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NURSE COMPETENCY AND TRAINING.
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Reviews studies on nurse education and training.... More...
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Paper Abstract:
Reviews studies on nurse education and training. General training. Foram elducational paths: Associate degree in nursing, Bachelor of Science degree in nursing , and diploma A.D.N. programs offered by community and junior colleges. Diploma programs, given in hospitals. Discusses studies on relationship between amount of training & tests of student competency. Other factors that influence competency of nurses.
Paper Introduction:
NURSE COMPETENCY AND TRAINING: A REVIEW OF THE LITERATURE
Introduction
According to a report issued by the Department of Labor (1998), as the largest health care occupation, there are over 2.2 million nurses currently working in the profession. About three out of every five of these nurses work in hospitals (both inpatient and outpatient departments. Others work mostly in offices, clinics and other health and/or home health care organizations and agencies (e.g., nursing homes, social service agencies, religious organizations, etc.) About one out of every four nurses work part-time.
In terms of general training, the Department of Labor (1998) reports that in all States, nurses are required to pass a national licensing exam and can be licensed in one or more Sta
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Theseinclude stress management programs, tutoring programs, and programs thatteach study and test-taking skills: Finally, all schools should and must attend to how they are definingand assessing competency. It was noted that what made theprogram excellent was not merely hours of training but rather that it wasstructured in such a way that nurses were allowed to integrate their basicnursing education with the extensive clinical practice hours they wereafforded. The above does not mean that no estimate may be made of some overallamount of training needed. Arathuzik and Aber (1998) examined for several factors related tocompetency scores on the National Council Licensure Examination-RegisteredNurse (NCLEX-RN) assessment. Others workmostly in offices, clinics and other health and/or home health careorganizations and agencies (e.g., nursing homes, social service agencies,religious organizations, etc.) About one out of every four nurses work part-time. Licenses must be periodicallyrenewed and some states require continuing education for license renewal. Journal ofProfessional Nursing, 14(2), 119-126. Nursing mistakes cause thousands ofdeaths, probe finds. Professional competence--can it be accuratelymeasured or defined? A summative evaluationof clinical competence: students' and nurses' perceptions of inpatients'individual physical and emotional needs. The scores of 24 pairs ofgraduate nurses and their preceptors (N ' 48) on the Clinical CompetencyRating Scale in three areas: problem solving, applying theory to practice,and psychomotor skills. Journal of Nursing Education, 22(5), 216-219. & Lantz, M. Findings indicatedthat all ratings were significantly higher following the preceptorship.Students also felt that the preceptorship experience contributedsignificantly more to their competency development than their weeklyclinical experiences during the year. (1993). Other authors have suggested that it is not so much the amount oftraining given in basic education programs but rather the amount oftraining nurses continue to receive once they graduate. Garvey, J. Further, the quality of the preceptors must be high and to ensurethis, Kallenbach and Lantz (1993) recommend desirable levels ofremuneration. Variance in competencyscores was found to be associated with students' level of familyresponsibilities; degree of emotional distress and fatigue; and financialand work burdens. In thisregard, the existing literature showed that most any nurse educationprogram can be improved if it provides certain support services. & Whittaker, K. Documentavailable:/www.cnn.com/2 /HEALTH/ 9/15/your.health Smith, C. Both nurses and patients were interviewedregarding these needs, and student nurses' and nurses' assessments werecompared with the individual patient's opinion. It was also suggested that there be ongoing evaluation ofthe preceptor program to monitor its cost-effectiveness and expectedoutcomes. al (2 ) suggested some domains that must be included in anycomprehensive assessment of whether in fact nurses are competent. Summary and Conclusions The review of literature presented here examined the existing researchon training and nurse competency as well as non-training factors thatinfluence competency. Another factor found to influence nurse competency is the degree towhich a given program provides support for any or all sociodemographicvariables that make it difficult for nurses to maximally perform. (1999). Rowland, R. In terms of general training, the Department of Labor (1998) reportsthat in all States, nurses are required to pass a national licensing examand can be licensed in one or more States. Aroian, J. ED 434 248). Thomson, A.M., Davies, S., Shepherd, B. (1997). Nurse Critical Care, 2(4), 186-19 . The development of competency standards for specialist criticalcare nurses. It