Developing Clinical Nurse Specialist Practice Competencies

Construction of an index system of core competence assessment for otolaryngology nurse specialists in China: A Delphi study

BACKGROUND

Clinical nurse specialists play a vital role in the work quality, patient safety and team development of nurses. However, there is currently no prior study constructing the index of core competence assessment for otolaryngology Nurse Specialists.

OBJECTIVES

To establish an index system for the evaluation of Chinese otolaryngology Nurse Specialists' core competence.

DESIGN

A Delphi study.

SETTINGS

The study was mainly conducted in a university-affiliated hospital in China.

PARTICIPANTS

Twenty-two experts with otolaryngology knowledge and practical experience from different regions and organizations in China.

METHODS

We used literature reviews and expert meetings to establish a draft index system . Subsequently, a two-round Delphi survey was utilized to consult opinions from 22 experts about the index for the evaluation of otolaryngology nurse specialists' core competence and provide qualitative comments on their ratings. Consensus was predefined as a mean important score of 4.0 or above and a coefficient of variation is not above 0.25 among the participants.

RESULTS

The final evaluation indexes of the core competencies for otolaryngology Nurse Specialists included 5 first-level indexes (clinical competence, critical thinking competence, leadership, professional development competence, professionalism), 19 second-level indexes, and 85 third-level indexes. The effective response rates of the two expert consultation rounds were 100 %. The expert authority coefficients were 0.864 and 0.859 in the first and second rounds of consultation, respectively. In the second round of consultation, the first, second and third indexes of Kendall's coefficient of concordance were 0.357, 0.330, and 0.232, respectively (P < 0.001).

CONCLUSIONS

The constructed evaluation indexes of the core competencies of otolaryngology Nurse Specialists are scientific, reasonable, comprehensive, and specific and may provide references for the training and evaluation of otolaryngology Nurse Specialists.

Tests on a scale for measuring the core competencies of paediatric specialist nurses: An exploratory quantitative study

AIM

This study aimed to develop a tool to measure paediatric specialist nurses' core competencies and examine the scale's validity and reliability.

DESIGN

An exploratory quantitative study.

METHODS

This study was performed in April 2022 with 302 paediatric specialist nurses in mainland China. Items were created through a literature review, a qualitative interview, and the Delphi method. The data were evaluated using descriptive statistics, independent sample t-test, explanatory factor analysis, Pearson correlation coefficient, Cronbach's alpha coefficient and split-half reliability.

RESULTS

The final scale consisted of five factors and 32 items. The factors were communication, coordination and judgement abilities; professional technology mastery ability; specialist knowledge mastery ability; medical-related processes; and evidence-based nursing competencies. The explained total variance of the five factors was 62.216%. The scale-level and item-level CVI of this scale was 1.00, and the mean CVR of the total scale was 0.788. The Pearson correlation coefficients of each dimension and the total dimension of the scale was 0.709-0.892, and within each dimension, it was 0.435-0.651. The Cronbach's α of this scale was 0.944, and its split-half reliability was 0.883.

Construct validity of advanced practice nurse core competence scale: an exploratory factor analysis

BACKGROUND

Determining the core competence of advanced practice nurses is foundational for promoting optimal design and implementation of advanced practice nursing roles. Core competencies specific to the contexts of the advanced practice nurse in Hong Kong have been developed, but not yet validated. Thus, this study aims to assess the construct validity of advanced practice nurse core competence scale in Hong Kong.

METHODS

We performed a cross-sectional study using an online self-report survey. Exploratory factor analysis was used to examine the factor structure of a 54-item advanced practice nurse core competence scale through principal axis factoring with direct oblique oblimin rotation. A parallel analysis was conducted to determine the number of factors to be extracted. The Cronbach's α was computed to evaluate the internal consistency of the confirmed scale. The STROBE checklist was used as reporting guideline.

RESULTS

A total of 192 advanced practice nurse responses were obtained. Exploratory factor analysis led to the final 51-item scale with a three-factor structure, which accounted for 69.27% of the total variance. The factor loadings of all items ranged from 0.412 to 0.917. The Cronbach's alpha of the total scale and three factors ranged from 0.945 to 0.980, indicating robust internal consistency.

CONCLUSION

This study identified a three-factor structure of the advanced practice nurse core competency scale: client-related competencies, advanced leadership competencies, and professional development and system-related competencies. Future studies are recommended to validate the core competence content and construct in different contexts. Moreover, the validated scale could provide a cornerstone framework for advanced practice nursing roles development, education, and practice, and inform future competency research nationally and internationally.

Status of core competencies of wound, ostomy and continence nurses and their influence on career success: a cross-sectional study

OBJECTIVES

The wound, ostomy and continence nursing practice has its own scope and standards, and each standard requires relevant competency. However, the core competencies of wound, ostomy and continence nurses that contribute to the career success are poorly known. To identify associations between career success and core competencies of wound, ostomy and continence nurses in China.

