Why is professional competence a fundamental requirement in nursing practice? In satisfying this query, one must reflect on one’s functions as a nurse. From this, one can realise the undeniable fact that nurses play a crucial role in the delivery of health care services. The very lives of people are at stake and so one must practice competently. Professional competence is a must in nursing practice. In line with this thought, this essay will explore one’s practice of nursing in relation to the Australian Nursing & Midwifery Council (ANMC) and the Australian Nursing Federation (ANF) competency standards. This essay will also explore what competence is all about and what it means to be a professionally competent nurse.
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The ANMC (2006, p.14) defines competence as the combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession or occupational area. Competency in nursing is very well acknowledged and sought by all health care institutions. There is always an inherent desire on the part of health care institutions to determine and improve the competence level of their nurses. In fact, Zuzelo (2009) relate that numerous healthcare institutions are investing time and money into systems that can assess competency of nursing professionals. In highly industrialised nations, competency of nursing professionals is sought after and achieved through competency based approach training (Cowan, Norman & Coopamah, 2005). The idea of competence seems to have ‘skills’ at its core, in particular clinical skills, that is ones essential to best practice (Roberts, 2009). However, skills without knowledge is dangerous, according to Roberts (2009). A professionally competent nurse does not neglect the important aspect of nursing as a caring profession. Being competent does not only imply that one is very knowledgeable and skilled. It also connotes one’s genuine care to patients. It is worthy to declare that caring and competency are not exclusive concepts but are naturally intertwined (Masters, 2005). To be professionally competent is to be properly qualified, capable, adequate for the purpose, and sufficient. As professional nurses, we are competent to practice nursing by virtue of our education and licensure as registered nurses. To be competent however, we must meet additional criteria.
The ANMC (2006) competency standards for the registered nurse comprises of 4 domains, namely professional practice, critical thinking and analysis, provision and coordination of care and collaborative and therapeutic practice. From among the sub-classifications of the first domain, what can be considered as most striking in relation to one’s practice include the need to practice in accordance with legislation affecting nursing practice and health care as well as the need to practice within a professional and ethical nursing framework (ANMC, 2006). These two sub-classifications are worthy to note because of the fact that moral and legal conflicts often complicate decision making in nursing practice. Nurses are typically confronted with conflicting scenarios which are often both important things to consider. The only dilemma is which of the two must be the top priority. For instance, taking care of a patient who refuses any form of treatment poses a legal dilemma on the part of the nurse. This is especially true because the ANMC (2006) competency standards direct nurses to recognise and accept the rights of others. On one side, there is the professional desire of the nurse to help the patient by initiating treatment. On the other hand, legal ethics dictate that patients have the right to refuse treatment. In one’s personal experience, taking care of a patient whose religion does not allow blood transfusion is a real dilemma. In this particular scenario, the nurse was torn between educating the patient to eventually accept treatment or simply respect the refusal of treatment and just relate to the patient the possible consequences of such refusal. It was clear in the nurse’s mind that the ANMC (2006) dictates one to accept individuals or groups regardless of race, culture, religion, age, gender, sexual preference, physical or mental state. Furthermore, there is the need to practise in a manner that acknowledges the dignity, culture, values, beliefs and rights of individuals or groups (ANMC, 2006). Unfortunately, this is easier said than done especially when one of the above mentioned factors goes against or impedes a crucial treatment that may actually save a patient’s life. It is true that religious faith is often invoked by patients when their health and wellbeing is threatened. According to Andrews and Boyle (2008) religion is especially crucial to patients during periods of health crisis. Although, adhering to a particular religion is mostly viewed as a positive concept for patients; unfortunately, such adherence does not always result into a positive outcome. It can hinder the patient’s acceptance to treatment and care. This points out to another important aspect of competence and that is, a deeper understanding of cultural diversity. In line with this, Cherry & Jacob (2005) state that health professionals which naturally include nurses, need to respond to the consequences of an increasing cultural diversity of nursing clientele in order to safeguard the welfare of all health care consumers. Different values and beliefs are adhered to by patients. Community, social and kinship ties, language, religion, food and cultural perceptions of health and wellness are all matters of importance that need to be understood by the nurse when working with culturally diverse patients (Daniels, 2004). Cultural diversity challenges nurses to triumph over cultural gaps with patients by providing culturally appropriate care (Daniels, 2004). Cultural competence is the process whereby a nurse provides care that is suitable to the client’s cultural context (Daniels, 2004). In essence, cultural competence is important in the practice of nursing. A nurse is only truly competent if he or she can knowingly handle patients whose entire value system is different from his or her own but still manages to establish and maintain a therapeutic relationship that paves way for effective implementation of nursing actions.
