by Andrew Thorn

Created on: November 03, 2009   Last Updated: February 03, 2012

In this evermore litigious society, there is a real fear that success may for some, come to mean an unblemished career without claims of negligence, abuse or liability through ommision. Worse still, it may mean simply reaching retirement without too much brutalisation or work stress or PTSD !

Perhaps though, we ought to take a more wholesome and altruistic analysis of successful nursing, as a career filled with reward through 'skillful care' and acknowledged 'competency'. It is important therefore to develop a clear perspective on these terms if we are to be successfully recognised and valued within our workplace.

There can be a degree of confusion surrounding the terms and purpose of measuring competence. A trawl trough literature even from just the past decade poses a multitude of complex issues. Manley & Garbutt (2000) question the purpose of assessment pointing out that, in the UK for example, competence frameworks are reflected in the human resource strategy. Competency in this respect can therefore be aligned with career progression targets and performance related pay. Some would suggest that competence can only be assessed through outcomes. It is difficult to assess the way in which a nurse utilises insight and experience to produce a tangible outcome or practice. What is easier to assess, is the actual practical outcome. In assessing competency, we can therefore only reliably analyse the product of a worker's expertise in a given area. The 'intelligent skill knowledge' (Pearson 1984) that underpins outcomes is implicit through competence but not reliably assessed, therefore competency can only be a measure of minimum standards.

Ramritu & Barnard (2001) formulate differing concepts of competence from their interviews with new graduate nurses. It was possible for them to relate these various conceptions logically as suggested by Marton (1986) and Bruce (1997) and construct a hierarchal approach to competence development over three levels ranging from safe practice to evolving competence. Perhaps this is more qualitatively described by Benner (1984) as a developmental continuum from Novice to Expert.

Tyrer & Oyebode (2004) point out that tests of clinical competence require assessment of knowledge, comprehension of the subject matter, analysis of all aspects of the topic, evaluation of the problem or clinical scenario, synthesis of the issues, and application of these elements in the management of clients.

My favoured view is that competence

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