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Nursing Human Resources Planning and Management Competencies
Developed by
Una V. Reid and Bridget Weller for the International Centre for Human Resources in Nursing
International Council of Nurses
Florence Nightingale International Foundation
All rights, including translation into other languages, reserved. No part of this publication may be reproduced in print, by photostatic means or in any other manner, or stored in a retrieval system, or transmitted in any form, or sold without the express written permission of the International Council of Nurses or the International Centre for Human Resources in Nursing. Short excerpts (under 300 words) may be reproduced without authorisation, on condition that the source is indicated.
Copyright © 2010 by International Council of Nurses 3, place Jean-Marteau, 1201 Geneva, Switzerland ISBN: 978-92-95094-46-8
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TABLE OF CONTENTS
About ICHRN
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About the Authors
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Acknowledgements
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Glossary of Terms
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Executive Summary
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Introduction
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The role of nurses in HR planning and management
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Why develop HR planning and management competencies for nurses?
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Chapter 1: Competencies and Nursing
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Chapter 2: The Nursing Human Resources Management and Planning Competency Framework
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Definition of domains competency
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Indicators of competency: a multilevel approach
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Competency Domains
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Competency Domain 1: Ethics and Standards
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Competency Domain 2: Resource Management
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Competency Domain 3: Workforce Planning
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Competency Domain 4: Work Environment
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Competency Domain 5: Staff Support and Performance
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Competency Domain 6: Leadership
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Chapter 3: Implementation
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Conclusion
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References
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Bibliography
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ABOUT ICHRN The International Centre for Human Resources in Nursing (ICHRN) was established in 2006 by the International Council of Nurses and its premier foundation, the Florence Nightingale International Foundation. The Centre is dedicated to strengthening the nursing workforce globally through the development, ongoing monitoring and dissemination of comprehensive information, standards and tools on nursing human resources policy, management, research and practice.
ABOUT THE AUTHORS Dr Una V. Reid is a graduate of the Kingston Public Hospital School of Nursing, Jamaica and the Simpson Maternity Pavilion, Edinburgh. She holds a Post-Basic Bachelor of Science Degree in Nursing from the University of Toronto; a Master of Science Degree in Nursing from the University of British Columbia; a Master of Education and a Doctor of Education from Teachers College, Columbia University. Dr Reid also holds post-doctoral certificates in the areas of health planning and health economics, and human resources policy and planning from York University (UK); health economics from the University of Aberdeen; quality assurance and accreditation, and problem-based learning from Maastricht University. Dr. Reid specializes in human resources development and has extensive work experience in various areas of nursing and human resources development in the Caribbean, UK, Canada, Australia, South East Asia, and East, Central, Southern African countries (ECSA). Bridget Weller is the Manager of the International Centre of Human Resources in Nursing at the International Council of Nurses. She has extensive experience in public sector health and community services policy and management positions. Her areas of interest include workforce development and strategy, acute health services, rural and regional health services delivery, health funding policy and health worker incentives.
ACKNOWLEDGEMENTS The authors would like to thank all those organisations and individuals who provided valuable information and input in the preparation of this paper, as well as constructive comment on earlier drafts of the paper.
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GLOSSARY OF TERMS
Competence: “The effective application of a combination of knowledge, skill and judgement demonstrated by an individual in daily practice or job performance. In nursing definitions, there is wide ranging agreement that, in the performance of nursing roles to the standards required in employment, competence reflects the following: • • •
knowledge, understanding and judgement; a range of skills, cognitive, technical or psychomotor and interpersonal; and a range of personal attributes and attitudes“ (ICN 2008 p.40).
Competencies: “A set of behaviours that encompasses skills, knowledge, abilities, and personal attributes that, taken together, are critical to successful work accomplishment. Competencies may be defined organisationally or on an individual basis” (Keel 2006). Indicators: For the purpose of the monograph, indicators are measurable behaviours that are representative of, and essential to the successful performance of the nurse manager. Human resources planning: “Human resources planning is defined as a dynamic and multisectoral process that involves forecasting the supply and demand of human resources needs, and formulating related policies and planning strategically to meet these needs within the context of the health sector strategic plan and budgetary resources” (Reid 2007). Human resources management: Human resources management is a process directed at managing an organisation’s workforce. It is accomplished through a strategic and logical approach to the development and sustaining of its workforce, who individually and collectively contribute to the achievement of the organisation’s objectives. Supervision: The active process of directing, guiding and influencing the outcomes of an individual’s performance of a task (ICN 2008 p.41).
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EXECUTIVE SUMMARY This document describes core competencies related to human resources planning and management. It reflects the context of the challenges faced by the health sectors and the nursing workforce globally, and the important role played by nurses in managing and leading teams of highly skilled health professionals, in providing leadership in the provision of service delivery and care, and contributing at the highest levels to the ongoing development of a health care system that can deliver key improvements in health outcomes. The development of a competency framework in human resources management and planning is intended to identify the core competencies that will allow nurses to effectively and efficiently develop and manage the nursing workforce in the health care system. In addition, nurses who are or will be in key leadership and management positions need to be prepared to manage rapid changes in a globalised and technologically driven world and a world with limited financial and human resources. The main purpose of the development of these competencies is to establish a common framework against which nursing human resources planning and management activities can be aligned, implemented, monitored and evaluated. Delineating these competencies can be useful in a number of ways. For example, it can support succession planning for the nursing workforce; help the establishment and maintenance of intra- and inter-health professional partnerships; support the promotion of a safe and healthy work environment; and support effective management, leadership performance and staff training, development and growth. This monograph describes the competencies directly related to human resources planning and management required by nurses in a management role. The nursing human resources management and planning competencies are grouped into the following six domains: • • • • • •
Ethics and standards Resource management Workforce planning Work environment Staff support and performance Leadership
Specific competencies are defined within these domains, and examples of indicators of competency are provided for each of four different levels of nurse with regard to their human resources management responsibilities. The four levels range from the role played by front line licensed nurses (RN, LPN, EN) in the workplace to nurses at the most senior levels of management and policy. Given the focus of the challenges of the health sector globally, and the importance the international community has placed on the crises of the nursing workforce, the ICN Nursing Human Resources Planning and Management Competencies monograph is a significant resource in the effective development of all levels of nurses responsible for managerial activities.
