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NOVEMBER 2010

Nurse and Midwife Clinical Competency Determination and Competency Development Planning

Toolkit

Mission Statement of the National Council

The purpose of the Council is to promote and develop the professional roles of nurses and midwivesin partnership with stakeholders in order to support the delivery of quality nursing and midwifery careto patients/clients in a changing healthcare environment.

© National Council for the Professional Development of Nursing and Midwifery 2010

This toolkit may be cited as “Higgins, A., Begley, C., Timmons F., McGonagle, I., Nevin M. et al (2010)Nurse and Midwife Clinical Competency Determination and Competency Development PlanningToolkit. Dublin: National Council for the Professional Development of Nursing and Midwifery”

Published by

National Council for the Professional Development of Nursing and Midwifery6-7 Manor Street Business Park, Manor Street, Dublin 7

t: 353 1 882 5300 f: 353 1 868 0366

e: [email protected]

w: www.ncnm.ie

Acronyms...................................................................................................................................3

Glossary of Key Terms................................................................................................................5

Foreword....................................................................................................................................7

Introduction and Overview: How to Use the Toolkit ....................................................................9

Competency Determination for Service Need...........................................................................13

Writing Competencies and Behavioural Indicators ....................................................................31

Competency Development Planning and Competency Assessment Processes .......................53

Competence Frameworks in Nursing and Midwifery.................................................................63

References ...............................................................................................................................71

Appendix 1...............................................................................................................................75

Appendix 2...............................................................................................................................77

Appendix 3...............................................................................................................................79

1NATIONAL COUNCIL FOR THE PROFESSIONAL DEVELOPMENT OF NURSING AND MIDWIFERY

Contents

2 NATIONAL COUNCIL FOR THE PROFESSIONAL DEVELOPMENT OF NURSING AND MIDWIFERY

ABA An Bord Altranais

ADoN Assistant Director of Nursing

AMP Advanced Midwife Practitioner

ANP Advanced Nurse Practitioner

CCAWI Centre for Clinical and Academic Workforce Innovation in the UK

CMM Clinical Midwife Manager

CMS Clinical Midwife Specialist

CNM Clinical Nurse Manager

CNS Clinical Nurse Specialist

CPD Continuing Professional Development

DoN Director of Nursing

ED Emergency Department

HSE Health Service Executive

ICN International Council of Nursing

NCNM National Council for the Professional Development of Nursing and Midwifery

MCQ Multiple Choice Question

OHM Office for Health Management

OSCA Observed Structured Clinical Assessment

RCN Royal College of Nursing

UK United Kingdom


Acronyms


A Competency Describes what is observed when a nurse or midwife combinesknowledge, skills, attitudes and judgement to perform role-relevanttasks. A competency is often written as a short descriptive statementcalled a competency statement.

Behavioural Indicators Behavioural indicators are the detailed and working part of anindividual competency. Behavioural indicators are a set of observablebehaviours that indicate that the nurse or midwife has the knowledge,skills, attitudes, values and professional judgement required foreffective performance of the competency identified.

Competence ‘A complex and multidimensional phenomenon and is defined as theability of the Registered Nurse [Midwife] to practise safely andeffectively, fulfilling his/her professional responsibility within his/herscope of practice’ (ABA, 2005a).

Competencies Competencies is the plural of a competency. They are a collection ofcompetency statements that relate to a nursing or midwifery role, anarea of professional practice, or a patient/client group.

Competency Framework A complete collection of competencies and their behavioural indicatorsthat are central to, and set the standards of effective performance for aparticular client group.

Symbol Ledgend


Glossary of Key Terms

Note: a) Please note that organisational policies regarding patient confidentially and data protection for patient notesshould be adhered to.

b) The ‘templates’, ‘case studies’, ‘sample sheets’ and ‘examples’ provided throughout the toolkit are intended as aguide only. They are not intended as a template for nursing and midwifery care.

CaseStudies

Figures Tips &Resources

Examples Tables


The Irish health service is driven by policy direction aiming to provide more services within primary,community and continuing care. A programmatic approach to change is being taken by the HealthService Executive with an initial focus on chronic disease. The current healthcare environment withinwhich nurses and midwives now work has intensified working processes and increased patientcomplexity. Patient populations are ageing, those with chronic diseases are living longer, hospitalstays are shorter with increased use of technology and invasive treatments, patients present with co-morbidities and multiple pathologies, patient turnover and subsequent admissions and dischargesare increased and care in the community is expanding. Patient safety and risk controls necessitateon-going clinical audit, utilization of evidence-based practice, adherence to clinical guidelines,introduction of care pathways and peer review. This means that processes for determining andattaining competencies for nurses and midwives building on identified core clinical competencies arerequired with due regard to scope of practice and service need. Initiatives such as service needsanalysis, the maintenance of portfolios, engagement in clinical supervision and clinical audit andother continuing professional development processes provide support for clinical competencydetermination and attainment.

To this end the National Council commissioned the School of Nursing and Midwifery, Trinity CollegeDublin, through an open tender process to develop and test a toolkit to assist service managers,nurse and midwife managers and nurses and midwives in clinical competency determination andcompetency development planning. The research team worked in partnership with a clinical teamand a National Council steering committee to develop the toolkit.

The toolkit that is presented here was informed by an extensive literature review, examination of thegrey literature and by piloting the toolkit. The toolkit includes information on: competencedetermination for service need, identifying and writing clinical competencies for practice, competencydevelopment planning and assessment and competency frameworks in Nursing and Midwifery.

I would like to thank the team from the School of Nursing and Midwifery, Trinity College Dublin, ledby Prof. Agnes Higgins and their clinical colleagues (see Appendix 1 for full list of authors) andKathleen Mac Lellan, Head of Professional Development and Jenny Hogan, ProfessionalDevelopment Officer who have worked extremely hard to produce this valuable document. It isimportant to note that this toolkit is not intended to form any mandatory update for registration.

This toolkit is published in tandem with a full report titled: The Development and Evaluation of atoolkit to Support Nurse and Midwife Clinical Competency Determination and CompetencyDevelopment Planning. This is available to download from our website: www.ncnm.ie. The reportdetails the process involved in developing the toolkit and I would advise anyone who wants to learnmore about competency development planning and the methodology used in developing the toolkitto read it.

Yvonne O’SheaChief Executive Officer


Foreword


IntroductionThe National Council for the ProfessionalDevelopment of Nursing and Midwifery inIreland commissioned through open tender thedevelopment of this toolkit to assist servicemanagers, nurse and midwife managers andnurses and midwives in the determination ofclinical competencies within a structuredcompetency development plan. A team basedin the School of Nursing and Midwifery, TrinityCollege Dublin developed the toolkit inassociation with relevant stakeholders atselected clinical sites and with internationalcollaborators. A full list of the project team andservices involved is included in Appendix 1. Inaddition, a number of services contributed bysharing examples of competencedocumentation used in their service and byutilising the toolkit and providing feedback ona draft toolkit during a pilot study. SeeAppendix 2 for a list of services whocontributed. The Development and Evaluationof a toolkit to Support Nurse and MidwifeClinical Competency Determination andCompetency Development Planning report ofthe literature and the process undertaken todevelop and test the toolkit is available fromthe National Council for the ProfessionalDevelopment of Nursing and Midwifery.

Purpose of the toolkitThis toolkit builds on nurses’ and midwives’experience of competency developmentplanning. The toolkit provides a systematicapproach to determining and developingcompetencies to meet service andpatient/client needs. It provides nurses and

midwives with a step by step resource toenhance consistency in competencedetermination and development across andbetween specialities and organisations.Emphasis is on competency determination atthree levels (Fig 1.). This toolkit is not intendedto form part of any mandatory updates forregistration.

CompetenceEffective clinical outcomes are influenced bythe competence levels of practitioners.

Patients and clients have complex, increasinghealthcare needs. Technological andpharmacological advances, changingdemographics, and increased internationalmobility mean that the nature of illness anddisease, and consequently the modes of caredelivery and management are changing. Thereis greater emphasis on patient safety, and thegeneral public’s knowledge about, andexpectations of, a quality health care serviceare rising. Consequently, competencydetermination and development is necessaryto ensure good quality care delivery, improvedpatient/client journey and ultimately improvedpatient/client outcomes. Figure 2 provides anoverview of the competency determinationand development process required to meeteffective clinical outcomes for patients/ clients


Introduction and Overview How to use the toolkit

FIGURE 1: Levels of competencydetermination

Service Team Individual

in light of the changing health care context.

Competency determination and developmentpresents a challenge in a time-pressuredenvironment, but their achievement hasbeneficial effects. The service or team that isstriving towards identifying their requiredcompetencies and planning to meet thoserequirements will ultimately be more focused,and thus more efficient and effective in

meeting service needs. Being able to planworkforce requirements and competencydevelopment programmes according tocompetencies required for the service, will notonly lead to improvement in service outcomes,but it will mean the reduction of repetition ofskill base in some areas, and expansion of skillbase for underdeveloped areas, thusimproving workload delivery and management.

Service needs

analysis

Service plan

Case load

Competency determination

for service need

Service

Team

Individual

Ongoingevaluation/

Audit of outcomes

Competency determination of the Nursing/

Midwifery team

Competency determination for the wider healthcare

team

Competency determination for individual

Nurse/Midwife

Competency development

planning

Effective clinical

outcomes for patient/clients

Practice standards

Policies/guidelines

Competency frameworks

FIGURE 2: Competency determination and development process to meet effective clinical outcomes and service needs


Changing Context of health care

• Changing healthcare policy.

• Changes in the health needs andexpectations of patients/serviceusers.

• Reconfiguration of services.

• Regulatory changes.

• Changes in local policies orprocedures.

• Introduction of new health carepractices and technologies.

• Emphasis on patient/client safety.

• Changing modes of healthcaredelivery.

• Introduction of HSE CareProgrammes.

• HIQA standards.

• Patient Safety First.

Changing landscape of nurse ormidwife practice

• Responding to changing needs ofa particular group ofpatients/clients (e.g. change incultural mix).

• Development of new or expandedroles.

• Development of nurse/midwife ledcare.

• Developments innursing/midwifery research andpractice.

• Emphasis on quality assuranceand audit.

Changing dynamic of thenursing or midwifery

• Changing locations of caredelivery.

• Changes in the skill mix of thenursing/midwifery team.

• Changes in the diversity of staff(bank, agency).

• Challenges in recruitment of staffwith required competencies.

• Changes in flexibility of workingtime (part time).

• Clinical career pathway.

Content of toolkitThe toolkit contains information on how to:

• identify and determine nursing and midwiferycompetencies based on service needs.

• profile the competencies of staff within theservice.

• write competencies and behaviouralindicators for practice.

• link competencies to competenceframeworks.

• develop and implement competencedevelopment plans at service, team andindividual level.

• complete an assessment of competencies.

How do I use this toolkit?The toolkit is divided into a number of colour-coded sections and Figure 3 will help you to

identify the section of the toolkit that is mostrelevant to your current needs. Read thestatements in Figure 3 and decide whichsection you wish to complete.

