1. Carlson, Elizabeth Ann

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Over the last few months, I have been asked to present and work on the development of competencies. I learned a lot as I worked to fulfill these requests and think it is worth sharing in this column. I will discuss what competencies are, how they can be structured, give some examples of competencies, and identify where various competencies can be found.


Merriam-Webster (n.d.) defines "competency" as the ability to do something well: the quality or state of being competent. Thus, a competency is the capability to apply or use a set of related knowledge, skills, and abilities required to successfully perform "critical work functions" or tasks in a defined work setting. Another way to define competencies is one you may have heard frequently: Knowledge, Skills, and Abilities or KSA.


When searching for information on competencies, 24,800,000 sites, thousands of books, and numerous organizations that write, use, and distribute competencies were uncovered. Clearly, competencies are of interest to many people. This level of interest may exist because of how useful competencies can be and in how many different ways they can be used. Competencies can serve as a structured understanding of what is expected, serve as guidelines for development, and/or be used for evaluation purposes.


Because competencies detail what behavior or approach is expected relative to certain outcomes, they are used throughout education. A list of competencies has multiple purposes educationally. First, it tells the student and the faculty member what the student needs to know upon graduation to be considered a competent graduate. It provides guidelines to the student and the faculty member as to what needs to be taught. It also serves to establish a standard understanding across programs as to what can be expected as minimal and/or initial abilities of the new graduate.


Competencies are also widely used in work settings because they serve as an objective mechanism for the employer to establish expected behaviors or outcomes for the employees. The employees can use these competencies as their guideline for development so they understand what the employer expects them to do not only in their current position but also if they seek advancement. Well-structured competencies serve as an evaluation platform because they tell the employees what they are expected to do to be successful.


There are thousands of sources of competencies available. A book that I highly recommend is Exceptional Leadership: 16 Critical Competencies for Healthcare Executives (2nd ed.) by Carson F. Dye and Andrew N. Garman. It was published in 2015 by Health Administration Press, has 293 pages, 22 chapters, and is available both in softcover and as e-book. It costs US $82.00. The authors put forth the idea that exceptional leaders use competencies to guide and develop their performance. The competencies encompass the leader's set of personal and professional skills, knowledge, values, and traits. Dye and Garman present 16 competencies grouped as four cornerstones overlaying a healthy self-concept.


The book begins with a case study of the mythical St Nicholas Health System. This case study is used for illustrative purposes throughout the remainder of the book as certain competencies are discussed and examples given. Each competency is described, as well as what action or behaviors demonstrate this competency. Common skill deficits that prevent successful mastery of the competency are discussed. There are highlighted boxes that address the over- or misuse of each competency as well. Each chapter also has two mini cases and discussion questions for the reader's self-reflection. Unlike a list of competencies generated by an organization for use by its members or employees as a guide or evaluation, the approach taken by this book is more conceptual and helps the reader learn what is meant by the particular competency and how he or she may be able to learn the skill.


Not surprisingly, the book is divided into five parts; the first four parts focused on one of the cornerstones. Cornerstone 1, Well-Cultivated Self-Awareness, has two chapters. As is the pattern for all chapters addressing a competency, Leading With Conviction (Competency 1) begins with a vignette based on the case study and leads the reader into the competency being discussed. Competency 2 is Using Emotional Intelligence. The second cornerstone, Compelling Vision, includes three competencies: developing the vision, communicating the vision, and earning loyalty and trust. Masterful Execution is the third cornerstone and includes generating informal power, building true consensus, mindful decision making, driving results, stimulating creativity, and cultivating adaptability. The last cornerstone is A Real Way With People. This includes the competencies of listening like you mean it, giving great feedback, mentoring, developing high-performing teams, and energizing staff.


Part 5 contains six chapters that address aspects the reader may encounter as he or she puts the 16 competencies to work. Three appendices offer self-reflection questions, a sample self-development plan, and sample interview questions based on the 16 competencies. Additional reading is offered.


I highly recommend this book as an excellent resource both for someone beginning to learn about competencies and for someone who wants to learn more and refine his or her skills. The next references discussed assume that the person using the competency lists has an understanding of what a competency is and how to acquire the needed knowledge, skills, and abilities.


