AACN News—November 2004—Opinions

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Vol. 21, No. 11, NOVEMBER 2004

President's Note
Live Your Contribution:Competence: More Than Technical Skill

By Kathy McCauley, RN, PhD, BC, FAAN
President, AACN

What do patients and families tell us they want most from healthcare providers? Certainly, they value compassion—kindness, warmth and personalized attention. However, as front-page stories remind us that medical errors kill more people than plane crashes each year, consumers focus more on technical than interpersonal skills. What consumers need and deserve, of course, is competence in both.

So, what is competence? Being well qualified and capable is how the dictionary defines it. But, in what? Highly tuned technical skills combined with critical-thinking prowess? Clinical decision making coupled with advocacy? Making a disjointed system work for a particular patient and family? Maybe competence means fine-tuning communication and collaboration skills so that everyone on the healthcare team understands what a patient needs and makes achieving it their goal?

Competence embraces all of this. It means living every dimension of our contribution. How do we become competent? Consider these steps: Understand it. Hone it. Recognize and celebrate it. Demand it.

Understand Competence
Novice nurses work hard to build the layers of skill that seem effortless to seasoned nurses. First, they master basic technical skills and learn to organize tasks. Integrating psychosocial support requires conscious effort. Patricia Benner and her colleagues tell the story of a new graduate who celebrated that, while providing technical care to her second patient with a gastrointestinal hemorrhage, she assessed the patient’s emotional situation and offered support.1 The nurse said, “What was good about this patient is that I didn’t forget that she was a patient, and I was talking to her, and it made me feel good because I was so scared.”

This story tells me we really aren’t competent—and certainly not living our contribution —unless we intentionally fine-tune our technical prowess and provide needed psychosocial support and address ethical dilemmas. In short, unless we see to it that all of a patient’s and family’s needs are met. Our understanding of competence evolves from novice to expert. It continually broadens and deepens to include the skills necessary to establish and sustain healthy work environments.

Hone Competence
My husband good-naturedly teases that, for someone with so many letters after my name, it’s amazing what I don’t know. Lee knows that I’m proud of what I know about cardiovascular nursing. But his comment shows that he grasps the essence of our competence dilemma.

There is so much to be known that none of us will be experts in every aspect of our profession. I am awed by the depth and breadth of what our generalist colleagues have mastered about critical care. But a more achievable goal for most of us is to surround ourselves with colleagues who excel in specific areas. Our collective competence will far surpass what any individual can achieve. Imagine working in a unit where one nurse is an expert in ventilator management and weaning. Another in managing complex wounds. And still another in reassuring scared families.

In my own practice, I’m a co-investigator on a major project to address the special needs of elders as they transition from hospital to home. After more than two decades as a nurse, I marvel at how much I am learning from colleagues expert in gerontology, community health and health policy. We have become so trusting and cohesive as we brainstorm tough problems, offer suggestions and celebrate each new milestone in the project.

Does this match your experience? Does it offer you a road map for your journey of personal competence?

Recognize and Celebrate Competence
The AACN Synergy Model for Patient Care clearly defines nurses’ competencies and how they are driven by the needs of patients and families. The credentialing programs for CCRN, CCNS and PCCN certification, along with the soon-to-be-launched CMC and CSC cardiac subspecialty certifications, are all based on the Synergy Model. Certification confirms our efforts to develop the knowledge base needed to care for acutely and critically ill patients and our commitment to continued learning. What better way to recognize and celebrate competence than by becoming certified. It’s a realistic goal along the journey to competence and cause for celebration when achieved.
But are technical skills and effective decision making the only markers of competence? Indeed, patients are unsafe when we lack these skills. Yet, patients are equally unsafe when we are unskilled communicators, insincere collaborators and weak advocates. Or when we exclude families because we don’t know how to help them make their best contribution. Or, when we cannot mobilize a broken system to obtain the supplies and services a patient needs. For me, living my contribution means not only making the effort to acquire these skills for myself, but also helping my colleagues master them.

Demand Competence
Competence isn’t optional. Nor is ignoring incompetence. We are, in fact, ethically obligated to maintain our own competence, support the efforts of others and call out incompetence when it appears.2 That requires us to reflect on how we judge another’s competence, especially the first time we work together. What standards, evidence and experience do we draw from to create our personal yardstick?

What would a unit be like when everyone is truly competent? Or moving along their competence journey with the help and support of experienced colleagues—colleagues who demand that we passionately work to become competent and who settle for nothing less. That is the difference between making a contribution and living it. A lived contribution becomes possible when we commit to work together, moving forward in our personal competence journeys, relying on and celebrating the contributions of our equally committed colleagues.

Easy? Not at all. Necessary? Absolutely.

If we did all the things we are capable of doing, we would literally astound ourselves.
—Thomas Edison

1. Dreyfus H, Dreyfus S, Benner P, eds. Implications of the phenomenology of expertise for teaching and learning everyday skillful ethical comportment. In: Benner P, Tanner C, Chesla C. Expertise in Nursing Practice. New York, NY: Springer Publishing; 1996:264.
2. American Nurses Association. Code of Ethics for Nurses With Interpretive Statements. Washington, DC: American Nurses Association; 2001.


‘Living Your Contribution’ Hits Home
To Kathy McCauley (AACN president) regarding “Live Your Contribution”:

As an experienced RN of 29 years, most at the bedside in critical care, I was having a bit of a “pity party” a few years ago. I was a diploma graduate who started in critical care immediately after graduation, achieved my CCRN certification four years later and went back to school to earn my BSN degree. However, as I looked at other nurses my age who had their MSNs and PhDs, I began wondering just what my contribution to the profession was and would be.

Taking a good look at myself and my strengths helped me decide how I could live my contribution. So, I was especially touched by Dorrie Fontaine’s “President’s Notes” editorials in AACN News the past year. They helped me realize just what my contribution has been and could be: mentoring new nurses and helping to instill a feeling of collaboration not only between disciplines in critical care but also nurse to nurse.

I have started teaching a portion of the critical care prep class. I precept new employees to critical care, and I am an AACN/CCRN ambassador. I have brought 17 new members into AACN this past year and have been actively recruiting coworkers to take the CCRN and PCCN exams.

It is rewarding for me to work with a fellow RN whom I have precepted and mentored, and to watch that person blossom into a truly exceptional critical care nurse. I am very proud of the group of nurses I work with on the night shift at Mt. Diablo Medical Center in Concord, Calif. They are supportive of each other and respectful of the special qualities that each individual nurse brings to our staff. I try to instill in each nurse who I precept that, though no one of us “knows it all,” we make a terrific team as a whole. And, we do.
Thanks for your contribution, Kathy, to all of us in AACN.

Sandra J. Cornish, RN, BSN, CCRN
Concord, Calif.

AACN News Is an Excellent Resource
I was impressed by the latest issue of AACN News (September 2004), with the headline story on moral distress. As a full-time graduate school student who is on active duty in the Air Force, I am away from the bedside for the first time in 10 years. This has given me the opportunity to read, research and study, which I had been neglecting in the day to day of the ICU.

Please keep up the good work. I can't believe what I was missing by not taking the time to read my newsletter every month. With its CEU offerings and ECG interpretation Practice Alert (plus the Web site), AACN News is an incredible resource that I will use in the future as a unit-based CNS. Thanks again for making my job easier.

Capt. Kathy Savell, USAF, NC, RN, BSN, CCRN
New Castle, Ala.

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