Competency:
Analysis of the Concept
Michelle Trigg
University of South Alabama

Abstract
Understanding the nature and meaning of nursing competency is the initial step in having an unambiguous definition of its practice. All healthcare professionals, including nurses, may only prove to be proficient in their capabilities if they are able to perform comprehensive assessments related to the provision and maintenance of safe and efficient care, the protection of all members of the general public, and the undertaking of all necessary actions in order to preserve the nursing profession. Any and all standards that are established, based on such a perspective, must be adhered to in practice and for the purpose of nursing evaluation. This paper will evaluate and explore the concept of competency and the ways in which the nursing profession integrates the many aspects of competency.
Keywords: competence, competency, concept analysis

Competency:
Analysis of the Concept
The concept of competency in nursing is a professional regulation and is extremely important to patient safety and outcomes. In the past, competency in nursing focused on evaluating clinical skills, and not the actual ability(ies) or comprehension of the science behind them (Allen et al., 2008). Nurse competency is a requirement in the clinical setting, and outlines the dimensions of integrating the application of skill, knowledge, and decision-making. The lack of a uniform meaning of nursing competence, as well as the lack of validity and reliability in the tools required, has resulted in the development of incoherent tools that evaluated only a minor aspect of nursing proficiency (Takase & Teraoka, 2011). The purpose of this concept analysis is to elaborate on the multiple layers of competency as it serves to enhance the professional practice of nursing.
Significance of Competency
Competency in nursing is significant in healthcare because it directly impacts the patient’s safety and health (Axley, 2008). It was introduced in the late 1990s as a strategy to evaluate clinically-based nurses as safe and efficient healthcare providers (Tilley, 2008). The code of ethics in nursing practice dictates that nurses be competent in providing the community with safe, efficient care (Jordan et al., 2008). Competency facilitates collaboration amongst healthcare professionals in order to expand nurses’ knowledge. This increased knowledge is incorporated into the nurses’ practice, promoting safer patient care. Ironside (2008) discusses that the safety of patients and nursing practice is based on the progress of competency in nursing.
Competency is also significant in nursing as it closes the gap between education and practice. Burns and Poster (2008) state that putting a competency assessment program in place will help to validate the transition of a novice nurse from a beginner level to a competent level in order to perform safely while demonstrating critical thinking. The development of an educational program with RN core competencies would help to prepare and equip a newly licensed RN to adopt and manage current and future challenges within the healthcare system (Black et al.,
2008).
Competency in nursing is a fundamental requirement in a clinical setting and is imperative for clinical reasoning in the emergency department (ED) setting. Clinical reasoning, which includes intuition, is vital in responding expediently to unforeseen circumstances, which are inevitable in the ED. According to Allen et al. (2008), competency promotes the nurses’ ability to identify and communicate an intuitive feeling regarding each patient’s condition. A competent nurse has the ability to act appropriately during crisis situations. Fundamentally, this component of competency involves the ability to stabilize patients, and to understand critical information that relates to unexpected changes in the clinical patient.
Competency in nursing also helps to increase job satisfaction and improve the patient experience. According to Kim and Kim (2014), nurse competency promotes the empowerment and the understanding among colleagues that are intended to benefit all. A competent nurse possesses autonomy and respect, which results in work performance satisfaction that generates improved process of patient care. Competency also increases the commitment to patient education that enhances his or her experience (Tilley, 2008).
Uses and Definitions of the Concept
The term “competency” is derived from the French word competens, meaning “sufficiency of qualification,” and from the Latin word compentia, meaning “meeting together, agreement, symmetry” (“Competency,” 2014b). The Online Etymology Dictionary states that competency stems from the root word “competence,” meaning “sufficiency to deal with what is at hand” (“Competency,” 2014a). The term competency may be defined in a variety of ways. The Oxford English Dictionary describes competency as “sufficiency to satisfy the wants of life,”
“meeting together, agreement, symmetry,” and “sufficiency of qualification” (“Competency,” 2014b). Merriam-Webster Online defines competence as “a sufficiency of means for the necessities and conveniences of life” and “having sufficient knowledge” to enable an action.
(Axley, 2008, p. 215). The terms, competent and competency, are frequently used interchangeably. The definition of competent, according to Merriam-Webster Online, is “proper or rightly pertinent, having requisite or adequate ability or qualities, legally qualified or adequate, or having the capacity to function or develop in a particular way” (“Competent,”
2014).
The definition and interpretation of competency varies across several disciplines. Legally, the concept of competency was defined, in relation to mental competency, over 50 years ago in the case of Dusky v. U.S. The U. S. Supreme Court has ruled that each defendant must be competent to stand trial, possessing a “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding” and possess “a rational as well as a factual understanding of the proceedings against him” (Fuller, 2014, p. 33).
