Education and training approaches for newly qualified nurses

Competency in Entry-Level Nurses

Competency In Entry Level Nurses

Competency in entry-level nurses: Implications for practice

Given the responsibilities shouldered by nurses, it is essential that all new nurses are competent to practice their profession when they graduate. The increased emphasis upon evidence-based practice in healthcare means that integrating this component of modern medicine into the framework of nursing education is required to produce graduates ready to face the future. Evidence-based practice is the assumption that "to affect better patient outcomes, new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context, and measured in terms of meaningful impact on performance and health outcomes" (Stevens 2013). Evidence-based practice means bridging the gap between academics and actual research. It is designed to "reduce illogical variation in care, which is known to produce unpredictable health outcomes" (Stevens 2013).

As well as being technically competent, nurses must be able to be strong critical thinkers. They must be able to evaluate different alternatives and select the best possible option. There is often no clear solution: rather the nurse must weigh a variety of alternatives. "The Health Professions Education report (IOM, 2003) declared that current educational programs do not adequately prepare nurses, physicians, pharmacists or other health professionals to provide the highest quality and safest health care possible. The conclusion was that education for all health professions were in need of 'a major overhaul' to prepare health professions with new skills to assume new roles" (Stevens 2013). Many healthcare professionals struggle to operate as part of an interdisciplinary team and put the principles of evidence-based research into action.

The report suggested that five core competencies become integrated into every future healthcare professional's education, including: providing patient-centered care; the collaborative and communication skills to work in an interdisciplinary team; the ability to employ evidence-based practice; the ability to engage in quality improvement; and the ability to utilize informatics (Stevens 2013). None of these skills are traditionally associated with nursing education specifically -- they are not nursing-specific technical competencies but imply a more general education in the worldview required by healthcare professionals in the future. They reflect the fact that nurses will be given more and more autonomy in making vital decisions that could have a permanent impact on their patients' lives. As well as making suggestions to change the ways in which nurses think about and perform the skills related to their practice, a measurement instrument to assess the nurses' ability to perform these techniques, the ACE EBP Readiness Inventory (ACE-ERI) was also developed to enable institutions to better measure such competencies and behaviors (Stevens 2013).

Nursing education must become more uniform as well as more comprehensive in its overview. "Programs for basic preparation of health professionals were to undergo curriculum revision in order to focus on evidence-based quality improvement processes. Also, professional development programs would need to become widely available to update skills of those professionals who were already in practice" (Stevens 2013). Without changing the way that education is provided to nurses, who are on the front lines of patient care, substantive improvements in quality and efficiency of care cannot be realized.

Nursing has thus grown more 'patient-centric' in its emphasis on quality control, adopting much of the language and standard assumptions commonly used in business, not just healthcare. Nurses are increasingly asked to make decisions about what works and what does not work and graduates must be prepared for this level of autonomy. Greater demands are also placed upon nurses passing through the educational system because of the increased demand for places at nursing schools. Despite the nursing shortage, entering into the profession remains difficult because of a lack of faculty to teach all would-be candidates. According to Holmes (2011), the passage of the Affordable Care Act and the heightened standards for entry into the nursing profession provide a unique opportunity for nursing to reconfigure itself as a profession in light of changes in the modern healthcare environment, and those changes must begin with nursing schools and the preparation of new nursing graduates to enter the workforce.

All of these forces have resulted in the demand for nursing schools to achieve an accountability similar to that deployed in other fields of healthcare .It is widely believed that "nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression" (Holmes 2011). Nurses must add to their skill sets throughout their careers, as demanded by changes in technology, and nursing schools are uniquely poised to create a new generation with which is more responsive to changes. "With the passage of the Affordable Care Act of 2010, the U.S. healthcare system will significantly change over the next decade, moving away from a hospital- or healthcare provider-centric model to much more of a patient- and family-centered model" (Holmes 2011). The individual will become the focus of care and as such, nurses' psychological and social competencies must increase accordingly. This will also mean less of a focus on acute nursing skills and more of a focus on preventative medicine. Nurses must become more competent not just at the treatment of disease but also upon facilitating factors in patients' lives to prevent disease transmission. "Treatment will focus more on preventive and chronic care management, rather than on episodic hospitalizations and fragmented responses" (Holmes 2011).

As well as providing nurses with more holistic backgrounds in their education, there is also an increasingly vocal chorus to demand emphasizing the BSN as the gold standard of nursing competency, versus an Associates' degree. "Although there's no definitive research that categorically demonstrates that care provided by BSN nurses results in better patient outcomes, it's obvious that students with experience in a wide variety of care settings and who have training in leadership, policy development, and patient safety will result in nurses able to more effectively work in a changing healthcare environment. These nurses will be ready to manage patients in a variety of settings and manage the transitions in their care" (Holmes 2011). To encourage nurses without a B.A. To obtain one, a variety of streamlining programs have been offered to enable nurses to make a more seamless transition between the A.A. And the B.A. while still working.