DESIGN

A cross-sectional survey with a convenience sample.

SETTING

Participants were recruited from 108 hospitals in 28 provinces.

PARTICIPANTS

A total of 123 wound, ostomy and continence nurses were surveyed.

MEASURES

Career success, core competencies and demographic characteristics of wound, ostomy and continence nurses, were measured in this study.

METHODS

A survey was distributed to 123 wound, ostomy and continence nurses were recruited from 108 hospitals in 28 provinces. Multivariate logistic regression was undertaken to explore associations between career success outcomes and core competency scores of wound ostomy and continence nurses and their demographic characteristics.

RESULTS

The career success and core competency of wound, ostomy and continence nurses were both above average. Nurses who had higher total scores of core competency were more likely to have higher career success, including total score (OR=4.90), career satisfaction (OR=5.58) and perceived internal (OR=4.55)/external (OR=3.42) organisation competitiveness. Higher competency in interpersonal communication (OR=7.70) and more time for wound care per month (OR=8.80) predicted higher career satisfaction. Additionally, nurses with higher professional development were more likely to score higher in perceived internal organisation competitiveness of career success (OR=4.36) and the overall career success (OR=5.96).

CONCLUSIONS

The career success and core competency of the wound, ostomy and continence nurses in China were at an above average level. The associations between career success and core competency of the wound, ostomy and continence nurses were positive, suggesting that competency enhancement could improve nurses' career success.

Core competencies of clinical nurse specialists: A comparison across three Nordic countries

AIM

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland.

BACKGROUND

Clinical nurse specialist roles were first developed more than 60 years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries.

DESIGN

A descriptive correlational study.

METHODS

An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline.

RESULTS

A total sample of 184 clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate = 72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p = .000) and in organisational competency (p < .05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency.

CONCLUSION

A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries.

RELEVANCE TO CLINICAL PRACTICE

The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.

Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis

AIM

To conduct a construct validity test on a clinical nurse specialist core competency scale.

BACKGROUND

Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research-driven efforts to develop and validate clinical nurse specialist core competencies.

DESIGN

A descriptive study, using an online self-report questionnaire, was conducted from May to September 2019 in three Nordic countries.

METHODS

An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50-item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study.

RESULTS

One hundred and eighty-four responses were obtained (Finland n = 52, Denmark n = 95, Iceland n = 37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale.

CONCLUSIONS

Based on the analysis and subjective interpretation, we suggest a 47-item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study.

RELEVANCE TO CLINICAL PRACTICE

The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate-level programme curricula and inform future competency research.

The development of competency frameworks in healthcare professions: a scoping review

Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O'Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.

Implementing a Transition-to-Practice Program for Novice Clinical Nurse Specialists: A Pilot Project

PURPOSE

The aim of this study was to determine the impact of a transition-to-practice program on job satisfaction among novice clinical nurse specialists (CNSs) in the US Air Force.

PROGRAM DESCRIPTION

A needs assessment was conducted among currently practicing Air Force CNSs (n = 30) to establish the necessity for a transition-to-practice program. Newly graduated CNSs (n = 8) were paired with experienced CNS mentors and met every 2 weeks for 2 months to discuss progress on the CNS core competencies. Before beginning the program, mentees self-reported perceptions related to the core competencies. Mentors focused on areas of self-reported low competency. The Nursing Context Index was administered preintervention and postintervention to assess the program's impact on job satisfaction.

OUTCOMES

Overall job satisfaction among novice CNSs improved from 5.01 to 5.57 (scale, 1-7) after completing the program. Personal satisfaction (4.30-5.63) and satisfaction with professional support (5.28-6.00) showed the greatest improvement out of the 4 elements of job satisfaction evaluated.

CONCLUSIONS

Transition-to-practice programs can be beneficial for novice CNSs in establishing their practice. Future studies with larger sample sizes over longer periods of time are necessary to determine the true impact of similar programs.

Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study

RATIONAL

The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development.

OBJECTIVES

To describe the formulation and validation process of the clinical nurse specialist core competencies.

DESIGN

Exploratory sequential mixed-method design.

METHODS

This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods.

RESULTS

Seventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles.

CONCLUSIONS

Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.

[Differences and similarities between the competencies of a nursing supervisor and an advanced clinical nurse specialist]

INTRODUCTION

With the aim of contributing to the development of a more specific professional regulation, the present study was to identify differences and similarities between the competencies of the nursing supervisor and clinical nurse specialist in an intensive care unit.

MATERIAL AND METHODS

A critical analysis of the literature published between 2003 and 2013 was conducted, identified through systematic searches in electronic databases, health management and practitioner journals and reference lists of the 17 items included.

