2010

Authors

  • Elaine Wells Elaine Wells

This study investigates the uniqueness and importance of the Australian National Competency Committee (ANCI) competencies to nurses and other health professionals. Very few Australian studies (Battersby, 1994; Hearn, Smith, Southerly & Close, 1995) have addressed this issue. Although there is widespread confusion of the term "competency", professional bodies regard competency standards as a process for supporting the integrity and control of their respective professions. The problem is that there is confusion across the health professions about competencies and their agenda. ANCI suggest that the nursing competencies reflect unique characteristics of nursing as well as those common with other professions. However, competencies that are unique to nursing have not been identified. ANCI have also not identified how competencies can enhance the development of nursing as a profession. The identification of differences in perceptions of uniqueness and importance of the ANCI competencies within nursing and across health professional groups may contribute to the debate on what is needed to achieve competence and those factors that may influence nursing autonomy, education, and future professional development. This study is important to assist in the identification of nursing as a profession in its own right. It will assist the arguments for and against economic reform in professional education courses and transfer of skills and competence across professions. This study compares the perceptions of nurses, physiotherapists, speech pathologists, and occupational therapists about the uniqueness and importance of the ANCI competencies to their professions. Participants completed a questionnaire that listed the ANCI competencies. They were asked to rate each competency first on uniqueness to their profession, and second, on importance to their profession. Two surveys were conducted; one in 1997 and the second in 2000. Surveys examined any change in perception over time by different cohort groups. The study takes a quantitative approach to data collection and analysis. Inferential analysis determined statistically significant differences and similarities of the four participating health professional groups. The differences are examined in relation to the characteristics that define a profession and implications for nursing are examined in relation to research, autonomy, and patient advocacy within an evidence-based practice framework. Eight hundred and thirty-one of questionnaires distributed were used in this study. The results showed that nursing emerged as significantly different to the other three health professions on perception of uniqueness of the competencies. Nineteen of the sixty-five competencies were perceived by nurses to be more unique to the nursing profession. This perception of uniqueness was found across all the four domains of the ANCI competencies. Although ANCI (2000) claimed that the competencies reflect the unique characteristics of nursing these characteristics have not previously been identified. This finding provides some support for the claim made by ANCI by identifying those competencies nurses perceive as more unique. The study findings showed also that the four participating health professions rated the ANCI competencies as important. However, there was a significant difference between nurses and the other three professional groups on the ratings of importance of the competencies of professional and ethical practice. The study found that nurses rated the competencies of this domain as more important than the other three professions rated these competencies. The findings indicate that the rank orders of importance of the competencies are different across the four professions. This reflects and indicates the different priorities and work roles of each of the four professional groups. It is interesting as well as being of concern to nursing that the participating nurses ranked research and management of care as being the least important of all of the competencies. This finding may help to explain why nursing research has been slow to develop in spite of changes to nursing education. Nurses have a subordinate past and are often described as doers rather than thinkers. It appears that this may not have changed. Current practice also reflects a dependency on other health professions such as the medical profession (Adamson & Harris, 1996). Finally, the study found that there was no change in nurses' perceptions of uniqueness over time. However, there was a slight increase in the nurses' ratings of importance of Critical Thinking and Analysis. There were no statistical significant differences for age, gender, year of graduation, state of residence, and employment status. The discussion chapter commences with an outline of the perceived importance of the competencies across the different health professions. Discussion compares the findings and methods of two important Australian studies of competencies (Battersby, 1994; Hearn et al. 1995, 1996) to this study. Discussion examines professionalism and identifies areas where nursing's perceptions of the competencies meet the criteria of a profession and where the four health professions have similar and different perspectives and qualities. Six characteristics of a profession that are discussed in relation to the perceptions of the ANCI competencies are: high intellectual functioning, special body of knowledge, responsibility and accountability, code of ethics, autonomy, and collegiality. The third part of the discussion highlights the implications of this studies' findings in relation to ANCI competencies as an evaluation tool, the empowerment of nurses, generic courses, scope of nursing, professional development, and curriculum development. The thesis concludes by arguing that 1) The ANCI competencies have the potential to increase the professionalism of nursing; 2) Nurses value accountability and responsibility, the code of ethics, and collegiality; 3) Nurses appear uncomfortable with the concept of autonomy; 4) Nurses undervalue high intellectual functioning and the importance of a body of knowledge; and 5) Perceptions are influenced by the context of competencies. The final chapter highlights a number of recommendations for nursing practice that include the need for further investigation of the uniqueness of the ANCI competencies. It is argued that there is a need for a number of changes to the ANCI competency list as well as a greater emphasis on research and management of care and support for discipline specific courses.It is apparent from the findings of this study that nursing education and clinical practice would benefit from the placement of more emphasis on the importance of research. Furthermore, nurses need to take better responsibility for pursing opportunities and funding for research and practice management. It is concluded that nursing research will increase the body of knowledge for the profession and will also increase professional autonomy with an outcome of better client care. Nurses need encouragement from administrators and educators to value management of care and the nursing process, as this will also encourage independence and quality of care provision. It is argued that commonalities in the perception of uniqueness and importance of competencies are not grounds for politicians to suggest the implementation of generic health professional courses. The commonality of the competencies being important to all four professions can be attributed to the complex nature of nursing practice, which captures aspects of other health professional roles and many of the competencies contribute to the characteristics that define a profession. There are differences in the rankings that can be attributed to the nature of knowledge, context, and priorities of the different professions. Each profession has its own governing body that ensures its members obtain an acceptable standard of professional competence and education. It has, and always will be, the responsibility of the profession to shape the service it provides (Pyne, 1998). This study highlights nurses' perceptions of competencies. The recognition of these perceptions could be used to guide nursing's strive toward autonomy, professional development, and recognition as a profession in its own right.