Tuesday, 10 March 2015

Response to Commentary: Relevance of competence and competencies to nursing

Jane O’Connell, RN PhD NP FFACNP
Glenn Gardner, RN PhD FACN
Fiona Coyer, RN PhD

Response to Commentary on O’Connell J. Gardner, G. & Coyer F. (2014) Beyond competencies: using a capability framework in developing standards for advanced practice nursing. Journal of Advanced Nursing 70(12), 2728-2735

Lima et al. write in defence of the capacity for competencies to provide an enduring framework for learning and teaching across all levels of nursing. Their Commentary raises some interesting and important points and will inform much needed discussion on the nature of ongoing development of skills and knowledge across learning domains in nursing. We concur with Lima et al’s assertion that development of nursing practice from foundation to advanced is a continuum; indeed this assumption is core to the thesis of our paper. Where we dissent is their conceptualization of capability as a disjuncture in this continuum.

Lima et al draw upon the work of Heywood et al (1992) to support their position for a proposed third approach (as distinct from a competence to capability model) to framing the development of an advanced nurse. The work of Heyward’s team, whilst relevant at the time, is limited in application to the contemporary health service context. It was developed 20 years ago to inform the now defunct Australian Standards Framework, and there has been no empirical work since to further test these concepts and processes. Conversely, the propositions developed in the O’Connell et al paper are informed by contemporary empirical research on advanced practice in nursing (for example O’Connell et al 2014b ; Gardner et al 2006), medicine and other health disciplines (for example Dijksterhuis et al, 2013; Durning et al, 2011).

Our paper proposes moving beyond competencies to capability as a framework for developing clinicians who will utilize advanced skills and knowledge in conditions of complexity. Lima et al suggest that the anecdotal evidence of undergraduate nursing curricula developers, teachers and students will attest to the fact that new nursing graduates also work to this level. They support this claim with reference to the Australian Qualifications Framework (AQF) (2013). This Framework explicates the level of knowledge and skill and their application for graduates across ten levels of vocational and higher education courses. It is a complex and graduated taxonomy of levels and qualifications that define the ‘relative complexity and depth of achievement and the autonomy required of graduates to demonstrate that achievement’ (AQF 2013). However Lima et al have been very selective in the example they use, selecting just one line out of context in the specifications for Bachelor Degree.

Further reading and comparison of the knowledge, skills and application criteria of AQF Level 7 (Bachelor Degree for the graduate nurse) and AQF Level 9 (Masters Degree for advanced practice nurse) will show a very different profile of practice; one that supports a capability framework for advanced practice in nursing.

Jane O’Connell, RN PhD NP FFACNP
Glenn Gardner, RN PhD FACN
Fiona Coyer, RN PhD
Queensland University of Technology
email: J1.oconnell@qut.edu.au


Australian Qualifications Framework Council. (2013). Australian Qualifications Framework. 2nd edition. Available at http://www.aqf.edu.au/wp-content/uploads/2013/05/AQF-2nd-Edition-January-2013.pdf accessed 5/3/2015

Dijksterhuis M., Schurwith L., Braat D., Teunissen P. & Scheele F. (2013). A qualitative study on trainees’ and supervisors’ perceptions of assessment for learning in postgraduate medical education. Medical Teacher, 35, 1396-1402.

Durning S., Artino A., Pangaro L., van der Vleuten C. & Schurwith L. (2011). Context and clinical reasoning: understanding the perspective of the expert’s voice. Medical Education, 45, 927-938.

Gardner G., Dunn S., Carryer J. & Gardner A. (2006). Competency and capability: imperative for nurse practitioner educationAustralian Journal of Advanced Nursing. 24(1): 8-14

Heywood, L., Gonczi, A. & Hager, P. (1992). A guide to development of competency standards for professions. Canberra: Australian Government Publishing Service.

O’Connell J., Gardner G. & Coyer F. (2014b) Profiling emergency nurse practitioner service: an interpretive study. Advanced Emergency Nursing Journal 36(3).

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