Over the past decade, public awareness has been raised about the need for regulatory boards to assure continuing competence of licensees. The Task Force on Healthcare Workforce Regulations of the Pew Health Professions Commission released in 1995 their recommendations for changing how health care professions, including nursing, were regulated. They recommended determining continuing competence as a regulatory board function. The Citizens Advocacy Center, a public policy organization located in Washington, DC, has also given similar advice. In 2000, the Institute of Medicine published a report, To Err is Human, which included a recommendation for health professional licensing bodies to determine licensees’ competence and knowledge.
The Board of Nursing determines minimum competency to practice nursing upon entry into practice. Entry-level competence is met by successful completion of an approved program of education and passing the national licensure exam (NCLEX). Prior to 2006, however, license renewal did not require any verification of the applicant’s continuing competency to practice.
In 1998 the Board approved a strategic plan which included the following initiative: “Operationalize Continued Competence and Determine the Role of the Board of Nursing with this Issue.” To address this initiative, the Board convened a workgroup made up of representatives from hospitals, long-term care, nursing organizations, nurse educators, board members, public members, and other stakeholders. The purpose of the workgroup was to review pertinent information and have dialogue regarding the Board’s role in determining continuing competence of nurses.
The workgroup developed the following definition of Continuing Competence:
Continuing Competence is the ongoing application of knowledge and the decision-making, psychomotor, and interpersonal skills expected of the licensed nurse within a specific practice setting resulting in nursing care that contributes to the health and welfare of clients served.
The process of determining continuing competence is based on the following assumptions:
The BON has an interest in ongoing competence based on the board’s legislative mandate to ensure minimum standards of competency and to provide the public safe nursing care.
Nurses desire to be competent in their practice.
There are a variety of mechanisms that can be used to determine continuing competence.
Determining continuing competence is:
An evaluative process carried out by the nurse, employer, and Board of Nursing; and
A self-directed and ongoing process carried out by the individual nurse, for purposes of licensure renewal.
The workgroup, after in-depth review and discussion of various materials/models, submitted recommendations to the Board at the September 2001 Board Meeting. The Board of Nursing approved the recommendations from the committee and endorsed the reflective practice approach.
Reflective Practice is defined as a process for the assessment of one’s own practice to identify and seek learning opportunities to promote continuing competence. Inherent in this process is the evaluation and incorporation of this learning into one’s practice.
A pilot demonstration project was completed in 2003, followed by a statewide educational approach preparing licensees, key stakeholders, and the public for implementation of continuing competence as part of licensure renewal.
The NC General Assembly passed G.S. § 90-171.23 (b) (20), the Continuing Competence requirement, into law in July 2005.
Continuing competence requirements for licensee renewal or reinstatement became effective July 1, 2006. The criteria are specified in rule 21 NCAC 36.0232.
Using a reflective practice approach, the licensed nurse must carry out a self assessment of her/his practice, and develop a plan for maintaining competence. This assessment is individualized to the licensed nurse’s area of practice. There are a wide variety of options/methods through which the nurse can choose to maintain continuing competence. Taking or passing an examination is not a requirement. Assessment tools have been made available by the Board of Nursing for use by the licensee and are available on the Board website at http://www.ncbon.com by clicking on “Quick Links” and choosing “Continuing Competence.”
Effective July 1, 2008, licensees seeking renewal or reinstatement must attest to having completed the chosen learning activity and be prepared to submit evidence of completion if requested by the Board upon random audit.