C
urrent methods of defining and measuring clinical
competency are not optimal or consistent. There is
no common definition of competence and no evidence for one best method to assess competence. Each
organization defines its processes to ensure staff competence. Many of these efforts focus on measuring the
nurse’s capability to perform a particular skill, not on the
nurse’s overall ability to perform in a practice setting
(Koncaba, 2007). This approach reinforces an archaic belief that professional nursing practice is about doing and
not about thinking. The knowledge required for a nurse
to ensure patient safety and quality is not traditionally
reinforced during competency validation.
In traditional competency programs, competency is validated on hire and annually thereafter using skill stations.
The validation process has been focused on moving large
numbers of nurses through the program with little connection to performance improvement, scope of practice, nursing expertise, performance appraisal, and, most importantly,
patient safety. Most often, only psychomotor skills are validated with little attention given to the clinical reasoning
that contributes to quality patient-focused care.