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INTRODUCTION Globally, health systems are experiencing major shifts in their structure, organisation, functions and management. Globalisation and the modernisation of health sectors are creating an increasingly diverse yet interconnected world. Within this ever-changing milieu, nurse managers are faced with many challenges, each demanding effective and dynamic leadership and management abilities if they are to be addressed adequately. The Toronto 2005 Regional Meeting of the Observatory of Human Resources for Health identified “Human resources are the foundation of the health system” as one of the guiding principles to support the efforts for the development of human resources for health. “The development of human resources in health forms the social and technical foundation of the health systems and their improvement. The contribution of the health workers is one of the most essential components of a health system’s ability to effectively provide quality care and to ensure equitable access to that care throughout the entire population” (PAHO & Health Canada 2005 p.1). It is increasingly recognised that health workforce gaps are serious deterrents to the success of global health initiatives such as attaining the Millennium Development Goals (MDGs), as well as the scaling up of activities for dealing with pandemics such as HIV/AIDS and avian influenza (WHO 2005). The health sector is labour-intensive, therefore health workforce costs are a significant proportion of health expenditure in most countries. The effective management of human resources (HR) will therefore continue to play a key role in the achievement of health outcomes, as well as being an important part of ensuring that the most effective use is made of scarce human and financial resources. The development of a competencies framework aims to assist nurses in preparing for this key role.
The role of nurses in HR planning and management In recent years, many nurses have experienced a dramatic shift in their roles and responsibilities. The nurses and nurse managers of today and tomorrow need to engage meaningfully in an environment characterised by ongoing workforce shortages, high turnover and absenteeism, and ever-growing demands and expectations in relation to both quality of care and value-for-money in health care delivery. The knowledge, skills and personal attributes needed to plan, guide, support and facilitate the development of an efficient nursing workforce and a positive work environment represent a particular set of competencies. Unlike many other professions, nurses will often be performing management and planning tasks concurrently with, and in addition to, an ongoing role in providing direct care. It is important to recognise that nurses occupy key leadership roles in health systems across the world. Frequently, particularly in areas of significant workforce shortage, the nurse may be the most senior health professional in a local community with responsibility for managing and coordinating day to day aspects of care, and often have accountability and supervisory relationships with support workers (ICN 2008). In Working Together for Health (WHO 2006), the 11
WHO World Health Report of 2006, team management was identified as a key part of creating an enabling working environment. Similarly, a number of strategies were identified in which managers play a direct role including developing clear job descriptions, supporting norms of conduct, exercising supportive supervision, ensuring adequate information and communication and promoting lifelong learning. In fact, supervision, coupled with audit and feedback, was identified as the levers that have the greatest influence of health workforce competence (WHO 2006 p. 87). In order to work effectively, nurse managers must develop a specific set of competencies related to planning and managing the most important resource at their disposal – their human resources. Human resources are the key to good health service delivery and quality care. Expenditure on HR comprises, on average, more than half of a nations’ total expenditure on health. The ability to effectively invest and manage these resources is therefore crucial. However, the historical focus on clinical training and development of health workers has resulted in a lack of attention given to more generic management skills, leading to ‘important gaps in the current response’ (WHO 2006 p. 84). Leadership and management skills are therefore recognised as a key part of many nurses’ practice, not just those with a formal management role within an organisational hierarchy. This is reflected in a range of work on nurse competencies that has been carried out across the world. For example •
•
•
•
•
The International Council of Nurses (ICN) includes both leadership and management and delegation and supervision among the competencies outlined in the Nursing Care Continuum Framework and Competencies (ICN 2008). The Canadian Government includes a full range of leadership competencies in its core competencies for public health, applicable to all health professionals working in the field (PHAC 2007). The United Kingdom’s NHS Knowledge and Skills framework includes people management as well as other generic management skills (such as financial management) among its competencies as well as a range of other key management skills such as communication, project management and planning, personal development, and service improvement (UK Department for Health 2004). An Australian Nursing Federation project funded by that country’s federal government identified ‘Leads practice’ as one of the key competency domains for advanced practice nurses, including a range of competencies such as leading teams, acting as a mentor and role model to others, and facilitating education and professional development for others (ANF 2005). The Western Pacific and South-east Asian Region includes “Leadership and Nursing Management” as one of its three competency domains (WPSEAR Secretariat 2005).
Why develop HR planning and management competencies for nurses? Nurses who are or will be in key leadership and management positions need to be prepared to manage rapid changes in a globalised and technologically driven world in which financial and human resources are limited. 12
As described in the management competency framework for the Welsh county Blaenau Gwent, a senior manager… “Informs prospective recruits what is expected of them; informs staff of the sort of attitudes and behaviours [that are expected of a nurse manager]; shapes and defines a culture based around strong principles such as partnership, continuous improvement, constructive challenge, and being citizen centred; and supports staff at all levels in their development in order to maximise their potential” (Blaenau Gwent 2007 p.4). The development of a competency framework in HR management and planning is intended to identify the core competencies required for nurses to effectively and efficiently develop and manage the nursing workforce in the health care system. In addition to the value for individual nurse managers seeking to develop their own managerial practice, development of these competencies establishes a common framework against which nursing HR planning and management activities can be supported, implemented and aligned. The Nursing Human Resources Planning and Management Competencies project reflects ICN’s commitment to strengthening the nursing workforce globally through the development, ongoing monitoring and dissemination of comprehensive information, standards and tools on nursing HR policy, management, research and practice, and reflects the three key goals of the International Centre for Human Resources in Nursing (ICHRN), namely:
• to build capacity in nursing HR planning and management at the national, regional and global • •
levels; to act as a resource for generating, collating, promoting and disseminating information, research and data related to nursing HR; to function as a catalyst for change and an international focal point for collaborating with others on nursing HR issues.
