Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice.
Purpose: The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program.
Methods: Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical advancement programs then participated in Delphi rounds aimed at reaching consensus on the developmental progression of the 186 KSAs through four levels of clinical advancement.
Results: Two Delphi rounds resulted in consensus by the expert participants. All eight competency domains were determined to be essential at all four levels of clinical practice. At the novice level of practice, the experts identified a greater number of KSAs in the domains of safety and patient- and family-centered care. At more advanced practice levels, the experts identified a greater number of KSAs in the domains of professionalism, teamwork, technology and informatics, and continuous quality improvement.
Conclusion: Incorporating the eight competency domains and the 186 KSAs into a framework for clinical advancement programs will likely result in more clearly defined role expectations; enhance accountability; and elevate and promote nursing practice, thereby improving clinical outcomes and quality of care. With their emphasis on quality and safety, the eight competency domains also offer a framework for enhancing position descriptions, performance evaluations, clinical recognition, initial and ongoing competency assessment programs, and orientation and residency programs.
In this study, the authors developed eight nursing competency domains and 186 related knowledge, skills, and attitudes for professional nursing practice, then sought to validate them and to determine their developmental progression within a clinical advancement program.
Kathleen G. Burke is corporate director of nursing professional development and innovation at the University of Pennsylvania Health System (UPHS), assistant dean of clinical nurse learning and innovation at the University of Pennsylvania School of Nursing, and senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, all in Philadelphia. Tonya Johnson is associate chief nursing officer at Southcoast Health System, New Bedford, MA; at the time of this study, she was nursing clinical director at the UPHS's Pennsylvania Hospital. Christine Sites is a nursing professional development specialist at the UPHS. Jane Barnsteiner is a professor emerita of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, and editor of translational research and quality improvement at AJN. Contact author: Kathleen G. Burke, firstname.lastname@example.org. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.