Statement on Continuing Competence
for Nursing: A Call to Action
Hospice and Palliative Credentialing Center (HPCC)
formerly National Board for Certification of Hospice and
Palliative Nurses (NBCHPN®)
Statement on Continuing Competence for Nursing: A Call to Action
June 2011
Available at www.goHPCC.org
Hospice and Palliative Credentialing Center
One Penn Center West, Suite 425, Pittsburgh, PA 15276
412-787-1057
www.goHPCC.org
Chief Executive Officer
Sally Welsh, MSN, RN, NEA-BC
swelsh@hpna.org
Director of Certification
Sandra Lee Schafer, RN, MN, AOCN®
sandralees@goHPCC.org
StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
Introduction
TheNationalBoardforCertificationofHospiceandPalliativeNurses(NBCPHN)recognized
aneedforadefinitionofcompetencetoguideusinvalidatingandrefiningourcertification
andrecertificationprograms.InJuly2010,theContinuedCompetenceCommitteeof
NBCHPNchargedtheContinuingCompetenceTaskForce(CCTF)to:

Distinguishbetweencompetenceandcompetency

Definecompetence

Definecontinuingcompetenceandindicatorsofcontinuingcompetence
Inthehopeofmakingastatementaboutprofessionalnursingcompetencewithuniversal
applicabilitytothenursingspecialtycertificationworld,NBCHPNsoughtmembersofthis
TaskForcewithabroadspectrumofexpertise.TheTaskForcewaschairedbyDr.Bette
CaseDiLeonardi.Dr.DiLeonardiisamemberofNBCHPNandisboard‐certifiedbythe
AmericanNursesCredentialingCenter(ANCC)inNursingProfessionalDevelopment.In
additiontoherNBCHPNresponsibilitiesshealsocurrentlyservesontheANCCNursing
ProfessionalDevelopmentContentExpertPanel.AdditionalNBCHPNmemberswho
servedontheTaskForceincludedthePresidentandPresident‐electofNBCHPN,Chairof
theNBCHPNContinuedCompetenceCommittee,CEOofNBCHPN,andDirectorof
CertificationofNBCHPN.Inordertobringaglobalperspectivetothetaskathand,aswell
astheneedtowidelydisseminateourfindings,additionaltalentswererecruitedoutsideof
NBCHPN.TheTaskForcewascompletewiththeadditionoftheeditorofTheJournalof
ContinuingEducation:ContinuingCompetencefortheFuture,Dr.PatriciaYoder‐Wise;the
DeputyDirectorofAmericanBoardofNursingSpecialties(ABNS)andChairoftheABNS
ResearchCommittee,Dr.MelissaBiel,andthepastBoardPresidentandcurrentLeadership
CouncilmemberfortheInstituteforCredentialingExcellencewhohasalsoservedonthe
ABNSBoardofDirectorsasthePublicMember,Ms.DedePahl.Sincethetimeatwhichthe
TaskForcewasformed,Ms.PahlwaselectedasthePublicMemberofNBCHPN.The
commitmentofthisTaskForcehasreflectedtheimportanceofthetask.
TheworkofCCTFhasculminatedinanexpressionofbeliefsaboutcompetenceanda
definitionofcompetence.NBCHPNhaspresentedthisworktotheABNSResearch
CommitteeinsupportoftheABNSresearchagenda.NBCHPNbelievesthatABNSmembers
mayfindthebeliefsanddefinitionusefulinguidingresearchandcertificationinitiatives.
Inthisdocument,NBCHPNpresents:itsbeliefsanddefinitionofcompetence;thereviewof
theliterature;thepotentialfortheuseofthisStatement;acompletelistingofthe
referencesconsulted;theprocessCCTFusedtoarriveatthebeliefsanddefinition
(AppendixA),andbriefbiographiesofCCTFmembers(AppendixB).
Page1of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
LiteratureReview
TheTaskForcebeganclarifyingbeliefsaboutcontinuingcompetencebyreviewingthe
considerableliteratureregardingcompetence.Someauthorsusedthetermcontinued
competence,whereasothersusedcontinuingcompetence.CCTFbelievesthatcontinuing
competencebestreflectsthedynamicandevolvingnatureofcompetenceandtherefore
chosethetermcontinuingcompetence.However,theliteraturereviewusestheterm
continuedcompetencewhenreferringtoliteraturethatusedthatterm.
Aconceptpaper,MeetingtheOngoingChallengeofContinuedCompetence,bytheNational
CouncilofStateBoardsofNursing(NCSBN)in20051broughtforththeimportanceofthe
obligationofsafepractice.“Thepublicneedsassurancethatnurseshavecurrent
knowledgeandaresafepractitioners.Thenurseneedstheincentiveofvalueaddedto
one’scareerandpractice.Theybenefitfromrequirementsthatarerelevanttotheir
practice,promoteprofessionaldevelopmentandcanbeusedtomeetthemultipledemands
ofemployers,boardsandothers”(p.3).