was noted that if nurse educationprograms desire to increase students' competency levels then programs mustinclude factors that address the variables of influence identified in thestudy. Dunn S.V., Lawson D., Robertson S., Underwood, M., Clark, R.,Valentine, T., Walker, N., Wilson-Row, C., Crowder, K. Nurse Education Today,19(2), 93-1 6. Effect of extern experiences onclinical competence of graduate nurses. It was concluded that student nursesneeded more training hours that focused attention on the need forindividualization of patient care. In this regard, it was can beaffected by the overall quality of the nurse education program; especiallyimportant in this regard is making sure that the program is congruent withthe philosophy, conceptual framework and objectives of the school. (1999). With respect to education, there are three major educational paths tonursing: Associate degree in nursing (A.D.N.), Bachelor of Science degreein nursing (B.S.N.), and diploma. The reviewed literature also showed that several non-training factorsalso influence levels of nurse competency. About three out of every five of these nurseswork in hospitals (both inpatient and outpatient departments. Findings of Oermann and Navin's (1991) study indicated that newgraduates rated themselves higher than their preceptors on all items in theCCRS. A.D.A. (1998). Vocational certificates and college degrees. (1991). (ERIC Reproduction Service No. Student Health Technology Information, 46(2), 191-194. (1995). The purpose of this paper is to provide such a review. Kallenbach, A.M. NURSE COMPETENCY AND TRAINING: A REVIEW OF THE LITERATURE Introduction According to a report issued by the Department of Labor (1998), as thelargest health care occupation, there are over 2.2 million nurses currentlyworking in the profession. Other Factors Influencing Competency of Nurses The literature suggests that in addition to amount of training andother training-related variables, there are several factors operating interms of nurse competency. (1994). Extern positions can also affect competency. & Navin, M.H. Documentavailable at:http:/stats.bls.gov /oco/ocos 83. Thomson, Davies,Shepherd and Whittaker (1999), for example, studied the competency levelsof a large sample of nurses in England determining that competency levelswere lowest for those nurses that did not receive continuing education,especially in areas that would assist them in their daily practice. The review isbroken down into two parts: (1) review of studies that have looked at therelationship between number or amount of training (in a nursing program)and tests of student competency; and (2) review of studies on other factorsthat influence performance on tests of nursing students competency. Also, the clinical competence of new graduates who had been externsduring their nursing programs was compared to that of graduates who did nothave this clinical experience. Further, significant correlations were found between competency andstudents' cumulative undergraduate nursing program grade point average;whether English was the primary language spoken at home; and level ofstudents' critical thinking ability. Journal of Advanced Nursing, 22(1), 58-65. Relationship of Hours of Training To Competence Is the competency of nurses improved proportionately to the hours oftraining they receive in nurse education programs? Thesewere the domains of: professional practice, reflective practice, enabling,clinical problem solving, teamwork, and leadership. In other words, competency comes from an applied approach to whatnurses are taught and not merely from the number of program hours. United States Department of Labor. For example, in some early research Garvey(1983) suggested that competency (as measured by either performance ontests or in actual practice) is at least to some extent dependent upon thequality of the nursing program itself. It isrecommended that income/salary and other compensation strategies be alignedwith organizational culture, and directly tied to performance. An alternative baccalaureate curriculum plan forRns. Nursing informatics in a registerednurse graduate program. Good programsemphasize role delineation, socialization, clinical skills, includepatients with a wide spectrum of ages and diagnoses, and provideopportunities for the application of new technologies. A.D.N. In other words, competency in relation to training isdependent not just on amount of training, but also the amount of traininggiven in specific areas. For example, based on their review of critical care nurse practice,Dunn et. Journal of Advanced Nursing,29(4), 942-949. & Breton, D. The literature also showed that competencyrequires continuous training and that nurse training programs fosteroptimal competency levels in students when they provide clinical practicetraining within a structured program that integrates what they learn in theclassroom with their actual practice in the field. Subjects in the study were 79 generic seniorstudents enrolled in an urban public university. One area requiring greater training wouldbe assessment of patients' needs. (1999).Continuing education needs of community nurses, midwives and healthvisitors for supervising and assessing students. Competency in relation totraining is dependent not just on amount of training, but also the amountof training