Continuing competence in nursing: a study of issues and perceptions

Throughout the history of nursing's professional evolution, its practitioners have remained committed to professional accountability, responsibility for the need to maintain competence through continuing education, lifelong learning, and to the quality and rigor of their educational preparation in undergraduate and graduate programs. In broad terms, the purpose of this thesis was to examine the opinions and concerns of a sample of RNs and RPNs of the changes implied by the RHPA: record their recent and current activities taken to accommodate the continuing competency expectation; identify the different patterns and settings of these CE activities in relation to respondents' work responsibilities; assess their outcome in terms of the impact on quality of care; and demonstrate a measurement device of practical use for monitoring the competency of nurses. The monitoring of practice and ensuring quality care is important for nursing on two counts: (1) for the protection of the public and the creation of trust and confidence between patient and nurse which is an important factor in promoting patient recovery and maintaining health; and also, (2) for members of the profession itself, in order to foster confidence in the caliber of their work and professional judgements. This responsibility represents the transfer of professional power, and the recognition of professional expertise and status to an occupational group that has struggled for many years to gain it. These gains must not be put at risk by failure to maintain clinical competence and demonstrate high standards of care. When the Regulated Health Professions Act was proclaimed and received Royal Assent in the Ontario Legislature in 1993, it required, by 1997, a Quality Assurance Committee to be established and charged with implementing competence-quality assurance procedures which required nurses to reflect on their clinical practice and their clinical practice and to participate in programs to promote and maintain competence. The research had several phases in which a number of different methods of investigation were used. To some extent the project phases followed the usual linear progression and, to some extent, they were interactive. The work began with a survey by mailed questionnaire and early analysis of the questionnaire findings. Then an interview schedule was designed and telephone interviews were held. The interview findings were used to reconsider the observations made from the evidence of the initial survey analysis, amplifying initial explanations and conclusions. The clinical testing was then carried out---sometimes after an interview, and sometimes in parallel with the interview. The individual nurses' reported CE activities were linked to the impact of the completed CE on nurse performance as measured in an Objective Structured Clinical Examination (OSCE). Thus, the desired interactive effect was achieved whereby the findings of one research activity improved the analysis of the survey results by confirming or drawing into question earlier observations, explanations and conclusions. Reinterviewing of some of the original interviewees in 2005 was completed in an effort to determine the relevance of the issues studied to present day practice of nurses. The purpose of collecting self-reported CE data was to assess common myths about its ubiquity, relevance and utility. (Abstract shortened by UMI.).

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