RESULTS

«Management and administration» and «direct clinical practice» were identified as specific competencies of nursing supervisor and clinical nurse specialist respectively. «Collaboration», «leadership» and «research» emerged as competencies shared by both profiles, but with different a operationalization way of conducting it.

CONCLUSIONS

These findings imply that regulation, education and implementation of these profiles must address their specific skills as the distinctive approach taken in operationalizing shared.

Role of the Clinical Nurse Specialist in the Journey to Magnet Recognition

Clinical nurse specialists (CNSs) work with and through other nurses as well as interprofessional team members to advance nursing practice, improve outcomes, and provide clinical expertise to effect system-wide changes to improve programs of care. They practice across the continuum and through 3 spheres of influence, encompassing the patient, nurse, and system. Clinical nurse specialists possess expertise in developing and refining structures, strategies, and processes to optimize outcomes at both the unit (micro) level and the organization or system (macro) level. This unique vantage point positions CNSs as ideal individuals to assume several key roles when a health care organization makes the decision to embark on the Magnet journey and to maintain Magnet recognition. The competence and competencies of CNSs and a health care organization’s desire to achieve and/or maintain Magnet recognition represent a synergistic match.

Clinical nurse specialists: then, now, and the future of the profession

PURPOSE

The role of the clinical nurse specialist (CNS) has evolved significantly over time and will continue to do so. Future students, faculty, and practicing CNSs should be aware of their roots, current status, and what the future may entail.

RATIONALE

An accurate understanding and reflection of the past, present, and future of this specific advanced practice nursing specialty could ensure its continued success as a predominate force in health restoration and the promotion of the health and well-being of people.

DESCRIPTION

A review of the literature yielded a lack of cohesive information about the evolution of the CNS role, prompting an investigation into the historical, current, and future aspects of the CNS.

OUTCOME

This article compiles information related to the evolution of the CNS role and what the future may entail.

CONCLUSION

An understanding of how the CNS role evolved, where it stands currently, and future considerations may help clarify the role, improve utilization of the CNS in a variety of settings, improve standards for CNS education and certifications, and advance this nursing practice specialty.

Infection preventionists' job descriptions: do they reflect expanded roles and responsibilities?

In the last decade, the scope of practice of infection preventionists has expanded beyond the traditional roles of solo practitioner and expert data collectors to roles of interventionists and crucial leaders in successful patient safety initiatives. We examined the job descriptions of a small group of practicing infection preventionists to determine whether they reflected this expanded scope and responsibilities.

What are the necessary practice competencies for two providers: dermal fillers and botulinum toxin type A injections?

There has been a steady increase in the number of individuals who undergo dermal fillers and botulinum toxin Type A injections. The majority of these procedures are performed by nurse providers. The purpose of this study was to collect national data on the current practice among nursing providers within the American Society of Plastic Surgical Nurses (ASPSN). The goal was to utilize the national data and develop a document of the necessary competencies to guide the practice of providers of dermal fillers and botulinum toxin Type A injections. A survey tool was developed and validated for content by expert nursing providers among the membership of the ASPSN and disseminated via e-mail to the membership of the ASPSN. In addition, data from investigator training, mentoring, and evidence from a review of the literature were also incorporated into the competency document utilizing the Competency Outcomes and Performance Assessment (COPA) model. Common core issues became apparent that included contraindications for the use of botulinum toxin Type A and dermal fillers, postprocedure complications as well as strategies in terms of managing complications. The data also revealed that there is no common method providers are taught to assess the aesthetic patient and a lack of a collaborative relationship in current practice. Overwhelmingly, the respondents supported the need for defined practice competencies. A competency document to guide the practice of providers of dermal fillers and botulinum toxin Type A has been developed for completion of this DNP project.

Generating scientific models of knowledge using arcs

BACKGROUND

Systematic approaches are needed to review literature on nutrition in heart failure for its scientific merit, relevance, and usefulness and identify directions for future research.

OBJECTIVES

To evaluate the feasibility of arcs (J.R.G., Indianapolis, Indiana), a computer program for managing data from literature and modeling knowledge, the objectives were to conduct an integrative review of 10 studies of nutrition in heart failure and generate scientific models of knowledge using arcs.

METHODS

A unit of knowledge in arcs is 2 variables linked by a statistical relationship. The computer program arcs categorized variables and relationships found in the 10 explanatory observational studies. It also provided a scientific model for further empirical testing.

RESULTS

The computer program arcs aggregated the following: 104 dependent and 93 independent operational variables and 60 associational, 16 predictive, 15 structural, 1 descriptive, and 85 difference relationships. A direct model produced by arcs postulated a structural relationship between cachexia and 18-month mortality, independent of age or New York Heart Association classification, which can be tested as a path theoretical model.

CONCLUSION

The computer program arcs appeared to be feasible for conducting an integrative review of nutrition in heart failure. A larger, representative set of literature will enable generation of knowledge and identification of gaps and inconsistencies in findings.