Can competence be assured?
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(Published version)
Date
2017
Authors
Vernon, R.
Chiarella, M.
Papps, E.
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Report
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In the absence of a quantifiable and defensible mechanism for assessing continuing competence, many regulatory jurisdictions have implemented continuing competence frameworks, using a variety of competence assessment tools. It is argued that a well-developed competence framework provides assurance to the regulator and the public that the nurse or midwife is continuing to be competent to practise. However, if the framework and associated competence indicators were a guarantee of continuing competence, then arguably no-one would present as a performance competence notification. In reality this is not the case, so the question remains; Is there a missing thread or a common theme and if so what is it?’This report presents the findings of a mixed method multiphase study, funded by the National Council of State Boards of Nursing (USA) Centre for Regulatory Excellence that was undertaken in 2015-2016. A comprehensive review of literature was completed and three sets of evaluation data were collected. These included:Phase One, part one - Analysis of five years of case law on the public record, from Australia and New Zealand, relating to complaints of unsatisfactory performance (how-so-ever defined), that have been prosecuted and adjudicated. Phase One, part two - Analysis of 712 complaint files related to performance provided by the New South Wales (NSW) Nursing and Midwifery Council (NMC). Phase Two - Semi structured interviews with 22 regulatory experts from New Zealand and Australia, all of whom had significant experience in audit and performance notification processes and or adjudication. Phase Three - A compilation of publically available statistical data relating to registration and notification/complaints data of nurses and midwives in New Zealand and Australia over the five year period 2010 - 2015.Similarities exist in terms of the performance complaint type, issues and percentages across the nursing and midwifery population in Australia and New Zealand. Whilst there are number of differences in terms of the operational aspects of the notification and complaints processes, similar concerns and issues were identified in relation to the types of complaint and the characteristics of the nurses and midwives who are the subject of a complaint. The most common competence and patient safety concerns resulting in performance notifications were: poor clinical care; inappropriate communication; inadequate administration and/or management. However, performance awareness or insight (personal insight, contextual insight and situational insight) was identified as critical factor in relation to the initial performance competence notification, the process of investigation and ultimately influenced the outcome in terms of counselling, remediation or sanctions. The findings of the study support the premise that a nurse or midwife that lacks insight is less likely to recognise or act upon (own) performance deficits or areas for improvement; participate in professional development opportunities; and acknowledge or take responsibility for errors; and may be more likely to work outside of scope of practice and boundaries; take short cuts; deflect accountability and attribute blame; and become isolated or seek positions where their practice is less visible. More work needs to be undertaken with regard to identifying the behavioural characteristics that underpin competence awareness and performance competence in the nursing and midwifery professions. Agreement is required on the language used to describe insight, or the lack of; clear guidelines are required relating to how insight is identified and assessed; and if ‘insight’ or ‘performance awareness’ can be taught, how this should this occur.
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Copyright 2017 The author(s)