According to Bigatel, Ragan, Kennan, May and Redmand (2012), competency in online teaching is defined as behaviors that reflect knowledge, skills and attitudes. These competencies are demonstrated by the following actions: 1) instructor encouragement of student participation in discussion forums, 2) instructor communication of required student conduct, 3) timely instructor provision of supportive feedback on assignments and exams that promote knowledge, and 4) instructor implementation of various communicative media in order to accomplish course objectives (Bigatel et al., 2012).
Competencies may be referred to as being “core,” which is an initial reference that was used in a scholarly article in a 1990 edition of the Harvard Business Review (Axley, 2008). In business, core competencies are defined as a combination of merged knowledge, skills, procedures, and technical capacities. Applying these competencies to a business plan gives a business a competitive edge in the marketplace. The core competencies are useful in promoting company expansion into new end markets as well as providing a significant benefit to customers
(“Core competencies,” 2014).
“Nursing competency” is a popular term in the clinical workplace, in professional literature, and in educational settings. In the past, competency in nursing was defined as the application of a set of skills to daily work (Cowin et al, 2008). It primarily involved technical and relationship skills, such as IV management, patient assessment, vital signs, comfort care, and patient and family communication. Although these skills are incorporated in its competency, nursing is a complex science, and therefore, such competency cannot be defined solely by the proficiency of its applied skills. A more recent definition of nursing competency is defined as the ability of a nurse to demonstrate individual characteristics, appropriate attitudes, personal values, acquired knowledge, and professional skills that allow for the fulfillment of professional accountability (Takase et al., 2011). A competent nurse be self-motivated in order to effectively provide safe and effective care for each patient, which should include the attributes listed above. Black et al. (2008) defines RN competence as the ability to comprehend and apply appropriate knowledge, skills, attitudes and judgments to allow nurses to provide competent nursing care in a variety of settings. Nursing competency is also defined, in educational settings, as a combination of key qualities and essential elements that may be employed in order to develop, implement, and maintain competencies in relation to validity and practical considerations (Windsor & Harvey, 2012). Therefore, education that is based on competency incorporates instruction and assessment that mainly seeks to identify and measure competency (Tilley, 2008). In this regard, the clinical RN is encouraged to use the educational knowledge and tools at his/her disposal in order to engage in reflective analysis, ongoing independent education and continued career development
(Cowin et al., 2008).
Antecedents, Consequences and Defining Attributes
Walker and Avant (2005) describe the characteristics of antecedents as precursors to the concept and the characteristics of consequences as the results of the concept’s occurrence. Furthermore, these characteristics are present as the concept appears. The following factors may be noted before competency in nursing can be demonstrated: 1) the education and knowledge needed to exhibit competency, 2) the responsibility represented by demonstrative behavior, and
3) the active involvement or engagement validated by corresponding actions (Henrik & Kerstin,
2008). The following characteristics are the results of the occurrence of competency: 1) patient safety, 2) effectiveness of care, and 3) a personal drive for continued learning (Allen et al., 2008).
Walker et al. (2005) describe the defining attributes as specific characteristics that frequently appear in the literature and are commonly associated with the concept. The defining attributes related to competency in nursing are as follows: * Professional standards in reference to certifications and qualifications * Cognitive ability in reference to perception, reasoning, and intuition * Collaboration in reference to communication and teamwork * Accountability in reference to obligation and consequences of action.
Model Case
A model case provides an example that demonstrates all of the defining attributes of the concept (Walker et al., 2005). The essential attributes for the concept of competency are demonstrated in the following case: Lori earned her baccalaureate degree in nursing (BSN) ten years ago and has been an ED RN for eight years. She is certified in BLS, ACLS and PALS (professional standards). Her daily responsibilities include the assessment and the recognition of emergent needs of each patient. Lori arrived to her workplace and was assigned to triage. During the triage of Henry – a 15-year-old male who complained of a rash and fever – Lori obtained empirical and qualitative data, and related patient history. Upon noting Henry’s low blood pressure, high heart rate, high temperature, and generalized rash and malaise, Lori began the process of analyzing clinical data. She proceeded to ask Henry about exposure to infectious disease, to which he responded that a classmate had been diagnosed with meningitis one week earlier. Lori immediately placed a face mask on Henry in order to decrease exposure to other patients, and brought Henry to a room (accountability). She alerted the doctor and the primary RN of Henry’s exposure to meningitis and her concerns for septic shock (cognitive ability). She then proceeded to assist the primary RN in administering IV fluids and antibiotics. However,
Henry’s vital signs did not improve, and Lori alerted the attending physician of no improvement in Henry’s condition, and another bolus of IV fluids was ordered (collaboration). After the second bolus of fluids, Henry’s vital signs stabilized, and an ICU bed was requested for continuation of care.

