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Are you confidently competent?

Chase, Linda K. PhD, RN, NEA-BC

doi: 10.1097/01.NUMA.0000413646.50095.e4
Department: Performance Potential

Linda K. Chase is the vice president and CNO of IU Health Methodist Hospital in Indianapolis, Ind.

The author has disclosed that she has no financial relationships related to this article.

Nurse manager competencies have been recognized as key contributors to a healthcare organization's success.1 In 1994, the Nurse Manager Competency Instrument (NMCI) was developed to measure competencies necessary for the role. Economic, workforce, and population changes were driving forces influencing the need to reexamine competencies in 2010. The result was an updated, evidence-based, quantitative instrument used to evaluate performance and inform development for current nurse managers or eligible nurse manager candidates.

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Measuring competencies

The NMCI consists of a competency rating scale with five domains, based on the Katz technical, human, and conceptual competency framework.2 (See Table 1.) Instructions for the instrument direct respondents to select the corresponding number, one through four, based on their rating of each competency statement. A Likert scale indicates the level of competency rating for both knowledge and ability importance levels: (1) contributes minimally, (2) contributes moderately, (3) contributes significantly, and (4) is essential for first-line nurse managers.

It has been suggested that there are three uses for the NMCI. One is to simply rate the importance levels of the competencies. Such ratings can inform levels of importance and provide direction for areas of focus. Secondly, the instrument can be used as a specific assessment tool. Self, peer, supervisory, or a combination of ratings can be completed with an individual focus. This approach may be considered to understand areas of strength and opportunity to formulate a development plan for an individual manager. Lastly, the NMCI can be considered for use as a pre- and postlevel of measurement for specific competency development. It's suggested that this is a way to plot progress in the knowledge and ability of individuals within the specific competencies. This gap analysis approach is useful to reframe competencies.

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Comparable frameworks

After conducting a literature review, it was discovered that the American Organization of Nurse Executives (AONE) has been a national leader in providing resources to direct nurse manager leadership development. These resources have been developed through alliances and focus on the nurse leader and manager role. They include, but aren't limited to, the Nurse Leadership Alliance Framework, the Nurse Manager Learning Domain Framework (including the Nurse Manager Inventory Tool), and Nurse Manager Engagement.35 The AONE Leadership Competency Framework delineates the roles of the nurse leader as communication and relationship management, professionalism, leadership, knowledge of the healthcare environment, and business skills and principles.3

A comparison of the AONE Leadership Alliance Framework and the NMCI revealed similarities: the AONE knowledge of the healthcare environment category parallels the NMCI technical category, the AONE communication and relationship category parallels the NMCI human category, and the AONE professionalism category parallels the NMCI conceptual category. The leadership categories exist in both frameworks, as do the AONE business skills, which are similar to the financial management category in the NMCI.

The AONE published the Nurse Manager Leadership Partnership Learning Domain Framework in 2006.4 This framework denotes managing business with financial management, human resource management, performance improvement, foundational thinking, technology, strategic planning, and clinical practice knowledge. Leadership includes human resource leadership, relationship management, influencing behaviors, diversity, and shared decision making. Lastly, leadership development includes personal accountability, career planning, personal journey, and optimizing the leader within.4

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Reliability and validity

Expert review and psychometric testing was done in 2010 to evaluate the reliability and validity of the NMCI. The initial construction of the instrument was done in 1994; however, given the dramatic change in the healthcare landscape and requirements of leadership, a decision was made to reexamine construct validity through the recruitment of an expert panel. AONE fellows (a subset of the AONE nurse manger membership who've participated in a 1-year program geared toward developing and networking the nurse manager role) were chosen to serve in this capacity. In 2010, there were 75 active fellows who were asked to review the competency statements as experts in the field. The AONE gave permission and supplied e-mail addresses to request review of the competency statements. Fifty-three AONE fellows provided feedback for a response rate of 71%.

Consultation from the nurse manager fellows resulted in nomenclature changes, adding clarity to the competency statements based on their expertise and suggestions for contemporary terminology. Table 2 illustrates the changes to the competency statements for the 2010 survey.

Reliability of the NMCI was initially established in 1994 through a test-retest process. A pilot provided two separate studies that were administered 2 weeks apart with managers from a large academic medical center (n = 20). A Pearson product moment correlation analysis was performed on the overall scale (r = 0.93) and on each categorical section of the survey from the two measures.1 This demonstrates stability over time. The results of the technical, human, conceptual, leadership, and financial management categorical correlations were 0.80, 0.85, 0.84, 0.91, 0.92, respectively.1 A second test-retest process was performed in 2010. Test-retest reliability was conducted 2 weeks apart with 23 nurse managers at another large academic medical center. The 2010 Pearson product moment correlation analysis was r = 0.88, and the 2010 results of the technical, human, conceptual, leadership, and financial management categorical correlations were 0.73, 0.76, 0.90, 0.86, 0.70, respectively.

Cronbach alpha was used to assess the internal consistency of the entire scale. The generally agreed upon lower limit for Cronbach alpha is 0.70.6 One issue in assessing Cronbach alpha is its positive relationship to the number of items in the scale. All knowledge and ability constructs in the 1994 and 2010 studies were analyzed, and all were found to have a Cronbach alpha value of greater than 0.70, indicating inter-item correlation of the NMCI constructs. The Cronbach alpha analysis revealed that both the 1994 and 2010 overall knowledge ratings were 0.941 and 0.950, respectively. In the overall ability ratings, a similar trend was noted, with the 1994 rating as 0.933 and the 2010 rating as 0.909.

The NMCI can be noted as a reliable and valid measure of important nurse manager competencies. The primary use of the instrument is to assess nurse manager competency within its five domains. It can also be used to develop individuals in the nurse manager role.

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Make an impact

The implications of measuring nurse manager competencies include an impact on nurse manager development and education related to knowledge and ability. These competencies, when developed, can make a difference in the overall influence of the nurse manager at the unit level, thereby creating an environment for improving patient and staff outcomes.

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1. Chase LK. Nurse manager competencies. J Nurs Adm. 1994;24(suppl 4):56–64.
2. Katz RL. Skills of an effective administrator. Harvard Bus Rev. 1955;33(1):33–42.
3. American Organization of Nurse Executives. AONE nurse executive competencies. Nurse Leader. 2005;3(1):15–22.
4. American Association of Critical-Care Nurses. Nurse Manager Skills Inventory.
5. Mackoff B. Nurse Manager Engagement: Strategies for Excellence and Commitment. Sudbury, MA: Jones and Bartlett Publishers; 2011.
6. Hair JF Jr, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate Data Analysis. 6th ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2006.
© 2012 by Lippincott Williams & Wilkins, Inc.