Throughout the toolkit, to assist withexplanations, case examples of competenciesand processes used to determine and assesscompetencies are provided. A number oftemplates are included at the back of therelevant sections to assist you in your ownwork on determining competencies for aservice, team or individual. These templatesare intended as guidelines and should bemodified to suit your specific needs.

The case study on the following page uses thecompetency determination and developmentprocess described in Figure 2 to plan thedevelopment of a new service. Try reading thisand thinking about how the toolkit may alsohelp you or your team meet service needs.

FIGURE 3: Navigate your way around the toolkit


Improved Clinical Outcomes throughSystematic Nursing and Midwifery

Competency Determination

CompetencyDetermination for

Service Need

Writing Competencies and

BehaviouralIndicators

CompetencyDevelopment Planning andCompetencyAssessmentProcesses

CompetenceFrameworks in

Nursing andMidwifery

Green Orange Red Purple

What do youwant to do?

Go to Sectioncoloured...


CASE STUDY – How the service benefited from using the toolkit

Susan is an ADoN in an intellectual disability service. She has been asked by the DoN to develop anurse-led dementia service for clients with an intellectual disability. A number of staff currently working inresidential services have expressed a wish to transfer to this service when the posts are advertisedinternally. How could this toolkit assist Susan and the DoN?

• Susan, with guidance from the DoN, and using the guidelines in the green section of the toolkit,completed a service needs analysis. This involved documenting the current and future needs of thenew service, the nursing competency requirements, and whether or not the present team membershad all the competencies required to meet the needs of the service. From this they were able todecide what needed to change and what solutions were available to them.

• The DoN and Susan, having read the purple section, agreed on a suitable competency framework toguide future developments.

• The next step was to determine and write competencies and behavioural indicators for the service,which Susan did in conjunction with other team members, using information from the green andorange sections. In the process, she was able to identify the competencies that were missing fromher partly-formed team.

• Susan used this information to write the advertisement to be used internally to select new staff tocomplement the skills of the existing team members. Staff who applied to transfer into the newservice were assisted to develop competence profiles, which informed the selection process.

• Each team member was assisted to produce their own competency development plan (CDP), usingthe orange and red section of the toolkit, which fed into the CDP for the team and the service. Workon practice standards and guidelines also commenced, as an on-going team project.

• The team agreed on a process of on-going audit and evaluation.

After 3 months, one team member, Katy, was not achieving the desired level of performance, asdemonstrated by assessing the competencies. Katy was 2 years qualified. When she commencedworking in the new unit, an orientation programme had been agreed and Jan (a preceptor) had beenallocated to give her guidance on achieving her goals. From the outset, Katy had specific knowledge ofthe various skills she needed to develop and how her competency would be assessed. She also knewhow to complete a self-assessment of her own competency and thus sought help as soon as sherealised that her competencies were not meeting the required level.

She met with the CNM and preceptor; they discussed areas of her practice that needed improvement,and developed a more focused CDP with her. Over time, with the focused CDP plan, and experience inthe department, Katy’s confidence grew and her competence developed. The toolkit had helped her toseek assistance at an early stage in her career in the new unit and with guidance, she achieved hergoals.

Competency Determinationfor Service Need

IntroductionDue to the constantly changing health careenvironment, achieving the right mix of staffwith the right competencies to meet serviceneed is an ongoing challenge. Competenciesare about capabilities: they are the behavioursthat effective individuals demonstrate whenundertaking specific clinical roles within theorganisational context (Whiddett & Hollyford2003), and include knowledge, skills, attitudes,values and judgmental ability. For example‘practises in accordance with legislationaffecting nursing practice’ (ABA 2005a) is anexample of a competency.

To ensure that the nursing or midwifery teamhave the required competencies to meetcurrent and future needs a systematicassessment of the competencies required,competencies available and a dynamiccompetence development planning approachis essential.

The purpose of this section is to provideinformation on how to determine and developthe competencies of the nursing andmidwifery team to ensure that current andanticipated future service needs are met.

Why might the competencyof a Nursing or Midwiferyteam need to be reviewed• Changes in the health needs

Amy is a CMM working in a busy prenatalclinic. She has noticed a significant shift inthe profile of the women attending theservice. The women are coming fromdiverse multi-cultural backgrounds with

some health issues that the team may nothave encountered. She is unsure if the teamhave the necessary competencies to meetthe changing needs.

• Changes in the profile of thenursing/midwifery team

Sophie is a DoN working in a hospice. Dueto experienced staff moving to work in thecommunity services the staff in the inpatientnursing team are largely junior, with 2-3years post registration experience. They arealso relying on the employment of staff fromthe local nursing agency.

• Developing a new service

Udoka is an ADoN in the mental healthservices. She has been asked to work withthe Assistant Director of Public HealthNursing to develop a nurse-led service inthe community for women experiencingperinatal mental health issues.

• Changes in nursing practice

Paradeep is a CNM in the children’soncology services and there have been verysignificant changes made to thechemotherapy anti-emetic policy. This willrequire significant changes in the team’snursing practice and the education of familymembers who are involved in the care ofchildren receiving chemotherapy.

• Developments in interventions oradvances in technology

John is a CNM on a general surgical wardand he has agreed to pilot the use of a newadministration pump for the delivery ofepidural medication. This will require the


Competency Determination for Service Need



team to review their practice and policy onmedication management.

These are just a few examples of reasons whythe competencies of a nursing or midwiferyteam to meet service need may to bereviewed.

Prior to reading the next section consider thequestions in Figure 1 in relation to your service.

There is considerable scope to harness thepotential of nurses and midwives to supportthe whole health care team in ensuring thehighest quality of care (NCNM 2009a).Determining and developing nursing andmidwifery competencies to meet serviceneeds is an essential part of this process.Figure 2 identifies a six step approach to thesuccessful determination and development ofcompetencies. A case study outlining theprocess is included at the end of this section.

FIGURE 1: Questions to consider aboutcompetency determinationand development

• What are the current and future needs of theservice/organisation?

• What are the nursing or midwifery competencyrequirements for this service?

- May need to consider the wider healthcareteam competencies.

• What is the profile of the nursing or midwiferyteam?

- Are the team members meeting the needs ofthe service?

- Do they have all the competencies required tomeet current service needs?

- Do they have all the competencies required tomeet projected future needs?

• What are the priorities for competencydevelopment?

• What creative and innovative solutions areavailable for competency development?

FIGURE 2: Nursing and midwifery team competency determination and developmentprocess to meet service need

STEP 1Identify the

needs of the service

STEP 4Identify the gaps

betweencompetenciesavailable andcompetencies

required

STEP 2Identify Nursing

of Midwiferycompetenciesrequired for the

service

STEP 3Identify the

competency profile of the Nursing and

Midwifery team

STEP 6Evaluate thecompetencydevelopment

plan

STEP 5Develop an action

plan for competencydevelopment

Competencydetermination and

development tomeet service need



STEP 1: Identify the needs ofthe serviceProfiling the needs of the service is an essential first step in identifying current serviceneeds and making projected decisions aboutpossible future needs. This type of horizonscanning is a key element of an innovative andreflexive service. A systematic approach toprofiling the needs of the service requiresconsideration of the characteristics of theservice, patient/client group and workforce.During the profiling analysis consider thefollowing questions:

Service profile

• What are the current local, national andinternational policies that are influencing andshaping the development of your service?

• What is the location of the service i.e.rural/urban, proximity to other essentialservices, and proximity to patients/ clients?

• What type of service is offered i.e. dayservices, specialist services?

• Identify anticipated clinical outcomes basedon clinical standards and best internationalevidence for practice.

Patient/client group profile

• What are the demographics, socio-economicstatus, mortality/morbidity rates, and health-related behaviours of the patients/clients whoaccess the service?

• Are there any indicators for emerging healthtrends that can be established? Is thepopulation changing? If so, in what way?

• Are there emerging healthcare issues that thenursing or midwifery team may need toprepare for?

Workforce profile

• What is the current profile of the staffworking in the service i.e. number of staff,age profile, educational level, range of gradesand disciplines?

• What is the current ratio of permanent, part-

time, agency/bank staff?

• Are there vacancies in the existing team andare there challenges in recruitment?

Once the profiling exercise is complete it willbe possible to identify the current and futureservice needs and prioritise them into short,medium and long-term/future anticipatedservice needs.

TEMPLATE: There are a number of templatesto assist you to document the outcomes ofthis step at the end of this section.

STEP 2: Identify the Nursing orMidwifery competencies requiredto meet service needTo analyse and identify the nursing ormidwifery competencies required to meet theservice need, consider the following questions.

• What are the core nursing or midwiferycompetencies required to deliver effectivecare now and in the near future? It may beuseful to consider the wider healthcare teamcompetencies.

• What are the specific nursing or midwiferycompetencies required to deliver effectivecare now and in the future?

• Are there other clinical competencies that thenursing or midwifery team will need now andinto the future (e.g. physical assessment,

Useful resources on serviceneeds analysis

• Service Needs Analysis: Informing Businessand Service Plans (NCNM 2009a).

• Measurement of Nursing and MidwiferyInterventions: Guidance Resource Pack(NCNM 2006a).

• Clinical Outcomes: Promoting patient safetyand quality of care (NCNM 2010).

• National Service Plan (www.hse.ie).

• HIQA Standards (www.hiqa/ie).

• Patient Safety First (patientsafetyfirst.gov.ie).



prescribing, family skills, informationtechnology, research and audit etc.)?

• Do all or some of the nurses or midwives inthe team need to possess all thecompetencies identified?

• Are there specialist nursing or midwiferycompetencies that would require clinicalnurse or midwife specialist or advancednurse or midwife practitioner roles within theservice?

• Does the team have the necessaryleadership and management competenciesto be responsive to change?

• Does the team have the necessaryeducation, mentorship or clinical supervisioncompetencies to support the developmentof the current team and its future members?

• Do the required competencies identified takeinto account the future needs of the service?

There may be a wide variety of competenciesrequired both now and in the future to meetservice need. Therefore it may be necessary toprioritise the competencies using the following:

Resources such as finance, time and skill mixmust be considered in order to developrealistic targets.

TEMPLATE: A useful template for recordingpriorities is included at the end of this section.

STEP 3: Identify thecompetency profile of the currentNursing or Midwifery teamHaving identified the competencies necessaryfor the service, the next step is to identify thecompetencies currently available within thenursing or midwifery team.

There are a number of aspects to take intoaccount when assessing the team’scompetency profile, so consider the followingquestions:

• Who makes up the nursing or midwiferyteam?

• What are the characteristics of the team,e.g. numbers, qualifications and experience?

• What are the skills, knowledge and abilitiesof each team member?

• What core, specialist and othercompetencies does the team have?

• Availability of external expertise/ consultancy(e.g. ANP/AMP, CNS/CMS) to the team?

Once this information is gathered it is possibleto document a detailed profile of thecompetencies the team possess.

TEMPLATE: Useful templates to assist inrecording the competencies of the team areincluded at the end of this section.

STEP 4: Identify the gapsbetween competencies availableand competencies required Once the competencies required for theservice and the competencies available withinthe team have been identified it will bepossible to identify the gaps and set goals andlearning outcomes for competencydevelopment. Matching the knowledge,abilities and skills of the team with the needsof the service and patient/client group isessential to mitigate real or potential riskfactors and prevent avoidable complicationsand injuries (Alberta Health Services in

FIGURE 3: Prioritisingcompetencies

Competenciesrequired

immediately• Essential• Desirable

Anticipatedcompetenciesfor the future

• Essential• Desirable



Canada, 2009). A clinically competent teamwill deliver better clinical outcomes.

