CORE COMPETENCIES IN
NURSING CREDENTIALING AND
CERTIFICATION
Future Directions of Credentialing
Research in Nursing: A Workshop
DISCLOSURES
Laurie M. Lauzon Clabo, PhD, RN
Dean, School of Nursing MGH Institute of Health
Professions
 Chair, American Association of Colleges of Nursing
(AACN) Task Force on Advanced Practice Registered
Nurses (APRN) Clinical Education


Work-in-progress; not yet finalized or approved by AACN
Board
“THE AACN BOARD OF DIRECTORS CHARGES THE TASK FORCE WITH
THE DEVELOPMENT OF A WHITE PAPER THAT RE-ENVISIONS CLINICAL
TRAINING FOR ADVANCED PRACTICE REGISTERED NURSES (APRNS).”
To meet the charge the task force should:
1.
2.
3.
Describe the current state of APRN clinical training,
challenges, and regulatory requirements.
Describe the current state of APRN clinical training,
challenges, and regulatory requirements.
Consider competency assessment as an emerging
and potential element of a re-envisioned approach to
APRN clinical training.
TO MEET THE CHARGE THE TASK FORCE
SHOULD:
4.
Develop a set of recommendations for restructured or
re-envisioned clinical training, including alternative
models for APRN clinical training that:
o maximize clinical resources;
o consider current and potential financial implications;
o provide opportunities to prepare APRNs with the full
graduate, role and population-focused competencies;
and
o highlight opportunities and innovations for
interprofessional learning and practice.
CURRENT CHALLENGES IN APRN
CLINICAL TRAINING
Increased demand for APRN services
 Many programs report being at capacity, with clinical
training (along with faculty shortages) cited as a major
constriction in the pipeline
 > 14,600 qualified applications not accepted for
graduate programs in 2012 (AACN, 2013)
 Competition and scarce resources for clinical training
sites and preceptors

CURRENT STATE OF APRN CLINICAL
TRAINING
Mounting regulatory issues for in-state and distancelearning students
 None, inadequate or unstandardized preceptor training
 Pressure to compensate preceptors
 Variable student competence when entering clinical
training
 Productivity impact on preceptors
 Competition for APRN learning experiences, particularly
in some areas of practice and geographic regions

CORE COMPETENCIES AS A FOUNDATION FOR
APRN EDUCATION AND PRACTICE:
A THREE DECADE JOURNEY
Core Competencies for Nurse Midwifery (1978, 2011)
Domains and Core Competencies for Nurse Practitioner Practice
(1990, 2011)
Statement on Clinical
Nurse Specialist Practice and Education (1998,
2004)
Scope of Nurse Anesthesia Practice (1980, 2013)
COMPETENCIES, LICENSURE AND
CERTIFICATION
Competencies
Measures of competencies
Identified by Professional
Organizations
(e.g. oncology, palliative
care, CV)
Specialty Certification*
Specialty
CNP, CRNA, CNM, CNS in the
Population context
Population Foci
Role
APRN Core Courses:
Patho/physiology,
Pharmacology, Health/Physical
Assessment
Licensure: based
on education
and certification**
APRN
* Certification for specialty may include exam, portfolio, peer review, etc.
** Certification for licensure will be psychometrically sound and legally defensible examination
be an accredited certifying program,
Diagram 2: Relationship Among Educational Competencies, Licensure, &
Certification in the Role/Population Foci and Education and Credentialing in a
Specialty
ONE MODEL: NURSE PRACTITIONER
REDESIGN
Giddens, J., Lauzon Clabo, L. M., Gonce-Morton, P. Jeffries, P., McQuade-Jones, B., & Ryan, S. (2014)
CURRENT STATE:
No finite set of nationally recognized, consensus-based
common/core competencies for APRNs
 Emerging national discussion regarding the reliance on
“clinical hours” requirements
 No evidence that clinical hour requirements serve as an
effective proxy for NONPF core competencies (Halas et
al., 2012)
 While a competency framework for APRN practice is
described as desirable, APRN professional organizations
are moving in unique trajectories that are exclusive and
unique to each particular role

CORE AND ROLE-SPECIFIC COMPETENCIES:
A MILESTONES APPROACH
Nurse
Practitioner
Clinical Nurse
Specialist
Core/Common
Nurse
Midwife
Nurse
Anesthetist
Preclinical
Experiences
Clinical
Education
Graduation
Continuing
Professional
Development
RECOMMENDATIONS IN CONSIDERATION
APRN TASK FORCE



Identify common APRN core competencies across
role and population focus
Identify milestones for the APRN core
competencies from pre-clinical experience to
graduation
Develop standardized assessment tool to be used
by preceptors and/or faculty based on the
common core APRN competencies.
BY
RECOMMENDATIONS FOR STUDY
1.
2.
3.
4.
Identification of essential competencies along multiple
dimensions (educational preparation, role, population
focus, continuing professional development)
Development of robust/efficient strategies for
assessment
Explore the relationship between competencies and
patient outcomes especially in light of the unit-based
nature of nursing practice in many settings
What, if any, relationships exist between individual
achievement of competence and
group/team/interprofessional performance?