Severalresourcesaddressedtheissueofwhoshouldberesponsibleforcontinuing
competence.LundgrenandHousemanpointedoutthatthePewHealthProfessions
Commission,theCitizenAdvocacyCenter(CAC)andmostfederationsofstateboardssee
continuingcompetenceasaregulatoryresponsibilitywhilemanyprofessional
organizationsoftenviewitasavoluntaryresponsibilityoftheindividualpractitioners.2
Thesesameauthors2suggestedthatstateregulatoryprocessesshouldonlyapplyinthe
settingofestablishingminimumcompetence.“Ifthegoalisnotsimplytomaintain
competence,buttoincreaseit,responsibilityforimprovementbecomesbroader,fallingnot
onlyonthestateregulatoryboardbutalsoontheworksettingandtheindividual
practitioner”(p.237).
CACsuggestedthatcontinuedcompetenceneedstobeacollaborativeeffortamong
professionalorganizations,regulatory(licensing)boardsandindividualpractitioners.3
NCSBNhasrecommendedthateducatorsalsobeheldresponsibleforcontinuing
competence.NCSBNsuggestedincorporatingstandardsintothecurriculum,promoting
studentstointegratethesestandards,andevaluatingresultingperformance.2Educators
wouldalsobeexpectedtoactasrolemodelsforstudentstoportrayexamplesoflifelong
learningandprofessionalaccountability.2
Regardingtheevolution,fluidity,anddynamicstateofcompetenceNCSBN1stated“Thereis
theinherentevolutionofpracticefromthenewgraduate‐entry‐leveltotheexperienced‐
focusedpracticelevelofcompetence”(p.1).TheCompetency&CredentialingInstitute
(CCI)4alsounderscoredtheseconceptsusingtheterm“continuingcompetence”toreflect
Page2of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
constantevolutioninresponseto“consumerneeds,technologicaladvancement,
professionalresponsibilities,andexpandedknowledge”(p.1).
NCSBNalsopointedoutthatnursingcareerstakedifferentpaths,whichvaryby
professionalrole,clinicalsettings,clients,andtherapeuticmodalities,aswellasthelevelat
whichhealthcareisdelivered.1ThiscomplementedtheideabroughtforwardbyLundgren
andHouseman2thatifcompetencevariesaccordingtothesituation,thenthemeasurement
ofcompetenceinoneareaisnotgeneralizabletootherareas.Practitionerslearnand
developnewskillsastheymovefromspecialtytospecialty,soprofessionalpracticein
differentsettingsrequirestheneedtodevelopandperfectspecializedcompetencies.2
ThereviewoftheliteraturealsosuppliedtheTaskForcewithseveralexamplesofexisting
definitionsforcompetenceaswellascontinuingcompetence.NCSBNdefinedcompetence
as“theapplicationoftheknowledgeandinterpersonal,decision‐makingandpsychomotor
skillsexpectedforthenurse’spracticerole,withinthecontextofpublichealth,welfareand
safety”2(p.235).Kanedefinedcompetenceas“Thelevelofanindividual’scompetencein
someareaofpracticecanbedefinedintermsoftheextenttowhichtheindividualcan
handlethevarioussituationsthatariseinthatareaofpractice”2(p.235).Cheethamand
Chiversproposedthatmeta‐competenciesarethebaseforprofessionalcompetencies,
whichincludeabilitiessuchascommunication,creativity,problemsolving,andmost
importantlyreflection.Theysuggestedthatcompetenciesalsoinvolveknowledge,
functionality,personalbehavior,valuesandethics.2
However,thedefinitionwhichmadethelargestimpactontheTaskForcewasthe
definitionofcontinuingcompetencesuppliedbytheCanadianNursesAssociationand
CanadianAssociationofSchoolsofNursing“Theongoingabilityofaregisterednurseto
integrateandapplytheknowledge,skills,judgment,andpersonalattributestopractice
safelyandethicallyinadesignatedroleandsetting.Personalattributesincludebutarenot
limitedtoattitudes,valuesandbeliefs”5.TheTaskForcechosethisdefinitionasabuilding
blockforitsdefinition.
BeliefsAboutCompetence
DistinctionbetweenCompetenceandCompetency
CCTFadoptedthedistinctionbetweencompetenceandcompetencyascraftedby
Schroeter:6“Althoughtheymaysoundsimilar,competenceandcompetencyarenot
necessarilysynonymous.Competencereferstoapotentialabilityand/oracapabilityto
functioninagivensituation.Competencyfocusesonone’sactualperformanceina
situation.Thismeansthatcompetenceisrequiredbeforeonecanexpecttoachieve
competency”(p.12).
Page3of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
Beliefs
AsCCTFexploreddefinitions,itbecameapparentthatadefinitionalonedidnotconveythe
complexityandimportanceofaconceptsointegraltoapracticediscipline.Thus,CCTF
createdasetofbeliefstounderpinthedefinitions.
