1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19 Assuring Provider Competence Through Licensure, Continuing Education, and Certification

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Competence: Definitions NCSBN: application of knowledge, interpersonal decision- making, psychomotor skills for nurse’s practice role ANA definition of three types of competence: –Continuing competence –Professional nursing competence –Continuing professional nursing competence ANA draft position statement (see Box 19.1)

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Competence: Definitions (cont.) Issues: –Overlap of definitions; no consensus of what it is, how to measure –Inability of professional nursing organizations to implement continuing competence mandates due to membership repercussion fears

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Competence: Definitions (cont.) Issues: –ANA advocating states to defer competence monitoring to professional association without governmental involvement –No national standards for defining, measuring, or requiring continuing competence –Lack of consensus about definition, measurement

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Professional Licensure Permission by competent authority to organization or individual to engage in practice or activity otherwise considered illegal Granted on basis of education, examination –Not performance Usually permanent; periodic fee, demonstration of competence or continuing education possibly necessary

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Currently, there is lack of agreement for defining and measuring competence.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Numerous definitions have been proposed for competence; however, there is no consensus for what competence is and how it should be measured.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensure Processes Nursing –NCSBN licensing exam (NCLEX-RN, NCLEX-PN) to test entry-level nursing competence –Passage indicating individual has met minimum competency standards for entry to practice –Nurse Licensure Compact

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensure Process (cont.) Medicine –Three licensure examinations –Clinical skills examination (as of 2004) –FSMB recommendations for relicensure

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensure Process (cont.) Pharmacy –Licensure examination upon graduation—North American Pharmacist Licensure Examination (NAPLEX) –State requirement of Multistate Pharmacy Jurisprudence Examination (MPJE)

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuing Education Nursing –Requirements variable –Majority of states with some requirement for CE for license renewal (see Box 19.2)

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuing Education (cont.) Medicine –44 states + Guam, Puerto Rico, Virgin Islands necessitating continuing medical education (CME) for relicensure of MDs, DOs –Requirements variable –States with laws directing format of CME –No central repository of CME; providers required to keep records for 6 years

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuing Education (cont.) Other health care professions –CE by almost all states for pharmacists; most require CE from approved sources –Many states requiring CE for acupuncturists, audiologists, occupational therapists –Physician assistants: 100 hours of CME every 2 years, sit for recertification every 6 years –48 states, D.C. mandate CE for dentist relicensure

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Pharmacists are required to take three licensure examinations and a skills examination.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Pharmacists are required to take the NAPLEX and MPJE exams for licensure. Physicians are required to take three licensure exams and a clinical skills exam.

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuing Education and Competence Limited research demonstrating correlation between CE, continuing competence, improved patient outcomes Concern of professional organizations about quality of mandated CE courses, lack of courses for experts, specialists No agreement on optimal number of annual credits for competence Pros, cons (see Box 19.1)

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Certification Formal recognition of specialized knowledge, skills, and experience No inclusion of a legal scope of practice Eligibility criteria –Years, types of work experience, minimum educational level –Active nursing license –Successful completion of nationally administered examination Duration: typically 5 years

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins American Board of Nursing Specialties Created 1991 Goals –Seek uniformity in nursing certification –Advocate for consumer protection –Increase public awareness of value of quality certification Only accrediting body specifically for nursing certification

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins American Nurses Credentialing Center Subsidiary of ANA; own corporation as of 1991 Created to provide tangible recognition of professional achievement in defined functional or clinical area of nursing Administration of more than 20 specialty, advanced practice certification examinations yearly

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A nurse who has obtained certification will need to be recertified in: A.2 years B.3 years C.4 years D.5 years

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Most certifications are valid for 5 years.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Certification and Advanced Practice Nurse Advanced practice nurses first to use professional certification to document advanced practice knowledge Certification in many states viewed as indicator of entry- level competence in advanced practice NCSBN recognition of certification examination as regulatory mechanism for advanced practice nursing Master’s degree necessary to take certification exam –Not really voluntary but required to ensure public safety, enhance public health

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Effect of Professional Certification Most research shows certification impacting positive work environment, improved patient outcomes External validation of specialized knowledge Increased income and hiring potential Validation of qualifications and expertise Increased career opportunities Enhanced professional autonomy (see Box 19.4)

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Work Environments to Value Certification Middle- and top-level nurse managers play most significant role in creating work environment that values, rewards certification –Tuition reimbursements, cash incentives; poster displays; paid time off for examination –Publicly recognizing employees earning certification Barrier to certification –Fear of test taking or failure

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflective Practice Assessment of one’s own practice to identify, seek learning opportunities –Evaluation, incorporation of learning into practice Self-assessment gaining popularity –Shift from continuing-education model to practice/professional portfolio model

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflective Practice (cont.) RNs in NC required to self-assess, develop plan for maintaining competence individualized to RN’s area of practice Similar continuing competency programs: –Nurses Association of New Brunswick –College of Registered Nurses of British Columbia

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Portfolios and Self-Assessment Professional portfolio –Biographical data, educational background –Certifications, employment history, short resume –Competency record or checklist –Personal, professional goals; development experiences; presentations; consultations; publications –Professional and community activities –Honors, awards, letters of thanks

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Currently, the focus is shifting from a professional portfolio model to a continuing-education one.

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Self-assessment is gaining popularity such that there is a shift from the continuing-education model to a professional portfolio model.

30. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Responsibility for Competence Assessment Who is responsible? –Individual (nurse accountability) –Professional organization (no oversight function) –Employer (performance appraisals; accreditation) –Regulatory board (broad scope, practice) –Certifying agency (knowledge expertise vs. practice expertise) –Shared ANA Code of Ethics statement

31. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation