Download - The role of the nurse manager in ensuring competence – the use of portfolios and reflective writing
The role of the nurse manager in ensuring competence ± the use ofportfolios and re¯ective writing
The replacement of the United Kingdom Central Council
for Nurses, Midwives and Health Visitors (UKCC) with
the new Nursing and Midwifery Council this summer
provides many opportunities for coalescing the roles
of the professional bodies, the service providers and
education in demonstrating evidence of a competent
profession. Charged with protecting the public through
professional standards, the UKCC devised several strat-
egies to demonstrate that registered practitioners are
competent, and remain competent, to practice. Not least
of these is the requirement for triennial reregistration
on the live professional register, a major step forward for
an aspiring profession, in terms of establishing standards
for demonstrating competence for all registrants.
Although the basis for self-regulation is in place, the
UKCC leaves the task of verifying and monitoring the
individual in a rudimentary state. For all practitioners
to remain on the professional register, the only require-
ment is to complete a `noti®cation of practice'. As a
self-verifying statement, the nurse con®rms that she has
ful®lled the minimum of ®ve days study and maintained
her personal pro®le. Unless that nurse is one of the small
percentage selected for audit, this is where it ends.
Reregistration is automatic, and licence to practice is
awarded. This process falls far short of the modernised
professional self-regulation outlined in the Government's
strategy Continuing Professional Development: Quality in
The New NHS (DoH 1999), and perhaps more worry-
ingly, can give the public no con®dence that a nurse has
maintained and developed standards through additional
learning activities (UKCC 1995).
The notion of self-veri®cation
Part of the problem lies with the notion of self-veri®cation.
At present a nurse is on her honour to have done what
she claims. With such a high number of registered
practitioners, a third of whom need to re-register every
year, the auditing processes are woefully inadequate in
terms of ensuring that competence is a reality rather than
assumed. The `professional pro®le' is supposed to provide
the evidence that a nurse has updated her knowledge
and skills and developed her practice. Yet the majority
of portfolios that I see are simply collections of certi-
®cates that attest to a nurse having attended a training
opportunity at some time1. Compared with the assessment
of competence that students undergo, i. e. assessment by
a person with the knowledge and skills to judge that
competence, we can have no faith that an attendance
combined with self-veri®cation actually means that the
person is competent.
The root of the problem here lies not with the individual
practitioner, but with the systems established at the insti-
gation of the use of portfolios/pro®les, and the assump-
tions behind the notion of veri®cation. In spirit, the
`pro®le' was conceived as being a record open to public
scrutiny and therefore available for con®rmation by others.
Indeed, that seems right and proper if the practitioner
is being awarded a licence to practice in the public
domain, which assumes some notion of the achievement
and maintenance of approved standards. In practice, the
advice from the UKCC confused the issue, by suggesting
that the pro®le/portfolio was to be a private record to
which no-one had automatic access. This then caused
problems with veri®cation, and placed the responsibility
®rmly on the individual practitioner.
Using others to verify competence
There are few nurses who work in total isolation ± most
are employed within the NHS, the rest work for
independent organizations and charities. All but a few
work with managers and colleagues, often within a
multidisciplinary team of other professional practitioners.
This provides an appropriate, and legitimate source for
peer review and veri®cation of competence, recorded
within the pro®le document. It seems incongruous that,
having established a rigorous system for assessing
1In using the terms pro®le and portfolio I am assuming a
differentiation; a pro®le is what is required as a minimum by the
UKCC, whilst a portfolio is the total collection of artefacts compiled
by a practitioner to paint a picture of themselves as a professional.
The contents of the pro®le are selected from the total portfolio.
Journal of Nursing Management, 2001, 9, 249±251
f 2001 Blackwell Science Ltd 249
competence preregistration, this has not been developed
further in postqualifying practice.
Surely the time has come, given the increasing will-
ingness from the Government to monitor all professions'
procedures for self-regulation, to involve the employer
in verifying competence as part of the assessment of
standards of care. Although the employer is responsible
for the standards of care achieved, they have no legal
responsibility in the process of ensuring the competence of
their practitioners, simply in verifying the documentation
that is presented to them at the start of employment. The
employer needs to ensure that the staff have the necessary
knowledge and skills to perform their job, but once
training is provided, again, there seems to be no system in
place for monitoring the effects of it in terms of standards
of care. The part that the employer does play, of course, is
in the event of misconduct or negligence. Surely, for the
safety of all concerned, the employer's responsibility needs
to be extended further than this, into the realms of
assuring the competence of all their employees, and being
accountable for that. For many years the notion of quality
in the NHS has rested in quantitative measures of achieve-
ment, yet the improvement of standards within the
NHS provided a mainstay for the recent Government's
success in securing a second term of of®ce. One strategy
that could be adopted would be a duty for nurse managers,
in whatever capacity they act, to be responsible for
qualitatively assessing the on-going competence of the
nurses for whom they are responsible.
Admittedly, this does occur to some extent, as it soon
becomes obvious if a nurse is grossly incompetent work-
ing within a team of other nurses. Yet, as an aspiring
profession, surely it is incumbent upon us to do more than
this; to actually take responsibility for ensuring that we are
all practising to the best available standards, utilizing
evidence-based practice and developing expertise.