Webelievethatcompetenceis:

aprofessionalandethicalobligationtosafepractice

acommitmentmadetotheindividual,theprofession,andtoconsumers

aresponsibilitysharedamongtheprofession,regulatorybodies,certification
agencies,professionalassociations,educators,healthcare
organizations/workplaces,andindividualnurses
o Healthcareorganizations/workplacesacceptresponsibilityformeasuring,
documenting,andsupportingcompetency,andforaddressingany
deficienciesinstaffmembers’competency


evolutionary,inthatitbuildsuponpreviouscompetenceandintegratesnew
evidence
dynamic,fluid,andimpactedbymanyfactorsastheindividualentersnewrolesand
newsituations
DefinitionofContinuingCompetence
Continuingcompetenceistheongoingcommitmentofaregisterednursetointegrateand
applytheknowledge,skills,andjudgmentwiththeattitudes,values,andbeliefsrequiredto
practicesafely,effectively,andethicallyinadesignatedroleandsetting.
CCTFbuiltitsdefinitionbaseduponadefinitionthattheCanadianNursesAssociationand
CanadianAssociationofSchoolsofNursingdeveloped(2004).5Theliteraturecontains
manyreferencestothisdefinition.1,5,7,8TheInternationalCouncilofNursesalsoendorsed
thedefinition.9
Page4of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
UsesoftheBeliefsandDefinition
CCTFbelievesthebeliefsanddefinitionwillserveasaguidetooperationalizecompetence
innursingpracticeandcredentialing,andmeasureoutcomesinresearchprojects.And
CCTFbelievesthatindicatorsofcontinuingcompetencearespecifictothespecialty
practicearea.ThisStatementmaybeausefultoolforspecialtyorganizationstoexplore
thealignmentofcorecompetencieswithspecialty‐specificcompetencies,astheTaskForce
didincomparingANAStandardsofPractice10withHPNAAdvancedPracticeNurseand
RegisteredNurseCompetenceTopics.11,12
TheAmericanNursesAssociation9hasprovidedasetofstandardsfornursingcareand
professionalperformancewithcompetenciesthatdefineeachstandardinprofessional
nursingpractice,regardlessofnursingspecialty.CCTFcomparedthesecorenursing
competencieswiththecompetenciesthattheHospiceandPalliativeNursesAssociation
(HPNA)identifiedfortheAdvancedPracticeNurse(APN)11andtheRegisteredNurse
(RN)12,asanexampleofapplyingcorenursingcompetencetospecialtypractice.Thetable
onthefollowingpagesdisplaysonlytheANAStandardsandnotthespecificcompetencies
thatANAlistsforeachstandard.
Thedefinitionandbeliefsalsoprovidesaframeworkforrefiningtheprocessof
certificationandre‐certificationinnursingspecialties.Thebeliefthatcontinuing
competenceevolvesandbuildsuponpreviouscompetenceimpliesarecertificationprocess
thatevidencesprofessionalgrowth.
InConclusion
CCTFrespectfullyoffersthisworktoourprofessionforitsuse.Welookforwardto
exploringpotentialdevelopmentsinresponsetothisCalltoActionindialoguewithABNS
andwithotherorganizationsinvolvedineducationandcredentialinginnursing.
Page5of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
HPNAAdvancedPracticeNurse(APN)andRegisteredNurse(RN)CompetenceTopicsandANAStandardsofPractice
andPerformance
NOTE:ThisTabledoesnotintendtoimplyequivalences,onlyrelationships.
HPNAAPNandRNApproved
CompetenceTopics
ANANursing:ScopeandStandard,2ndedition
Clinicaljudgment
Standard1.Assessment
Theregisterednursecollectscomprehensivedatapertinenttothehealthcare
consumer’shealthand/orsituation.
Standard2.Diagnosis
Theregisterednurseanalyzestheassessmentdatatodeterminethediagnosesorthe
issues.
Standard3.OutcomesIdentification
Theregisterednurseidentifiesexpectedoutcomesforaplanindividualizedtothe
healthcareconsumerorthesituation.
Standard4.Planning
Theregisterednursedevelopsaplanthatprescribesstrategiesandalternativestoattain
expectedoutcomes.
Standard5.Implementation
Theregisterednurseimplementstheidentifiedplan.
Standard5A.CoordinationofCare
Theregisterednursecoordinatescaredelivery.
Standard5B.HealthTeachingandHealthPromotion
Theregisterednurseemploysstrategiestopromotehealthandasafeenvironment.
Standard5C.Consultation
Thegraduate‐levelpreparedspecialtynurseoradvancedpracticeregisterednurse
providesconsultationtoinfluencetheidentifiedplan,enhancetheabilitiesofothers,
andeffectchange.
Standard5D.PrescriptiveAuthorityandTreatment
Page6of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
HPNAAPNandRNApproved
CompetenceTopics
Advocacy&ethics
Professionalism–notatrue
matchhere
Collaboration
Systemsthinking–notatrue
ANANursing:ScopeandStandard,2ndedition
Theadvancedpracticeregisterednurseusesprescriptiveauthority,procedures,
referrals,treatments,andtherapiesinaccordancewithstateandfederallawsand
regulations.
Standard6.Evaluation
Theregisterednurseevaluatesprogresstowardattainmentofoutcomes.
