Entry-Level Competencies For Registered Nurses
Entry-Level Competenciesfor Registered NursesNursing Practice Expectations
AcknowledgmentsThe Jurisdictional Collaborative Process (JCP) to Revise Entry-Level Registered NurseCompetencies has existed since 2004 (Black, et al., 2008). During 2011-12, JCP revised thecompetencies and supporting statements reported in Competencies in the Context of EntryLevel Registered Nurse Practice (2008). Professional staff from 10 jurisdictions participated inthe revision process and agreed upon this version as completed in December 2012.Initially, Laurel Brunke, executive director of the College of Registered Nurses of BritishColumbia, served as liaison between the JCP and the group that was incorporated as theCanadian Council of Registered Nurse Regulators (CCRNR) in 2012. The purpose of this liaisonrole was to facilitate open and frequent communication about JCPs’ mandate and deliberations.In April 2012, Diane Wilson Máté, executive director of the College of Registered Nurses ofManitoba, assumed the liaison role.All project participants from January 2011 to December 2012 listed below are acknowledged fortheir commitment, expert contributions and humour that created a humanistic, enthusiastic,synergistic and dynamic working process:1.Association of Registered Nurses of Prince Edward Island (ARNPEI). Paul Boudreau RN,Coordinator, Regulatory Services2. Association of Registered Nurses of Newfoundland and Labrador (ARNNL). SiobhainnLewis RN, Nursing Consultant – Policy and Practice3. College and Association of Registered Nurses of Alberta (CARNA). Debra Allen RN, Policyand Practice Consultant; Manager, Regional Coordinator Program (Alternate Vice-ChairJan/11-March/12; Vice-Chair April/12-completion)4. College of Nurses of Ontario (CNO). Erin Bruce RN, Entry-to-Practice, Professional PracticeDepartment5. College of Registered Nurses of British Columbia (CRNBC). Joyce Black RN, EducationConsultant (Chair); Sonia Acorn RN, Project Assistant
6. College of Registered Nurses of Manitoba (the College). Peggy Martens RN, Consultant,Nursing Practice (Jan/11-Feb/12; Vice-Chair Jan/11-March/12); Sherry Brown RN,Consultant, Nursing Practice (Feb/12-completion)7. College of Registered Nurses of Nova Scotia (CRNNS). Paula Prendergast RN, PolicyConsultant (Alternate Vice-Chair April/12-completion)8. Nurses Association of New Brunswick (NANB). Odette Comeau Lavoie RN, Senior RegulatoryConsultant9. Registered Nurses Association of the Northwest Territories and Nunavut (RNANT/NU).SheilaHumphrey RN, Director of Regulatory Services and Policy10. Saskatchewan Registered Nurses’ Association (SRNA). Terri Belcourt RN, Nursing PracticeAdvisor (Jan/11-completion); Karen Turner RN, Nursing Advisor, Regulatory Services, nonvoting (Oct/11-completion)The JCP extends appreciation to observers from Assessment Strategies Incorporated and theCanadian Nurses Association: Annik O’Brien MA (Jan/11-July/12) and Karine Georges MSc(Sept/12-completion). Annik and Karine are project consultants to the Canadian RegisteredNurse Examination.Thank you to the editor, Jennifer O’Neill, Communications Officer with ARNNL, whose attentionto detail and thoughtful edits were valuable in fine-tuning the document and bringing the JCP’svision and hard work to fruition. Her efforts are appreciated.The JCP wishes to acknowledge the contribution of freelance graphic designer Chris Johnston, ofToronto, Ontario, who designed the graphic depiction of the conceptual framework for organizingthe entry-level registered nurse competencies. This graphic work has stood the test of time andhas not changed since the 2006 report.