This step will also help to identifycompetencies within the team that are beingunderutilised and could be harnessed for thebenefit of patients/ clients and the whole healthcare team.

In setting priorities for competencydevelopment activities at service level it maybe helpful to consider:

• What competencies and levels are requiredby all members of the team?

• What competencies and levels are requiredby specific members of the team only?

TEMPLATE: Useful templates to assist inrecording these tasks are included at the endof this section.

STEP 5: Develop an action planfor competency developmentDeveloping and implementing any action plansfor competency development will require theidentification of clear learning outcomes, basedon the gaps identified.

The competency development plan needs toinclude goals (short, medium, long term), andidentify the resources required to implementCPD.

When planning any competency developmentactivities a nurse or midwife manager needs toconsider the points included in Table 1. Table 2gives further examples of competencydevelopment activities and resources that arefocused on competency development planningfor the individual practitioner.

One aspect of competency developmentplanning may be the development of existingstaff to take on expanded roles and higherlevels of decision making. A number of papershave been published by the National Councilfor the Professional Development of Nursingand Midwifery, which provide useful informationto assist in determining whether or not

enhanced nursing or midwifery roles, includingANP/AMP and CNS/CMS, may be required,and these may be useful to refer to:

TEMPLATE: A template to assist recordingthe competency development plan is includedat the end of the section.

Useful resources

• Framework for the Establishment ofAdvanced Nurse/Midwife Practitioner Posts(NCNM 2008a).

• Framework for the Establishment of ClinicalNurse/Midwife Specialist Posts (NCNM2008b).

• Enhanced Midwifery Practice (NCNM2008c).

• Clinical Nurse Specialist and AdvancedNurse Practitioner Roles for Nurses workingin Older Persons Nursing (NCNM 2007).

• Enhanced Nursing Practice in EmergencyDepartments (NCNM 2008d).

• Clinical Nurse Specialist and AdvancedNurse Practitioner Roles in IntellectualDisability Nursing (NCNM 2006b).



TABLE 1: Competency development activities to meet service needs - points to consider

CPD

• Are the competencydevelopmental activitiesclearly related to the needsof the service?

• Are the aims and learningoutcomes clearly identifiedand achievable?

• Do the learning outcomesaddress all the knowledge,skill and attitudinalrequirements required?

• Is there a clear strategy forevaluation of thecompetency developmentplan?

• Are some developmentactivities mandatory andothers optional?

• What ongoing developmentis needed to sustain andreinforce the competencydevelopment outcomes?

• Does the development planinclude a wide range ofactivities that are bothpractice and classroomfocused?

Management

• Are there any policies orstructures that need to bein place to support thecompetency developmentplan?

• Are the lines ofaccountability, responsibilityand authority relating tocompetency developmentactivities clear?

• What strategies are neededto communicate the plan toall people concerned?

• What incentives may beintroduced to encouragepractitioners to undertakecompetency developmentactivities?

• Can I recruit to the team toaddress a specificknowledge and skills deficitwithin the team?

• How do I motivate peopleto continue working todevelop their potential?

Resources

• Are there people within theexisting team that have thecompetencies and cancontribute to thecompetency developmentplan?

• Are there experiencedpeople in education andmanagement who canprovide additional expertisein competencydevelopment?

• What personnel areavailable within the NursingPractice Development Unit,Centre for Nurse/MidwifeEducation or the LocalHigher Education Institutionthat may assist?

• Are there existingcompetency developmentprogrammes/activitieswithin or outside the servicethat can be utilised e.g.HSEland, master classes,clinical supervision,induction programmes?

• Who needs to be involvedto ensure the resourcesneeded are available, suchas funding, venues,equipment?

• How much time will berequired for competencydevelopment activities?

• Is there an opportunity towork with other services orunits to minimise resourcesrequired?



Note: The red section discusses competency development planning for the individual practitioner,and it may be helpful to refer to this section.

TABLE 2: Competency development activities and useful resources

Within the unit/ward

• Organise mentoring,preceptorship or coachingby experienced staffmember.

• Organise a period ofobservation with an expertin the area.

• Read local policy andprotocols.

• Attend a journal club.

• Read literature and makepresentation to ward staff.

• Undertake some reflectivewriting for inclusion inportfolio.

Within the service/hospital

• Participate in clinicalsupervision.

• Practise skills (clinical orinterpersonal) in the skillslaboratory.

• Undertake a shortcourse/training in centre forNurse/Midwife Education.

• Watch video on relevantarea of practice.

• Participate in a committeeinvolved in developing thisaspect of practice.

• Contribute to an audit orresearch project in the area.

Outside the service

• Undertake a third levelaccredited course ormodule.

• Attend a conference,workshop or seminar.

• Organise a short visit orsecondment to anotherservice.

• Submit an article/poster forpublication or presentation.

Useful resources to support competency development planning

• Guidelines for Portfolio Development for Nurses and Midwives, 3rd edition (NCNM 2009b).

• Framework for the Establishment of Clinical Nurse/Midwife Specialist Posts (NCNM 2008b).

• Framework for the Establishment of Advanced Nurse Practitioner and Advanced Midwife PractitionerPosts, 4th edition (NCNM 2008a).

• Clinical Supervision: A Structured Approach to Best Practice (NCNM 2008e).

• www.hseland.ie.



STEP 6: Evaluate thecompetency development planAll competency development plans should beevaluated carefully against agreed objectivesand time frames. A review should consist ofevaluating both the process and outcomesand should be conducted on a regular basis.When goals have not been met, an explorationof the reasons needs to be completed and afuture plan developed.

A case study is provided at the end of thissection.

Principals of competencydetermination anddevelopment to meetservice needs: key tosuccessDetermining and developing competencies tomeet service need, particularly in a fast-changing and complex healthcare environmentis a challenging task and is part of a processof change management. In all changemanagement activities it is important thatrelevant stakeholders are involved from theoutset. Involving key stakeholders will helpcreate ownership and reduce any anxietiesthat people may have about competencydetermination and development. Somecompetency development plans may haveassociated resource implications. Therefore, ifthe competency development work of theteam is to have the desired impact then thesupport of senior managers is a fundamentalrequirement. Key stakeholders may vary fromservice to service and will include members ofmanagement, the clinical team, educators andmembers of the multidisciplinary team.

The key to successful competencydetermination and development at servicelevel is summarised in Table 3.

RESOURCE: Other information regardinggood change management techniques can befound at www.hseland.ie

TABLE 3: Tips for competencydetermination

• Relevant stakeholders are identified andincluded from the beginning.

• Support from senior management is inplace.

• Communication processes are clear.

• Team involvement and commitment isharnessed.

• Adequate resources are agreed.

• Roles of individuals are clarified.

• Priorities are set for competencydevelopment based on service need.

• Aims and objectives for competencydevelopment are clear and achieveble.

• Evaluation and review dates are built in.

• Action plans are developed if targets arenot met.



Case study – Manager

Sarah is a midwifery manager who has been appointed to a medium-sized maternity unit for thespecific purpose of introducing and developing a midwifery-led unit (MLU). She trained in the UK tenyears ago and has four years’ experience of working in a birthing centre there. On appointment, theDirector of Midwifery discussed with Sarah the way in which midwifery-led services might be introducedand together they drew up a list of competencies that team members would require. To assist her inplanning, Sarah convened a group consisting of two staff midwives, a midwife manager from the labourward, a woman who had experienced both home and hospital births, and a student midwife.

Identifying the needs of the service

Sarah and her group identified the following:

• The current local, national and international policies that were thought likely to influence and shape thedevelopment of their new service [the KPMG report (KPMG 2008), the Cochrane review of midwifery-led care (Hatem et al 2008) and the report of the “MidU” study in HSE- Dublin North-East (Begley et al2009).

• The location of the service, which was mixed rural and urban, with good proximity to a regionalhospital and the main maternity unit, and reasonable proximity to most service users. The needs ofwomen in the more isolated areas were discussed.

• The type of service offered was 24-hour specialist midwifery services, with full access to care at alltimes.

Needs of the women

Sarah and her group identified:

• The demographic profile, socio-economic status, perinatal mortality and morbidity rates, and health-related behaviours of the women who usually accessed maternity services in the area.

• In the process, they found that annual records of intervention in labour, and maternal and perinatalmorbidity rates, in particular, were poorly kept, an issue that needed to be addressed in their planning.

• They also noted that the population was changing, due to increased numbers of women coming tolive in the area from other countries. The midwives noted the need to become more aware of tropicaldiseases as a result.

Nature of the midwifery team required

Sarah and her group identified:

• The number of midwives required to staff the new MLU, based on numbers involved in theestablishment of the first MLUs in Drogheda and Cavan (Begley et al 2009).

Identifying the competencies required for the midwifery led unit

• Core competencies were identified based on the ABA Practice Standards for Midwives (ABA 2010).

• It was noted that, due to the change in context, midwives would require development and support inindependent decision-making.

• Specialist competencies were identified as: caring for women birthing in water, promoting normality(e.g. giving non-interventionist care, using expectant management of the third stage of labour),medication prescribing, and suturing the perineum.

• Priority was given to the first two competencies.

Continued overleaf



Case study – Manager (continued)

Identifying the competency profile of the midwifery team

• Sarah was able to recruit her new team by advertising internationally and interviewing both internaland external candidates to achieve the optimum profile.

• She used a process of competency identification and assessment, working with her support group tolist the characteristics and competencies required to make a rounded team.

• These competencies were then used to construct an interview schedule.

• As team members were appointed, Sarah was able to document with them the competencies thatthey had, and that they were required to obtain.

Identifying gaps in competencies

Sarah documented

• What competencies and levels she felt were required by all members of the team prior toappointment (e.g. philosophy of women-centred, non-interventionist care, ability to make independentdecisions, competent in all areas of midwifery).

• What competencies and levels she felt were required by specific members of the team only (e.g. theMLU leader needed to be expert in all areas of care, three members of the team requiredcompetency in water births, to guide and teach the others, three members of the team requiredcompetencies in perineal suturing to guide and teach the others, etc.).

• In conjunction with her team, Sarah devised a competency development action plan (below), whichincluded a number of activities to be undertaken over a period of 8 weeks. The nature of thedevelopment activities also provided Sarah, her team and her Director of Midwifery with evidencefrom a variety of sources that would assist them in evaluating the success or otherwise of the actionplan.



Sample sheet

Microsoft Word version available on CD

Case study - action plan for team competency development (short term)



Sample sheet


Profiling the service



Sample sheet


Service user needs



Sample sheet


Nursing or Midwifery competencies required for the service



Sample sheet


Priority Nursing or Midwifery competencies required for the service



Sample sheet


Profile of the current nursing or midwifery team



Sample sheet


Competencies of the nursing and midwifery team - identifying the gaps



Sample sheet


Competency development action plan

Writing Competencies and Behavioural Indicators

IntroductionThe identification and writing of competenciesfor practice does not occur in isolation fromthe wider needs of service, team andindividual practitioner. The identification ofcompetencies should take account of theoverall service plan for the organisation,division, ward or unit and the current andanticipated needs of patients/clients whoattend the service. See the green section formore details. In addition to the service plan,the identification of competencies needs tooccur within the context of best availableevidence on the care and treatment ofpatients/clients, clinical outcomes and ongoingclinical audit.