StandardsofProfessionalPerformance
Standard7.Ethics
Theregisterednursepracticesethically.
StandardsofProfessionalPerformance
Standard8.Education
Theregisterednurseattainsknowledgeandcompetencythatreflectscurrentnursing
practice.
Standard10.QualityofPractice
Theregisterednursecontributestoqualitynursingpractice.
Standard12.Leadership
Theregisterednursedemonstratesleadershipintheprofessionalpracticesettingandin
theprofession.
Standard14.ProfessionalPracticeEvaluation
Theregisterednurseevaluatesherorhisownnursingpracticeinrelationto
professionalpracticestandardsandguidelines,relevantstatutes,rules,andregulations.
StandardsofProfessionalPerformance
Standard13.Collaboration
Theregisterednursecollaborateswithhealthcareconsumer,family,andothersinthe
conductofnursingpractice.
StandardsofProfessionalPerformance
Page7of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
HPNAAPNandRNApproved
CompetenceTopics
ANANursing:ScopeandStandard,2ndedition
matchhere
Standard15.ResourceUtilization
Theregisterednurseutilizesappropriateresourcestoplanandprovidenursingservices
thataresafe,effective,andfinanciallyresponsible.
Standard16.EnvironmentalHealth
Theregisterednursepracticesinanenvironmentallysafeandhealthymanner.
Cultural&Spiritual(APN)
Cultural(RN)
Facilitatoroflearning
Communication
Research(APNonly)
StandardsofProfessionalPerformance
Standard11.Communication
Theregisterednursecommunicateseffectivelyinallareasofpractice.
StandardsofProfessionalPerformance
Standard9.Evidence‐basedPracticeandResearch
Theregisterednurseintegratesevidenceandresearchfindingsintopractice.
Page8of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
AppendixA
ContinuingCompetenceTaskForce(CCTF)Process
MembersofCCTFcollectivelybroughtconsiderablebreadthofexperienceandperspective
tobearupondefiningcompetence,asreflectedbythebiographicalinformationinthe
ContinuingCompetenceTaskForceMemberssectionofthisdocument.TheTaskForce
metmonthlybyconferencecall,enhancedbyweb‐baseddocumentsharing.NBCHPNstaff
supportedTaskForcecommunicationsandmeetings.
Atthefirstmeeting,membersintroducedthemselvesandparticipatedindiscussionto
clarifyandcrystallizethetask:

Distinguishbetweencompetenceandcompetency

Definecompetence

Definecontinuingcompetenceandindicatorsofcontinuingcompetence
TheTaskForceacceptedaworkplandesignedtoaccomplishthetaskbyearly2011.The
TaskForcediscusseddistinctionsbetweencompetenceandcompetencyandadopted
Schroeter’sdistinction.6
Membersacceptedanassignmenttoreviewreferencematerialsdistributedpriortothe
meeting,identifyphrasesandconceptscriticaltothetask,andsubmittheseselectionsto
thechair.Membersidentifiedadditionalsourcesofbackgroundinformationincluding
selectionsfromtheABNSbibliographyandtheHospiceandPalliativeNursesAssociation
(HPNA)ApprovedCompetenceTopics.Staffmadetheseresourcesavailabletoall
members.TheReferencesectionofthisdocumentincludesallreferences.Thevolumeof
materialpertinenttothetaskbothdelightedandchallengedmembers.Thechaircollated
members’responsestotheassignmentanddistributedasummarydocumentpriortothe
secondmeeting.
Atthenextmeeting,membersdiscussedthesummaryoftheirliteraturereviewand
identifiedtheneedtoexpressbeliefsaboutcompetenceasasetoftenetstoguidethe
definitionofcompetence.Throughdiscussion,membersextractedbeliefsabout
competencefromtheresourcematerialandfromtheirownexperiencesandperspectives.
Insubsequentmeetings,theTaskForcediscussedandrefinedexistingdefinitionsof
competence.Membersacceptedthechallengeofremainingfocusedonthecircumscribed
taskofdefiningcompetenceandrecognizedthatelaboratinguponimplicationsfor
certificationandspecialty‐specificcompetencieswentbeyondthescopeoftheirassigned
task.TheTaskForceacknowledgedtheroleofcorecompetenciesandconfirmedthatthe
Page9of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
newlyformedbeliefscapturedtheconceptthatcompetenceisdynamic,fluid,andimpacted
bymanyfactorsastheindividualentersnewrolesandnewsituations.
Ultimately,CCTFrefineditsstatementofbeliefsanddefinitionofcompetence.Theprocess
includedcontinuedreflectiononworkpreviouslyaccomplishedtoassureconsistencyand
thatthesebeliefsdidindeedunderpinthedefinition.TheTaskForcedecidedtobeginthe
processofsharingitsworkandaplannedtopresenttheStatementtotheABNSResearch
CommitteeinsupportoftheABNSResearchAgenda.
EachTaskForcemeetingincludedaprocessofexaminingpreviousworkofCCTF,re‐
examiningliteraturepreviouslyreviewed,andintegratingnewlyidentifiedresources,such
astheAmericanNursesAssociation(ANA),Nursing:ScopeandStandardsofPractice10,The
InstituteofMedicine(IOM),TheFutureofNursing13andrecentpertinentpublications.
