The NP Role Core Competencies Matter!

Today we’ll discuss the National Organization of Nurse Practitioner Faculties (NONPF) NP Role Core Competencies with three NPs who were instrumental in the revision of them. Welcome Dr. Robin Arends, Dr. Mary Beth Bigley, and Dr Jan Tillman, would you start by telling the audience, a bit about yourself and your role and the revision of the competencies.

I guess we'll start with Robin.

Hello, my name is Robin Arends, and I am the APN program director for South Dakota State University. My role in the revision of the NP role core competencies was that of the Chair of the NONPF Curriculum Leadership Committee. Working closely with Jan Mary Beth and the CLC committee we worked on the charge to the committee from the NONPF Board of Directors to review, update, and revise the NP core competencies.

Great. thank you. Mary Beth?

So thank you for having us. I’m Mary Beth Begley I'm the CEO of NONPF and I'm also an Adult Nurse Practitioner and a former educator. In my role at NONPF I oversee the work of all committees, including the Curricular Leadership Committee, that has done the revisions on the competencies. So, thank you again for having us.

Oh, you're welcome, and Jan?

I am Jan Tillman and I’m a Family Nurse Practitioner. I'm also the Program Director for the Post Masters DNP program and Coordinator the DNP core and project courses at East Carolina University in North Carolina. This is the fourth year I’ve been on the Curriculum Leadership Committee, and we've worked to integrate the new AACN and competencies into nurse practitioner education. I'm delighted to be here with you today.

Well, you know, you're all extremely busy in your respective University roles and so the work that you've done on the NP role competencies is that much more impressive, and I know that you worked with a larger committee but that you took leadership roles in this. So thank you very much for attending today. And I've said that the introduction, in the introduction that the revision of the nurse practitioner role competencies, is important work. Would you please expand on this and tell us a bit of why it's important?

That's a very good question so fundamentally I think it's important to know that the NP students build on their competencies that they achieve during their registered nurse educational program. You know as NPs we're licensed independent practitioners who practice autonomously as well as on a team. And this is so that we can provide health care for all the population, as well as be able to work in any healthcare setting. NP educational programs have established the standards to make sure that our graduates are competent. It is to assess and be able to evaluate the competencies so that we provide safe, high-quality patient centered care upon their graduation.

Building upon Mary Beth's overview, the nurse practitioner role core competencies are truly the competencies that all nurse practitioner graduates should be able to demonstrate in order to provide that safe, effective care to patients of all population foci. It's important for many reasons. First, it's important to the educators to know what the competencies are so that there's quality and consistency in our nurse practitioner education. It's also important to patients, as these are the competencies which ensure that their nurse practitioner provider has the knowledge and skills needed to provide care, and we're going to healthcare community or setting. It's also important for a healthcare administration, health care administrators, because they know what the competencies, they can expect from nurse practitioners are. And finally, it’s also important to help policymakers because it provides a common language, on which to base policy.

Okay, you've explained, really quite well and eloquently the importance of nurse practitioner role competencies and have they always been used in this way, or they've been used, perhaps differently in the past? Any examples that you can provide?

So the, the competencies have been used by educators to help frame curriculum.

There's many different ways to meet the competencies it’s important for educators to know the essential items to include in the curriculum for nurse practitioners.

I did not think the way that the competencies are used is an educational change as they really do complement the new AANC Essentials.

I would say another important part of that is that even though competencies, we want our students to be competent we put our competencies at the highest level so that they're safe when they graduate, competencies are evaluated throughout curriculum, and it's important that you achieve the competency knowledge base, and that you're able to then take that knowledge and utilize it in your mid program courses, to be able to analyze what that means, as it relates to the work you're doing in your new role as a nurse practitioner. Then further, in the more senior courses, be able to synthesize all the knowledge and the application of the knowledge. So at that point you're achieving this competency at the highest level.

And that's that's the way NP education has always been operationalized. But the new competencies have been written in a way that they're measurable at the highest level and professional to be able to see throughout a program of study how they can integrate them at these different levels.

To expand on that, at the university level, we're having our students actually take those NP role competencies and reflect on the competency in their daily clinical setting. So very much what Mary Beth was talking about in their clinical logs, they select the NP role competencies that reflect that patient encounter or that experience of the day, so that they can track their own forward movement so it takes it from a macro to a micro level pretty quickly.