This section provides an overview of writingcompetencies and behavioural indicators.Competency assessment processes areoutlined. Six completed competencystatements, behavioural indicators, evidenceto support competency attainment andcompetence rating scales are provided in thissection.

What is a competencystatement and abehavioural indicator?Competency statement

A competency describes what is observedwhen a nurse or midwife combinesknowledge, skills, attitudes and judgement toperform role-relevant tasks. A competency isoften written as a short descriptive statementcalled a competency statement, whichoutlines the underlying principles for the taskor role to be undertaken. Figure 2 provides anexample of a competency statement.

Behavioural Indicators

Behavioural indicators are the detailed andworking part of an individual competency.They are statements of the behaviour thatwould be observed when effectiveperformance of the competency isdemonstrated. Behavioural indicators need tobe explicit and clearly indicate the knowledge,skills, attitudes and professional judgementrequired of the nurse or midwife to achieveeffectively the competency identified andshould be based on standards for current bestpractice. Figure 3 provides a short example ofsome of the behavioural indicators that may


Writing Competenciesand Behavioural Indicators

FIGURE 1: Context of competencyidentification

FIGURE 2: Example of acompetency statement

Plans and manages effectivelythe pre-operative care of a

patient going for gastrointestinalsurgery

CompetenciesClinical

outcomes

Best availableevidence

Service Plan



be observed for effective performance of thecompetency listed.

As a Nurse or Midwife, whymight you want to writecompetencies andbehavioural indicators?There are a number of reasons why a nurse ormidwife might want to write competencies andbehavioural indicators. Before proceeding youshould read the reasons and examples frompractice and consider how this section of thetoolkit might assist you in writingcompetencies.

1 To identify the knowledge and skillsrequired by nurses or midwives within aparticular role or service

Emily is a CNS working in mental healthwith people who are engaging in substancemisuse. As part of the service developmentplan she would like to identify the nursingcompetencies that are required to provideeffective care to this patient/client groupand which reflect her specialist level ofpractice.

2 To reflect a changing mode of caredelivery

Michael is an ADoN in a general hospital.The ED department in the hospital is nolonger accepting acute trauma, and theemphasis has now changed to walk-inpatients. Michael would like to determinecompetencies for staff to reflect thischanging mode in the delivery of care in ED.

3 To provide a framework for staff to self-assess their competency

Olamide is CNM in an Intellectual DisabilityService in the community. Her team areintroducing a performance developmentplan and they would like to identify andwrite the nursing competencies for thisservice, which can assist them to self-assess their own competency and developeducation plans as appropriate.

4 To assist in the recruitment or inductionof staff

Lauren is a CMM on a postnatal ward andwishes to identify and document thecompetencies required for that unit toprovide a basis for the education of staffand the recruitment and induction of newmidwifery team members.

5 To assist with own competencydevelopment

Orla is a Public Health Nurse working withthe traveller population. Planning for theintroduction of Cystic Fibrosis MetabolicScreening is currently in progress. As thisand other inherited metabolic conditions aremost commonly found amongst travellerfamilies, the protocol for the management of

FIGURE 3: Example of behaviouralindicators

Competency: Plans and manageseffectively the pre-operative care ofa patient going for gastrointestinalsurgery

• Plans, implements and evaluates pre-operative care in conjunction with the multidisciplinary team.

• Implements care according to localguidelines on gastrointestinal surgery.

• Identifies and manages preoperative riskseffectively and completes preoperativechecklist.

• Applies the principles of effectivecommunication and education whenproviding the patient, family member orcarer with information about the pre-operative experience.

• Administers prescribed pre-operativemedications including bowel preparationsin accordance with hospital policy.

• Communicates accurate and relevantinformation to the multidisciplinary team.

• Maintains accurate and comprehensivenursing records of the care given.


these metabolic screening conditions willchange. As this change is imminent Orlaneeds to identify the competencies andbehavioural indicators that will guide her selfassessment development plan.

Identifying and writingcompetencies for practiceThe process for identifying and writingcompetencies involves the following threesteps.

Step 1: Getting the right peopleinvolvedIdentifying and getting commitment from theright people is key to the success of anycompetency identification process. In decidingwho, when and how to involve people considerthe following questions:

• What clinical expertise is required to identifythe competencies and behavioural indicatorsfor the service/team?

• Is the expertise within the service/team or doI need to consult with external people?

• What level of support is required frommanagement or members of the multi-disciplinary team to integrate thecompetencies into practice?

• What resources are required to develop thecompetencies and support any subsequentcompetence development activities?

• How do I enlist the commitment of thepeople who will be using the competencies?

REMEMBER: Not everyone will need to beinvolved in the whole process, and somepeople may only need to be informed of whatis happening. A case study and a template isprovided at the end of this section to assistyou in documenting this step.

Step 2: Collecting the relevantinformation on current bestpracticeCollecting the relevant information on currentbest practice is critical and can often be themost time consuming element in the process.Identifying and documenting relevantcompetencies and behavioural indicatorsinvolves an examination of the knowledge,skills and judgements required by nurses andmidwives to perform their various roles. To dothis, information or evidence will need to begathered about the current best practice thatis required to perform the role or task. Toassist with the identification of current bestevidence key people and documents shouldbe consulted (Table 1 on next page). Thisshould include clinical standards. Data can beobtained in a number of ways such as:

• Observation of a selection of staff who areengaged in the practice for which thecompetencies are being developed. It is notadvisable only to analyse the behaviours ofexpert practitioners, it is important to includea wide spread sample of nurse or midwiferypractitioners to identify competencies acrossall levels.

• Structured one-to-one interviews or groupdiscussion with the key stakeholders.

• Questionnaires to nurses and midwives,patients/clients and family members.

FIGURE 4: Process for identifyingand writingcompetencies andbehavioural indicators

Step 1:Gettingthe rightpeople

involved

Step 3:Writing the

competenciesand

behaviouralindicators

Step 2:Collecting

the relevantinformationon current

bestpractice



Whiddett and Hollyforde (2003) advise using acombination of methods to obtain informationabout relevant competencies and behaviouralindicators. For example, observing practicemay be useful for observable psychomotor ormanual skills but will not allow analysis ofmental activities, such as reasoning orthinking. To access this information, groupsessions or interviews may be moreappropriate.

Step 3: Writing thecompetencies and behaviouralindicatorsCompetencies should be written in a way thatfacilitates ease of understanding and use. Ifthose using competencies find them difficult orfrustrating to understand, they may beignored. Well-written competencies take noteof the principles outlined in Table 2a.

Behavioural indicators must describebehaviour that is observable when effectiveperformance of the competency isdemonstrated. Behavioural indicators need tobe explicit and clearly indicate the knowledge,

skills, attitudes and professional judgementrequired of the nurse or midwife. For example:‘thinking logically’ is not observable but‘organising nursing tasks logically’ is. Similarly,‘knowing the side effects of medication’ is notobservable but ‘teaching a patient/client theside effect of medication’ is. Table 2b provides

TABLE 1: Sources to assist with identifying current best practice

People

• CNS/CMS and ANP/ANP.

• Nursing and midwifery experts.

• Nurses and midwives who will be the usersof the competencies.

• Other professional experts working withinthe area.

• Professional Nursing and Midwiferyorganisations.

• Other organisations involved in the topicarea, e.g. Motor Neurone Diseaseassociation.

• Patient client advocacy groups.

• Individual patients/clients and familymembers.

Documents

• International guidelines e.g. NICE.

• National clinical guidelines.

• Systematic reviews e.g. Cochranedatabase.

• Other published research.

• Local clinical guidelines or practicestandards.

• Guidelines and competency documentspublished by An Bord Altranais.

• Competency documents publishedelsewhere.

• HIQA Standards.

• Patient Safety First.

• Are short descriptive statements thatoutline the principle of a task or role to beperformed.

• Are discrete in their description and do notoverlap with other competencies.

• Reflect An Bord Altranais’s definition ofcompetence as outlined in the glossary ofterms at the beginning of the toolkit.

• Reflect the roles or tasks that all peopleusing the competencies engage in.

• Reflect the philosophy and language of theorganisation.

• Only appear once in the documentation.

• NOTE: Do not be tempted to produce alarge number of competencies as themore you include the less distinct fromeach other they become.


TABLE 2a: Well writtencompetencies:


some guidelines for writing effectivebehavioural indicators.

EXAMPLES: There are a number of examplesof competency statements and behaviourindicators at the end of this section that youshould refer to when you write your owncompetencies and behavioural indicators.

Competency assessmentOn completion of the competencies andbehavioural indicators the next step is theidentification of a competency assessmentprocess. If required refer to the green sectionand red section for details of creating acompetency development plan.

Collect evidence andreflect on performanceThe process of assessing competency requiresthe accumulation of evidence aboutperformance, from a variety of sources, over aperiod of time and in a range of situations. Thefollowing are examples of sources of evidencethat may be used to inform an assessment ofcompetency.

Sources of information/evidence:

• Self-assessment by checking performanceagainst policies, clinical guidelines or otheravailable practice standards.

• Self-assessment using evidence that hasbeen collected from reflecting on everydayperformance, such as a reflective diary.

• Speaking with colleagues to collect dataregarding outcomes of care.

• Interviewing people receiving care (clients,family members) to collect data regardingexperiences and outcomes of care.

• Asking a mentor, preceptor, clinicalsupervisor, peer or manager with experiencein practice to observe performance andprovide feedback.

• Auditing documentation such as care plansor other records.

• Certificates of attendance at courses,conferences or workshops.

• Results of completed tests (writtenassignments, MCQ, OSCA).

• Discussion/reflection groups with colleagues.

• Quality improvement monitors i.e.compliance with infection control policies.

• Contain a statement of action that canbe observed.

• Describe the context or rationale for theaction.

• Contain the simple, clear language so thatthey care not open to differentinterpretations.

• Are relevant to the performance of thecompetency.

• Are sufficient in number to demonstrateeffective performance of the competency.

• Are appropriate to all practitioners who willuse the competency documentation.

• Only appear once i.e. cannot be transferredto another competency.

TABLE 2b: Writing effectivebehavioural indicators (Whiddett and Hollyforde2003)


It is important to check the quality of evidence.For example, attending a skills workshop twoyears previously and not having theopportunity to practice the skill does notsupport good evidence for competencyattainment. The characteristics of goodevidence are outlined in Table 3.

Decide on how thecompetencies will beassessedA common use of a competency document isto assist nurses or midwives to reflect on theirperformance and guide them in a self-assessment process. The availability of clinicalstandards and guidelines for practice (nationaland or local) will inform the assessmentprocess. If these are not currently availablethey will need to be developed.

In addition, there are a number of rating scalesthat may be used to guide the assessmentand facilitate the nurse or midwife to make ajudgement about performance.

Some examples are:

• Competent/not yet deemed competent.