TheprospectofsharingitsworkwithABNSenergizedTaskForcemembersand
strengthenedthecommitmenttofurthertheexplorationofhownursingcompetence
impactsdifferentaspectsofhealthcareincluding:research,nursingpractice,patientcare,
education,leadership,informatics,andtheotherdiverserolesandspecialtiesinwhich
nursespractice.CCTFrespectfullyoffersthisworktoourprofessionforitsuse.
Page10of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
AppendixB
ContinuingCompetenceTaskForceMembers
BetteCaseDiLeonardi,PhD,RN‐BCchairedtheContinuingCompetenceTaskForceand
hasservedasaboardmemberoftheNationalBoardforCertificationofHospiceand
PalliativeNurses(NBCHPN)since2008.Dr.DiLeonardihaspracticednursingformore
than40yearsinavarietyofrolesincludingstaffnurse,schoolnurse,administrator,and
educator.Since1993shehaspracticedasanindependentconsultantineducationand
competencymanagementforthehealthprofessions.Shehaspublishedandspeaksona
varietyofprofessionaltopicsandhasdesignedandteachesWeb‐basedcoursesforboth
academicandcontinuingeducationprograms.Shewasamongthefirstgroupofnurses
whichANCCcertifiedinNursingProfessionalDevelopment(NPD)andservesonthe
ContentExpertPanelfortheNPDexamination.Sheservesontheeditorialboardofthe
JournalofContinuingEducationinNursingandisanactivememberoftheNationalNursing
StaffDevelopmentOrganization(NNSDO).
MelissaBiel,DPA,RNhasover25yearsexperienceinthenonprofitandhealthcare
fields.Sheservesasaconsultanttoavarietyofhospitals,communityclinics,andnonprofit
organizations.SheistheDeputyDirectoroftheAmericanBoardofNursingSpecialties
(ABNS),anationalorganizationforspecialtynursingcertification.Inthisroleshedirects
ABNS’sresearcheffortsandsupportstheworkoftheABNSResearchCommittee.Dr.Bielis
adjunctfacultyatBrandmanUniversityandalectureratCaliforniaStateUniversity,Long
Beach,teachingintheHealthAdministrationdegreeprograms.Sheistherecipientofthe
2008OutstandingSeniorLecturerawardfromChapmanUniversityCollege.Herscholarly
activitiesincludeprofessionalservice,publicationsandspeakingthataddressnursing
certification,communitybenefit,credentialingresearchandavarietyofclinically‐focused
topics.
Virginia(Ginger)Marshall,ACNP‐BC,ACHPNhas17yearsofexperienceasabedside
nurseand11yearsasanursepractitioner.ShehasservedontheNationalBoardfor
CertificationofHospiceandPalliativeNurses(NBCHPN)andontheAPNExamination
DevelopmentCommitteesince2008.In2010sheservedaspresidentforNBCHPNandfor
theAllianceforExcellenceinHospiceandPalliativeNursing.Ms.Marshallhasauthored
articlesandhasperformedbothlocalandnationalpresentationsontopicsrelatedto
palliativecare.In2005,shehelpedtostarttheUniversityofUtahHospitalPalliativeCare
service.ShecurrentlypracticesatUniversityofUtahHospitalwheresheservesas
programdirectorforthePalliativeCareService.SheisboardcertifiedinAcuteCarebythe
AmericanNursesCredentialingCenter(ANCC)andinHospice/PalliativeCarebyNBCHPN.
Page11of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
DedePahl,MBAjoinedtheNBCHPNBoardofDirectorsasthepublicmember,beginningin
January2011andservesontheContinuingCompetencyCommittee.Ms.Pahliscurrentlya
leadassessorfortheAmericanNationalStandardsInstitute,specializinginISO/IEC17024
(anInternationalStandardwhichsetsoutcriteriaforanorganization'scertification
programforindividualpersons)regardingpersonnelcertification.Asavolunteer,shewill
alsoserveontheBoardofTrusteesfortheCommissionforGraduatesofForeignNursing
Schools,beginningJanuary2011.Inthepast,Ms.Pahlservedtwotermsasthepublic
memberontheBoardoftheAmericanBoardofNursingSpecialties(ABNS),including
serviceonitsaccreditationcommittee,andontheNationalOrganizationforCompetency
Assurance[NOCA,nowInstituteforCredentialingExcellence(ICE)]BoardofDirectors,
includingasitspresident.SherecentlyretiredastheexecutivedirectorfortheInvestment
ManagementConsultantsAssociation,aninternationalmembershipandcredentialing
associationforinvestmentprofessionalswithover7000membersand5500certificants.