The development of a competency framework promises a number of potential benefits. It will better acknowledge the existing management skills employed within nurses’ current scope of practice at various levels of their nursing positions. It will also provide for greater consistency in the development of job roles and descriptions, and inform the ongoing development of relevant continuing education and training curricula and effective professional development tools. The Framework supports the development of a consistently robust approach to nurse management and supervision, which has been demonstrated as a key factor in creating a positive working environment (WHO 2006). A more effectively deployed and motivated nursing workforce has been proven to be a major factor in improving health system and patient outcomes. Applied appropriately, competencies “set developmental needs critical for accomplishing the organisation’s mission; and provide structure and logic for making effective and efficient individual and staff development decisions” (NOAA n.d. p.1). They also assist in ensuring appropriate job placement, i.e., the right people in the right jobs at the right time, and form the basis for individual and organisational performance evaluation. These competencies promise significant benefits for health service organisations. They contribute to maximise the productivity of the workforce (WHO 2006), identify staff development and training needs, inform decisions to support workforce development, and provide a key skill 13
pool that can enhance a range of personnel practices and nursing resources planning and management. The framework also promotes effective participation by nurses in health service management and in more effective collaborative practice and coordination across professions and organisations (PHAC 2007). By better equipping nurses to perform these key human resource management roles, where the principles of fair, efficient, performance-driven and collaborative management and supervision is embedded into everyday practice, these competencies also aim to contribute to the achievement of better health care delivery and through that, better health outcomes.
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CHAPTER 1: COMPETENCIES AND NURSING Competencies are the standardised requirement for an individual to properly perform a specific job. The competencies encompass a combination of essential knowledge, skills and attitudes necessary for daily practice or job performance and contribute to the achievement of target outcomes. ICN’s Nursing Care Continuum Framework and Competencies document, adapting the definition from regulation terminology, defines competence as: “The effective application of a combination of knowledge, skill and judgement demonstrated by an individual in daily practice or job performance. In nursing definitions, there is wide ranging agreement that, in the performance of nursing roles to the standards required in employment, competence reflects the following (ICN 2008 p.40): •
knowledge, understanding and judgement
•
a range of skills, cognitive, technical or psychomotor and interpersonal; and
•
a range of personal attributes and attitudes“
Competence “focuses on what is expected of an employee in the workplace rather than on the learning process; and embodies the ability to transfer and apply skills and knowledge to new situations and environments” and should be related to realistic workplace practices, expressed as outcomes, and understandable to trainers/teachers, supervisors and potential employers (Department of Human Service Victoria 2005).
Box 1: Advantages of a Competency Framework •
prove a clear picture of the roles and responsibilities of the nurse;
•
promote individual and collective professional accountability;
•
provide a foundation for the design of nursing curricula and processes of assessment in both theory and practice settings, which will ensure not only that nurses are educated and trained to meet current needs for health care and nursing in their country, but are committed to maintaining their competence;
•
assist in specifying professional expectations associated with nursing roles;
•
provide a foundation for setting job-specific performance criteria.
Source: ICN (2003)
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CHAPTER 2: THE NURSING HUMAN RESOURCES MANAGEMENT AND PLANNING COMPETENCY FRAMEWORK The competency framework details six domains of practice for nursing human resources planning and management. Each domain contains a number of relevant sub-domains. Four levels of nurses are described in Table 1, each progressing to an increasingly developed role and function in terms of their contribution to human resources and planning and management. A summary of these key domains and the key competency areas within each is provided in Figure 1.
Definition of domains competency The Ethics and Standards domain includes the competencies for ensuring nursing practice within an ethical and professional practice framework. Nurses demonstrating competencies in this domain will maintain courteous and professional standards of behaviour in accordance with relevant legal and ethical issues and respect common values of individuals and groups while striving for continuing improvement of service delivery and nursing workforce. As noted by the International Civil Service Commission, “Standards for ethical practice promote common values and define the behaviour and performance expected. They are inherently part of the overall human resources management strategy” (ICSC 2001 p. 19). The Resource Management domain includes competencies to mobilise administration of appropriate records and personnel systems; manage payment of classification and compensation arrangements; develop and use position descriptions and associated salaries and allowances; adhere to relevant labour laws and regulations; ensure that a full staffing complement is maintained within budget; and allocate available staffing resources in a way that is fair, reasonable, and maximizes productivity. A nurse who is competent in this domain will be able to manage the available nursing resources to ensure that they are allocated rationally, effectively and efficiently, so that services can be maintained at all times, and targeted to the areas of greatest need when required.
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Figure 1: Summary of Competency Domains
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The Workforce Planning domain includes developing projections of staffing levels required to deliver on goals and priorities; planning and implementing changes to service delivery and the implications for staffing requirements; developing and implementing strategies to recruit and retain staff; succession planning; supporting innovative approaches to workforce challenges; and identifying and implementing measures to improve quality and productivity. Nurses who are competent in this domain will demonstrate capability in the planning and management of the nursing workforce to ensure that their organisation strategically plans to have sufficient staff, with the appropriate skills, to meet current and future needs of their populations or clients (NWP 2005). This includes systematic assessment of future nursing staff requirements in terms of numbers, levels of skills and competencies, education, and related policies. The process also includes strategies for developing and retaining the nursing workforce to meet the health sector strategic goals and objectives.1 The Work Environment domain includes working to ensure that the safety and security of staff is maximized; that the physical environment, facilities and equipment are adequate; sexual harassment, workplace violence and verbal and physical abuse are eliminated; that appropriate measures are taken to avoid injury and fatigue; that staff feel valued and have opportunities to contribute to planning, problem solving and decisionmaking; and a work-life balance is promoted. Unhealthy, unproductive work environments are characterised by: • • • • • •
occupational hazards; physical and psychological violence; unreasonable workloads; insufficient remuneration; limited career development opportunities; general deterioration of working conditions.
