The Emergency Nurses Association (ENA) recently developed Competencies for Nurse Practitioners in Emergency Care (ENA, 2008). These entry-level competencies are intended for use by nurse practitioners (NPs) in emergency care regardless of setting (e.g., urgent care, fast track, emergency department). Other advanced practice nursing specialties in emergency care, specifically clinical nurse specialists (CNSs), are also in the process of developing entry-level competencies for CNSs who practice in emergency care.
WHAT ARE COMPETENCIES?
Competencies are broadly defined as essential knowledge, behaviors, and skills that an individual should possess and demonstrate to practice in a specific discipline or specialty area. In 1990, for example, the National Organization of Nurse Practitioner Faculties (NONPF) established entry-level core competencies for all NPs, regardless of their specialty area. These competencies have since been updated and revised (NONPF, 2006). Emergency Nurses Association supports the NONPF core competencies. Subsequently, utilizing the NONPF framework, ENA proceeded with the development of their specific entry-level competencies for NPs in emergency care. All of these validated competencies from NONPF and now from ENA incorporate the essential knowledge, skills, and behaviors that an NP should have to practice in emergency care.
WHY SHOULD AN ORGANIZATION DEVELOP COMPETENCIES?
Competencies delineate the unique aspects of a particular area of practice and provide a model for entry into that practice. Competencies for advanced practice nurses (APNs) support their practice. Competencies are also used in academic settings as a foundation for curricula. Competencies (e.g., skills checklists) are also used to prepare APNs for work in their specialty area. In addition, demonstrating competency in a particular area prepares an APN for employment in that specialty practice.
Entry-level competencies vary from state-to-state based on each particular state's rules and regulations, the practice environment, and particular employer arrangements. It should also be mentioned that enhanced skills and knowledge gained over time may alter competencies-both for the individual and for credentialing purposes.
Although competencies provide a model for entry-level practice, competencies in and of themselves do not stipulate a scope of practice. The scope of practice for an APN within a particular state is regulated by the state board of nursing (National Council of State Boards of Nursing, 2009). Competencies are reviewed, reevaluated, and revised periodically as the science of advanced practice nursing evolves and changes. New evidence brings new competencies that will be added to the list of current competencies.
Having competencies within a specialty then begs the next question, "How does one demonstrate competency?" Presently, competency can be achieved through various pathways including a combination of successful academic course completion (e.g., emergency care concentration), continuing education course completion (e.g., advanced electrocardiogram interpretation), and on-the-job instruction (e.g., minor procedures suturing). In the near future, credentialing in a specialty area affords APNs an additional method by which they can demonstrate their competency in a specialty area. These certification mechanisms include but are not limited to examination, portfolio review, and peer review and are discussed in the next section.
WHAT IS CERTIFICATION?
Certification is a general term used to describe a designation earned by an individual that validates that he/she possesses a specific body of knowledge and is qualified to perform a particular skill or behavior. "Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession" (APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee, 2008, p. 7).
The term certification is also used to specifically describe the granting of a particular title (Family Nurse Practitioner, Board Certified [FNP-BC]) to a recipient from an approved agency (e.g., American Nurses Credentialing Center [ANCC]). This certification is awarded after the recipient has successfully completed an academic course of study and passed a certification examination.
According to the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee, 2008), APRN Regulation includes four essential elements: Licensure, Accreditation, Certification, and Education (LACE). In this context, the term regulation is used more broadly. Councils, commissions, colleges and universities, associations, and specialty organizations are working collaboratively to achieve standardized APRN regulation.
Although some organizations have developed competencies and have created specialty certification mechanisms within their own organizations, other associations have yet to establish formal mechanisms. Some specialty nursing organizations (e.g., ENA) are investigating potential specialty certification mechanisms for APNs. Some of the credentialing options for APNs presently include but are not limited to (1) examination, (2) portfolio, and/or (3) peer review.
Examination
Examinations are based on the scope and standards of practice for a specialty. A "blueprint" is developed and examinations are designed by the APNs certified in that particular specialty. Individual questions go through a rigorous process to ensure that they are valid and reliable prior to being included on an examination. Certifying bodies utilize a psychometrician to ensure that the examination is psychometrically sound and legally defensible.
Portfolio
Portfolio is a comprehensive representation of professional abilities (skills) and achievements. A portfolio is much more in-depth than a curriculum vitae. It includes, but is not limited to, a demonstration of competencies attained (e.g., skills acquired), research, educational activities, instruction, and publications to name a few.
Peer Review
Peer review is the evaluation of an individual's work by an individual with similar qualifications (e.g., direct observation, collaborative practice, record review).
WHAT IS THE VALUE OF CERTIFICATION?
According to the ANCC, "Certification protects the public by enabling anyone to identify competent people more readily. Simultaneously it aids the profession by encouraging and recognizing professional achievement. Certification also recognizes specialization, enhances professionalism and, in some cases, serves as a criterion for financial reimbursement. It may also foster an enlarged role within the employment setting. Because certification of nursing practice signifies attainment of specific criteria and knowledge, skills, and abilities in a specific specialty field, certified nurses comprise a minority of the professional nurse population" (ANCC, 2008, p. 1).
IMPLICATIONS FOR ADVANCED NURSING PRACTICE
According to the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee 2008), "APRNs include certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners. Each has a unique history and context, but shares the commonality of being APRNs. While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state" (p. 5). As APN specialty organizations develop competencies, they will need to consider certification as well-by examination, portfolio, and/or peer review. Certification will also recognize specialization, promote professionalism, and enhance job opportunities and reimbursement within each specialty. And, APNs will continue to protect the patients they serve.
Karen Sue Hoyt, RN, PhD, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA
Jean A. Proehl, RN, MN, CEN, CCRN, CPEN FAEN
Emergency Clinical Nurse Specialist, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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