You’ve identified some really important uses. First of all you talked about the alignment of the NP Core Competencies with the national position statements for NPs. You also spoke about the use of the core competencies in developing curricula that would then reflect the expectations of NPs once they practice. And then finally you talked about the usefulness of the new nurse practitioner competencies in in self-evaluation for nurse practitioners who are moving forward either within their education program or even after they've completed that. Because, and this is the important part, you've identified that they're measurable, and this huge. Competencies as concepts are wonderful, but if there's no way to use them to as a benchmark for your own practice, or for an education program then it's really difficult to see what the value is. But it sounds like you've created competencies that are helpful in all these respects do. So the next question then is, and I asked for a personal reason because I think sometimes, in my experience that the competencies came before the regulation so it was more of a wish to have certain things happen. So how are in your minds and NP role competencies going to be used in the US to guide regulation? Or is their role?

So, yes, actually, their competencies have a big role in regulation. The document that guides the NPs from a regulation standpoint, is the consensus model. And this is very particular to the United States, but this document was put in place in 2006. And it basically…But let me tell you the whole title here for it's The Consensus Model for a APRN Regulation, Licensure, Accreditation, Certification, and Education. From that standpoint all of the APRN, and NP is one of the APRNs came together to draft this, to guide the regulation around all advanced practice nursing. So this is also referred to as the LACE model, and you'll see licensure the L is granting the authority to practice. The A is accreditation which is the formal review, and the approval and recognition by an agency of the educational degree so the accreditation, that all schools have to go through. Certification is the C and that's the formal recognition of

the knowledge, skills, and experience by taking an exam, usually. Then education is the formal education.

In the consensus model as we look at the United States across our six population focus roles that we have, tracts that we have, it says that, in addition to some overlying principles, that all of the populations are guided from an educational standpoint, through the competencies that are developed for that population. It's very different than many other countries that their competencies are for more of a general nurse practitioner where in the United States, we have family nurse practitioners, we have adult nurse practitioners that are adult gero nurse practitioners, either in primary care, or acute care. We have pediatric nurse practitioners that are pediatric nurse practitioners in either primary care, or acute care. Women's health nurse practitioner, psych mental health nurse practitioners neonatal nurse practitioners. Did I miss any? I don't think so. So there, it's a little bit different. The model is different. That document, at the top says that all nurse practitioners have to have advanced health pathophysiology, advanced health pharmacology and advanced health assessment, all three courses. So even within the competencies, we know that there's certain coursework at the advanced level that all nurse practitioners will have no matter what population they're in.

And when we did this work, the CLC committee kept at the forefront of their mind that all our programs need to be accredited. And for this accreditation then they discuss what frameworks and guidelines and standards they use to guide their program and curriculum. So the NP role core competencies are truly a part of this, as they seek accreditation, or re-accreditation.

You hit on something that I also find, maybe useful, with respect to having these NP real competencies is the competencies are national. And I understand that the US very similarly to Canada, every jurisdiction or every State has different legislation with respect to nurse practitioners in Canada, it has been helpful to have a national framework for nurse practitioners and the competencies because that was used then to demonstrate to regulators what the nurse practitioner could do, and that in fact, in some ways, informed changes to legislation.

So I don't know if that was part of the hope for your NP Role Core Competencies but it certainly is I think in our minds. We're certainly in Canada moving towards a one license across the country. Which will be interesting, painful actually, as we move toward it but I'm not sure if you have something similar ideas in the States or…

Each State has their own regulations and one of the things that Consensus Model was to do is to try to get the State's Nursing Practice Acts at least at one level. You know, I think over time many States have decided to add and subtract from that. So, it hasn't been ideal, but it is the standard and I think we're trying to regenerate the fact that it's important that people understand that so there’s no role confusion. An NP student graduate has options as to where they take a national certification, a national licensing exam. And so far as if they want to get certified, through which professional organization, there's not just one, we don't have one national license. There's actually a couple of States where you don't even have a national license, as long as you've been educated, and you can get your State license based on submission of documentation. You don't need to pass an exam, although I wouldn't advocate that for anybody because people move from State to State. I don't think I would want to be two years out of my NP program before I had to sit and take my boards again. But you know it's a very complicated system, and we follow it as much as possible and we try as much as possible to get the States in alignment to the best that we can. Some State practice acts are very brief, and some are books. So, it depends on the State on how their Practice Act is written, on board of nursing or Joint Board of Nursing and Medicine.

It's similar in Canada. Only we only have 10 provinces, not 50 States so it's a little less complicated for sure, but I see that that really adds to the NP role competencies, as a national standard in that way so adds to the importance of them for sure. So, then what is next? What's next on the agenda for NONPF?