One strategy for this is already in place ± the opportu-
nity to use the personal portfolio ± and would not add
greatly to the manager's workload. A manager already has
responsibility for performance appraisal of staff, and for
ensuring that the workforce has the necessary training
and skills to do the job they are asked. The link between
this and the portfolio is often tenuous. Some managers
use the portfolio at appraisal meetings, and when inter-
viewing for new appointments; for others it is an irrele-
vance, located solely in the realms and responsibilities
of the individual. But what a waste of an opportunity!
In constructing a portfolio, and given appropriate and
innovative support and encouragement, a nurse can not
only provide a retrospective record of competence, but
also create a dynamic working tool for their present and
future career. Whilst it is naõÈve to assume that the majority
of nurses will voluntarily spend time creating a document
that no-one else ever sees, and that has no relevance for
them beyond keeping all their certi®cates in one place;
if its development became part of the way that nurses
practice, and was used within managerial systems we may
have a strategy that is exciting and innovative, and could
be used as a model for other professions. However, certain
developments would need to be in place if the portfolio is
to be used as more than a collection of documents.
Setting standards for a professional portfolio
The UKCC concentrated in its early years on specifying
detailed criteria for competence in preregistration, and
latterly, postregistration courses, choosing to focus on
the educational preparation for practice ± whereas the
standards for demonstrating competent professional
practice following that remain udeveloped. In fact,
they do not, as yet, exist. What the Professional Code
of Conduct (UKCC 1992a), the Scope of Professional
Practice (UKCC 1992b) and the Guidelines for Profes-
sional Practice (UKCC 1996) do instead is to establish
a set of standards that the practitioner, unless found
to be falling short, is assumed to adhere to and achieve.
What is not speci®ed are the standards for assessing
a professional pro®le. In fact, the guidelines given to
practitioners about the pro®le are minimal (UKCC 1995)
and have resulted in a great deal of confusion and diverse
strategies for portfolio compilation, often dependent upon
attending educational workshops which expect the tutor
involved to interpret the UKCC criteria. This has in turn
resulted in a plethora of professionally produced and
marketed portfolios which include examples of re¯ective
writing demonstrating how the practitioner's practice
has developed, and their competence been maintained,
as a result of their educational, training and profes-
sional activities. Not only is this evidence of competence,
it is a source of nursing knowledge, generated through
experiential learning and re¯ective practice. However,
we still see the collection of attendance certi®cates
presented with the assumption that these confer com-
petence. Therefore, a task for the new Nursing and
Midwifery Council will be to review the guidelines and
advice offered to practitioners in terms of the standards
expected when compiling portfolios and pro®les as
evidence of competence.
However, employers, and more appropriately nurse
managers, also have a role to play in facilitating their
staff in compiling pro®les that truly demonstrate their
professional competence, as opposed to paying lip-service
to a system that has yet to be tested in terms of
accountability to the public.
M. Jasper
250 f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 249±251
The three sources of authority for the practitioner;
the professional body, the employer and education are not
yet working together in helping nurses demonstrate
competence and developing their practice. More impor-
tantly, the mechanisms instigated by the UKCC, whilst
a step in the right direction, do not, as yet, ensure that
the public receive care from competent practitioners.
Whilst the employers, and by designation those managing
nurses, are failing to utilize a strategy that is already in
existence.
Challenges to nurse managers for the future
It seems that nurse managers could have a key role to play
in facilitating their staff in terms of using portfolios and
re¯ective writing. Whilst the responsibility for their own
practice lies with the individual, the nurse manager is
charged, by the UKCC, in serving the interests of patients
and clients and the wider interests of society to avoid any
inappropriate delegation to others which compromises
those interests (UKCC 1992). Hence it is incumbent on all
nurses who manage others to be actively involved with
assessing the competence of their staff to perform the
duties assigned to them. Perhaps it is within the interests
of nurse managers themselves to devise innovative and
collaborative ways of working with staff, and recording
that input, in creating the evidence of competence.
At a simple level this could be writing a statement for
inclusion within a nurse's portfolio to con®rm that
competence has been witnessed. However, many more
strategies could be adopted that would serve the purposes
for not only the individual, but for management of
the service as well.
Active involvement in facilitating portfolio work would
provide information for staff development needs and
manpower planning; it may facilitate systems of clinical
supervision, and even develop teamwork for practice
development and problem solving. Ultimately though, the
greatest bene®t is in motivating staff through a human
interest in them as people. At a time of serious low morale
and staff crises in the NHS, nurses want to be treated as
if they are valuable and important ± any interest in their
own development and competence demonstrated by nurse
managers will pay dividends in terms of commitment and
enthusiasm and result in improvements in standards of
care too.
References
DoH (1999) Continuing Professional Development: Quality in The
New NHS. HMSO, London.
UKCC (1992a) The Code of Professional Conduct. UKCC, London.
UKCC (1992b) The Scope of Professional Practice. UKCC, London.
UKCC (1995) PREP and you. UKCC, London.
UKCC (1996) Guidelines for Professional Practice. UKCC, London.
Dr MELANIE JASPERPrincipal Lecturer
School of Health & Social CareUniversity of Portsmouth
PortsmouthUK
Editorial
f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 249±251 251