By James X. Stobinski
The aging American population, relatively high rates of medical insurance and the desire of patients to remain active all drive the increasing demand for surgical care. But the practice of surgery requires sufficient numbers of qualified staff and we are experiencing shortages of perioperative nurses at present. The retirement of many seasoned practitioners during the pandemic and an overall nursing shortage are also contributing factors. During a recent conference many perioperative leaders told me they are devoting considerable resources to the orientation of perioperative nurses with many of those accessions being new graduates. These areas are where the novice perioperative nurses are needed to meet staffing needs.
Competency assessment is central to the education and training of novice perioperative nurses. Fukada (2018) in her seminal work on nursing competency states that nursing faces challenges in operationalizing the process of competency assessment. It is important here to define the term competency. At NIFA we endorse a holistic definition espoused by Fukada “… as a complex integration of knowledge including professional judgment, skills, values and attitude …” (p. 1). This definition reinforces the widely used knowledge-skills-attitude (KSA) framework of competency described by van Echtelt (2020).
In American nursing, we have prominent nursing theorists such as Patricia Benner and acknowledged thought leaders such as Donna Wright. They have written extensively on competency assessment. What we lack, however, are widely accepted methods for doing such assessment. We also do not make extensive use of competency assessment instruments as do nurses in Europe and Australia. In general, American nurses make assumptions regarding competency as I have stated previously in OR Today (The Four Assumptions of Nursing Competency, 2021).
Tilley (2008, p. 60) details one salient assumption regarding competency assessment when she stated, “Currently, in most states, a nurse is determined to be competent when initially licensed. Continued competency is assumed thereafter unless otherwise demonstrated.” I was not aware of Tilley’s work when I first published my thoughts on perioperative nursing competency in the AORN Journal in 2008, the same year of Tilley’s publication. Looking back at my article, I must say that we have made scant progress is some areas and significant challenges remain. Tilley emphasizes one significant issue in that, “The dominant method to assess a health care professional’s continued competency is traditional didactic continuing education …” (p. 60). The assumption being that these methods are effective in maintaining or enhancing competency, but there is little evidence to support that view.
At NIFA we believe that competency assessment in perioperative nursing is challenging and there are some best practices which can be used to improve the process. We believe that true residency programs are part of the solution and we are revising our offerings to incorporate these features. We also believe that a combination of assessments and reflective learning can foster meaningful professional development. Continuous professional development (CPD) can enhance and maintain competency if done well and based in the best current evidence. NIFA uses the knowledge-based test, one component of the CFPN credential administered by the Competency and Credentialing Institute, as the final examination in our courses. We believe that a psychometrically sound measurement of the knowledge component best establishes whether students have the requisite knowledge needed for safe, proficient early career practice. These are just a few quick examples of best practices.
It has been 15 years since that AORN Journal article on nursing competency. I look forward to a more current examination of that topic in a future publication. In upcoming columns, I will continue to address perioperative nursing education and research topics.
– James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is the director of education for the National Institute of First Assisting.
References
Fukada M. (2018). Nursing Competency: Definition, Structure and Development. Yonago acta medica, 61(1), 1–7. https://doi.org/10.33160/yam.2018.03.001
Stobinski, J. X. (2008) Perioperative nursing competency. AORN Journal (88)3. pp. 417-436.
Stobinski, JX. (2021, DEC). The Four Assumptions of Nursing Competency. Industry Insights. OR Today Magazine.
Tilley, D.D.S. (2008). Competency in Nursing: A Concept Analysis. The Journal of Continuing Education in Nursing, 39(2), 58-64; quiz 65-6, 94. https://wilkes.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/competency-nursing-concept-analysis/docview/223320935/se-2
van Echtelt, R. (2020). Everything you ever needed to know about KSA. https://www.ag5.com/everything-you-ever-needed-to-know-about-ksa/