Ms.PahlalsoservedasChiefOperatingOfficeroftheCertifiedFinancialPlannersBoardof
Standards(withover100,000certificantsworldwide),servedasISOSecretaryforthe
technicalcommitteeonpersonalfinancialplanning,andheldavarietyofpositionswithin
thefinancialservicesindustry
BarbaraSchmal,MS,RN,CHPN,CLNCisthecurrentpresidentoftheNationalBoardfor
CertificationofHospiceandPalliativeNurses(NBCHPN)andhasalsoservedtwotermson
theRNExaminationDevelopmentCommitteeasacontentexpert.Ms.Schmalhasbeena
nursefor35years,andhasworkedinend‐of‐lifecaresince1992.Shecurrentlypractices
asaclinicalresourcenurse/educatorforHospiceoftheValleyinPhoenix,AZandan
adjunctfacultymemberforGrandCanyonUniversity.Ms.Schmalhaspresentedatstate
andnationallevelsandhasauthoredseveralcomputer‐andWeb‐basededucational
modulesrelatedtohospiceandpalliativecare.
DeniseStahl,RN,MSN,ACHPNhasmorethan20yearsexperienceasaClinicalNurse
Specialistworkinginoncology,bonemarrowtransplant,phaseIclinicalresearch,palliative
careandhospice.Ms.StahliscurrentlytheProgramManagerforHospiceandPalliative
CareservicesforVISN4ofVAHealthcare.Sheisresponsibleforgrowthanddevelopment
ofpalliativecareandhospiceservicesacross104countiesinthenetwork,inbothinpatient
andoutpatientcaresettings.SheservesasaboardmemberoftheNationalBoardof
CertificationofHospiceandPalliativeNurses(NBCHPN)andtheAPNExamination
DevelopmentCommittee.Ms.StahliscertifiedasanEducationinPalliativeandEndofLife
Care(EPEC)andEndofLifeNursingEducationConsortium(ELNEC)trainerfornursesand
physicianswhoworkinend‐of‐lifecare.Sheregularlypresents,bothlocallyandnationally,
regardingavarietyofclinicalandprofessionaltopicsrelatedtoend‐of‐lifecare.
Page12of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
PatriciaS.Yoder‐Wise,RN,EdD,NEA‐BC,ANEF,FAANservesastheEditor‐in‐Chiefof
TheJournalofContinuingEducation:ContinuingCompetencefortheFuture,whereshe
conductsanannualsurveyofstateboardsofnursingandprofessionalcredentialingbodies
relatedtorequirementsforinitialandcontinuingcredentialing.Inadditiontoteachingat
twouniversities,Dr.Yoder‐WiseservedasPresidentoftheAmericanNursesCredentialing
Center(ANCC),theworld’slargestcredentialingorganizationinnursing.Sheis
author/coauthorofnumerousarticlesandseveraltexts,includingLeadingandManagingin
Nursing.ShemostrecentlyservedontheTexasNursesAssociation’sTaskForceon
continuingcompetence,whichresultedinareportofabroadviewofcompetenceanda
changeintheTexasBoardofNursing’sacceptanceofcertificationasasecondavenuefor
meetingtherequirementforcontinuingcompetencedemonstration.
SandraLeeSchafer,RN,MN,AOCN,haspracticednursinginavarietyofroles.She
workedasabedsidestaffnurseinmedicalsurgicalnursingandcriticalcare,asaClinical
NurseSpecialistincancercareandpainmanagementandasaQualityImprovement
Mangerforlongtermacutecare/rehabilitation.Acontributingauthortothreecancer
nursingbooksandseveralnursingjournals,Ms.Schaferhasgivennumerouspresentations
locally,nationally,andinternationallyonpainandsymptommanagement,cancercare,care
attheendoflife,caringforthecaregiver,communication,andprofessionalpractice.She
heldleadershippositionswithmanyorganizationsonalocalandnationallevelincluding
theAmericanCancerSociety,ThePennsylvaniaStateCancerPainInitiative,The
PennsylvaniaSocietyofOncologyandHematology.ShewasNationalPresidentofthe
OncologyNursingSociety.Ms.SchaferiscurrentlyDirectorofCertificationfortheNational
BoardforCertificationofHospiceandPalliativeNurses(NBCHPN).Herworkfocuseson
thecoordinationofalladministrativeactivitiesinvolvingcertification.Shealsoservesasa
BoardmemberoftheAmericanBoardofNursingSpecialties(ABNS).
JudyLentz,RN,MSN,NHA,inthecapacityasCEOoftheNationalBoardforCertificationof
HospiceandPalliativeNurses(NBCHPN),servedasamemberoftheContinuing
CompetenceTaskForce.Ms.Lentzhasbeenpracticingnursingfornearly50yearsina
varietyofroles:staffnurse,administrator,oncologyclinicalnursespecialistandfinallyas
anassociationexecutiveforthepastnearly11years.SheparticipatedontheAmerican
NursesAssociation(ANA)TaskForcetowritetheScopeandStandardsforNurse
Executives.MsLentzhaspublishedonvarioustopicsandpresentedlocally,regionallyand
nationally.NBCHPNhasbeenamemberoftheAmericanBoardofNursingSpecialties
(ABNS)since2000whereMs.Lentzservedaspresidentin2004‐2005.SheisalsotheCEO
oftheHospiceandPalliativeNursesAssociation,theHospiceandPalliativeNurses
FoundationandtheAllianceforExcellenceinHospiceandPalliativeNursing.