• Numerical scoring system.

• Categorical scoring system.

• Positive/negative indicators.

Competent/not yet deemed competent

Identifying two distinct levels ‘competent’ or‘not yet deemed competent’ is a simple

method of rating whether or not the relevantcompetencies have been achieved. See theexample on the following page (Table 4) ofhow these two levels can be incorporated intoa competency document.

Numerical scoring system

Another scale which may be used is anumerical system. Table 5 demonstrates howa five point numerical system can beincorporated into a competency document.

Categorical scoring system

A categorical system such as Patricia Benner’s(1984) novice to expert continuum is one ofthe most common methods used withinnursing and midwifery (Table 6). Anotherexample of a categorical scoring system isSteineker & Bell’s (1979) experiential taxonomy(Table 7).

RESOURCE: If you choose to use one ofthese methods of assessing clinicalcompetence, look carefully at the explanationsof the various categories. A more detailedexplanation of both Benner (1984) andSteineker & Bell’s (1979) levels are included atthe end of this section.

Positive/negative indicators

Some competence frameworks includeexamples of effective or ineffective behaviours,which an individual can reflect on to ascertainwhether or not they are competent.

EXAMPLES: An example of how theseassessment systems can be incorporated intoa competence document is included in Tables4, 5, 6 and 7 on the following page.


TABLE 3: Characteristics of goodevidence

• Comprehensive: from a variety of sources.

• Consistent: shows consistent achievementacross time and in different situations.

• Valid: relates directly and appropriately tocompetence.

• Current: has been collected in the recentpast.



TABLE 4: Competency assessment documentation using two levels of measurement

TABLE 5: Competency assessment documentation using a numerical system

TABLE 6: Competency assessment documentation using a categorical system usingBenner (1984)

TABLE 7: Competency assessment documentation using Steineker & Bell’s (1979)experiential taxonomy



Linking the competenciesto a Nursing or MidwiferyframeworkA competence framework is a term applied toa complete collection of competencies andtheir behavioural indicators that are central to,and set the standards of, effectiveperformance for a particular client group. Ifthe competencies identified are for a role orservice, they may need to be organised into acoherent framework. The domains ofcompetence or practice standards outlined byABA (2005a, 2005b; 2010) or, the coreconcepts outlined by the NCNM for ANP/AMPor CNS/CMS role (2008a, 2008b) will assistwith the process. The purple section providesmore detail on competence frameworks.

Integrating thecompetencies into practiceThe final step in this process is utilising thecompetencies in practice. If a large number ofcompetencies and their behavioural indicatorshave been identified it may be worthwhile topilot them to see if people find them relevant,useful and user-friendly. A selection of peoplewho will use the competencies can providefeedback using methods such as individualinterviews, questionnaires or focus groups.When feedback has been received thecompetencies and behavioural indicators canbe modified accordingly.

If the competency determination process hasbeen well planned and the intended use of thecompetencies agreed at the outset, integratingand utilising them in practice will pose littledifficulty. Emphasis needs to be placed onagreeing and informing users on how thecompetencies and relevant documentation willbe integrated into existing processes, howpeople will be supported to use them and howthey will be modified and kept up to date toreflect service need and changes in practice.

CASE STUDY: The case study at the end ofthis section provides an example of theprocess involved in identifying and writing

competencies at local level for a particularservice or department.

TEMPLATES: A number of templates areincluded at the end of this section to assistwith:

• Identifying the key people that need to beinvolved.

• Gathering information to inform the writing ofcompetencies.

• Checking the effectiveness of thecompetencies and behavioural indicatorsdeveloped.

Tips to keep in mind whenidentifying and writingcompetencies for a service or role

• Get the key people involved.

• Do not underestimate time required.

• Decide on purpose of the competencies.

• Consult a variety of people within andoutside the team.

• Refer to available documentation.

• Keep a competency statement short.

• Write behavioural indicators that areobservable.

• Decide on a simple assessment strategy.

• Include a process for the ongoing updatingof competencies.



Example A

Sandra is a mental health nurse who has been qualified for 20 years and has spent muchof that time working in long term care environments. Recently Sandra has taken up theopportunity to work in primary care with people experiencing psychosis. This presents Sandrawith a number of challenges as she is aware that theory and interventions in the area of voicehearing has changed. Below is an example of a competency and behavioural indicators thatSandra, the CNS in Psychosis and the service user expert by experience has developed.

Completed competency statements, behaviouralindicators, evidence to support competence attainmentand competence rating scales.

Continued overleaf



Example A (Continued)




Example B


Ann is a CNM II on a busy medical ward in a large hospital. The nursing staff skill mixchanges regularly on the ward and, where available, bank staff and agency staff are used to fillvacancies. Many patients on the ward receive intravenous antibiotics. Ann wishes to write acompetency to reflect the necessary skills and knowledge required by staff on the ward toengage safely in this practice of intravenous (IV) antibiotic administration. Below is an exampleof behavioural indicators and evidence that Ann might include in this competency.



Example C


Rachel is a CNS in Diabetes working in the diabetic out-patients department of a hospital.She would like to identify and write a nursing competency for all nursing staff in thedepartment regarding the safe management of patients who attend the out-patientdepartment with a diabetic foot ulcer. Below is an example of behavioural indicators andevidence that Rachel may include in this nursing competency.



Example D


Farai is a CNM II in a Supported Living Service for people with a mild IntellectualDisability. He would like to develop a competency for all nursing staff in the service to ensurebest practice in person-centred approaches to care. Below is an example of behaviouralindicators that Farai may include in this competency.



Example E


Josephine is the assistant director of public health and she would like to develop acompetency for all nursing staff in the service around clinical decision making. Below is anexample of behavioural indicators that she may include in this competency.



Example F


Jane is a CNM II working in a large prison. The nursing staff in the prison work as part ofa multi-disciplinary team delivering care to clients with wide ranging drug and alcoholdependency problems. In recent times she has noticed an increasing amount of clientsattending the addiction services within the prison. She would like to develop competencies toassist all nursing staff to work effectively as part of the wider multi-disciplinary team in theprison to deliver effective care to this group of clients.



Case study – Process for identifying and writing competencies

Carol is a CNM II working in the phlebotomy department of a large hospital and led the process ofwriting competencies for the purposes of induction and planning development activities for nursing staff.Below is the way that Carol determined the relevant competencies.

The questions Carol asked herself:

• Am I aware of all those I need to involve and the stage at which I need to involve them?

• Do all those that need to be involved know enough about competencies or do I need to do someeducation before we begin?

• Is the purpose of the competencies determination process clearly defined?

• Is the plan to involve stakeholders sufficiently comprehensive?

• How will communication be managed throughout and what strategies will be used?

• Have I allocated sufficient time and resources to the activity?

• What are the potential problems that can be anticipated?

• How can I allay any fears or anxieties people may have?

• How will I ensure that the competencies identified are kept up-to-date and reviewed?

The people Carol involved:

• Director of Nursing: kept her informed of the activity and progress.

• Assistant Director of Nursing: invited her to a meeting in the preparation phase.

• A range of nursing staff with phlebotomy experience: throughout the whole process.

• Facilitators of a venepuncture training course: throughout the whole process.

• Laboratory staff, risk management staff, infection control staff and relevant medical personnel who areinvolved in ordering bloods : at various stages in the process.

• Representation from phlebotomy department in another hospital with expertise in writing competenciesfor a similar department: at the beginning and end of the process.

The information Carol collected to determine the competencies included:

• Published literature and research.

• Audit documentation of blood ordering trends.

• Risk management documentation-needle-stick audit information.

• Patient surveys.

• Local/national policies or practice guidelines e.g. HSE (2010b) guidelines on intravenous cannulation.

• Observation/opinion of a range of phlebotomists.

How Carol piloted the competencies identified:

• Asked a selection of phlebotomists to comment on the clarity of the language and the relevance anduser friendliness of the documentation.

• Piloted the competencies for a period of time with the staff within the department and then reviewedand updated.

How Carol incorporated the competencies into practice:

• Used staff meetings to discuss the competencies.

• Organised a workshop for the team.

• Included them in all induction literature and induction programmes.

• Personally mentored staff in using them to self-assess and develop competency development plans.



Template 1



Template 1: key people to involve in identifying and writing competencies for practice


Template 2



Template 2: Collecting the relevant information

Gathering information - Sources of information


Template 3



Checklist for determining competencies

Template 3: Checklist for competency


Benner (1984) from novice to expert

Novice Novices have no experience of a particular situation. The rule-governed behaviour typicalof the novice is extremely limited and inflexible. As such, novices have no "life experience"in the application of rules. "Just tell me what I need to do and I'll do it." This rule-governedbehaviour is limited and inflexible. They have no ability to prioritise tasks and new skills areperformed in a non-confident manner where understanding is limited. The novice requiresclose supervision, assistance with non-routine situations and continuous education, eitherformal or informal.

Advanced Advanced beginners continue to require assistance in setting priorities and cannot Beginner determine essential interventions in complex situations. These nurses and midwives

require mentoring support in the clinical area. They demonstrate marginally acceptableperformance as they can deal with more non routine situations than the novice but stillneed frequent assistance from more expert colleagues and formal or informal education.

Competent Competence, typified by the practitioner who has been on the job in the same or similarsituations two or three years, develops when the nurse or midwife begins to see his or heractions in terms of long-range goals or plans of which he or she is consciously aware. Forthe competent nurse or midwife, a plan establishes a perspective, and the plan is basedon considerable conscious, abstract, analytic contemplation of the problem. Theconscious, deliberate planning that is characteristic of this skill level helps achieveefficiency and organisation. The competent practitioner lacks the speed and flexibility ofthe proficient nurse or midwife but does have a feeling of mastery and the ability to copewith and manage the many contingencies of clinical nursing. The competent person doesnot yet have enough experience to recognise a situation in terms of an overall picture or interms of which aspects are most salient, most important. The competent practitionerneeds selected assistance or supervision, can manage most complex situations butrequires frequent informal and formal education to keep practice up to date.

Proficient The proficient performer perceives situations as wholes rather than in terms of singleaspects. Proficient nurses and midwives understand a situation as a whole because theyperceive its meaning in terms of long-term goals. The proficient nurse or midwife learnsfrom experience what typical events to expect in a given situation and how plans need tobe modified in response to these events. The proficient practitioner can now recognisewhen the expected normal picture does not materialise. This holistic understandingimproves the proficient nurse's or midwife’s decision making; it becomes less labouredbecause the nurse or midwife now has a perspective on which of the many existingattributes and aspects in the present situation are the important ones. The proficient nurseor midwife acts as a mentor and supervises other practitioners, manages all situationseffectively and requires formal and informal education in order to keep current

Expert The expert performer no longer relies on an analytic principle (rule, guideline, and maxim)to connect her or his understanding of the situation to an appropriate action. The expertnurse or midwife, with an enormous background of experience, now has an intuitive graspof each situation operating from a deep understanding of the total situation. The experttrains other nurses or midwives to be mentors and oversees unit experiences, manages allsituations effectively by anticipating complications and requires formal education to keepcurrent

[Adapted from Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.]



