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For a decade now, New Zealand nurses have had to declare each year that they continue to be competent to practise safely. DR RACHAEL VERNON, a leading researcher into New Zealand and other nations’ continuing competence frameworks, says such frameworks can predict and imply a nurse is safe to practise, but never guarantee.

How safe is the health professional caring for you or your loved ones is an issue that has gained increasing public attention over recent years.

Assuring the public that robust processes exist to ensure and monitor the continuing competence and safety of nurses to practise has become a priority for nursing regulatory authorities (see sidebar).

In general, nurses understand that they must meet a minimum standard of competence for initial registration, but the concept of ensuring continuing competence throughout their professional career is not so well understood. Maintaining ongoing competence as a nurse is influenced by a number of factors, including individual behavioural traits (such as insight, judgement and decision making) and environmental factors (such as the context of practice, health policy and systems, access to resources, and patient acuity).

Current literature suggests that despite models being developed to “ensure” continuing competence, behavioural traits and environmental factors have the potential to significantly influence a nurse’s continuing competence and safety to practise at any given time or situation.

Translating knowledge into safe nursing practice requires the nurse to be able to make clinical judgements, based on sound knowledge and skills. A lack of self-awareness or personal insight has been identified as a key contributor to unsafe practice. Nurses who lack personal insight are less likely to reflect on or assess their own practice. They are also less likely to seek continuing professional development opportunities or recognise when their practice or environment is unsafe.

However, in the absence of a quantifiable and defensible mechanism for assessing continuing competence, many countries have implemented continuing competence models using a range of competence indicators.

I was lead researcher of an evaluation of the Nursing Council of New Zealand’s Continuing Competence Framework, completed in 2010, that concluded the framework is a well-accepted and recognised regulatory tool for assessing and monitoring the continuing competence of nurses and their safety to practise.

This New Zealand research was the first internationally published study to evaluate a continuing competence framework in practice. The interest in the findings from nursing regulatory jurisdictions internationally led to the development of a separate piece of research, completed in 2012, that determined the international consensus view of regulatory experts from six countries (Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States of America), with regard to what constitutes continuing competence and also the foundations for the development of a best practice international consensus model for the assessment of continuing competence.*

It is argued that it is the professional responsibility of all practising nurses to maintain their competence to practise. It also argued that well-developed and comprehensive continuing competence frameworks provide assurance to the regulator and the public that the nurse is indeed continuing to be competent to practise. But no independent indicator of competence has been identified that can ensure the continuing competence of a nurse.

However, there are many common philosophies and processes related to measuring, assessing and monitoring continuing competence. In addition, there is a presumption that the measurement and/or assessment of the competence and continuing competence of nurses, assures and ensures their safety to practise.

Overall, the findings from the 2010 and 2012 studies have identified that the indicators of continuing competence (self-assessment, recent practice hours, and continuing professional development/education) are all considered to be appropriate indicators of competence, and when used together can predict continuing competence and therefore may imply safety to practise.

However, they cannot guarantee that a nurse is safe to practise on any given day. In addition, the stipulation of a minimum number of practice, and continuing professional development/education hours, when used independently, are pragmatic or arbitrary requirements and not considered to be a valid measure of competence, continuing competence, or safety to practise.

But on the other hand evidence of recent practice and active engagement in professional development/education opportunities arguably provides a more robust indication that the nurse’s knowledge and skills are continuing to be current, and that the nurse might be aware of what they do not know or what skills and knowledge they lack.

Therefore the assessment of competence can only be used as the yardstick that will predict continuing competence and imply safety to practise.

In conclusion, the assessment of a nurse’s competence at any time during their career is a predictor that demonstrates their continuing competence, or not and therefore implies their safety to practise, or not. However, it cannot ensure the safety of the individual nurse to practise at any given time.

Author: Dr Rachael Vernon, head of EIT’s School of Nursing, was the first New Zealand nurse in 33 years to be awarded the Fulbright Senior Scholar Award for Research. Her research looked at the relationships between legislation, policy, public safety, and continuing competence requirements for nurses, nationally and internationally.