Academic journal article Nursing and Health Care Perspectives

A PROPOSED FRAMEWORK for Differentiating the 21 Pew Competencies by Level of Nursing Education

Academic journal article Nursing and Health Care Perspectives

A PROPOSED FRAMEWORK for Differentiating the 21 Pew Competencies by Level of Nursing Education

Article excerpt

ABSTRACT. NOW NEARLY A DECADE OLD, the original Pew Health Professions Commission Competencies have stood up well to the test of time. The competencies were designed to provide all health professionals, from physicians to physical therapists, with a general guide to the values, skills, and knowledge they would need to be successful in the health care system that was beginning to emerge in the late 1980s. They have been used across the range of health professions and in many practice settings to create a framework for curricular change, work redesign, and assessment of professional competence.

The interpretation of the competencies offered here should prove to be a useful tool to nurses and health system leaders as they carry on the hard work of adapting the current model of nursing practice to the demands and realties of the contemporary and continually evolving health care environment. This work is important for two reasons. First, many of the skills and attributes of the professional nurse are not adequately used or valued by the health care system because the profession is both fragmented and poorly differentiated and articulated. Without markers that define and promote collaborative practice within nursing, the full potential of nurses at all levels of preparation will continue to be inadequately and inappropriately deployed.

This model exacerbates the current nursing shortage because it fails to use nurses in appropriate, well-delineated, and challenging roles. Without this kind of differentiation, one that can be owned and supported by all nurses, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the companion teaching-learning strategies proposed here offer one approach to rationalizing both nursing education and practice, with the potential for improving the quality of care, and reducing fragmentation, cost, and public confusion.

THE PEW HEALTH PROFESSIONS COMMISSION has been recognized as a leader in health professions workforce policy and planning for the last decade. Sponsored by the Pew Charitable Trusts, its purpose was to explore health professions education and recommend reforms to "ensure that today's students will contribute to and thrive as practitioners in tomorrow's radically different and ever-changing new health care environment" (I, p. vii). Nearly 10 years later, the predicted "radically different ... health care environment" has arrived and continues to be "ever-changing" Given the chaotic environment of health care delivery and professional practice, the Commission's charge remains a relevant guidepost for the nation's health professions schools.

In its 1991 report (1), the Commission outlined "Competencies for 2005," a set of 17 expanded abilities and attitudes required of practitioners to meet the nation's evolving health care needs. The Commission charged the nation's health professions and their educational programs to interpret and apply the competencies in the context of their unique missions.

Widely circulated in the 1990s, the Pew competencies informed both dialogue and debate about health professions education across the range of disciplines. A 1997 survey of health professions education programs (2) revealed that large numbers of schools were both aware of and drawing upon the Commission's recommendations, and working on incorporating the competencies in their curricula. The professions reporting use of the competencies ranged from 63 percent in schools of allopathic medicine to 93 percent in schools of nursing and allied health.

In its fourth and final report, the Commission updated and expanded the list to "21 Competencies for the 21st Century," and recommended that health professions schools use the competencies "as a benchmark for assessing the current status of their educational programs and for developing strategic directions for change" (3, p. …

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