On October 23rd, 2014, we updated our
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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.”
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???
Tools used for Competency
Reflective practice and portfolios
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
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
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
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
Why are professional health care organizations reluctant to support re-examination?
What are some consequences of mandating re-testing?
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.
What is the Differences Between Certification, and Licensure?
State/government defines a scope of practice, grants permission for practice of a profession, and to use a particular title (restricted to license)
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
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
Should certification be required? Why or why not?
Benefits of Certification
Research suggests certification:
Encourages a positive work environment and improved patient outcomes
Enhances nurse’s autonomy
Facilitates collaboration in the workplace
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).
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)
Accreditation Process for ANCC
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.)
(list consists of ABNS approved certification programs)
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
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
Do most employers value professional certification? Do nurses?
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
A process for the assessment of one’s own practice to identify and seek learning opportunities to promote continued competence
New Brunswick’s Model (Canada)
Self-assessment of nursing practice to determine learning needs
Development and implementation of a learning plan to meet the identified learning needs
Evaluation of the effect of learning activities
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
Could reflective practice/ portfolios replace CE as a requirement to ensure competence
Which is a better option for assuring competency?
Reflective practice and portfolios
The individual registered nurse has a professional obligation to maintain competence
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.
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)
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.
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
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)
Why do you think so few nurses are willing to pursue a doctoral degree?
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)
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
Doctor of Nursing Practice (DNP) Program
Baccalaureate 2nd Bachelors Foundation Core Family NP Public Health Leadership Residency/Capstone DNP RN to BSN *Multiple entry points possible Cognates/Electives Psych NP
The Big Transition
The AACN provides numerous tools to make the DNP transition a reality
Roadmap task forces
The 8 Essentials
“ Building the bridge as you walk on it…”
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)
How difficult with it be for APRN programs to meet the 2015 deadline recommended by AACN?
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
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?
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.
(2009). About ANCC . Retrieved from http://www.nursecredentialing.org/FunctionalCategory/AboutANCC.aspx on November 13, 2009
(2008). American board of nursing specialties: ABNS . Retrieved from http://nursingcertification.org/index.html 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 www.aacn.org.