The development of competency standards for specialist critical care nurses

In defining the contemporary role of the specialist nurse it is necessary t o challenge the concept of nursing as merely a combination of skills and kn owledge. Nursing must be demonstrated and defined in the context of client care and include the broader notions of professional development and compet ence. This qualitative study sought to identify the competency standards fo r nurse specialists in critical care and to articulate the differences betw een entry-to-practice standards and the advanced practice of specialist nur ses. Over 800 hours of specialist critical care nursing practice were obser ved and grouped into 'domains' or major themes of specialist practice using a constant comparison qualitative technique. These domains were further re fined to describe attributes of the registered nurses which resulted in eff ective and/or superior performance (competency standards) and to provide ex amples of performance (performance criteria) which met the defined standard . Constant comparison of the emerging domains, competency standards and per formance criteria to observations of specialist critical care practice, ens ured the results provided a true reflection of the specialist nursing role. Data analysis resulted in 20 competency standards grouped into six domains : professional practice, reflective practice, enabling, clinical, problem s olving, teamwork, and leadership. Each of these domains is comprised of bet ween two and seven competency standards. Each standard is further divided i nto component parts or 'elements' and the elements are illustrated with per formance criteria. The competency standards are currently being used in sev eral Australian critical care educational programmes and are the foundation for an emerging critical care credentialling process. They have been viewe d with interest by a variety of non-critical care specialty groups and may form a common precursor from which further specialist nursing practice asse ssment will evolve.