Table Of ContentsPreface1Assumptions2Profile Of Entry-Level Registered Nurse Practice3Application Of The Competencies Expected During Nursing Education3Context Of The Practice Environment4Entry-Level Registered Nurse Competencies5Professional Responsibility And Accountability6Knowledge-Based Practice7Specialized Body Of Knowledge7Competent Application Of Knowledge8Ethical Practice11Service To The Public12Self-Regulation13Glossary Of Terms14References17Entry-Level Competencies for Registered Nurses
PrefaceDuring 2011-12, staff from 10 regulatory bodies (called the Jurisdictional Collaborative Process (JCP)group) collaborated together to revise the Entry-Level Competencies for Registered Nurses. Revisionswere based on environmental scanning, literature reviews and simultaneous stakeholder consultationwithin each jurisdiction.The purpose of this process is to enhance the consistency of the entry-level registered nurse*competencies required by the participating jurisdictions. This provides support for the workforcemobility requirements of the Federal Agreement on Internal Trade.The entry-level competencies serve the primary purpose of nursing education program approvalby describing the competencies required for entry-level registered nurses to provide safe, competent,compassionate and ethical nursing care in a variety of practice settings. The competencies alsoserve as a guide for curriculum development and for public and employer awareness of the practiceexpectations of entry-level registered nurses.The competencies are client-centred, futuristic and incorporate new developments in society, healthcare, nursing knowledge and nursing practice. The competencies aim to ensure that entry-levelregistered nurses can function in today’s realities and are well-equipped with the knowledge and skillsto adapt to changes in health care and nursing.For more information about the entry-level registered nurse competencies in Manitoba please contactthe College of Registered Nurses of Manitoba.*Words or phrases in bold are listed in the Glossary of Terms. They are displayed in boldupon first reference.Entry-Level Competencies for Registered Nurses1
AssumptionsThe following assumptions are made about the preparation and practice of entry-level registered nurses:1. Requisite skills and abilities (the College, 2012)are required to attain the entry-level registered nursecompetencies.2. Entry-level registered nurses demonstrate Englishor French language proficiency (reading, writing,listening and speaking). Entry-level registered nurseshave the ability to express and receive written, verbal ornon-verbal information and the ability to interact withothers in a clear, respectful and professional manner.3. Entry-level registered nurses are prepared asgeneralists to enter into practice safely, competently,compassionately and ethically: in situations of health and illness with people of all genders and across the lifespan with the following possible recipients of care:individuals, families, groups, communities 5. Entry-level registered nurses enter into practice withcompetencies that are transferable across diversepractice settings.6. During their nursing education program, experiencewith these competencies may vary for each entry-levelregistered nurse. Their experience may be limited insome practice environments and with some clients.7. Entry-level registered nurses have a strong foundationin nursing theory, concepts and knowledge, health andsciences, humanities, research and ethics.8. Entry-level registered nurses are prepared to engage ininterprofessional collaborative practice, essential forimprovement in client health outcomes.9. Entry-level registered nurses are beginning practitionersand populationswhose level of practice, autonomy and proficiencyacross diverse practice settings.will grow best through collaboration, mentoring and4. The practice setting of entry-level registered nursescan be any environment or circumstance where nursingis practised. It includes the site where nursing care isprovided and programs designed to meet2health-care needs.support from registered nurse colleagues, managers, thehealth-care team and employers.
Profile of Entry-Level RegisteredNurse PracticeApplication of the CompetenciesExpected During Nursing EducationEntry-level registered nurses are at the point of initialCollege approved nursing education programs areregistration, following graduation from a College ofrequired to provide opportunities for students to apply theRegistered Nurses of Manitoba (the College) approvedentry-level competencies for registered nurses in directnursing education program. Their beginning practice drawspractice learning experiences. Nursing educationon a unique experiential knowledge base shaped by specificprograms must ensure that student practice learningpractice experiences during their education program. Theyexperiences/clinical hours reflect College standards andare health-care team members who accept responsibilityprepare graduates to achieve the competencies. To fulfilland demonstrate accountability for their practice. Inthe practice learning experience requirements, nursingparticular, they:education programs and health-care settings work in recognize their limitations,partnership to ensure students have access to quality ask questions,learning experiences. exercise professional judgment, and determine when consultation is required.Innovative arrangements developed by nursing educationprograms to provide practice learning experiences areEntry-level registered nurses realize the importance ofencouraged, provided they are structured with learningidentifying what they know and do not know, what theiroutcomes that are evaluated. Student practice learninglearning gaps may be, how and where to access availableexperiences might include practice with children in schools,resources. They display initiative, a beginning confidencedaycares or community centres, or with older adults in aand self-awareness in taking responsibility for theirvariety of settings, including public and community livingdecisions in the care they provide.