A proposed framework for differentiating the 21 Pew competencies by level of nursing education

NOW NEARLY A DECADE OLD, the original Pew Health Professions Commission Com petencies have stood up well to the test of time. The competencies were des igned to provide ail health professionals, from physicians to physical ther apists, with a general guide to the values, skills, and knowledge they woul d need to be successful in the health care system that was beginning to eme rge in the late 1980s. They have been used across the range of health profe ssions and in many practice settings to create a framework for curricular c hange. work redesign, and assessment of professional competence. The interpretation of the competencies offered here should prove to be a us eful tool to nurses and health system leaders as they carry on the hard wor k of adapting the current model of nursing practice to the demands and real ties of the contemporary and continually evolving health care environment. This work is important Tor two reasons. First, many of the skills and attri butes of the professional nurse are not adequately used or valued by the he alth care system because the profession is both fragmented and poorly diffe rentiated and articulated. Without markers that define and promote collabor ative 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 thi s kind of differentiation, one that can be owned and supported by all nurse s, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the co mpanion teaching-learning strategies proposed here offer one approach to ra tionalizing both nursing education and practice, with the potential for imp roving the quality of care, and reducing fragmentation, cost, and public co nfusion.