By James X Stobinski, Ph.D., RN, CNOR CSSM(E), CNAMB(E)
This month, to quote Shakespeare from the play Henry V, I would like to go “Once more unto the breach…” and discuss the concept of nursing competency.(1) This column was spurred by a comment from a colleague who recently asked a thought-provoking question on perioperative nursing competency. How do we, as a profession, ensure competency over the course of a career? I would like to share some recent foundational developments which I believe have promise to answer the salient question raised by my colleague.
As background, I must state that researchers and academics do not all agree on terminology in this area. Australian researchers use the term competence, and Americans use the term competency in referring to the ability to consistently perform safe nursing care. Just for the sake of this column let’s use these terms interchangeably. Some fundamental questions come to mind on this topic. First, how do we define competency? And secondly … Who makes the determination if a perioperative nurse possesses competency?
This brings us to an essential issue in that, “There is a lack of consensus in both theoretical and operational definitions of competence in nursing.”(2) Donna Tilley, in a seminal 2008 article, made a far-reaching statement when she informed us that in the matter of nursing competency, “… in most states, a nurse is determined to be competent when initially licensed. Continued competency is assumed thereafter unless otherwise demonstrated.”(3) In short, we have not had a well-accepted and commonly used method to assess nursing competency. We also do not have a consistent process for assessing competency once a nurse enters a nursing specialty such as perioperative nursing.
Recently, a group of Australian academics took on the daunting task of defining nursing competence. These researchers used Walker and Avant’s model of conceptual analysis to give us a contemporary definition of nursing competence. This model, “… presents the systematic process for analyzing a concept for a clearer definition.(4) Defining nursing competence has vexed our profession for years but Swift and her colleagues, in their 2025 article, documented a rigorous review of the literature to produce a practical, serviceable definition. Their definition of nursing competence is, “A nurse with attainment of full registration who demonstrates the knowledge, skills, capability, and professional attributes to provide safe and quality nursing care that ensures optimal patient outcomes.”(2)
This article, which offers a compelling contemporary definition of nursing competence, is very recent from a historical perspective. Time will tell if this definition, even with its foundational rigorous methodology, will gain wide acceptance. But there are two important points for perioperative nurses to consider in the Swift article. First, the methodology now exists to address issues such as how our profession defines competency. Second, this same precise process could be used to define competency specific to the perioperative nursing specialty. With a definition we can then develop and refine more consistent competency assessment processes. An accepted definition of competency sets the stage for the critical work of competency assessment.
With the increasing demand for surgery and persistent staffing shortages how we define and measure competency is not an esoteric question. To the question posed by my colleague which opened this column I would respond that nursing, as a profession, must take responsibility for determining and assuring competency throughout a career.
Greg Durkin, a nursing professional development specialist, has detailed how a nursing competency assessment program could be operationalized.(5) An accepted definition of competency coupled with an assessment program gives us the essential tools needed for this work. It will not be an easy task, especially for perioperative-specific competency, but it is necessary work and a worthy challenge.
– James X. Stobinski, Ph.D., RN, CNOR(E), CSSM(E), CNAMB(E), is a faculty member at Central Michigan University and director of hospital and ASC surgical education relationships with National Institute of First Assisting (NIFA).
References
1. Poetry Foundation (2026). Speech: “Once more unto the breach, dear friends, once more.” https://www.poetryfoundation.org/poems/56972/speech-once-more-unto-the-breach-dear-friends-once-more
2. Swift, LM; Kearney, LN; Hyun, A; Levett-Jones, TL; Bogossian, FE, Defining registered nurse competence: A contemporary concept analysis, Collegian, 2025, 32 (4), pp. 258-265.
3. Scott Tilley, D.D. (2008). Competency in nursing: A concept analysis. Journal of Continuing Education in Nursing;39:58–64.
4. Ebling Library: University of Wisconsin-Madison-Health Sciences (n.d.) Research guides: Nursing Resources: Concept analysis. https://researchguides.library.wisc.edu/c.php?g=861013&p=11146882#:~:text=Let%20us%20now%20explore%20the,concept%20for%20a%20clearer%20definition
5. Durkin, GJ (2019). Implementation and evaluation of Wright’s competency model. Journal for Nurses in Professional Development, 35(6), 305-316. https://doi.org/10.1097/NND.0000000000000575