Nurses who are competent in this domain will demonstrate abilities to both identifying and implementing ways to exert a powerful influence over the environment and workplace culture. The Staff Management, Support and Performance domain includes providing opportunities for ongoing training, education and professional development and growth; providing constructive feedback and review; providing advocacy and support for staff; managing performance through both remedial action and recognition and reward; building effective teamwork, communication and negotiation. The focus of staff support and performance is to attract, develop and retain the nursing workforce in an enabling work environment. It involves communication, advocacy, mentoring, recruitment and selection processes, supportive supervision, performance appraisal, staff training and
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There are a range of resources widely available which look at workforce planning in greater detail than is provided here. For example, the UK’s National Health Service (NHS) has developed the ‘UK Wide Workforce Planning Competence Framework’ and an accompanying interactive CD. This document is available at www.healthcareworkforce.nhs.uk/workforce-planning-competenceframework/.
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development, recognition and awards, equitable personnel policy administration, and preventing and resolving conflict. The Leadership domain includes the knowledge, skills and capacities which enable the leader to empower those around them and harness their strengths toward collective effort. It includes effective collaboration, developing strategic alliances and partnerships, negotiation skills, high level oral and written communication skills, building and motivating teams, and decision-making.
Indicators of competency: A multi-level approach Although competencies are common across many different roles, their application and the level of competency vary according to the particular work roles and contexts. This is reflected in the diverse expectations, as shown in the individually defined performance measures. For example, a workforce planning approach that is most suitable for a multicampus hospital in a large city will not be the same as that required in a rural community health service in a remote area. Similar competencies will be required, but they will be applied and expressed in different ways. Similarly, the human resources planning and management competencies required by a Director of Nursing will be different in nature from those required by a nurse with responsibility of managing a team of clinical nurses in a specific ward/unit of a hospital. Both will need to assess their staffing needs, but at a different level of detail. As well, the level of responsibility associated with specific work roles or designations will vary across countries, locations and organisations. Each will take different types of actions in response. For the purposes of the monograph, four levels of nurses’ role and function descriptives have been developed in an attempt to capture the diversity of nurses’ contribution in the development, design and delivery of health services as viewed in the HR management context, as outlined in Table 1.
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Table 1: Four levels of ‘nurse’ used in determining the performance indicator of nursing HR planning and management in each competency domain. Level
Role and function description
Example Position Titles
1
Qualified nurses working in the field, encompassing the promotion of health, prevention of illness, and care of physically ill, mentally ill and disabled people of all ages in primary, secondary and tertiary health care settings including community settings. They are responsible for the supervision and delegation of the work of auxiliary personnel, for the quality of patient care and for the standard of nursing practice.
Ward Nurse, Duty Nurse, Registered Nurses (RN), Community Nurse, Enrolled Nurse, Licensed Practical Nurse
2
A Registered Nurse, who is clinically and/or administratively responsible for a designated unit, facility or programme. S he/he plays a role in leading a team by facilitating and collaborating the team’s processes toward the completion of the tasks. The responsibility includes developing and implementing standards of practice and managing human and material resources to provide sound nursing HR management practice within a defined area.
Ward Sister, Nurse Team leader Charge Nurse, Head Nurse, Public Health Nurse Manager
3.
A senior nurse manager who manages the clinical and administrative nursing service, and provides leadership in an organisation such as a hospital or health service. Within that organisation, she/he is responsible for the design and execution of strategic plans; quality improvement; service continuity in patient care, nursing workforce, educational programmes, work environment, and organisational structures and systems that will successfully lead to significant outcomes in patient care, nursing workforce welfare and nursing education programmes. He/she is a responsible for the nursing division and the coordination with support services.
Director of Nursing Department Matron, Vice-President of Nursing, Director of Nursing Education Programme
4
A senior nurse manager is responsible for the maintenance, strategic development and strengthening of nursing practice and the nursing profession across at a regional or national level. The responsibilities of this role are overarching and may impact a range of different organisations. She/he participates in health policy development and provides advice to regional and national authorities on matters pertaining to the development of nursing standards and healthcare service delivery.
Chief/Principal of Nursing Officer Director-General of Nursing, Nurse Registrar
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The behaviours across the four levels of nurses are intended to be cumulative, reflecting the increased level of expertise, knowledge and skill that is required at higher levels of responsibility. Thus, ‘Level 1’ competency will apply to qualified nurses, including those who may not hold a position which is formally designated or recognised as ‘manager’. However, as demonstrated by the range of competencies for the generalist nurse listed in Table 1, this may include a leadership role in the workplace. Nurses with responsibility of managing and supervising a programme or unit may require a ‘Level 2’ competency in addition to the ‘Level 1’ competencies. Following this approach, a position requiring Level 3 behaviours is presumed to include Level 1 and Level 2 behaviours, and so on. The approach is illustrated by tables provided in pages 21 to 31. The tables provide examples of performance indicators of competency at each of the four nurses’ levels, and for each of the competency areas. Although they are intended to be broadly applicable, the working environment and organisational context will play an important role in exactly how specific work roles are defined and delineated. The competencies required can be adapted according to these different circumstances.
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Competency Domains2 Competency Domain 1: Ethics and Standards Examples of Performance Indicators Competency
Level 1
Level 2
Level 3
Level 4
1:A
Professionalism Promotes & maintains professional practice
Maintains courteous & professional standards of behaviour at all times in the workplace & in dealing with nursing & non-nursing colleagues, patients & members of the community.
Establishes standards & maintains a work environment in which all staff behaves courteously & professionally at all times.
Advocate for quality health & nursing care. Promotes & maintains the professional image of nursing across areas of direct responsibility & the organisation as a whole.
Provides leadership & actively promotes the core values of nursing amongst the community & other key stakeholders.
1:B
Legal & ethical practice Practices in accordance with relevant legislation, regulation, guidance & standards of practice.
Identifies relevant legislation, national polices & procedural guidelines & practices accordingly.
Ensures that the teams are aware of the current legislation, national policies & procedural guidelines, & their implications for the workplace.
Monitors changes in legislation & national policy & takes necessary action to ensure that these are reflected in procedural guidelines & other organisational processes & systems.
Contributes nursing perspective to the development of relevant legislation, national policies & procedural guidelines through participation in relevant forums & discussions.
1:C
Respect Respects the values, customs, spiritual beliefs & practices of individuals & groups.
Treats others in the workplace with respect & practices care delivery with regard for customs & spiritual beliefs of patients.
