Authors Whittaker, Smolenski and Carson (Assuring Continued Competence - Policy Questions and Approaches: How Should the Profession Respond? ) ask how nursing needs to respond to policy issues surrounding continuing competency in nursing. Before putting pen to policy, nursing needs to clarify some of the fundamental language shaping continuing competency policy. I was especially taken by the framework developed by the ANA Expert Panel. The Panel’s assumptions and definitions present language such as "professional," "domains of practice" and "scope of practice," underscoring the importance of clearly explicating what we mean when we say "continuing competence in nursing." Continuing competence in what? In the discipline? In professional nursing practice? In clinical nursing practice? And, are these all the same questions and the same competencies? This writer doesn’t come with any answers. Perhaps this letter merely "talks out loud" about some of our continuing, fundamental questions as they impact this policy.
The Panel’s terms, professional, domains of practice, and scope of practice, caused me to dig out one of the first classics required in my MSN theory course at St. Louis University, Donaldson and Crowley’s (1978) discussion of the discipline of nursing. While all of nursing certainly does not agree with their conceptualization of the discipline (Johnson, 1991), they do provide a way to frame questions of continuing competence. Donaldson and Crowley distinguish between the "discipline of nursing," "professional nursing practice," and clinical nursing practice," urging us not to confuse the inextricably bound, yet discrete, constructs.
Professional nursing practice, say Donaldson and Crowley (1978), is broader than clinical nursing practice which has an immediate focus on the individual. The scope of professional competency "goes beyond that required for delivery of health care to individuals, preparation of future practitioners and conduct of systematic enquiry" (p. 118). Based on Donaldson and Crowley’s conceptualization of the discipline, professional practice, and clinical practice, it is fitting to ask whether the Expert Panel’s definition of "continuing professional nursing competence" encompasses the richness and scope suggested by Donaldson and Crowley. Or, does the Expert Panel delimit continuing professional nursing competence to Donaldson and Crowley’s "clinical nursing practice"?
Policy assumptions and definitions limiting competence to clinical nursing practice alone might be problematic. The generic health care worker is already in place, performing much of what has traditionally been regarded as "nursing." Nagle (1999) states that nursing’s future will not be sustained based on its technical acumen and "knowledge base borrowed from other disciplines" (p. 71). Nursing must, she argues, articulate its professional and disciplinary uniqueness. If Nagel is accurate, will the framework of assumptions and definitions presented (so far) by the ANA Expert Panel capture measures of professional and disciplinary uniqueness as well as technical acumen or will policy capture only a keyhole, "technical rationality"(Pryjmachuk, 1996) view of how we can competently and continuously serve the public?
Whittaker, Smolenski and Carson certainly make it clear that nursing’s collective leadership is examining the tough, complex nature of the continuing competency issue. The language needing explication is very thorny, messy. Again, this writer certainly does not claim any new insight into questions surrounding "the discipline," for these questions are decades old and certainly won’t be settled with this policy issue. Perhaps for this particular policy issue we can establish the thorniness of the language itself while achieving as much clarification as possible.
Our nation’s policy makers like things clean and tidy. There is nothing clean or tidy about disciplinary and professional issues and the policy that comes out of these questions won’t be clean or tidy either! I think there is something magical about saying just that.
Still, we are left with a fundamental fact: policy that doesn’t legitimate nursing at its fullest, however assumed and defined, may further hide, silence and deny much of what nursing can be. And, as we know all too well, funding DOES tend to follow policy.
Barbara J. Dunn, RN, MSN
Armstrong Atlantic State University
Savannah, GA 31419-1997
Donaldson, S. K. & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26 (2), 113-120.
Johnson, J. L. (1991). Nursing science: Basic, applied, or practical? Implications for the art of nursing. In J. W. Kenney (Ed.). Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (4th ed.) (pp. 86-94). Boston, MA: Jones and Bartlett.
Nagle, L. M. (1999). A matter of extinction or distinction. Western Journal of Nursing Research, 21 (1), 71-82.
Pryjmachuk, S. (1996). A nursing perspective on the interrelationships between theory, research and practice. Journal of Advanced Nursing, 23, 679-684.