Page13of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
TheContinuingCompetenceTaskForcedeeplyappreciatesthesupportoftheNBCHPN
officestaffandparticularlyDawnZwibel,AssistantDirectorofCertification,incoordinating
anddocumentingourmeetingsandinpreparingourStatement.
References
1. NationalCouncilofStateBoardsofNursing.MeetingtheOngoingChallengeof
ContinuedCompetence.2005.Availableat:
https://www.ncsbn.org/Continued_Comp_Paper_TestingServices.pdf. Accessed
December30,2010.
2. LundgrenBS,HousemanCA.Continuingcompetenceinselectedhealthcare
professions.JournalofAlliedHealth.2002;31:232–240.
3. SwankinD,LeBuhnRA,MorrisonR.Implementingcontinuingcompetency
requirementsforhealthcarepractitioners.AARP.2006.Availableat:
http://assets.aarp.org/rgcenter/health/2006_16_competency.pdf. Accessed
December30,2010.
4. ByrneM,WatersL.CCIThinkTank.Continuedcompetenceleadershipforum:From
piecestopolicy.Post‐eventwhitepaper.Denver,CO:Competency&Credentialing
Institute;2008.Availableat:www.cc‐institute.org.AccessedDecember30,2010.
5. CanadianNursesAssociationandCanadianAssociationofSchoolsofNursing.
(2004).Jointpositionstatement:PromotingcontinuingcompetenceforRegistered
Nurses.Ottawa,Canada:Author.Availableat:http://www.cna‐
aiic.ca/CNA/documents/pdf/publications/PS77_promoting_competence_e.pdf
AccessedMarch5,2011.
6. SchroeterK.CompetenceLiteratureReview.Denver,CO:Competency&
CredentialingInstitute;2008.Availableat:http://www.cc‐
institute.org/docs_upload/competence_lit_review.pdf.AccessedDecember30,
2010.
7. Vandewater,D.Bestpracticesincompetenceassessmentofhealthprofessionals.2004.
CollegeofRegisteredNursesofNovaScotia.Availableat:
http://www.crnns.ca/documents/competenceassessmentpaper2004.pdf.Accessed
December30,2010.
8. VandewaterD.Updatetobestpracticesincompetenceassessmentofhealth
professionalspolicypaper.CollegeofRegisteredNursesofNovaScotia.2006.
Page14of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
Availableat:
http://www.crnns.ca/documents/Update%20to%20Best%20Practices%20in%20C
ompetence%20Assessment%2006.pdf.AccessedDecember30,2010.
9. InternationalCouncilofNurses(2006).Continuingcompetenceasaprofessional
responsibilityandpublicright.Geneva,Switzerland:Author.Availableat:
http://www.icn.ch/images/stories/documents/publications/position_statements/
B02_Continuing_Competence.pdfAccessedMarch8,2011.
10. AmericanNursesAssociation.Nursing:ScopeandStandardsofPractice.4thed.
SilverSpring,MD:Nursebooks.org;2010.
11. HospiceandPalliativeNursesAssociation.CompetenciesforAdvancedPractice
HospiceandPalliativeCareNurses.Pittsburgh,PA:HospiceandPalliativeNurses
Association;2002.
12. HospiceandPalliativeNursesAssociation.CompetenciesfortheGeneralistHospice
andPalliativeNurse.2ndedition.Pittsburgh,PA:HospiceandPalliativeNurses
Association;2010.
13. InstituteofMedicine.TheFutureofNursing:LeadingChange,AdvancingHealth.
2010.Availableat:www.iom.edu/nursing.Accessed:December2010.
AdditionalReferenceListing
1. AllenP,LauchnerK,BridgesRA,Francis‐JohnsonP,McBrideSG,OlivarezA.(2008).
Evaluatingcontinuingcompetency:achallengefornursing.JournalofContinuing
EducationinNursing.2008;39(2):86–91.
2. AmericanBoardofNursingSpecialties.APositionStatementoftheValueofSpecialty
Nursing.2005.Availableat:www.nursingcertification.org.AccessedDecember30,
2010.
3. AmericanBoardofNursingSpecialties.ValueofCertificationSurveyExecutive
Summary.2006.Availableat:
http://nursingcertification.org/pdf/executive_summary.pdf.AccessedDecember
30,2010.
4. AmericanPhysicalTherapyAssociation.ContinuingCompetency:Ideas,Perspectives,
andRealities.2010.Availableat:http://ptboard.nv.gov/PT‐
CEApprovedCourses.asp.AccessedDecember30,2010.
Page15of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
5. AzzarelloJ.Settingvalidcut‐offscoresforcompetency.JournalforNursesinStaff
Development.2003;19(5):234–239.
6. BargerM,CamuneB,GravesB,LambertoJ.Thepast,presentandfutureofassessing
continuingcompetencyformidwives.JournalofMidwiferyandWomen’sHealth.
2009;54(5):338–340.