Develops & maintains knowledge of the values, customs, spiritual beliefs & practices of nurse as individuals & groups & utilises this knowledge in the development of operational plans & delivery of care.
Develops & implements policies, procedures, guidelines & standards to ensure that the organisation respects nurse’s values, customs, spiritual beliefs & practices of individuals & groups in its dealings with both staff & the community.
Ensures the effective & efficient development & implementation of health care policy in congruence with the values, customs, spiritual beliefs & practices of nurse as individuals & groups.
2
Throughout these tables, footnotes are provided referring the reader to relevant competencies as outlined in the International Council of Nurses; Nursing Care Continuum Framework and Competencies (2008).
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Competency
Examples of Performance Indicators Level 1
Continuing improvement Is committed to continuous review improvement to care, based on evidence
1:D
Promotes dissemination, use, monitoring & review of professional standards & best practice guidelines3.
Level 2 Provides leadership in developing the evidence base for professional standards & best practice & leads in developing & adapting standards to the 4 practice context .
Level 3 Disseminates, promotes & implements best practice across the organisation, & proactively seeks ways to improve service delivery.
Level 4 Uses contemporary evidence of practice to critically evaluate current approaches to health care delivery & seek to improve population health outcomes through continual improvement.
Competency Domain 2: Resource Management Examples of Performance Indicators Competency
Level 1
Level 2
Level 3
Level 4
2:A
Operational planning Prepares & implements detailed operational plans for staffing & human resources allocation.
Implements operational plans by managing time & workload to ensure that high quality care is delivered.
Plans the continuity of work unit activities with attentive to the type of nursing human resources required based on the skill & capacities of nursing staff. Ensures that both short & long term needs are met, & implements plan within scope of responsibility.
Develop & integrate human resource planning framework for nursing service that addresses consumer & system needs, supply-demand, education & deployment. Manage & coordinate the implementation of the nursing operations plans to balance & address the diverse programme needs & priorities of the organisation.
Formulates & implements a strategic plan for the development of nursing including adequate contingency plans for emergency &/or disaster response.
2:B
Staff allocation Allocates staff rationally & equitably, based on patient dependency, acuity, programme requirements & nursing workforce skills
Creates & manages staffing patterns to meet patient care needs.
Maintains a comprehensive knowledge of patient needs, programme requirements, & individual staff abilities & talents & utilises this knowledge in the allocation of staff including the development of rosters.
Ensures that available nursing resources are distributed across the organisation to maximise quality service delivery with regard to patient flow, service profile & programme requirements.
Recognises the population diversity & related health needs, & advocates for health policies, which support the distribution of health human resources including nurses according to need.
3 4
ICN (2008) n.82. ICN (2008) n.82.
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Competency
Examples of Performance Indicators Level 1
Level 2
Level 3
Level 4
2:C
Personnel systems & records Ensures accurate personnel information is available, according to organisational & employment requirements.
Ensures that personnel information relevant to employment is accurate & upto date.
Maintains accurate & up-to date personnel information on all staff members, & ensures the timely & accurate recording of such in accordance with organisational requirements.
Ensures effective & secure systems are in place for the effective gathering & recording of personnel information, consistent with organisational requirements & accepted practice of information management.
Establishes a national information management system for recording nursing workforce, & other forms of data.
2:D
Labour laws & regulations
Observes the rights & responsibilities applicable to the terms & conditions of employment.
Complies with fair employment laws & regulations. Manages nursing staff in accordance with the requirements established under the terms & conditions of employment.
Complies with legal aspects of fair employment. Seeks to protect & advance the interests of nurses & the nursing profession in the development & implementation of employment contracts & agreements, & manages industrial negotiations & processes.
Negotiates with key stakeholders to ensure that the legal & industrial frameworks & resources are in place to ensure that nurses’ employment rights & entitlements are fair & enforceable.
2:E
Budget & financial management Demonstrates knowledge of financial management techniques in the management of the nursing workforce, including budgeting, supply management & productivity measures.
Adheres to organisational procedures in relation to purchasing, acquisitions, & financial delegations.
Is aware of & considers the budget implications when making staffing decisions.
Utilises health care economic principle & clearly demonstrates the financial impact of nursing staffing models on patient, organisation & community outcomes in presenting financial information. Liaises effectively with financial staff to ensure that human resources planning across the organisation occurs within appropriate budget parameters; lobbying effectively for financial resources as required.
Maintaining knowledge of health care financing principles. Analyses the long & short term financial implications of policy options & their implications for decisionmaking for the nursing workforce & the sector as a whole.
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Competency Domain 3: Workforce Planning Examples of Performance Indicators Competency
Level 1
Level 2
Level 3
Level 4
3:A
Data analysis Develops, monitors & analyses key indicators of current & future workforce needs & challenges.
Records & reports systematically on key data relevant to workforce planning in the workplace (e.g. identified needs & shortages).
Recognises key workforce planning indicators & ensures that these indicators are collected, analysed, & reported on in a timely & effective manner, in line with organisation needs & planning processes.
Analyses workforce indicators that will most effectively & efficiently inform decision-making on key workforce needs & challenges. Implements systems to ensure that these indicators are monitored & analysed in a timely & effective manner. Updates the profile of nursing human resources, vacancy information, weighted supply & demand factors with commitment to regular & ongoing adjustment.
Utilises effectively evidence of nursing workforce needs & challenges in the development of strategies & proposals for the future development of the nursing workforce & the establishment of human resources for health, which are adequate to meet the health service needs of the community.
3:B
Manage workforce supply Identifies, plans & implements strategies to address current & future nursing workforce needs.
Recognises the workforce implications of operational decisions & ensures that colleagues are aware of operational & staffing issues that may impact on workforce planning & requirements.
Assesses the current & future staffing profile required to meet operational needs in order to deliver operational requirements. Develops recruitment, retention & other strategies seeking to meet these needs. Supports level 1 nurses with human & technical resources that allow nurses to do the required work within reasonable hours.
Implements evidence-based approaches to workforce planning across the organisation. Develops strategies to resolve operational workforce management issues, such as workload, overtime, absenteeism & deployment.
