Preparation for advanced practice enables nurses to specialize in clinical and non-clinical roles. Those who opt to become nurse educators develop expertise in teaching. Nurse administrators specialize in the leadership and management of an organization. On the other hand, nurse practitioners focus on providing primary and acute care. A good understanding of how the competencies are parallel or different in concept and implementation promotes a better appreciation of the various advanced nursing roles.
Core Competencies of Clinical and Non-clinical Advanced Roles
There are similarities in the clinical and non-clinical competencies of nurse educators, nurse practitioners, and nurse administrators. They must possess critical thinking as well as systems thinking skills that enable them to initiate inquiries into current practice (Phillips & Simmonds, 2013). Evaluating teaching, nursing, and management practices for effectiveness and adherence to standards requires the ability to analyze the factors that shape these practices and get to the root of issues. As such, the specific aspects that require improvement are determined accurately. A sound analysis of problems leads to comprehensive and more effective solutions.
Subsequently, competencies in advanced clinical and non-clinical roles relate to the leadership skills necessary in implementing change for the resolution of issues. Enhancing the nursing curriculum to equip new nurses with the skills to respond to emerging needs requires change management. It is also needed in improving clinical practice to bring about better outcomes. Further, change management is a requisite in establishing a culture of safety in the organization (Ques, Montoro & Gonzalez, 2010). Quality improvement (QI) is another common competency and relates to change management. Nursing education and health care services are subject to benchmark standards and quality indicators. It is expected that nurses in advanced practice can lead change toward achieving QI goals. In addition, clinical and non-clinical roles require competencies in collaboration. Partnerships with stakeholders are important in enhancing care and nursing school curricula. Meanwhile, multidisciplinary collaboration facilitates improvements in clinical practices.
Further, competencies in promoting evidence-based practice (EBP) are also requisites in enacting advanced roles. EBP ensures that practices are supported by the findings of empirical research and are therefore more likely to be effective in relation to the outcomes investigated (Ques, Montoro & Gonzalez, 2010). EBP is one strategy in attaining quality improvement goals in academic, clinical, or management settings. Skills in research, data management, and research utilization are other competencies that cut across clinical and non-clinical nursing roles. Research generates evidence that, when appraised and translated into specific settings, will improve practice. Last, competencies in ethics and the use of technology are common in all advanced roles.
There are differences in the competencies as well. Non-clinical advanced roles require more non-clinical skills, e.g. teaching, curriculum development, research, marketing, health care financing, and succession planning (AONE, 2011; NLN, 2007; NONPF, 2011). These skills have a direct impact on nursing education and organizational matters such as human resource capacity and development, patient volume, and operating budgets. Non-clinical competencies also impact patient care through better service delivery, and a knowledgeable and skilled workforce (Safriet, 2011). On the other hand, clinical advanced roles focus on frontline nursing care with competencies that include assessing, diagnosing, and treating patients.
Implementation of Competencies
Competencies are implemented within the health care system but target different settings, namely direct care, management of care, administration, and nurses’ academic preparation (O’Grady, 2008). These components consist of practices specific to the nurse specialization and are shaped by factors particular to the practice setting. All nurses in advanced practice exercise leadership, critical and systems thinking as well as other common competencies for the purpose of influencing the health policies, structures, systems, processes relevant to their role (Stevens, 2013). Therefore, differences in specialization and practice settings lead to the differential implementation of common competencies. Implementation also involves the application of skills in situations uniquely encountered in each practice setting. Curriculum revision and educational activities set nurse educators apart from their peers while nurse practitioners apply their competencies in direct patient care.
In terms of similarities, the implementation of competencies takes place in professional nursing environments where nurses are of varying levels of proficiency, age, culture, and other attributes (Jeffreys, 2008), e.g. student or post-graduate nurses as well as novice, competent, proficient, and expert nurses or faculty. Further, the application of competencies, regardless of the setting, similarly impact patient care albeit directly or indirectly. For instance, a quality issue will require modifications in clinical practices that are the domain of nurse practitioners. Changes in guidelines and protocols will require the education and training of the nursing staff by nurse educators. Nurse administrators, meanwhile, play a role in governance.
Conclusion
Nurses in advanced practice assume greater responsibilities in specialized clinical and non-clinical roles. Attached to these roles are various competencies. Across these roles, there are similar competencies including critical and systems thinking, leadership, research, change management, evidence-based practice, quality improvement, collaboration, and use of technology. There are differences as well and highlight the unique contributions of each role. In practical terms, the implementation of common and unique competencies allows nurses to influence similarly common and unique systems and processes in their chosen specialty and practice setting. Across all roles, advanced practice nurses implement their competencies in environments characterized by diversity with the ultimate goal being to improve patient care.
References
American Organization of Nurse Executives (2011). The AONE nurse executive competencies. Retrieved from http://www.aone.org/resources/leadership%20tools/nursecomp.shtml
Jeffreys, M. (2008). Dynamics of diversity: Becoming better nurses through diversity awareness. NSNA Imprint, 2008(Nov/Dec), 36-41. Retrieved from http://www.nsna.org/portals/0/skins/nsna/pdf/imprint_novdec08_feat_jeffreys.pdf
National League for Nursing (2007). Core competencies of nurse educators with task statements. Retrieved from http://www.nln.org/profdev/corecompetencies.pdf
National Organization of Nurse Practitioner Faculties (2011). Nurse practitioner core competencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/imported/IntegratedNPCore CompsFINALApril2011.pdf
O’Grady, E.T. (2008). Advanced practice registered nurses: The impact on patient safety and quality. Retrieved from http://www.ahrq.gov/professionals/clinicians- providers/resources/nursing/resources/nurseshdbk/OGradyE_APRN.pdf
Phillips, J., & Simmonds, L. (2013). Change management tools part 1: Using fishbone analysis to investigate problems. Nursing Times, 109(15), 18-20. Retrieved from http://www.nursingtimes.net/Journals/2013/04/12/k/x/z/Using-fishbone-analysis--to- investigate-problems-160413.pdf
Ques, A.A.M., Montoro, C.H., & Gonzalez, M.G. (2010). Strengths and threats regarding the patient’s safety: Nursing professionals’ opinion. Revista Latino-Americana de Enfermagem, 18(3), 339-345. Retrieved from http://www.scielo.br/pdf/rlae/v18n3/07.pdf
Safriet, B.J. (2011). Federal options for maximizing the value of advanced practice nurses in providing quality, cost-effective health care. Retrieved from http://www.iom.edu/~/media/Files/Activity%20Files/Workforce/Nursing/Federal%20 Options%20for%20Maximizing%20the%20Value%20of%20Advanced%20Practice% 20Nurses.pdf
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodica ls/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based- Practice.html