The experiential taxonomy (Steineker and Bell 1979)

Exposure The individual will have observed a competent practitioner carry out aspects ofnursing care, shows a willingness and ability to relate the practice observed and itsunderlying theory to their own previous experience. Demonstrates ability to analyseand discuss with the practitioner why and how certain aspects of care were carriedout, and identifies sources and types of information required to enhance furtherapplication of knowledge to the practice observed.

Participation The individual now shows the ability to participate in the delivery of care undersupervision on a more sustained basis with less prompting and greater confidence.Shows greater ability to communicate effectively. Demonstrates a wish to acquirefurther information and ability to analyse and interpret information. Applies problemsolving skills and knowledge base to meet different situations.

Identification The individual demonstrates the ability to explain the rationale for nursing action.Requires less supervision whilst caring for a group of patients/clients, is able totransfer knowledge to new situations. Seeks and applies new knowledge andresearch findings, demonstrates ability to use problem solving skills, critical analysisand evaluation.

Internalisation The individual demonstrates the ability to participate under close supervision of acompetent practitioner in carrying out aspects of care, having demonstratedknowledge by analysis. Questions practitioner on aspects of care and its rationale,decision-making, practical skills, and means of acquiring further information andopportunities for practice. Shows ability to perform manipulative skills,operationalises communication and problem solving skills with guidance.

Dissemination The individual demonstrates the ability to plan, implement and evaluate care forpatients/clients under minimal supervision. Advises others, shows ability to teachjunior colleagues, identifies personal management style and shows ability to managecare delivery by junior staff. Critical analysis, evaluation and decision-making skillsare demonstrated.

[Adapted from Steineker N., Bell R. (1979). The experiential taxonomy: a new approach to teaching and learning. Academic Press,New York.]




Competency Development Planningand Competency Assessment Processes

IntroductionThis section provides support for managers tomentor nursing or midwifery team members todevelop individual competency plans foreffective service delivery.

This section also supports individual nursesand midwives to develop a competencydevelopment plan inclusive of assessmentprocesses. This is in order that individualnurses and midwives can contribute to theoverall competency pool of the nursing ormidwifery team focusing on effective clinicaloutcomes. This individual competencydevelopment planning and assessment willalso contribute to nurse or midwife’s portfoliodevelopment.

It may to useful to refer back to the green andorange sections. The green sectiondiscusses issues in relation to competencedetermination for the nursing or midwiferyteam to meet the needs of a service. Theorange section provides guidance on writingcompetencies and assessment processes.

The following are some examples frompractice where nurses and midwives may wishto carry out an assessment of their practiceand create a competency development plan.

• Marie is a staff nurse working in a localhospital for a number of years. She isthinking of applying for a job in a nursinghome. She would like to carry out anassessment of her competencies andupdate her portfolio. She will use this as partof her evidence of CPD and to prepare forpotential job interviews.

• Lorna is a nurse working in the prisonservice. She has taken on the role of co-ordinator of the substance misusedetoxification programme and would like tocarry out an assessment of hercompetencies to identify areas forimprovement

• Raji is working in paediatric intensivecare. Following the introduction of somenew equipment, the protocol for ventilatingbabies has been revised and he would liketo assure himself of his competencies in thisarea.

• Alice is a Public Health Nurse attached toa Health Centre in a Local Health Officearea. A primary care team has recently beenestablished and this has resulted in achange of practice. Alice would therefore liketo carry out an assessment of hercompetencies to identify areas forimprovement, in particular in the area ofchairing clinical team meetings, and todiscuss these with her line manager.

• Aveen is a mental health nurse who hasmoved from a hospital to community care.The clinical nurse manager has provided herwith nursing competencies for the service,and Aveen would like to carry out anassessment of her competencies to identifyareas for improvement and discuss hercompetency development plan with hermanager.

• David is a midwife in the labour ward whohas taken on a role as preceptor to Ciara, anewly qualified midwife. He would like someassistance with his own competencies as a


Competency Development Planning and Competency Assessment Processes



preceptor in supporting Ciara with herassessment and development ofcompetencies.

Competency developmentplanning and assessmentprocessesThe competency development planningprocess for an individual nurse or midwife is acyclical process, which enables a nurse ormidwife to identify strengths and gaps in skilllevel, set goals and develop action plans toassist in achieving desired competencies. Theprocess described in this section involves fivesteps (outlined in Figure 1). A case studyexample that relates the steps to a practicalexample is provided at the end of this section.You will also find templates for documentingthe steps of both your assessment and

competency development plan at the end ofthis section.

Step1: Identify desiredcompetencies and behaviouralindicatorsThe relevant competencies or behaviouralindicators for the area of practice or role mayalready be available. They may be containedwithin documents that exist within theservice/organisation such as those outlined inTable 1 on the following page.

If the competencies are not available it may benecessary to work with the manager or teamto identify relevant competencies andbehavioural indicators. If this is the case theorange section of this toolkit providesguidance on writing competencies andbehavioural indicators.

FIGURE 1: Competency assessment and development planning process

STEP 1Identify desired

competencies andbehaviouralindicators*

STEP 2Collect evidence

and reflect onperformance

STEP 5Evaluate thecompetency

development plan

STEP 4Develop andimplement acompetencydevelopment

plan

STEP 3Complete acompetencyassessment

Competencydevelopmentplanning and

assessment processfor the individualnurse or midwife

*Refer to orange section



Step 2: Collect evidence andreflect on performance

Assessing competencies requires a nurse ormidwife to reflect carefully on their practice andexamine each competency statement andbehavioural indicator.

This step involves asking the followingquestions:

• Do I have the knowledge, skills and attitudesnecessary for each competency andbehavioural indicators identified?

• What evidence do I have to indicate that Ican demonstrate the competency andbehavioural indicators identified?

The process of assessing competence requiresthe accumulation of evidence aboutperformance, from a variety of sources, over aperiod of time and in a range of situations. Thefollowing are examples of sources of evidencethat may be used to inform an assessment ofcompetency.

Sources of information/evidence:

• Self -assessment by checking performanceagainst policies, clinical guidelines or otheravailable practice standards.

• Self -assessment using evidence that hasbeen collected from reflecting on everydayperformance, such as a reflective diary.

• Speaking with colleagues to collect dataregarding outcomes of care.

• Interviewing people receiving care (clients,family members) to collect data regarding

experiences and outcomes of care.

• Asking a mentor, preceptor, clinicalsupervisor, peer or manager with experiencein practice to observe performance andprovide feedback.

• Auditing documentation such as care plansor other records.

• Certificates of attendance at courses,conferences or workshops.

• Results of completed tests (writtenassignments, MCQ, OSCA).

• Discussion/reflection groups with colleagues.

• Quality improvement monitors i.e.compliance with infection control policies.

It is important to check the quality of evidence.For example attendance at a skills workshoptwo years previously in the absence of clinicalpractice would not be considered goodevidence. The characteristics of good evidenceare outlined in Table 2.

Step 3: Complete acompetency assessmentAfter reviewing each competency and relevantbehavioural indicators in light of the evidence,it is necessary for a nurse or midwife to makea judgement about their performance and ratetheir level of competence. There are a numberof rating scales that may be used to assist withthis process.

• ‘Competent’ or ‘Not yet deemed competent’.

• Numerical scoring system.

TABLE 1: Documentation whichmay containcompetencies for practice

• Competency framework documents.

• Practice standards.

• Clinical or practice guidelines.

• Policy documents.

• Unit or service objectives.

TABLE 2: Characteristics of goodevidence

• Comprehensive: from a variety of sources.

• Consistent: shows consistent achievementacross time and in different situations.

• Valid: relates directly and appropriately tocompetence.

• Current: has been collected in the recentpast.



• Categorical scoring system.

• Positive/negative indicators.

A more detailed explanation of each scale isincluded in the orange section of the toolkit.You should look at these explanations carefullyif you choose to use one of these methods.

The outcome of this competency assessmentwill be the identification of the competenciesachieved and the competencies that requirefurther development.

Step 4: Develop and implementa competency development planWhere the desired level of competency is not

achieved a clear competency developmentplan should be devised to enable attainmentof competency. Competency developmentactivities included in the plan can be formal orinformal. Table 3 outlines a variety ofcompetency development activities andresources that a nurse or midwife mayconsider when developing a plan.

When devising the plan remember to specifythe timeframe for achieving objectives as wellas the source or type of evidence that will beused to assess the outcomes.

TABLE 3: Competency development activities and useful resources

Within the unit/ward

• Organise mentoring orcoaching by experiencedstaff member.

• Organise a period ofobservation with an expertin the area.

• Read local policy andprotocols.

• Attend a journal club.

• Read literature and makepresentation to ward staff.

• Undertake some reflectivewriting for inclusion inportfolio.

Within the service/hospital

• Participate in clinicalsupervision.

• Practise skills (clinical orinterpersonal) in the skillslaboratory.

• Undertake a shortcourse/training in centre foreducation.

• Watch video on relevantarea of practice.

• Participate in a committeeinvolved in developing thisaspect of practice.

• Contribute to an audit orresearch project in the area.

Outside the service

• Undertake a third levelaccredited course ormodule.

• Attend a conference,workshop or seminar.

• Organise a short visit orsecondment to anotherservice.

• Submit an article/poster forpublication or presentation.

Useful resources to support competency development planning

• Guidelines for Portfolio Development for Nurses and Midwives, 3rd edition (NCNM 2009b).



• Clinical Supervision: A Structured Approach to Best Practice (NCNM 2008e).

• www.hseland.ie.



Step 5: Evaluate thecompetency development planThe final step is the evaluation of thecompetency development plan. It may beuseful to ask a colleague or manager to helpwith this.

If having reviewed the plan the desiredcompetency level has been achieved within thetime period identified, consider the followingquestions.

• What supports were useful in achieving thedesired level of competence?

• What supports would I use in futurecompetency development plans?

• Are new development activities required foranother competency?

If having reviewed the plan the desiredcompetency level has not been achieved withinthe specified timeframe, consider the followingquestions.

• What were the reasons for not achieving thecompetency?

• Were the goals reasonable and achieveble?

• Was the time frame unrealistic and thereforeneeds to be extended?

• Are the supports identified helpful?

• Are additional or different supports required?

• Do I need to ask for guidance for a seniorcolleague?

Asking and answering the above questions willassist in determining what action is nextrequired to achieve the competency.

The five step process of competencydevelopment planning described in this sectionwill act as a valuable tool in assisting incontinued professional development. It will alsoensure efficient, effective care and enhance theoverall functioning and clinical outcomes of theservice/team.

TEMPLATE: At the end of this section atemplate to document a personal competency

development plan based on Benner’s (1984)novice to expert continuum is included. A moredetailed explanation of Benner’s categories isincluded in the orange section of the toolkit.You should look at this explanation carefully ifyou choose to use this method.

The template will assist in documenting theactions undertaken to develop competencyand the evidence to support competencyachievement and the evaluation. It can also beadded to a professional portfolio as evidenceof continuing professional development.

How frequently should Iassess my competenciesTimeframes will be dependent on suchvariables as the complexity of the competency,the opportunity for clinical practice andexperience and the emergence of newevidence etc.

The current health care environment is everchanging and consequently there will be manyoccasions when competence assessment anddevelopment will be necessary to ensurequality safe patient/client care. Some examplesof these situations were outlined at thebeginning of this section, such as: changes incare process or new interventions, changes intechnology, publication of new guidelines orprotocols, taking on a new role, expanding anexisting role, moving to a new area of practice,and/or returning to nursing and midwiferypractice after a period of absence.



Tips to keep in mind when building a competency development plan

• Prioritise the competencies that require development.

• Set realistic goals for competence development.

• Consider time constraints, resources and other supports that may be required.

• Set a review date that is achieveble.

• Use a variety of evidence to inform a self assessment.

• Identify both formal and informal competency development activities.

• Consider how people within and outside your immediate team may provide assistance .

• Review the competency development plan within agreed timeframe.

• If progress not achieved review actions and support as alternative actions and support structures may berequired.



Case study

Paul is a mental health nurse who qualified six months ago. Since qualifying, he has worked in acare of the elderly day service, filling in for a staff member who was on leave of absence. On their returnPaul was redeployed to the mental health day hospital. During his orientation the CNM provides Paul with alist of competencies that he requires as part of his role. One of the competencies was to ‘Develop recoveryoriented care plans in association with service user/family member’. This competency and its relatedbehavioural indicators are outlined opposite. Effectively assessing competence required Paul to reflectcarefully on his professional performance/practice in the light of the competency statement and behaviouralcriteria/indicators identified. To achieve this, Paul used self-assessment strategies and asked his CNM toobserve him developing a recovery care plan with a service user and review the written documentation ofthe plan developed. Although Paul was competent in developing a plan of care with the client group heworked with previously, following his self-assessment and feedback from the CNM, he rated himself, usingBenner’s framework, as an advanced beginner in a number of the behavioural indicators identified.



Example: competency development plan

In conjunction with the CNM Paul devised a competency development plan (below), whichincluded a number of activities to be undertaken over a period of 6 weeks. The nature of thedevelopment activities also provided Paul with evidence from a variety of sources that wouldassist him in evaluating the success or otherwise of his development plan.



Template 1


Competency assessment and development planning



Template 2


Personal competency development plan

Competence Frameworks in Nursing and Midwifery

IntroductionThis section provides information oncompetence frameworks and provides someguidance on how to link the competenciesidentified for a service or role to an overallcompetence framework. Before progressingyou may wish to consider the followingquestions.

Questions to consider:

• What do I know about competenceframeworks?

• What are the core competence frameworksthat underpin my professional practice?

• Are there specific competence frameworksthat have been developed to support myspecific role/area of practice?

• Are competence frameworks utilised withinmy service/organisation and, if so, for whatpurposes?

What is a competenceframework?A competence framework is a term applied toa complete collection of competencies andtheir behavioural indicators that are central to,and set the standards of, effectiveperformance for a particular client group (olderpersons), condition (Parkinson’s, stroke,substance misuse), role (peri-operative care)or department (theatre, rehabilitation, labourward). In other words a competenceframework is a way of organising lists ofcompetencies and their behavioural indicatorsinto an organised, structured and integratedwhole (Whiddett & Hollyforde 2003).

Competence frameworks provide an explicitlink between the competencies required forsafe and effective care, based on serviceneed, and the competencies that individualnurses or midwives must possess, or need toacquire. In nursing and midwifery, acompetence framework also communicates ashared understanding of the values and beliefsof the professions.

How are competenceframeworks structured?Although there may be various approaches toconstructing competence frameworks, they allhave three similar basic elements:

• Competency statements.

• Behavioural indicators.

• Competency domains/core concepts/clusters or practice standards.

Competency statements

A competency statement is a brief writtendescription outlining the expected knowledge,skills and judgement that nurses and midwivesuse to provide effective care (Whiddett &Hollyforde 2003).

Behavioural indicators

Behavioural indicators are the behaviours thatone would expect to observe when a persondemonstrates effective performance in thestated competency. Therefore, each individualcompetency will comprise several behaviouralindicators (Whiddett & Hollyforde 2007).


Competence Frameworksin Nursing and Midwifery



Competency domains/coreconcepts/clusters/practice standards

A competency domain/core concept/cluster isa collection of closely related competencies,which are grouped together under an overallterm that represents one category or aspect ofprofessional practice. Within the professions ofnursing and midwifery a collection of closelyrelated competencies may also be referred toas “practice standards”.

Figure 1 above shows how a competencydomain/core concept/cluster/standard can beconstructed. This competency domain (CD)contains four competencies (C), eachcontaining three behavioural indicators (BI).Typically a competence framework maycontain between five to eight domains/coreconcepts/clusters.

Nursing and Midwiferycompetence frameworks inIrelandThe major competence frameworks in nursingand midwifery in Ireland are:

• Common or core competence frameworks.

• Role-specific competence frameworks.

• Competence frameworks for nurses ormidwives working with a particularpatient/client group.

• Competence frameworks for expanding rolesin nursing and midwifery.

Core competenceframeworksCommon or core competence frameworks innursing and midwifery contain competenciesthat are appropriate to all nurses or midwives,across all organisations and at all levels. AnBord Altranais’s Domains of Competence fornurses (ABA 2005a) and midwives (ABA2005b), available at www.nursingboard.ie, areexamples of core competence frameworks.These frameworks describe the knowledgeand skills nurses and midwives need toachieve competency for registration with ABA.Both frameworks include five domains (Figure 2).

FIGURE 1: Construction of a Competency Domain

FIGURE 2: Domains ofCompetence (ABA2005a)

B1B1B1 B1B1B1 B1B1B1 B1B1B1

CD

C C C C

Holisticapproaches to

care andintergration of

knowledge

Organisation and

management of care

Professional and ethical

practice

Personal andprofessionaldevelopment

Interpersonalrelationships

Domains ofCompetence



Each domain includes individual competenciesand relevant behavioural indicators, whichdescribe the elements within the particularcompetency that are deemed to reflect safeand competent nursing or midwifery practice.

An Bord Altranais recognises and supports thedistinct professional identity of midwives andhas recently published competencies relatedspecifically to the profession of midwiferyentitled The Practice Standards for Midwives(ABA 2010, available at www.nursingboard.ie).Nine practice standards are identified (Figure 3)and each standard includes relevantcompetencies and practice guidelines.

Role-specific competenceframeworksWithin nursing and midwifery practice in Irelandthere are also role-specific competenceframeworks, which identify core competenciesthat are applicable to all nurses and midwiveswithin a particular role such as ANP/AMP andCNS/CMS.

The NCNM (2008a) identified four coreconcepts (Figure 4) with the associatedcompetencies for the ANP/AMP role. These

ANP/AMP concepts are shared by all whopractise at this level (NCNM 2008a).

The NCNM have identified five core conceptswith associated competencies for clinical nurseand midwife specialists in Ireland. TheseCNS/CMS concepts (Figure 5) are shared byall who practise at this level (NCNM 2008b).

FIGURE 3: Midwifery PracticeStandards (ABA 2005b)

FIGURE 4: Advanced Nurse andMidwife practitionerrole concepts (NCNM2008a)

FIGURE 5: Clinical Nurse orMidwife specialist roleconcepts (NCNM 2008b)

Clinicalfocus

Patient/Client

advocacyConsultancy

Educationand

training

Audit andresearch

CNS/CMSCore

Concepts

Research

Expertpractice

Autonomyin clinicalpractice

Professionaland clinicalleadership

ANP/AMPCore

Concepts

Practices inaccordance

with legislationUnderpinned

by philosophy ofmidwifery

Practises inaccordance with

scope ofmidwifery practice

Encompassesthe full range ofactivities of the

midwifeWorks in

partnershipwith the

woman andher family

Communicateseffectively in

one-to-one andgroup situations

Communicateseffectively withother membersof healthcare

team

Supportsdevelopment andprovision of care

in clinicalgovernanceframework

Acts to enhance

development of self and

others

PracticeStandards

for Midwives



Competence frameworksfor Nurses and Midwivesworking with particularpatient/client groupWithin Ireland the five domains of competencepublished by ABA (2005a, 2005b) have beenused to develop published competencies fornurses and midwives working with a particularclient/patient group. The ABA publicationProfessional Guidance for Nurses working withOlder People is an example of a competenceframework for nurses working with a particularclient group (ABA 2009).

Competence frameworksfor expanding roles inNursing and MidwiferyNurses’ and midwives’ roles have expanded toreflect a wide variety of practices in responseto the needs of patients/clients within thedynamic healthcare environment. Below aresome examples of these expanded roles thatare based on ABA’s Domains of Competence(2005a, 2005b).

• Requirements and Standards for EducationProgrammes for Nurses and Midwives withPrescriptive Authority (ABA 2007).

• Requirements and Standards for NurseEducation Programmes for Authority toPrescribe Ionising Radiation (ABA 2008).

Linking competencies to aNursing or MidwiferyframeworkTo ensure that the competencies identified arebeing developed in an integrated manner, it isimportant that they are linked to existingcompetence frameworks that have beenpublished. An Bord Altranais’s Domains ofCompetence for nurses (ABA 2005a) andmidwives (ABA 2005b) may assist with thisprocess. If the competencies are written forthe ANP/AMP or CNS/CMS role the coreconcepts outlines by the NCNM (2008a,2008b) should be used. Organising thecompetencies into a coherent framework willenable users to identify any gaps and minimiseoverlap.

Utilising a framework will also ensure that eachgroup or individual involved in identifyingcompetencies within the organisation areusing an overall coherent competencedevelopment approach. An example of howthe competencies required to care for childrenrequiring an arterial line may be linked to An

TABLE 1: Benefits of using competence frameworks in practice

Performance management

• Provide structure andscope to the setting ofobjectives.

• Provide a focus on thebehaviours that arerequired to perform a role.

• Identify how thosebehaviours are to bemeasured and assessed.

• Assist in planning for futureCPD.

Learning and development

• Facilitate the nurse/midwifemanager to review andidentify the developmentand training needs of staff.

• Inform services in thecommissioning andevaluation of CPDprogrammes.

• Guide and supporteducators in the design,delivery and evaluation ofCPD programmes.

• Facilitate the individual nurseto identify their CPD needs.

Recruitment and selection

• Describe the organisation’saspirations and thebehaviours required for aparticular role, for example,in a job advertisement andjob description.

• Provide criteria to designand assess candidatesusing competency-basedinterviews.

• Provide criteria to structurefeedback to interviewcandidates.

Bord Altranais’s Domains of Competence fornurses (ABA 2005a) and is provided at the endof this section.

Benefits of utilisingcompetencies andcompetence frameworks inpracticeDeveloping and using a competenceframework for your service or role can assist ina number of areas of professional practice asoutlined in Table 1 (on previous page).

InternationalNursing/Midwiferycompetence frameworks In addition to core competence frameworksmany countries have produced specificcompetence frameworks relating to a variety ofnursing practice internationally. Depending onyour area of practice, some of these may be ofinterest to you. It is important to rememberthat they are not using the domains ofcompetence or core concepts identified byABA or the NCNM (Table 2).

• Closing the Gap: A capability framework forworking effectively with people with combinedmental health and substance use problems(dual diagnosis) (Hughes 2006).

• Competencies: A Competency Framework fornurses working in Parkinson’s diseaseManagement (RCN 2009a).