7. BrixeyMJ,MahonSM.Aself‐assessmenttoolforoncologynurses:preliminary
implementationandevaluation.ClinicalJournalofOncologyNursing.
2010;14(4):474‐480.
8. BurnsB.Continuingcompetency:what’sahead.JournalofPerinatalNeonatal
Nursing.2009;23(3):281–227.
9. ByrneM,DelaroseT,KingCA,LeskeJ,SapnasKG,SchroeterK.Continued
ProfessionalCompetenceandPortfolios.JournalofTraumaNursing.2007;14(1):24–
31.
10. DobsonCL,HessRG.Pursuingcompetencethroughcontinuingeducation.Journalof
NursingRegulation.2010;1(2):8–13.
11. DrenkardK.NursingCertification:StateoftheScience.JONA.2010;40(10)
Supplement:S1‐S77.Compendiumofpreviouslypublishedarticles:
a. ColemanE,CoonS,LockhartK,etal.Effectofcertificationinoncology
nursingonnursing‐sensitiveoutcomes.2009:S35–S42.
b. HartS,BerquistS,GajewskiB,DuntonN.Reliabilitytestingofthenational
databaseofnursingqualityindicatorspressureulcerindicator.2006:S16–
S25.
c. Kendall‐GallagherD,BlegenM.CompetenceandCertificationofRegistered
NursesandSafetyofPatientsinIntensiveCareUnits.2009:S68–S75.
d. ManojilovichM.PredictorsofProfessionalNursingPracticeBehaviorsin
HospitalSettings.2005:S45–S51.
e. NewhouseR,JohantgenM,Provovist,JohnsonE.PerioperativeNursesand
PatientOutcomes–Mortality,Complications,andLengthofStay.2005:S54–
S67.
f. WadeC.PerceivedEffectsofSpecialtyNurseCertification:AReviewofthe
Literature.2009:S5–S13
Page16of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
g. ZulkowskiK,AyelloE,WexlerS.CertificationandEducation:DoTheyAffect
PressureUlcerKnowledgeinNursing?2007:S28–S32.
12. EricssonKA,WhyteJ,WardP.Expertperformanceinnursing–reviewingresearch
onexpertiseinnursingwithintheframeworkoftheexpert‐performanceapproach.
AdvancesinNursingScience.2007;30(1):E58–E71.
13. HendersonJ.Practicesandrequirementsofrenewalprogramsinprofessional
licensureandcertification.NationalOrganizationforCompetencyAssurance.2009.
Availableatwww.credentialingexcellence.org.AccessedDecember30,2010.
14. InstituteforCredentialingExcellence.Guidelinesforperformanceexamination.2010.
Availableat:www.credentialingexcellence.org.AccessedDecember30,2010.
15. InstituteofMedicine;CommitteeonPlanningaContinuingHealthProfessional
EducationInstitute.RedesigningContinuingEducationintheHealthProfessions.
Washington,DC:NationalAcademiesPress;2010.
16. IronsideP.Epilogue:safeguardingpatientsthroughcontinuingcompetency.Journal
ofContinuingEducationinNursing.2008;39(2):92–94.
17. JordanC,ThomasMB,EvansML,GreenA.Publicpolicyoncompetency:howwill
nursingaddressthiscomplexissue?JournalofContinuingEducationinNursing.
2008;39(2):81–85.
18. KrapohlG,ManojlovichM,RedmanR,ZhangL.Nursingspecialtycertificationand
nursing‐sensitivepatientoutcomesintheintensivecareunit.AmericanJournalof
CriticalCare.2010;19;490–498.
19. LenburgCB.TheFramework,ConceptsandMethodsoftheCompetencyOutcomesand
PerformanceAssessment(COPA)Model.AmericanNursesAssociation.2000.
Availableat:http://nursingworld.org/mods/archive/mod110/copafull.htm.
AccessedDecember30,2010.
20. MelanderS,KleinpellR,McLaughlinR.EnsuringclinicalcompetencyforNPsin
acutecare.TheNursePractitioner.2007;32(4):19‐20.
21. SharoffL.Aqualitativestudyofhowexperiencedcertifiedholisticnurseslearnto
becomecompetentpractitioners.JournalofHolisticNursing.2006;24(2):116–124.
22. ThomasMB,BenbowDA,AyarsVD.Continuedcompetencyandboardregulation:
Onestateexpandsoptions.JournalofContinuingEducationinNursing.
2010;41(11):524–528.
Page17of18
6/8/11 StatementonContinuingCompetenceforNursing:ACalltoAction
June2011
23. TilleyD.Competencyinnursing:aconceptanalysis.JournalofContinuingEducation
inNursing.2008;39(2):58–64.
24. ValenteS.Improvingprofessionalpracticethroughcertification.JournalforNurses
inStaffDevelopment.2010;26(5):215–219.
25. WendtA,AlexanderM.Towardastandardizedandevidence‐basedcontinued
competenceassessmentforregisterednurses.JONA’sHealthcareLaw,Ethics,and
Regulation.2007;9(3):74–86.
Page18of18
6/8/11