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