given in specific areas, the amount of continuing educationtraining nurses receive, and the degree to which a given nurse program notonly provides a good number of hours of clinical practice training but doesso within a structured program that integrates what they learn in theclassroom with their actual practice in the field. What the foregoing studies indicate is that the question of whethernurse competency can be improved by improving the number of hours oftraining they receive is not a realistic one. & Wikblad, K. Moreover, even if competency standards aredeveloped, the authors suggest that they may need to differ depending uponnurses area of specialty. More training hours is said tobe one way in which states can combat the problem, more training in termsof what is required for licensed nurses and what is required for licensingrenewal. (1983). Competency levels of nurse, according to Kallenbach and Lantz (1993)requires preceptorship and skill validation. There, at least atfirst, does appear to be reason to believe that simply increasing thenumber of hours nurses are trained will increase their competence. Student nurses and nurses also showed uncertainty in some of theirassessments, mainly concerning emotional needs. It wasconcluded that ongoing education was the key to building and maintainingthorough competency. Preceptorship and skillvalidation programs. Generally, licensed graduates of any of the three program typesqualify for entry level positions as staff nurses. Registered nurses. The graduate level curriculum provided opportunitiesfor nurses to earn either Associate Degrees or a Bachelor's Degrees.Results for the program showed high levels of competency in nurses wereassociated with about 85 hours of training. Post-hoc analyses, (t-tests), indicated significant differencesbetween the nurses' own ratings and those of their preceptors on problemsolving, applying theory to practice, and psychomotor performance as wellas total CCRS. Further,Flannery states that increased competency must be associated with anincrease in compensation for both the nurse and, where relevant for theteam he or she works with. In addition, good programs were said to include patients with awide spectrum of ages and diagnoses, opportunities for the application ofnew technologies and an appropriate skill validation plan. & Goldenberg, D. Methods used in the study involved requiring subjects to rate theirconcrete and abstract competencies and the importance of divergent andconvergent competencies before and after the program. Seminars in Nurse Management, 2(3), 135-139. For example, some authors have suggested that it is not necessarilythe number of hours of training nurses receive that makes for high levelsof competency but rather the number of hours of training they receive incertain very specific areas of clinical practice. Thus, the quality of apreceptor program is another factor than can affect nurse competency. If nurses are to attaincompetency in the tasks required of them, then they need differentialamounts of training in different areas with some areas requiring a smalleramount of training than others. Causes wereattributed to over-work and poor training. In additional research on competency and preceptorship, Ridley,Laschinger and Goldenberg (1995), used a pre-posttest design to examine theeffect of a senior preceptorship experience on the adaptive competencies,environmental press perceptions and learning styles of third-year communitycollege nursing students (n'55). Flannery, T.P. Brown, B.L. (1997). The implication of this study is clear. Factors associated with NationalCouncil Licensure Examination-Registered Nurse success. Diplomaprograms, given in hospitals, last two to three years. Related to the foregoing is the fact that Dunn, Lawson, Robertson,Underwood, Clark, Valentine, Walker, Wilson-Row, Crowder and Herewane(2 ) report that determining the competency of any nurse group isdifficult in that institutions and organizations vary in what they considerto be competency standards. Aroian and Breton (1997), for example, examinedthe effects of an innovative program facilitating the pathway to graduateeducation in nursing. & Herewane, D.(2 ). In Lofmark, Hannersjo and Wikblad's (1999) study, both the students'and the nurses' assessments showed close similarities with the patients'own estimations, although certain under- and overestimations for bothphysical and emotional needs were found, with a predominance ofoverestimation of emotional needs. ERICDigest, 212. This because the literature indicated that scorescan, to some extent, vary in conjunction with the way in which schoolsconceptualize and measure the competency variable. The foregoing facts make investigation of nurse training and itsrelationship to competency an important and significant area of study; andone way to study this is through a review of the existing research in thearea. Another factor found to contribute to nurses' level of competency isexternships with studies indicating that nurses participating in theseprograms feel a stronger sense of competence than nurses who do notparticipate. Unfortunately, no study has directly examined for a relationshipbetween hours of training and competency in the area of nursing. Lofmark, Hannersjo andWikblad (1999), for example, examined the competency of a sample