Another important issue within the sphere of the first domain of professional practice implies the need to question and/or clarify orders and decisions that are unclear, not understood or questionable (ANMC, 2006). Moreover, there is the necessity to question and/or clarify interventions that appear inappropriate with relevant members of the health care team (ANMC, 2006). In following this directive, a nurse may often hesitate to question the validity of a particular intervention whether it was given by a fellow nurse or by some other health care professional such as a doctor. In one’s own practice, hesitation comes from the desire not to create a conflict and bad blood with colleagues and fellow members of the health care team. Unfortunately, in abiding the directive of questioning particular actions of another when deemed inappropriate will more often than not cause some form of disagreement or clash between the professionals. Inter-professional conflicts have been documented since the time of Florence Nightingale (Kalisch & Kalisch, 1977 cited in Coombs, 2004). In one’s personal experience, the common escape route for this possible conflict is to question an order by way of politely suggesting an alternative which in reality is not an alternative but a recommendation to abolish the questioned order. For example, in questioning a doctor’s order, the nurse would typically suggest to the doctor the need for the latter to also consider some other assessed patient data with the hope that the doctor will realise that he or she made a mistake instead of directly asking the doctor why he or she prescribed such seemingly inappropriate order. It is an extremely rare scenario where a nurse openly recommends to the doctor to change what the latter has ordered. The subservience of nurses over doctors is a scenario that is very common especially in areas where doctors and nurses are in constant interaction with each other which if pondered upon occurs in almost all areas of a health institution. This particular doctor-nurse type of interaction is referred to as a doctor-nurse game (Stein, 1967 cited in Stein-Parbury, 2008). The doctor-nurse game described over 30 years ago persists in the communication patterns of some doctors and nurses ( Knox & Simpson, 2004). In line with this issue, a truly competent nurse knows how to play the game well. He or she is able to question other professionals’ actions if necessary without causing unhealthy disagreements among them. Effective team behavior operates when health care providers communicate openly and courteously with each other ( Wolf, 2006).
The second domain focuses on the implications of researching for evidence based practice (ANMC, 2006). This domain also points out the obligation to participate in ongoing professional development of self and others (ANMC, 2006). In one’s own practice of nursing, continuing professional education has always been one’s primary goals. It is a way of empowering oneself to be able to keep up with the trends in the practice of nursing. Attending formal and informal lectures and orientations makes one feel more competent. In essence, competence entails seeking out continuing professional education in order to build up a well founded source of knowledge and skills that will be necessary in coping with the dynamic changes in healthcare. Continuing education is intended to ensure health care practitioner’s knowledge is current (Griscti, 2006). In the advent of modern technology and skyrocketing increase for the demand of high quality care, nurses must be keen in upgrading or at least maintaining the current accepted level of competency required upon them. The high competency required upon nurses is only natural considering the fact that nurses are at the forefront of health care delivery. Nurses who stay abreast of new information and apply evidence-based theory to their practice will be able to provide competent, quality care to their patients (Valloze, 2009). This is the reason why competence is such a crucial issue in the practice of nursing.