Well, the next step for NONPF Curriculum Leadership Committee is to work with faculty volunteers from across the country to further target integration of the NP Role Core competencies and those sub competencies within the population foci. The integration must be somewhat explicit to ensure that we're providing the foundation for applying each sub competency to primary and acute care settings across the lifespan. And while there are similarities there are also differences, as we all know, in the way that individual sub- competencies are applied to care populations. For instance, caring for the adolescent in a primary care clinic versus an octogenarian in a hospital setting. Our committee is first concentrating on the integration of the competencies the sub-competencies for nurse practitioners and family practice and adult gerontology primary, and acute care.

Now, we’ll then work to revise our competency for the other population focus tracks alongside our partners, which are organizations that will help ensure integration of the competencies for pediatrics, neonatal, women's health, and psych mental health nurse practitioner education programs. Our work is integral for NP education programs. The NP Role Core Competencies can be the framework for NP curriculum. As we said earlier, embracing the role competencies ensures that nurse practitioner education programs have some standardized criteria, just as you were talking about, that provides structure to student learning experiences to course assessments, and to program outcomes, similar to those and sister organizations. These common role competencies ensure that nurse practitioners in the workforce, are ready to provide person-centered and population focused care, no matter where they were educated.

To build upon Jan's answer, NONPF as an organization is really committed to really complete in the competency for all of our population focus tracks. And then, as a part of that we will continue to educate our nurse practitioner members to fully understand the competencies, the changes that occurred with the competencies, work with them to map to their curriculum, and then identify and methods for evaluation of these competencies.

The other thing that I think is important here, and I think Robin spoke about this earlier as we were very deliberate in the drafting of the NP Role Core Competencies to scaffold them down from the ACCN Essentials. That's the document that came out earlier in the year that set, the sub level one and two competencies across all of nursing. And we didn't feel that we needed to repeat anything that was already in there at the advanced practice level if it was something that was completely applicable. What these competencies did was focused on nursing, and the nurse practitioner. So I think that getting that message, and having faculty understand that they're not just mapping their curriculum to the NP Role Core Competencies, but they have to back up and see what was in the Essentials document because that's just as relevant to their NP programs.

And the other thing that's important here and it's not new. The previous competencies were all written at the doctoral level. We have a movement to move entry level education for NP programs to the doctoral level the DNP level. So the competencies that we have for the NP competencies are all written at the doctoral level. So that's know another thing that we need to help our faculty understand and then how to operationalize.

I think Roberta, one of the things to share, you know, it sounds a lot like a regulatory, very structured approach and it is, but it is also to provide the tools for that nurse practitioner over the years. So we have to remember that it provides structure but it also provides meaning. That those are clinical competencies, but they're also in the larger system domains of healthcare, finance, technology, translation of science, leadership, population health, all the things that have to be included in that NP’s toolbox on a daily basis so that she or he be can provide healthcare wherever they're at.

You know, I couldn't agree with all of you more. I'm very excited about these competencies. People kind of look at me funny, but I think it's because I've learned over the years that documents like this are not are not benign, they can be very powerful and used in ways that really can promote and support nurse practitioner practice and the nurse practitioner profession moving forward. That's certainly one of the reasons why I asked you to come in today to talk about it. And I think when I've read them through them, I was really quite impressed with how nicely you took very complex environment and education factors and blended them into a document that is usable. I mean I can't say that enough. If the competencies aren't something that can be used at the practice level, then there is no point in having them. I can see that these would be a nice fit and could be something that could be used not only for the education as benchmarks, but also moving forward. So, you know, really.

Again, I don't know, I've seen bad documents create bad outcomes. And I've seen good, well thought out and well produced documents and structures like this, be really helpful tools moving forward. So, again, you know, congratulations! That was a lot of work. I know that too and I think the outcome is really quite valuable.

Thank you. I think we're starting to see it generate a lot of enthusiasm and overall excited about moving forward with our next steps.

Yeah, that's great. Is there anything else any of you want to add before we sign off?

Review the documents:

NONPF NP Role Core Competencies https://www.nonpf.org/page/NP_Role_Core_Competencies

American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/AACN-Essentials/Download

The Consensus Model for a APRN Regulation, Licensure, Accreditation, Certification, and Education. https://www.nursingworld.org/certification/aprn-consensus-model/faq-consensus-model-for-aprn-regulation/