Analyses key issues in the planning of human resources for health as they impact on the nursing workforce, & works with other key stakeholders within & beyond the nursing workforce to develop effective strategic approaches to meeting current & future workforce needs.
3:C
Manage skills supply Identifies, plans & implements strategies to ensure that the nursing workforce has the skills & competencies to meet emerging needs & priorities.
Identifies areas where further skills & competencies are required.
Ensures that staff have the skills & capabilities to meet emerging scientific, technological, demographic & epidemiological advances, challenges & requirements.
Develops strategies whereby emerging workforce & service delivery needs can be met through the utilisation & development of existing staff skills, including appropriate use of multi-disciplinary teams & approaches to care.
Liaises with relevant stakeholders including education providers to ensure nurses are equipped with knowledge, skills & attitude required to deliver care effectively & that education is responsive to changes in technology, professional practice, structures & systems of health service delivery.
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Competency
3:D
Development & innovation Keeps abreast of developments in workforce planning for nursing & other human resources for health.
Examples of Performance Indicators Level 1
Level 2
Level 3
Level 4
Keeps abreast of workforce models & practices in human resources for health, & their implications for nurses, & uses this knowledge in reflecting on personal practice & workforce models.
Identifies & facilitates opportunities for the development of more effective workforce planning & management in the workplace, & works with others to implement these models of practice.
Appraises current practice in respect of programme delivery & patient care & implements changes to ensure that optimal use is being made of the nursing workforce & other human resources for health to maximise efficiency & quality of care.
Promotes approaches to care delivery, which ensure that the best use is made of key knowledge & skills of the range of health care professionals in the delivery of high quality care in line with community needs.
Competency Domain 4: Work Environment Examples of Performance Indicators Competency
Level 1
Level 2
4:A
Safety Creates & maintains a safe physical work environment.
Maintains knowledge of organisational safety, Total Quality Management including risk management practices & procedures, & observes them in daily practice.
Implements, monitors & reports on Total Quality Management including risk management strategies, reviewing adverse events, injuries or near-misses & identifies & implements remedial action. Develops a process whereby nursing leaders & administrators work with front-line nursing staff to assess the safety & health at workplace environment on an ongoing basis to identify problems & implement strategies to address them.
4:B
Freedom from intimidation, violence or abuse Creates a work environment with zero tolerance for intimidation, sexual harassment, & workplace violence.
Monitors the work environment to identify risk of intimidation, sexual harassment & violence & respond proactively, in line with local protocols & procedures.
Identifies threat or potential threat of intimidation, sexual harassment & violence to staff, & develop & implement ways for prevention, minimization & eradication.
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Level 3 Plays a key role in the implementation monitoring & review of Total Quality Management including risk management strategies & develops strategies to maintain & improve a safe work environment in timely & effective manner.
Ensures that the necessary elements – including physical environment, staffing resources & operational protocols – are in place to ensure a workplace free of violence, sexual harassment & intimidation.
Level 4 Promotes the importance of positive practice environments & the effects on the delivery of effective, high quality health care.
Advocates at the highest levels for the development & effective management of work environments free of intimidation, sexual harassment & violence.
Competency
Examples of Performance Indicators Level 1
Level 2
Level 3
Level 4
4:C
Workload & balance Ensures that workloads are reasonable, sustainable, & fairly distributed, & that staff are able to establish a healthy & sustainable work/life balance
Prioritises workload & manages 5 time effectively.
Monitors the level & distribution of workload across the team, & seeks to develop approaches to staffing & rostering which meet the needs of staff. Collaborates with nurses & employers to ensure a reasonable workload & addresses issues of staff mix & practice environment.
Develops & implements organisational protocols & policies to promote & enhance a balanced & sustainable working life for staff, & considers & addresses the workload implications of new programmes & initiatives in planning & service development. Puts in place policies that allow nurses to function to the maximum of their professional practice abilities.
Advocates for the need to establish sustainable & fair workloads for nurses, & proactively seeks to develop strategic approaches to the management of nursing workloads.
4:D
Valuing diversity Values cultural & other diversities at the workplace, ensures a work environment free of discrimination, & preserves staff dignity.
Contributes to the development of a work environment free from discrimination & preserving the dignity of nursing & non-nursing colleagues, patients & their family.
Fosters a work environment that preserves dignity & is free from discrimination by fostering cultural exchange & understanding & ensuring staff value cultural diversity in their daily practice.
Establishes an organisational culture in which dignity is preserved, cultural diversity is valued & both the delivery of services & the employment & management of staff are free from discrimination, ensuring that these values are reflected in organisational polices & procedures.
Advocates for all nursing staff to be treated with dignity & respect & promotes diversity in the development of the nursing workforce, & monitors the enforcement of these polices in the workplace.
4:E
Risk identification & management Actively manage risk & ensure that nursing & other staff have the knowledge & skills necessary to prevent avoidable accident, incident, injury & illness.
Identifies opportunities to improve the work environment & alerts work colleagues & supervisors to any actual or potential areas of risk.
Keeps a record of identified areas of actual & potential risk & action taken to address them, including utilising information in the implementation of organisational approaches to risk assessment & management.
Conducts a systematic review of sources of risk across the organisation & uses this to develop prioritised strategies for the development of a safer & more supportive work environment.
Works with key stakeholders including government, other professionals & the community at large to improve the work environment for all nurses.
5
ICN (2008) n.62.
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Competency
Examples of Performance Indicators Level 1
Level 2
Level 3
Level 4
4:F
Remediation Provides access to treatment for staff who have suffered a workplace accident, incident, injury or illness, & supports their safe return to work.
Provides positive support for colleagues who are at risk of, or who have suffered a workplacerelated harm, & work cooperatively to assist their safe return to work.
Works with affected staff & other team members to plan & implement necessary treatment & support for those who have suffered harm resulting from a workplace related incident.
Ensures the availability of resources including financial, & access to information & advice to support supervisors & their staff in providing access to treatment of staff who have suffered a workplace accident, incident, injury or illness.
Establishes systems & protocols for proactive workplace risk management.
4:G
Managing conflict Manages workplace conflicts through mitigation, negotiation, consensus & mediation.
