Competencies Scope of Practice and Standards of Practice for Nurse Administrators

Today, nurse administrators are playing an increasingly important role in a wide range of health care settings, and there has been a corresponding increase in interest in understanding the relevant competencies, scope and standards of practice for this profession in recent years. To this end, this paper reviews the relevant literature to identify the scope and standards for nursing administrators, followed by a description of the profession’s general characteristics. Finally, a summary of the research together with two insights that were learned from this assignment concludes the paper

Although every nurse administrator position is unique in some way with respect to scope, they all typically follow the 17 competency-based standards of practice set forth in the American Nursing Association’s (ANA’s) text, Nursing Administration: Scope and Standards of Practice (2nd ed.) as well as relevant standards promulgated by nursing administrator certifying boards and accrediting organizations such as the Joint Commission. Although the 17 competency-based standards of practice are extensive, they are not exhaustive and there are other sources that nurse administrator draw upon as well.

Based on these and other nursing resources together with empirical observations and discussions with experienced nursing administrators, one of the overarching themes that emerges from these different sources is the need for nurse administrators to apply evidence-based standards of practice. Likewise, this point is also made by Kalb and O’Connor-Von (2015) who note, “Standards from other professional organizations stress the use of evidence in nursing and health care. These include the ANA's Nursing: Scope and Standards of Practice; Quality and Safety Education for Nurses from the QSEN Institute; and the Core Competencies for Interprofessional Collaborative Practice” (p. 213).

With respect to the scope of practice, nurse administrators serve in a variety of capacities in health care settings, including most especially management, education and administration. As a result, although nurse administrators are completely training and educated in patient care, they typically are not directly involved in this aspect of nursing since their responsibilities are generally focused on the foregoing capacities. Beyond these similarities, effective nurse administrators tend to share some common characteristics as well, including those discussed below.

A telephonic (NA #1) and face-to-face interview (NA #2) with two full-time nurse administrators provided some valuable insights concerning the different factors made them effective at their jobs. For example, NA #1 indicated that he was most effective at using the “people skills” that are required to forge strong professional relationships in ways that facilitated his ability to perform his administrative duties while NA #2 cited her task orientation as being responsible for her effectiveness as a nursing educator.

Although these are essentially diametrically opposite management strategies, they are not mutually exclusive, especially since both NA #1 and #2 stressed the need to incorporate evidence-based methods in their day-to-day practice. Indeed, these specific characteristics of an effective nurse administrator are largely consistent with the results of a survey of 1,586 nurse administrators practicing in the United States by Kalb and O’Connor-Von (2015) that identified the use of evidence-based practice for teaching and evaluation nursing student performance and progress.

Other characteristics of an effective nurse administrator identified during these interviews included the following:
· They are detail oriented;
· They are flexible in their leadership style;
· They have a commitment to excellence and optimal patient care; and,
· Truly effective nurse administrators possess up-to-date knowledge of nursing practices and standards.
In addition, other characteristics of effective nurse administrators cited by Tuten (2012) include the following:
· They are pragmatic realists;
· They are good at time management;
· They are expert in their knowledge of business principles;
· They possess a solid knowledge of organizational behavior and resource management; and,
· They possess superior “people skills” (para. 3).

On the one hand, identifying personal strengths is a rewarding and gratifying process since it can serve to reinforce individual self-esteem and the sense of self-efficacy. In this regard, a soul-searching assessment of my two personal strengths identified (a) an unwavering commitment to high quality health care services and (b) a strong desire for career advancement to higher levels of nursing leadership where I can apply my knowledge, abilities and training to their best effect and participate in the decision-making process that affects organizational directions and goals. This strength is consistent with the observation by Davis (2015) who points out that many nurse administrators view their positions as a stepping stone to higher-level executive positions in a health care setting (Davis, 2013). Likewise, a nursing administrator Web site specifically states that, “Oftentimes, nurses are drawn to this position because they want to obtain executive positions and/or play a role in the policy-making process” (Nursing administrator roles and responsibilities, 2018, para. 4).

Conversely, identifying any personal weaknesses is far more challenging since it requires a careful and honest evaluation of current and past performance as well as the feedback that has been received from peers, subordinates and supervisors. The above-described self assessment identified two weaknesses that will require additional effort on my part in order to truly excel: (a) a reluctance to directly confront higher authorities even when I believe they are wrong and (b) a tendency towards procrastination and a lack of time management skills that adversely affect my ability to meet some administrative deadlines.