Hamric, Hanson, O’Grady & Tracy (2014) define competencies as “a broad area of skillful performance.” Competencies include activities implemented by advanced practice nurses while providing direct patient care and the processes, knowledge and skills used in all aspects of advanced practice. There are seven core competencies associated with the advanced practice registered nurse. In addition to the seven core competencies, nurse practitioner education and nurse administrator education have additional competencies needed to become proficient in each of those roles (The American Organization of Nurse Executives (AONE) 2011; The National Organization of Nurse Practitioner Faculties (NONPF), 2012). While there is overlap of some of the competencies the nurse executive role and the nurse practitioner role each have specific skills needed to attain expertise in each role. Nurse executives plan, direct, coordinate and supervise health care delivery.
He or she must have expert knowledge regarding patient care delivery, marketing, management, ethics, and human resource management, as well as additional knowledge. Due to the wide range of knowledge needed, nurse executives need to attain expertise in many areas. AONE has outlined five competencies and detailed the skills needed for each (2011). According to AONE communication and relationship-building is a competency that must be mastered in order to cultivate relationships and establish rapport and includes skills such as relationship management, effective communication, influence of behaviors, shared decision making and ability to work with diversity. The professionalism competency includes ethics, evidence-based clinical and management practice, advocacy, and personal and professional accountability (AONE, 2011).
The nurse administration works at the executive level so professionalism must be maintained. Nursing leadership must be upheld by mastery of skills like foundational thinking skills, change management and succession planning. The business skills competency can be met by the nurse administrator upon mastering business management, human resource management, marketing and strategic management and information management and technology (AONE, 2011). The health care system which the nurse executive manages can be a large complex system, such as an acute care hospital that has a level I trauma center, a pediatric unit, labor and delivery unit, cardiac intensive care, and neonatology. Because of this complexity competency of health care environment knowledge must be mastered and includes the skills of clinical practice knowledge, delivery models, health care economics and policy, governance, patient safety, quality improvement and case management (AONE, 2011).
According to the National Organization of Nurse Practitioner Faculties (2012), upon graduation from a nurse practitioner program the graduate must possess mine competencies without regard to the population of focus. By mastering these competencies the nurse practitioner will have the skills and knowledge needed to practice independently. NPs provide direct patient care so the competencies and skills needed differ slightly from the competencies needed for nurse administrator. The practice inquiry competencies and the quality competencies are similar in that they both involve using knowledge gained from clinical practice to improve health care quality. Quality competencies include using best evidence to improve clinical practice, evaluating access to care, cost, quality and safety, organizational structure, financing, marketing and policy decisions and their impact on health care quality.
Practice inquiry competencies involve applying clinical investigative skills, practice inquiry, analyzing clinical guidelines, generating knowledge from clinical practice and providing leadership while applying new knowledge. The technology and information literacy competencies are related to information literacy skills, literacy in information systems, integrating technologies into clinical practice and the delivery of health to improve health outcomes (NONPF, 2012). To function effectively the NP must understand health care policy and regulations. He or she must be competent in the evaluation of policy and its implication on health care delivery and outcomes and must promote access, quality and equality. All of these skills fall under the policy competencies (NONPF, 2012). Health delivery systems competencies relate to the development of health care systems, the organizational structure and functions or health delivery systems and applying that knowledge to improve health care delivery (NONPF, 2012).
Along with a clear understanding of policy the NP must have expert knowledge of the independent practice competencies. NONPF list the independent practice competencies skills as the ability to function as a licensed practitioner, exhibiting accountability, managing previously diagnosed and undiagnosed patients and providing patient-centered care while observing cultural diversity and respecting patient decisions. There are some overlapping competencies within the NP and the nurse executive role. Both professions contain a leadership competency and both advanced practice nurses are expected to participate in professional organizations and to initiate change. The NP competency includes advocating for improved access, quality and cost effective health care while the nurse executive competency includes staff support and adapting leadership style (AONE, 2011; NONPF, 2012).
The NP scientific foundation competency and the nurse executive knowledge of health care environment competency have areas of overlap such as the use of research to improve practice and decision making and evidence-based practice, and outcome measurement. The nurse executive skill of expert practice of ethics is outlined under the professionalism competency. Hamric et al. (2014, p. 101) state the transition from student to professional APN can be rife with behavioral, attitudinal and value conflicts. Hamric et al. further state that there are phases an APN moves through during role implementation.
The first stage laying the foundation, occurs when graduate NPs sit for certification examinations for their specific roles, and look for available positions. The second stage generally last up to three months after the first position and consists of anxiety related to low confidence and low competence. One strategy to facilitate role implementation for all APNs is to develop a structured orientation plan. Although there are numerous practice setting and roles the nurse executive and the NP both benefit when clear expectations, needs, values, goals policies and procedures of the specific agency are made available upon hire (Hamric et al., p. 102).
Hamric, A. B., Hanson,C. M., O’Grady, E. T., Tracy, M. F. (2014) Advanced Practice Nursing: An Integrative Approach, 5th Ed. [VitalSource Digital Version]. St. Louis, MO: Elsevier Saunders. The American Organization of Nurse Executives. 2011. The AONE Nurse Executive Competencies. Retrieved September 11, 2014 from http://www.aone.org/resources/leadership%20tools/nursecomp.shtml The National Organization of Nurse Practitioner Faculties. 2012. Nurse Practitioner Core Competencies April 2011, Amended 2012. Retrieved September 11, 2014 from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf
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