The salient component of the third domain relates the significance of the nursing process which naturally includes conducting a comprehensive and systematic assessment, planning and implementing safe and effective evidence based nursing care, and then evaluating the expected outcomes (ANMC, 2006). To simply describe it, the nursing process is a problem-solving technique (Carpenito-Moyet, 2007). It is a step by step strategy utilised by a nurse in solving patient problems that come within the scope of nursing practice. In one’s own practice of nursing, the tricky part of nursing process is the nursing assessment. Nursing assessment may be defined as the systematic and continuous collection and analysis of information about patients (Rosdahl & Kowalski, 2007). It is difficult to confidently say that one has thoroughly assessed a patient. It is because one needs to consider a wide array of factors. There is also the burden to ensure that one’s assessment is comprehensive in as much as it becomes the basis of nursing and medical interventions. In connection to this, competency in nursing comes when one is able to collect and distinguish which patient information is important and which can be discarded. The care of patients is dependent upon the competency of the nurse is assessing those signs and symptoms that are related to the patient’s medical condition.
For the fourth domain, what is most relevant to one’s practice are the need to establish and maintain therapeutic relationship with patients and the necessity to collaborate with other health care professionals in providing comprehensive nursing care (ANMC, 2006). As a nurse, building and sustaining a therapeutic relationship with patients is important. It is the initial step in obtaining patients’ trust and confidence. Dossey & Keegan (2009) declare that it is an important part of nursing care. In an effective therapeutic relationship, patients feel the genuine support of nurses while the nurses feel a certain degree of satisfaction in his or her role (Dossey & Keegan, 2009). Initiating a therapeutic relationship with patients is in compliance the ANMC (2006) requirement of undertaking assessments which are sensitive to the needs of individuals or groups. Competency standards in this domain includes that a nurse has the ability to address the physiological, psychological, physical, emotional and spiritual needs of patients and significant others as well as to optimize the physical and non-physical environment ( Dunn, Lawson & Robertson, 2000). A competent nurse always begins his or her interventions by establishing a therapeutic relationship with patients that will increase efficacy of succeeding interventions.
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The ANF competency standards consist of 3 domains namely conceptualises practice, adapts practice and leads practice (ANF, 2005). As an experienced practitioner, one can meet these competency standards by reflecting on one’s own experiences and placing these experiences in correct perspective for future reference. One can learn how to better provide nursing care for a particular scenario by reflecting on previous experiences that are similar to the one currently confronted with. What is required in order to meet the competency standards contained within the first domain is self-reflection. Self-reflection activities are an essential component of expert nursing practice (Dossey & Keegan, 2009). This self-reflection; however, must be coupled with formal continuing development or education plus implementation of researches of relevant issues in nursing practice. This is because of the fact that this domain requires use the best available evidence and health and/or nursing models (ANF, 2005). Research in nursing will help in identifying evidence-based nursing practice (Polit & Beck, 2004).
For the second domain, one can satisfy the competency standards contained within by being dynamic in finding out possible reliable sources that will support a particular method of rendering nursing care. This is because the second domain directs nurses to draw on a wide repertoire of knowledge and processes to tailor nursing practice in complex and challenging clinical situations (ANF, 2005). Furthermore, as an experienced practitioner, one needs to further upgrade one’s technical skills in handling subordinates if any and in abiding by institution policies more strictly. One must also develop how to predict possible scenarios which may result from interventions implemented.
The third domain of the ANF competency standards relates the concept of promoting and improving nursing practice through leadership. Definitely, as an experienced practitioner there have been many instances when one has asserted oneself as the leader of the group in order to smoothly direct patient care. For an experienced practitioner to successfully meet the third domain, one must hone one’s leadership skills. Honing one’s leadership skills does not necessarily mean that one should always act as the team leader. In becoming a leader one must also experience being a member and under the authority of another professional’s leadership. The leadership often invoked in this domain is one that solicits active participation of the members. This implies a collaborative leader. Milstead & Furlong (2006) state that a collaborative leader is what is most sought in today’s health care system.
To sum up, true professional nursing competence requires accumulation of evidence based knowledge and skills. It also entails understanding cultural diversity and how it affects the kind of care that must be provided. Competence is also equated with genuine care. The ANMC competency standards are crucial in directing the way nurses must think and act. In the same light, the ANF competency standards help experienced nurses to become even better. These competency standards may be idealistic but it is certainly realistic and attainable if only nurses give more of their time reflecting on their own practice and in trying to assimilate through actions these competency standards.
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