Confronts conflict in nonjudgmental fashion, making effective use of communication skills & existing mechanisms to 6 achieve resolution .
Addresses conflicts promptly & creatively, recognising the potential for opportunities & new 7 solutions . Ensure the confidentiality of the person involved.
Establishes & implements fair & transparent protocol. Processes conflict resolution in consultation with the concerned staff by having a visible presence & acting as an exemplary role model
Works with key stakeholders including national nurses associations, other professional bodies & relevant statutory bodies to ensure that mechanisms are available for the resolution of conflicts involving nurses with regard to due process.
6
ICN (2008) n.59. ICN (2008) n.59.
7
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Competency Domain 5: Staff Support and Performance Examples of Performance Indicators Competency
Level 1
Level 2
Level 3
Level 4
5:A
Roles & responsibilities Defines & effectively communicates duties, roles & responsibilities to staff.
Practices in accordance with established duties, responsibilities & expectations as well as professional standards & scope of practice.
Communicates with staff clear & appropriate job descriptions, duties, responsibilities & expectations.
Ensures a consistent & standardised approach to the communication of duties, responsibilities & expectations to staff, in line with a cohesive organisational structure.
Reviews nurses’ scope of practice & advocates for the establishment & maintenance of a consistent & standardised career structure & approach to job roles.
5:B
Orientation & inservice training Provides effective orientation & ongoing in-service education, which reflects operational policies & values of the organisation.
Seeks learning opportunities in the workplace & shares knowledge & experience with colleagues.
Ensures that all staff are provided with effective orientation, & participates in inservice education, which reflects operational policies & values of the organisation.
Plans & implements programmes of ongoing inservice education across the organisation, which reflects established operational policies & values.
Ensures an ongoing programme of orientation & in-service education is in place at all health care facility/educational institution for new nursing staff recruits.
5:C
Supervision & delegation Delegates activities commensurate with scope of practice & abilities & provides effective & supportive, & learning-oriented supervision.
Monitors & uses a range of supportive strategies including precepting when supervising &/or monitoring delegated care, maintains accountability when delegating to others, & contributes to policy & protocol development around delegation 8 of clinical responsibilities
Offers supportive strategies including mentoring, coaching & precepting as part of supervisory responsibility, & contributes to policy & protocol development that relates to delegation of clinical responsibilities within nursing & across the health 9 professions.
Ensures that appropriate organisational policies & protocols are in place to support the delegation of responsibility & is an integrated part of clinical governance arrangements.
Fosters professional autonomy, responsibility & accountability of the nursing workforce
8 9
ICN (2008) n. 73, 74,75. ICN (2008) n. 73,74.
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Competency
Examples of Performance Indicators Level 1
Level 2
Level 3
Level 4
5:D
Training development & growth Prepares staff training & development plans with employees based on organisation & employees needs.
Assumes responsibility for lifelong learning & maintenance of competence.
Plans & implements an approach to staff training & individual staff development, which both reflects operational objectives & helps improves the quality of care outcomes.
Investigates the feasibility & develops operational plans for funding continuing education for nurses. Monitor the need for specialty programs. Provides funding, supports training & evaluates the outcomes of training & development.
Develops strategic approaches to nurse training & developments in the context of existing standards, changes & trends in health care delivery & contemporary policy, theory & practice.
5:E
Recognise & reward performance Recognises & rewards staff performance.
Values & acknowledges the efforts of nursing & non-nursing colleagues including both the individual’s performance & contribution to the achievements of the care team.
Implements merit-based systems for performance assessment & reward with balance, transparency, fairness & equity, consistent with organisational policies, procedures & values. Recognises & rewards nurses who act as preceptors & mentors.
Develops the organisation’s capacity for the formal recognition & reward of performance, inclusive of financial & non-financial means.
Promotes the contribution of nurses to the delivery of key national & global health care goals, lobbying for the recognition & reward of their contribution amongst key stakeholders.
5:F
Discipline & remediation Implements fair & just processes of remediation wherever instances to address poor or unprofessional practice, including just & fair disciplinary measures were necessary
Challenges behaviour & health care practice that could compromise client safety, privacy or dignity, & recognises & acts upon breaches of law relating to the professional role &/or professional code of 10 conduct/practice
Participates in creating systems to monitor & respond to situations where behaviour or health care practice may compromise client safety, 11 privacy & dignity
Develops & implements a performance management policy to support the ongoing process of identifying, evaluating & developing the work performance of staff so that the facilities strategic goals & objectives are more effectively achieved.
Works with key stakeholders including employers, regulatory bodies, unions & national nurses associations to ensure robust & transparent performance management systems & reporting mechanisms to protect the public through safe & competent practice.
10 11
ICN (2008) n.12 16. ICN (2008) n. 12.
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Competency Domain 6: Leadership Examples of Performance Indicators Competency
Level 1
Level 2
Level 3
Level 4
6:A
Leadership & teamwork Communicates appropriate leadership style & values that are supportive of the health system, & the nursing workforce, & are in congruence with a healthy work environment.
Articulates own leadership contributions & supports expectations of other team members, & reinforces goals to promote respect & confidence 12 within the team.
Creates confidence in self & in the organisation to inspire others by tailoring leadership behaviours to maximise the contribution of others, & clearly 13 defines expectations of others . Identifies & support incentives that facilitate teamwork. Creates a bond with team member & leads by example
Provides professional input on behalf of nurses. Represents & advocates for the interests of nurses & the nursing profession & participates effectively as a member of an organisation’s leadership group. Maintains effectiveness in interpersonal relations. Communicates, listens & addresses factors to support teamwork to achieve organisation’s strategic objectives.
Models behaviours, which reflect & promote nursing’s values & its contribution to the development & provision of high quality health care & improved health outcomes.
6:B
Partnerships & alliances Builds alliances & partnerships nationally & internationally in support of services for patients, nursing workforce, & others.
Works collaboratively within & with other professionals in health care to enhance nursing & other health services being 14 accessed by clients
Utilises leadership, team building, negotiation & conflict resolution skills to build intra/inter-professional, agency & community partnerships to improve quality of care & address gaps/barriers to 15 access.