(Harwood, Reimer-Kirkham, Sawatzky, Terblanche & VanResearch demonstrates that during the first 12 monthsof employment, entry-level registered nurses experiencea complex but relatively predictable array of emotional,Hofwegen, 2009). Such experiences augment other requiredpractice learning experiences with clients in acute care andother traditional health-care settings.intellectual, physical, sociocultural and developmentalStudents benefit from multiple learning opportunitiesissues that, in turn, feed a progressive and sequentialincluding practice in laboratory settings where they canpattern of personal and professional evolution (Duchscher,begin to apply the entry-level competencies in a controlled,2008). This role acquisition occurs in part by observingsafe environment without risk to clients. The literatureother registered nurses in practice and within the socialreports increased use of simulation to promote learning andnetwork of their workplace.help ensure client safety by preparing students for practiceTime is required to establish professional relationships,learn practice norms and consolidate nursing practiceknowledge and judgment. As confidence develops in theirnew role, entry-level registered nurses assume higher levelsof responsibility and manage increasingly complex clinicalsituations. Their proficiency and efficiency with respect toworkload management and technical skills will improvewith support and experience.Entry-Level Competencies for Registered Nurseslearning experiences (Harder, 2010; Norman, 2012;Weaver, 2011). Notwithstanding the value of simulatedlearning, nursing education program approval reviews,conducted by the College, require evidence that students areprepared as generalists and have direct practice learningexperiences with clients across the lifespan and in a variety of acute care and community settings to achieve theentry-level competencies.3
Context of the Practice EnvironmentEntry-level registered nurses are employed in diverse practice environments (e.g., hospital, community, home,policy and protocol documents (online or hard copy);andclinic, school, residential and correctional facilities) that reference materials (including online reference resources).range from large urban to remote rural settings. Employers Provide position-specific education and professionalcreate and maintain practice environments that supportdevelopment through orientation, in-service educationcompetent registered nurses in providing safe, ethicaland quality health care. The practice environment alsoand mentorship programs. Encourage and support experienced registered nursesinfluences the consolidation of entry-level registered nurseto mentor entry-level registered nurses (e.g., providepractice and the development of further competence.education and recognition for registered nurse mentors).It is unrealistic to expect entry-level registered nurses to through the integration of experiences, supportfunction at the level of practice of experienced registerednurses. Entry-level registered nurses require a reasonableperiod of time to adjust to work life as employeesand mentoring. (e.g., they need sufficient time to discuss and planencourage entry-level registered nurses to feel welcome,care with colleagues and those clients receiving care;safe, valued, respected and nurtured ease their transitionthey benefit from matching new registered nurses withinto practice and help reduce stress, increase competenceCreating quality practice environments is the sharedexperienced ones). provide opportunities for entry-level registered nursesnursing regulatory bodies, professional organizations andto demonstrate their competencies before assumingpost-secondary educational institutions. The followingCRNNS, 2007; Curtis, de Vries, & Sheerin, 2011; Downey,these responsibilities. processes, which are essential for the development of2011), are vital to support entry-level registered nurses to setting that support entry-level registered nurses inpractice and request assistance without being criticized.Identify and inform entry-level registered nurses of thedevelopment of their practice. Resources could include:registered nurse leaders (e.g., clinical educators, clinicalmanagers, advanced practitioners);4Promote an environment that encourages entry-levelregistered nurses to pose questions, engage in reflectiveresources available to support the consolidation and the practice of entry-level registered nurses. Provide initial experiences working in a practiceconsolidating their knowledge application and skills. Provide clarity about responsibility and accountability,ongoing constructive feedback and formal evaluationParslow, & Smart, 2011; Saintsing, Gibson & Pennington,practise safely, competently and ethically:Identify the competencies required in a particularsetting, position or situation of added responsibility andresponsibility of governments, employers, registered nurses,indicators, derived from a variety of sources (CRNBC, 2010;Consider workload and staff scheduling that addressthe transitional needs of entry-level registered nurses(Duchscher, 2008). Supportive practice environments thatand support safe, ethical and quality health care.Provide opportunities to strengthen leadership skills
