CORE COMPETENCIES IN NURSING CREDENTIALING AND CERTIFICATION

Future Directions of Credentialing Research in Nursing: A Workshop

DISCLOSURES

Laurie M. Lauzon Clabo, PhD, RN

Dean, School of Nursing MGH Institute of Health Professions

Chair, American Association of Colleges of Nursing (AACN) Task Force on Advanced Practice Registered Nurses (APRN) Clinical Education Work-in-progress; not yet finalized or approved by AACN

Board

“THE AACN BOARD OF DIRECTORS CHARGES THE TASK FORCE WITH THE DEVELOPMENT OF A WHITE PAPER THAT RE-ENVISIONS CLINICAL TRAINING FOR ADVANCED PRACTICE REGISTERED NURSES (APRNS).”

To meet the charge the task force should:

1. Describe the current state of APRN clinical training, challenges, and regulatory requirements.

2. Describe the current state of APRN clinical training, challenges, and regulatory requirements.

3. Consider competency assessment as an emerging and potential element of a re-envisioned approach to APRN clinical training.

TO MEET THE CHARGE THE TASK FORCE SHOULD:

4. Develop a set of recommendations for restructured or re-envisioned clinical training, including alternative models for APRN clinical training that:

o maximize clinical resources;o consider current and potential financial implications; o provide opportunities to prepare APRNs with the full

graduate, role and population-focused competencies; and

o highlight opportunities and innovations for interprofessional learning and practice.

CURRENT CHALLENGES IN APRN CLINICAL TRAINING

Increased demand for APRN services Many programs report being at capacity, with clinical

training (along with faculty shortages) cited as a major constriction in the pipeline

> 14,600 qualified applications not accepted for graduate programs in 2012 (AACN, 2013)

Competition and scarce resources for clinical training sites and preceptors

CURRENT STATE OF APRN CLINICAL TRAINING

Mounting regulatory issues for in-state and distance-learning students

None, inadequate or unstandardized preceptor training Pressure to compensate preceptors Variable student competence when entering clinical

training Productivity impact on preceptors Competition for APRN learning experiences, particularly

in some areas of practice and geographic regions

CORE COMPETENCIES AS A FOUNDATION FOR APRN EDUCATION AND PRACTICE:

A THREE DECADE JOURNEY

Core Competencies for Nurse Midwifery (1978, 2011)

Domains and Core Competencies for Nurse Practitioner Practice (1990, 2011)

Statement on Clinical Nurse Specialist Practice and Education (1998, 2004)

Scope of Nurse Anesthesia Practice (1980, 2013)

COMPETENCIES, LICENSURE AND CERTIFICATION

Com petencies

M easures of com petencies

Id e n tifie d b y P ro fe s s io n a l O rg a n iz a tio n s (e .g . o n c o lo g y , p a llia tiv e ca re , C V )

S p e c ia lty C e rtif ic a tio n *

Specialty

C N P , C R N A , C N M , C N S in th e P o p u la tio n co n te xt

A P R N C o re C o u rse s : P a th o /p h ys io lo g y , P h a rm a c o lo g y , H e a lth /P h y s ic a l A ss e ss m e n t

Population Foci

Role

APRN

L ic e n s u re : b a s e d o n e d u ca tio n a n d ce rti fic a tio n **

* C e rtif ic a tio n fo r sp e c ia lty m a y in c lu d e e xa m , p o rtfo lio , p e e r re v ie w , e tc . * * C e rt ifica tio n fo r lic e n s u re w ill b e p sy c h o m e tr ic a lly so u n d a n d le g a lly d e fe n s ib le e xa m in a tio n b e a n a c cre d ite d c e rtify in g p ro g ra m ,

Diagram 2: Relationship Among Educational Competencies, Licensure, & Certification in the Role/Population Foci and Education and Credentialing in a Specialty

ONE MODEL: NURSE PRACTITIONER REDESIGN

Giddens, J., Lauzon Clabo, L. M., Gonce-Morton, P. Jeffries, P., McQuade-Jones, B., & Ryan, S. (2014)

CURRENT STATE:

No finite set of nationally recognized, consensus-based common/core competencies for APRNs

Emerging national discussion regarding the reliance on “clinical hours” requirements

No evidence that clinical hour requirements serve as an effective proxy for NONPF core competencies (Halas et al., 2012)

While a competency framework for APRN practice is described as desirable, APRN professional organizations are moving in unique trajectories that are exclusive and unique to each particular role

CORE AND ROLE-SPECIFIC COMPETENCIES: A MILESTONES APPROACH

Nurse Practitioner

Clinical Nurse Specialist

Nurse Midwife

Nurse Anesthetist

Core/Common

Preclinical Clinical Graduation ContinuingExperiences Education Professional Development

RECOMMENDATIONS IN CONSIDERATION BY APRN TASK FORCE

Identify common APRN core competencies across role and population focus

Identify milestones for the APRN core competencies from pre-clinical experience to graduation

Develop standardized assessment tool to be used by preceptors and/or faculty based on the common core APRN competencies.

RECOMMENDATIONS FOR STUDY

1. Identification of essential competencies along multiple dimensions (educational preparation, role, population focus, continuing professional development)

2. Development of robust/efficient strategies for assessment

3. Explore the relationship between competencies and patient outcomes especially in light of the unit-based nature of nursing practice in many settings

4. What, if any, relationships exist between individual achievement of competence and group/team/interprofessional performance?