Utilises leadership, team building, negotiation & conflict resolution skills to build intra/inter-professional, agency & community partnerships to better understanding the needs & better match between supply & demand for health professionals pertaining to the interests of nurses, quality care improvement & address 16 gaps/barriers to access.
Develops & utilises strategic partnerships with key stakeholders, organisations & civil estates (e.g., the media) nationally & internationally in promoting the interests of nurses & nursing.
12
ICN (2008) n. 58,60,61. ICN (2008). n.58,60,61. 14 ICN (2008) n.77. 15 ICN (2008) n.77.) 16 ICN (2008) n.77. 13
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Competency
Examples of Performance Indicators Level1
Level 2
Level 3
Level 4
6:C
Change management Works effectively in a dynamic health care system.
Provides feedback & offers suggestions for changes in own sphere of practice & deals effectively with the impact of change on own practice or the 17 organisation.
Introduces, evaluates & manages innovation & change in the health system through 18 encouraging creativity & assists team members to manage the impact of change on their own practice.
Analyses both the risks & opportunities associated with change processes & acts to ensure their effective & positive implementation, supported with adequate resources.
Builds capacity of the nursing workforce to both initiate & cope with changes in the dynamic health system in order to strengthen the workplace & improve health care delivery.
6:D
Decision-making Engages effectively in ethical decisionmaking.
Makes decisions ethically & transparently, within the scope of one’s professional responsibilities, & with appropriate consultation with patients & colleagues.
Models ethical decision-making in the team environment, promoting & maintaining a sound understanding of ethics among team members, & acts as a resource to staff on ethical judgment.
Ensures that there are appropriate organisational structures & systems (including, where relevant, reference groups) in place to support ethical decision-making in the workplace, including both clinical & non-clinical decisions.
Models the highest standards of ethical decision-making in dealings with other organisations & public life.
6:E
Accountability Accepts accountability & responsibility for one’s own professional judgment & actions.
Accepts accountability for own professional judgment, actions, outcomes of care & continued competence in accordance with scope of practice, increased responsibility, legislative acts & 19 regulations .
Accepts responsibility for one’s own actions & judgements, those delegated to others, & the judgement & actions of staff for whom you are responsible.
Promotes an organisational culture which values both individual accountability & organisational accountability for actions taken in accordance with accepted policy, procedures & guidelines.
Accepts responsibility to represent all nurses at the highest level of public debate.
6:F
Strategy & negotiation
Recognises long term goals & objectives & identifies & suggests ways to achieve them in the context of short term service delivery priorities
Uses creative problem-solving & high-level communication skills to identify common & diverging interests & develop creative approaches which will achieve long term outcomes within the workplace, in line with organisational goals & clinical roles & responsibilities.
Demonstrates ability of system thinking & contributes most effectively to long-term improvements for nurses & better nursing outcomes.
Utilises knowledge of the civil, political, economic & social environment to advocate for & promote the contribution of nursing & the position & role of nursing in health care delivery.
17
ICN (2008) n.65. ICN (2008) n.31. 19 ICN (2008) n.12. 18
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CHAPTER 3: IMPLEMENTATION No one model of implementation including monitoring and evaluation strategies will fit the diverse conditions of international nursing and health care and will need to be considered within the context of: • • • •
current approaches to nursing education and professional development; the extent to which nurses play an active and influential role both in national health policy development, and in the senior management of policy and service delivery organisations such as hospitals, health centres and government departments; prevailing nursing regulation including registration requirements, and; the different administrative and management capacities of locations and organisations.
Since countries are at different stages of development of nursing, in those countries where similar competencies and indicators for nurses with management responsibilities have already been officially defined and in use, the proposed framework may be used for updating or verifying such competencies. Where such competencies and indicators do not exist, this framework can be reviewed and adapted to the national context with full participation of key stakeholders, including nursing regulation bodies, national nursing associations, and health service policy makers and administrators. At the level of individual nurse, the competencies can be used to inform their own practice in HR management and practice. In addition, these competencies can be utilised to develop specific job descriptions or define work roles, in conjunction with the other range of competencies relating to nursing practice and the provision of care as outlined in the Nursing Care Continuum Framework and Competencies. It should be recognised, however, that health care organisations are extremely diverse. The diversity of structures and therefore the individual roles that are defined within those structures means that there is no ‘one size fits all’ approach to establishing the required set of competencies for an individual role as defined by a contract or position description. The mix and levels of competencies required for an individual job role, the structure of the organisation, or the circumstances and challenges that a programme or organisation is facing at the time will all influence the competencies required. For example, a programme that is in the midst of an extensive change process may need a higher level of competency in relation to change management than is otherwise required. Conversely, if a nurse takes over a team where the structure and organisation is stable, but serious issues in motivation or performance are evident, competencies in the domains of staff support and performance of work environment may be highlighted more strongly.
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For this reason, the examples of competencies provided here should be viewed critically within individual contexts to ensure that they are targeted to meet the key demands that all levels of nurses face in regard to HR management. Taking a ‘mix and match’ approach, whereby competencies of different levels are applied within the one job role, may be suitable in cases such as these.20
20
An example of this approach is provided by the guidance developed by the UK’s Royal College of Nursing in relation to the Knowledge and Skills Frameworks for nursing posts (RCN 2005, p.9).
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CONCLUSION Nurses play a key role in patient care, and in the ongoing development and delivery of health services. There is a long history of nurses and nursing developing innovative approaches to care provision through the development of new ways of working, influencing the focus and delivery of care, and promoting the achievement of health outcomes. The role of nurses as leaders and managers is increasingly being recognised. Nursing management is becoming a larger and more complex role as health care and the organisations that provide it become more complex. As well, nurses are increasingly taking up posts at the highest level of health care management, as programme managers, chief executives and heads of department. The development and articulation of the range of competencies that are required for nurses to become an effective HR planners and managers have historically received less attention than those related to the complex task of clinical care delivery. However, in an environment where all health workers, including nurses, are an increasingly scarce and valuable resource, the development of these competencies becomes more and more urgent. The competencies outlined here, and the examples of how achieving competency may be defined for nurses at different levels and stages of their careers, aim to support nurses in that role.
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