of nursesto assess patient needs. Department of Labor, 1998). Journal of Post Annesth Nursing, 8(5), 316-321. Recommendations were for the establishment of tutoring programs,stress management programs and supportive programs teaching study skillsand test-taking skills. & Aber, C. Ridley, M.J., Laschinger, H.K. programs. Garvey (1983) feels that in many programs too little time is spent onmaking sure that nurses thoroughly understand those basics required of RNstudents and that most programs over-reach by attempting to includelearning requirements for RNs beyond the basic degree requirements.Moreover, it is suggested that many programs suffer inadequacies becausethey do not take care in terms of developing a program congruent with thephilosophy, conceptual framework and objectives of school. What is especially interesting in any discussion of nurse training andcompetency is identifying what one means by the term "competency." Smith(1997), for example, notes that professional competence is a complex anddynamic concept. programs, offeredby community and junior colleges, take about 2 years to complete. Dynamic pay strategies for the changing healthcare environment. (September 1 , 2 ). Lofmar, A., Hannersjo, S. The effect ofa senior preceptorship on the adaptive competencies of community collegenursing students. Thereview ends with a summary and the formulation of conclusions abouttraining and competency based on the reviewed literature. However, some of these programs are better than others and thedegree to which nurses improve their competency level will, in part, bedetermined by the quality of the externship program itself. Regarding the reviewed literature on training andcompetency, it may be concluded on the basis of this literature thatrelationships between competency and training are not simple and certainlynot linear in the sense that increased training necessarily leads toincreased competence. Only a small numberof programs, about four percent, offer diploma level degrees (U.S.Department of Labor, 1998). Journal of Advanced Nursing, 31(2), 339-346. They also have anappropriate skill validation plan. Rather, the existing research indicated that efforts to improve nursecompetency should pay attention to the different amounts of training neededin different areas. A growing number ofprograms require clinical experience in a wide variety of health caresettings (U.S. Inthis regard, the authors note the preceptor program must be able to teachrole delineation, socialization, clinical skills, and policy and procedureto orientees while supporting preceptors and providing feedback. Nurses who had been externs rated themselvessignificantly higher than non-externs on psychomotor performance, and thetotal CCRS score. However,there is pertinent literature in this regard. While the foregoing training and education required of nurses seemssubstantial, Rowland (2 ) informs that in a report issued by theInstitute of Medicine, it was found that up to 98, patients die inhospitals every year due to medical errors and that nursing mistakes aloneare responsible for thousands of these injuries and deaths. Their assessments werecloser than student nurses/patients or nurses/patients, and also closer forphysical than for emotional needs. Still another non-training factor contributing to levels of nursecompetency as related to on-the-job competency, is compensation. Nursing Connections, 4(4), 3-18. Nurses'competency levels can be improved if the organization and/or agencies wherethey work use effective and dynamic compensation strategies. Goodstrategies include the alignment of compensation with the generalorganizational culture, a program that ties compensation rewards directlyto performance, and a program where increases in competency are accompaniedby increases in compensation. References Arathuzik, D. For example, Oermann andNavin (1991) studied the effects of externships, offered collaborativelybetween schools of nursing and hospitals, on the clinical competence of newgraduates in their first nursing position. Oermann, M.H. However, nursesspecializing in different areas may require different competency standardsfor use in evaluating their knowledge and performance. Flannery (1994) reported that still another factor, one that is saidto be directly related to on-the-job competency levels, is compensation.Flannery states that the literature indicates that competency of nurses cangreatly increase when compensation strategies are used effectively. Thisbecause it is fairly well established that, in general, benefits andadvantages to individuals tend to build with growing amounts of education.For example, Brown (1999) notes that, regardless of one's profession orcareer, increased education is associated with: increased knowledge ofone's discipline or field; greater job options; greater income; and, tosome extent, stronger on-the-job performance. (1998). In an extensive review of the nurse competency literature,Smith found many difficulties in both defining and measuring competence andfelt that if a strong definition and assessment of competency were to bedeveloped special attention need to be paid to identifying the importanceof self-assessment, clinical supervision and reflective practice ascomponents of professional practice.
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