Entry-Level Registered Nurse CompetenciesThe entry-level competency statements have been organizedfamily, group, community or population who is the recipientusing a standards-based conceptual framework to highlightof nursing services and, where the context requires, includesthe regulatory purposes of entry-level registered nursea substitute decision-maker for the recipient of nursingcompetencies. The conceptual framework organizes theservices. In some clinical settings, the client may be referredcompetencies in five categories:to as a patient or resident. Professional Responsibility and Accountability Knowledge-Based Practice Ethical Practice Service to the Public Self-RegulationThe conceptual framework depicts a cycle in which noone category of competencies is more or less importantthan another.It is recognized that safe, competent, compassionate andFigure 1: Conceptual Framework for OrganizingCompetenciesethical registered nursing practice requires the integrationand performance of many competencies at the same time.Hence, the number of competencies and the order in whichthe categories or competency statements are presented isProfessional Responsibilityand Accountabilitynot an indication of importance; rather, the conceptualframework simply provides a means of presentation.Additionally, although many competencies may be suitablyKnowledge-BasedPracticeSelf Regulationplaced in more than one category, they are stated in onecategory only for the sake of clarity and convenience. Pleasenote that anywhere in the document where examples areprovided, it is intended to mean “including, but not limitedClientto” the examples stated.Individuals, Families,Groups, Communities,PupulationsThe following overarching competency statement applies toEthicalPracticeService tothe Publicall categories of competencies:All registered nurses practise in a manner consistent with:(a) The Standards of Practice for Registered Nurses(CRNM, 2012);(b) Nursing code of ethics;Jurisdictional Competency Process:Entry-Level Registered Nurses(c) Scope of registered nursing practice applicable inManitoba; and(d) Federal and provincial legislation and regulations thatdirects practice.The conceptual framework illustrates the registered nursingpractice standards used in the jurisdictions that collaboratedto develop the entry-level competencies. The standards-basedframework is used to organize the competency statementsand highlight the regulatory purposes of the entry-levelregistered nurse competencies. It is important to note theThis statement is placed on its own at the outset because ofits essential and overriding importance. This competencystatement highlights the multiple professional, ethical andlegal sources of knowledge required for safe, competent,compassionate and ethical registered nursing practice.centrality of the client in this conceptual framework, as theclient is central to nursing practice. Client is the individual,Entry-Level Competencies for Registered Nurses5
Professional Responsibility And AccountabilityDemonstrates professional conduct and that the primary duty is to the client to ensure safe,competent, compassionate, ethical care.Competencies: Professional Responsibility and Accountability1. Represents self by first and last name and professionalcompleting assigned responsibilities and communicateshealth-care team.about responsibilities completed and not completed.2. Is accountable and accepts responsibility for ownactions and decisions.3. Recognizes individual competence within legislated12. Uses conflict resolution strategies to achievehealthier interpersonal interactions.13. Questions unclear orders, decisions or actionsscope of practice and seeks support and assistanceinconsistent with client outcomes, best practices andas necessary.health safety standards.4. Articulates the role and responsibilities of a registerednurse as a member of the nursing and health-care team.5. Demonstrates a professional presence and modelsprofessional behaviour.6. Demonstrates leadership in client care by promotinghealthy and culturally safe practice environments.7. Displays initiative, a beginning confidence,self-awareness and encourages collaborativeinteractions within the health-care team.8. Demonstrates critical inquiry in relation to newknowledge and technologies that change, enhance orsupport nursing practice.9. Exercises professional judgment when using agencypolicies and procedures, or when practising in theabsence of agency policies and procedures.10. Organizes own workload and develops timemanagement skills for meeting responsibilities.611. Demonstrates accountability and responsibility indesignation (protected title) to clients and the14. Protects clients through recognizing and reporting nearmisses and errors (the RN’s own and others) and takesaction to stop and minimize harm arising fromadverse events.15. Takes action on recognized unsafe health-care practicesand workplace safety r
The entry-level competencies serve the primary purpose of nursing education program approval by describing the competencies required for entry-level registered nurses to provide safe, competent, compassionate and ethical nursing care in a variety of practice settings.
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entry-level RN to function at the level of practice of an experienced RN. 2. The entry-level RN works within the registered nursing scope of practice, and appropriately seeks guidance when they encounter situations outside of their ability. 3. The entry-level RN must have the requisite skills and abilities to attain the entry-level competencies. 4.
teamwork competencies, strategic action competencies, global awareness competencies, self-management competencies and communication competencies. Strategic action competencies Strategic action competencies refer to the manager’s abilities to grasp the overall strategy of the company and ensure employees’ efforts are in line with the strategy.
practice. 2. Entry-level competencies form the foundation for all aspects of nurse practitioner practice, and apply across diverse practice settings and client populations. 3. Entry-level competencies build and expand upon the competencies required of a registered nurse and address the knowledge, skills and abilities that are included in the .
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