieved on November 15, 2009 from