Borderline Case
A borderline case contains some of the defining attributes but not all of them (Walker et al., 2005). The following case is an example of a borderline case for the concept of competency: Rachel is a BSN graduate and has been working as an RN on a medical surgical floor for six months. She is certified in BLS and ACLS, and has successfully completed a hospital-based RN residency program (professional standards). Rachel arrived to work, and received her assignment from the charge RN. She received the summary of her assigned patient’s progress from the previous, on-duty RN. She completes an accurate assessment of Cathy – a 21-year-old female who is diagnosed with appendicitis-post appendectomy. During her assessment, Rachel notes a firm abdomen and documents appropriately. She then continues to complete her assessments of each of her assigned patients. She rounds on Cathy two hours later and notes that
Cathy has a fever. Rachel proceeds to notify the charge nurse and the physician of Cathy’s elevated temperature (collaboration) and administers an antipyretic medication. After two more hours, Rachel assesses Cathy and discovers that she is diaphoretic and lethargic. Rachel alerts the physician and charge RN of Cathy’s declining condition (collaboration). Cathy is diagnosed with sepsis and transferred to the ICU. Upon reviewing Cathy’s chart, it was noted that Rachel had documented a rigid abdomen four hours earlier, but failed to take action. Rachel admits her mistake of not reporting the abnormal finding and her lack of clinical reasoning. In response, she enrolls in a postsurgical and sepsis class to improve her cognitive ability (accountability).
Related Case A related case does not contain all the attributes of the concept, but relates similar ideas (Walker et al., 2005). The following is an example of a related case: Mabel is a retired RN, who has twenty-five years of nursing experience. After four years in retirement, Mabel decided to volunteer in the pediatric unit. Her duties included feeding, interactive play, and watching over unsupervised patients. Mabel arrived on the pediatric unit and was asked to tend to Cassidy, an unaccompanied infant, who was “fussy” and needed to be fed. She proceeded to Cassidy’s room to comfort her and prepare a bottle of formula for feeding. Mabel held Cassidy in her arms during the feeding, burping her accordingly, and returned her to the crib raising the side rails
(accountability). She returned to the nurses’ station to inform the RN that Cassidy had tolerated the feeding well (collaboration).
Contrary Case A contrary case does not have any defining attributes, or is not representative of the concept (Walker et al., 2005). The following is an example of a contrary case: Nicole is an RN and has been working in an urgent care facility for five years. She is required to maintain BLS certification, but has failed to renew it. She arrives at work and is unable to receive report due to short staffing. The waiting room is full, and patients have been waiting over two hours to be evaluated. Nicole rapidly performs an inadequate assessment on Mark – a 42-year-old who is complaining about pain in his left ankle. She does not ask Mark about his history, and assumes that his ankle pain is a consequence of trauma. She documents pain with ambulation, but neglects to assess Mark’ ankle and collaborate with the physician. Mark’s ankle is edematous, red, and warm to touch. He has not had any recent trauma. A verbal order for an X-ray of the left ankle is given by the physician, and an assessment is not complete due to the crowded waiting room. The radiologist reads the X-ray as a negative fracture, and Mark leaves the urgent care facility without being evaluated by the physician due to the long wait.

Conclusion Competency is a major underpinning of the nursing profession as evidenced in a wide spectrum of related scholarly literature. A concise definition of nursing competency is paramount to the development of a foundation in the delivery of safe and effective patient care. On the other hand, this definition is only the initial step in the broad practical application of the concept of competency that should be comprehensively applied in the clinical setting. The concept of competency is crucial to the nursing profession, must be accurately and effectively applied, and should be comprehensively assessed in order to maintain strict adherence to the professional and ethical standards of nursing.

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