How do you know your certificants are as capable today as they were when they passed the exam? If you don’t have a good answer to this question yet, be prepared to have one. At some point, one of your certificants may just fall into this category, and people will be asking the question for you, the certifying body. Even if you aren’t prepared to embark on an ambitious continuing competence initiative, it may help to understand what others are doing and have an explanation for why you made the choices you made.
The American Board of Nursing Specialties has implemented several diverse recertification programs that offer various models for continuing competence in specialty nursing that may interest you and your programs. Despite their diversity, their programs target common underlying principles. This discussion reviews four program models for continuing competence in specialty nursing and describes some of the underlying principles that bind them, which include:
- College and Association of Registered Nurses of Alberta (CARNA) – The Continuing Competence Program (CCP)
- Hospice and Palliative Care Corporation (HPCC) – Situational Judgment Exercise (SJE)
- Oncology Nurses Certification Corporation (ONCC) – Individual Learning Needs Assessment (ILNA)
- Orthopaedic Nurses Certification Board (ONCB) – Reflective Practice Exercise
CARNA Continuing Competence Program
The CARNA Continuing Competence Program requires that on an annual basis, every licensed nurse and nurse practitioner in Alberta must complete a continuing competence learning plan. The learning plan includes the following phases:
- Learning Priorities
- Execution
- Reflection
The learning priorities phase allows a licensee to choose performance indicators from the competency model for their professional level (e.g., nurse vs. advanced nurse). Once they select their performance indicator, they use that as a reference for ongoing continuing professional development. They need to complete one activity related to their selected performance indicator (although many complete more than one). At the end of each cycle, they write a narrative that describes how that activity informed their learning priorities.
This program and the ONCB reflective practice exercise represent the most qualitative implementations of a continuing competence program. Unlike many other programs, CARNA uses no points and relies exclusively on the member’s discernment with respect to the learning priority and the activity that addresses it. While the implementation is simple for both the members and the program, they implement a sophisticated audit mechanism to identify those who may not be taking the process as seriously as intended.
- Assessment: No
- Competency reference: nurse and nurse practitioner competency models at the behavioral indicator level
- Qualitative vs quantitative: Qualitative
- Activities: Broad and unclassified
- Reflection: Yes
HPCC Situational Judgment Exercise
HPCC is a pioneer in nursing continuing competence. Their definition of continuing competence remains a reference for organizations such as the National Coalition of State Boards of Nursing (NCSBN). Rather than require reflection of the learning process, HPCC determined that the greatest omission in available assessment and education is the application of knowledge. They developed a specialized assessment to evaluate a certificant’s decision-making in various scenarios to assess the application of knowledge. Every nurse must complete the situational judgment exercise each recertification period. In addition to the SJE, HPCC requires a relatively conventional accumulation of continuing professional development activities. In addition to continuing education courses, certificates can accumulate points by completing various activities, such as public speaking, academic research, and professional publications.
The advantage of the SJE approach is that it targets a specific behavior and set of competencies unlikely to be measured by anyone else. The program retains simplicity by providing an online system in which certificants track their recertification activities.
- Assessment: Yes
- Competency reference: certification content outline
- Qualitative vs quantitative: Quantitative
- Activities: Broad and classified according to category (e.g., continuing education, public speaking, publications)
- Reflection: No
Oncology Nurses Certification Corporation)—Individual Learning Needs Assessment
ONCC made an early decision that certificants must demonstrate competence in all areas of the content outline during the recertification process. Every activity must be mapped to a content domain, and certificants must complete a minimum number of credits proportional to their representation on the content outline.
The “twist” ONCC offers is that certificants can achieve domain requirements through an online assessment. At the beginning of each recertification cycle, certificants complete the Individual Learning Needs Assessment (ILNA). Comprising both retired items and items specifically developed for the ILNA, this assessment delivers domain-specific results regarding a certificant’s strengths and weaknesses. High achievement in a domain results satisfies the domain requirement. Certificants then concentrate their efforts on learning areas of weakness.
- Assessment: Yes
- Competency reference: certification content outline
- Qualitative vs quantitative: quantitative
- Activities: Broad and classified according to category (e.g., continuing education, public speaking, publications)
- Reflection: Yes?
Orthopaedic Nurses Certification Board—Reflective Practice
Like the CARNA continuing competence program, ONCB asks certificants at the beginning of each cycle to describe the area in which they expect to grow. Then, as they complete learning activities and record them on their transcript, the system reminds them of their priorities and offers an opportunity to reflect on the impact of learning. After their recertification cycle, certificants must submit a written reflection on their learning. The primary differences between this approach and CARNA’s are that ONCB’s cycles are typically three years instead of annually, and ONCB manages activity achievement in the form of points awarded according to the duration of a course.
- Assessment: No
- Competency reference: certification content outline
- Qualitative vs Quantitative: Quantitative
- Activities: Broad and classified according to category (e.g., continuing education, public speaking, publications)
- Reflection: Yes
Models for Continuing Competence in Specialty Nursing—Key Principles to Consider for Your Organization
To determine which of these approaches would most suit your programs, consider the following questions:
- Assessment:
- Are your program competencies best assessed in the form of a specific exercise or distributed across multiple activities?
- Do you want your assessment to be summative (e.g., determines evaluation) or formative (e.g., guides learning)?
- Competency reference:
- What framework do you want to use to organize your competency assessment (e.g., a content outline or a competency model)?
- Qualitative or quantitative?
- Do you want to evaluate activities according to a central currency (like hours), or do you just need your certificants to express the activity’s value in a more holistic sense?
- Activities
- Are there many expressions of learning and professional advancement, or do you consider the list of eligible activities to be more narrow?
- Reflection:
- How important is it to your community that you give people an opportunity to establish their own priorities?
- How important is it that the reflection is objective (like an assessment) or subjective (like a discernment exercise)?
The Right Option for You
We have much to learn from models for continuing competence in specialty nursing. As you design your continuing competence program, you will need to balance program options and align them to your certificants’ expectations for recertification. The Citizen Advocacy Center once described the principles of a sound program design in the acronym “APPLE”.
- Administratively feasible
- Professionally acceptable
- Publicly credible
- Legally defensible
- Economically feasible
Acceptability, credibility, and defensibility all have to do with the fairness and thoroughness of your design process. The administrative and economical dimensions are more dependent upon the technology you use to manage your program.
Make sure you partner with technology companies that have the tools and mindset to help you navigate the technical requirements of your program.