Because we are in healthcare, it seems appropriate to learn about competencies compiled by healthcare professional groups. An excellent resource was developed by the National Center for Healthcare Leadership (NCHL). The NCHL Health Leadership Competency Model (2006, p. 1) "was developed to provide the field with a comprehensive, validated competency model that will be suitable as the foundation for a breadth of leadership assessment and development applications." The NCHL grants permission for noncommercial use of the model as detailed at the website:


When viewed on the NCHL webpage, a Venn diagram illustrates the overlapping nature of the three parts: transformation, execution, and people. Subsumed under each part is detailed information explaining what is meant by the overarching competency.


Therefore, Transformation is described as "visioning, energizing, and stimulating a change process that coalesces communities, patients, and professionals around new models of healthcare and wellness" (NCHL Web site, pg. 4, n.d.). The knowledge, skills, and abilities needed for transformation are further detailed as achievement orientation, analytical thinking, community orientation, financial skills, information seeking, innovative thinking, and strategic orientation. Similarly, Execution is "translating vision and strategy into optimal organizational performance" via accountability, change leadership, collaboration, communication skills, impact and influence, initiative, information technology management, organizational awareness, performance measurement, process management/organizational design, and project management (NCHL Web site, pg. 4, n.d.).


The third component, People, is "the ability to implement staff development and other management practices that represent contemporary best practices, comply with legal and regulatory requirements, and optimize the performance of the workforce, including performance assessment, alternative compensation and benefit methods, and the alignment of human resources practices and processes to meet the strategic goals of the organization." As discussed previously, more detailed information is provided. In total, the model presents 26 competency and career-stage targets.


The NCHL Health Leadership Competency Model (2006) has been used by not-for-profit organizations to develop their internal leadership competency development programs. Your organization may have developed a tailored competency development program. In one such case, the organization provides references, on-the-job learning suggestions, and workshops addressing the specific competency. This approach is very useful because the employees know what their organization expects as leadership behaviors.


Within nursing, professional organizations have developed competencies for their members' use. The American Association of Colleges of Nursing has developed what it terms "essentials" that can also be seen as the terminal competencies expected of the graduates of the various nursing degree programs. These essentials serve as a description of the expected knowledge, skills, and abilities of the graduates and guide the colleges as they develop the educational program.


The Quality and Safety Education for Nurses Institute faculty defined competencies for quality and safety that need to be developed in nursing prelicensure and graduate programs. These knowledge, skills, and attitudes focus on patient-centered care, teamwork and collaboration, evidence base practice, quality improvement, safety, and informatics.


The American Organization of Nurse Executives (AONE) updated its Nurse Executive Competencies in 2011. These competencies are based on the belief that managers at all levels must be competent in five arenas. These arenas are communication and relationship building, knowledge of the healthcare environment, leadership, professionalism, and business skills. As have the previous sources discussed, each of the five arenas has detailed descriptions of what constitutes competence in the specific arena. AONE has an easily accessed downloadable PDF available at:


One feature of the AONE competencies that are very useful is the concrete examples given for the majority of the expected knowledge, skills, or abilities detailed. For example, under communication and relationship building is relationship management and the skills listed include "deliver bad news in such a way as to maintain credibility and follow through on promises and concerns and assert views in non-threatening, non-judgmental ways" (AHA News, pg. 4, n.d.). Similar types of examples are found throughout the document and enable the reader to clearly visualize how to meet the competency.


As you search for nursing competencies, you will find many available to use in addition to the ones discussed. I would expect that most of the competencies may use slightly different wording but have overlapping concepts and content with one another. Although it may at first appear confusing, it does offer the reader the opportunity to work from the competencies worded in the manner best suited to his or her learning. Therefore, if you don't "relate" to the competencies from Dye and Garman or one of the professional organizations, continue your search because I am confident you will find a set of competencies that work for you.




(n.d.). Merriam-Webster Web site. Retrieved September 2, 2015, from


(n.d.). National Center for Healthcare Leadership Web site. Retrieved September 2, 2015, from


AHA News. (n.d.). Retrieved September 2, 2015, from


NCHL Health Leadership Competency Model. (2006). Retrieved September 2, 2015, from,3238[Context Link]