• Sexual health competencies: an integratedcareer and competence framework for sexualand reproductive health nursing across theUK (RCN 2009b).

• Competency framework for Nursing StaffWorking in the Scottish Prison Service (NHS2005).

• A Route to Enhanced Competence inPerioperative Practice For OperatingDepartment Practitioners and Nurses (NHS2002).



TABLE 2: Examples ofcompetence frameworks



Example

The following is an example of how competencies in relation to caring for a specificpatient/client group may be linked with An Bord Altranais’s Domains of competence (ABA2005a). The patient/ client group are children requiring an arterial line.

Relating competencies to core competence framework anddomains of competence

Continued on next page




Example (Continued)

Continued on next page




EXAMPLE (Continued)


Alberta Health Services 2009 Enhancing Nursing Role Effectiveness Through Job Redesign, Aproject funded by Alberta Heritage Foundation for Medical Research, Alberta.

An Bord Altranais 2005a Requirements and Standards for Nurse Registration EducationProgrammes, Dublin, An Bord Altranais.

An Bord Altranais 2005b Requirements and Standards for the Midwife Registration EducationProgramme, Dublin, An Bord Altranais.

An Bord Altranais 2007 Requirements and Standards for Education Programmes for Nurses andMidwives with Prescriptive Authority, Dublin, An Bord Altranais.

An Bord Altranais 2008 Requirements and Standards for Nurse Education Programmes forAuthority to Prescribe Ionising Radiation (X-Ray), Dublin, An Bord Altranais.

An Bord Altranais 2009 Professional Guidance for Nurses Working with Older People, Dublin, AnBord Altranais.

An Bord Altranais 2010 Practice Standards for Midwives, Dublin, An Bord Altranais.

Begley, C., Devane, D. & Clarke, M. 2009 An evaluation of midwifery-led care in the Health ServiceExecutive North Eastern Area: the report of the MidU study [Online]. HSE. Available:http://www.hse.ie/eng/services/Publications/services/Hospitals/midwifery%20north%20east.pdf [Accessed 14 September 2010].

Benner, P. E. 1984 From novice to expert: excellence and power in clinical nursing practice, MenloPark, California,, Addison-Wesley Pub. Co., Nursing Division.

Hatem, M., Sandall, J., Devane, D., Soltani, H. & Gates, S. 2008 Midwife-led versus other modelsof care for childbearing women. Cochrane Database of Systematic Reviews,Art.No.:CD004667.DOI:10.1002/14651858.CD004667.pub2.

Health Service Executive 2010a HSE National Service Plan 2010 [Online]. Available:http://www.hse.ie/eng/services/Publications/corporate/National%20Service%20Plan%202010.pdf [Accessed 13th November 2010].

Health Service Executive 2010b A Guiding Framework for Education, Training and CompetenceValidation in Venepuncture and Peripheral Intravenous Cannulation for Nurses and Midwives,Dublin, Health Service Executive.

Hughes, L. 2006 Closing the gap: a capability framework for working effectively with people withcombined mental health and substance use problems (dual diagnosis). Mansfield: CCAWI.

KPMG (2008) Independent Review of Maternity and Gynaecology Services in the Greater DublinArea. Available: http://www.hse.ie/eng/services/Publications/services/Hospitals/Independent_Review_of_Maternity_and_Gynaecology_Services_in_the_greater_Dublin_area_.html. (Last accessed September 14, 2010).


References


National Council for the Professional Development of Nursing and Midwifery 2006a Development ofMeasurement of Nursing and Midwifery Interventions: Guidance and Resource Pack, Dublin,National Council for the Professional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2006b Clinical NurseSpecialist and Advanced Nurse Practitioner Roles in Intellectual Disability, Dublin, NationalCouncil for the Professional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2007 Clinical NurseSpecialist and Advanced Nurse Practitioner Roles in Older Persons Nursing, Dublin, NationalCouncil for the Professional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2008a Framework forthe Establishment of Advanced Nurse Practitioner and Advanced Midwife Practitioner Posts,Dublin, National Council for the Professional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2008b Framework forthe Establishment of Clinical Nurse/Midwife Specialist Posts : Intermediate Pathway, Dublin,National Council for the Professional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2008c EnhancedMidwifery Practice, Dublin, National Council for the Professional Development of Nursing andMidwifery.

National Council for the Professional Development of Nursing and Midwifery 2008d EnhancedNursing Practice in Emergency Departments, Dublin, National Council for the ProfessionalDevelopment of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2008e ClinicalSupervision: A Structured Approach to Best Practice, Dublin, National Council for theProfessional Development of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2009a Service NeedsAnalysis: Informing Business and Service Plans, Dublin, National Council for the ProfessionalDevelopment of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2009b Guidelines forPortfolio Development for Nurses and Midwives, Dublin, National Council for the ProfessionalDevelopment of Nursing and Midwifery.

National Council for the Professional Development of Nursing and Midwifery 2010 Clinical Outcomes- Promoting Patient Safety and Quality of Care: Implications for Nurses and Midwives,National Council for the Professional Development of Nursing and Midwifery.

National Health Service 2002 A Route to Enhanced Competence in Perioperative Practice ForOperating Department Practitioners and Nurses, NHS UK.

National Health Service & Royal College of Nursing 2007 Developing and sustaining effective teams,London, Royal College of Nursing.

National Health Service Scotland 2005 Competency framework for nursing staff working within theScottish prison service, NHS Scotland.

Royal College of Nursing 2009a Competencies: A Competency Framework for Nurses working inParkinson's disease management, London, Royal College of Nursing.


Royal College Of Nursing 2009b Sexual health competencies: an integrated career and competenceframework for sexual and reproductive health nursing across the UK, London, Royal Collegeof Nursing.

Steinaker, N. & Bell, R. 1979 The Experiential Taxonomy: A New Approach to Teaching and Learning,New York, Academic Press.

Whiddett, S., Hollyforde, S. & Chartered Institute Of Personnel and Development. 2003 A practicalguide to competencies : how to enhance individual and organisational performance, London,Chartered Institute of Personnel and Development.

Whiddett, S., Hollyforde, S. & Chartered Institute Of Personnel and Development. 2007Competencies, London, Chartered Institute of Personnel and Development.



TCD team:Prof. Agnes Higgins School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier St,

Dublin 2.

Prof. Cecily Begley School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier St,Dublin 2.

Dr Fiona Timmins School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier St,Dublin 2.

Ian McGonagle ESC Project Manager, Centre for Clinical and Academic WorkforceInnovation, University of Lincoln.

Mary Nevin Research Assistant, School of Nursing and Midwifery, Trinity CollegeDublin, 24, D’Olier St, Dublin 2.

Clinical team:Sandra Delamere Advanced Nurse Practitioner, St James’s Hospital, Dublin.

Miriam Kelly Midwifery Practice Development Co-ordinator, Our Lady of LourdesHospital, Drogheda, Co Louth.

Rachel Howe CNM2 Clinical Facilitator – Child Health, AMNCH, National Children’sHospital, Tallaght.

Toni O’Connor Advanced Nurse Practitioner, St Patrick Hospital, Dublin.

Philippa Ryan Withero Acting Nurse Practice Development Advisor, AMNCH, Tallaght.

Deirdre Burns Clinical Nurse Specialist, Cope Foundation, Cork.

Anne Lynott Acting Director of Public Health Nursing, Public Health Nurse Services,HSE.

Martina McGuinness Nurse Practice Development Coordinator, MHS, Dublin South-West.

Frances Nangle-Connor Director of Nursing, Prison Services.

Michelle Russell Assistant Director of Nursing- Nurse Practice Development Co-ordinator St. Mary’s, Phoenix Park, Dublin.

International advisor:Prof. Ian Norman Professor & Associate Dean, School of Nursing & Midwifery, King’s

College London.


Appendix 1 Research team




Appendix 2 Clinical sites and clinical leads

The Children's UniversityHospitalTemple StreetDublin 1

Children’s Caroline O’ConnorNursing Practice Development

The Adelaide andMeath Hospitals IncorporatingThe National Children'sHospital (AMNCH)TallaghtDublin 20

Children’s Rachel HoweCNM2 Clinical Facilitator ChildHealth

The Adelaide andMeath Hospitals IncorporatingThe National Children'sHospital (AMNCH)TallaghtDublin 20

General Phillippa Ryan WitheroActing Nurse PracticeDevelopment Advisor

Elizabeth O’NeillActing Clinical Nurse Manager

St James HospitalDublin 8

General Sandra DelamereANP

St Francis Hospice Station RoadRahenyDublin 5

General Kevin ConnaireDirector of Education

Galway University HospitalNewcastle Road Galway City

General Edel MannionCNM2 Nursing PracticeDevelopment

Hannah KentPractice DevelopmentCoordinator

Mayo General Hospital Westport RoadCastlebarMayo

General Justin KerrAssistant Director of Nursing

COPE FoundationBonningtonMontenotteCork

Intellectual Disability Deirdre BurnsEarly Intervention Team Leader

Site Discipline Clinical Lead


St Patricks University HospitalJames Street Dublin 8

Mental Health Toni O’ConnorANP Eating Disorders

MHS, Dublin South West HSEDublin Mid-Leinster 2nd Floor, Block E Westland ParkNangor Rd, Dublin 12

Mental Health Martina McGuinnessNurse Practice DevelopmentCo-ordinator

Coombe Women’s HospitalDublin 8

Midwifery Angela DunneDivisional Director

Our Lady of Lourdes HospitalDrogheda

Midwifery Miriam Kelly, Midwifery PracticeDevelopment Co-ordinator

Area 3 Dublin South West Dublin South City21/25 Lord Edward StreetDublin 2

PHN Julie Lynch Director of Public HealthNursing

Area 5 HSE Dublin West Public Health Nursing Dept.Local Health Office AreaDublin WestCherry Orchard HospitalBallyfermot, Dublin 10

PHN Anne Lynott Acting Director Public HealthNursing

St Mary’s Hospital Phoenix ParkDublin 20

General and care of the olderperson

Michelle RussellAssistant Director of Nursing-Nurse Practice DevelopmentCo-ordinator

Irish Prison ServiceIrish Prison Service HQ

General and Mental HealthNursing

Frances Nangle-ConnorDirector of Nursing

Site Discipline Clinical Lead



Appendix 3 Services that submitted examples ofcompetency development activities

Our Lady of Lourdes Hospital, Drogheda, Co. Louth.

Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Dublin.

St James’s Hospital, Dublin.

Roscommon County Hospital.

Waterford Regional Hospital.

Connolly Hospital, Blanchardstown, Dublin.

Mental Health Services, Dublin South East.

Cork University Hospital.

South Tipperary General Hospital Clonmel.

Waterford Institute of Technology.

Mid-Western Regional Hospital, Dooradoyle, Limerick.

Mayo General Hospital.

Ballyshannon, Co. Donegal, HSE West - NMPDU.

HSE Dublin North- NMPDU.


National Council for the Professional Development of Nursing and Midwifery6-7 Manor Street Business Park, Manor Street, Dublin 7. t: 353 1 882 5300 f: 353 1 868 0366e: [email protected] w: www.ncnm.ie