The Perfect Assessment: Competency

Mind the GapBackground

Whilst working as a postgraduate course coordinator I regularly had discussions with students, nurse educators and the higher education team of the ‘ideal’ assessment. Everyone seems to have their own views and preferences on the correct method of assessment. This variability is matched by workplaces and universities assessing using an array of assessment methods for nurse training.

Keywords: competency, competent, test, assessment, professional development.

Education Question

You are the nurse educator and a nurse in your unit is struggling to meet the expected standards set by your nurse leadership team. The manager has asked you as the educator to spend time with the nurse and assess levels of competence. What is your approach to this situation and how are you going to assess this nurse?

Competence & Competency

“Competence is focused on the description of the action or behaviour, whereas competency is focused on the individual’s behaviour underpinning the competent performance.” (Tilley, 2008, pg. 63).

Example of national standards of nursing competence from NMC (UK):

“The standards for competence apply to all fields of nursing and are set out in four main areas of professional nursing practice. These are professional values, communication and interpersonal skills, nursing practice and decision-making, and leadership, management and team working. ”

Professional Competence: Multidimensional Model

The assessment may measure one, some or all of the following domains:

  • Knowledge
  • Skills
  • Attitudes
  • Decision making
  • Problem solving
  • Professional attributes (interpersonal skills)

Education Theory

Understanding and addressing how people learn using Bloom’s Taxonomy, includes the cognitive domain, the affective domain and the psychomotor domains for educational objectives. To guide the framework for assessment commonly the Bondy (1983) 5 point rating scale is utilised which provides a hierarchy of competence:

  1. Independent
  2. Supervised
  3. Assisted
  4. Marginal
  5. Dependent

Assessment Options:

  • E-learning package
  • Blended approach (e-learning & hands on assessment)
  • Objective structured clinical examination (OSCE)- Simulation
  • Oral case presentation: the hot case
  • Exam
  • Multiple-choice
  • Essay
  • Reflection
  • Self-assessment
  • Practice portfolio
  • Checklist skill task
  • Appraisal: formative and summative

McDonald (2014) states that “a multidimensional approach is essential to assess all aspects of behavior. This is especially true when assessing psychomotor skills, affective behavior, or higher-level cognitive ability such as critical thinking” (pg 7-8).

The correct assessment will be determined by the instructional process and intended learning outcomes.

Formative & Summative

An authentic form of assessment which requires ongoing development and a process of feedback. Formative (assessment for learning) and summative (assessment of learning) assessments provide an opportunity for self assessment and constructive feedback (Looney, 2011).

Qualities of Assessment

  • Validity
  • Feasibility
  • Fidelity to practice
  • Reliability
  • Practical considerations
  • Authenticity

“Reflect effective performance and can be evaluated against well-accepted standards” (Leigh et al, 2007).


Competence is difficult to define and lacks consensus. Is it assessing potential or ability?

Elements of subjectiveness exist if competence is judged by observing nurses’s performance. There is a lack of consensus on using a competency model for teaching and evaluating. And at what point does competency need measuring to move from general to specialised competency (Tilley, 2008). Is the capability framework approach more representative of ability and performance? One of the ongoing difficulties is agreement between employers and Universities in nurse education. Employers want work ready graduates, Universities want lifelong learners.


Anderson, L.W. (Ed.), Krathwohl, D.R. (Ed.), Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., Raths, J., & Wittrock, M.C. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s Taxonomy of Educational Objectives. New York: Longman. [example here]

Bondy, K, N. (1983). Criterion-referenced definitions for rating scales in clinical evaluation. Journal of Nursing Education. Vol. 22, no. 9, pp. 376-382. [example here]

Leigh, I. W., Smith, I. L., Bebeau, M. J., Lichtenberg, J. W., Nelson, P. D., Portnoy, S., … & Kaslow, N. J. (2007). Competency assessment models. Professional Psychology: Research and Practice, 38(5), 463.

Looney, J. W. (2011). Integrating Formative and Summative Assessment: Progress toward a Seamless System? OECD Education Working Papers, No. 58. OECD Publishing (NJ1).

McDonald, M., & Ovid Technologies, Inc. (2014). The nurse educator’s guide to assessing learning outcomes (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Tilley, D. D. S. (2008). Competency in nursing: A concept analysis. The journal of continuing education in nursing, 39(2), 58-64.

Social Media for Nurses: Twitter

Beginners Guide To Twitter

Twitter is a service to communicate and stay connected through the exchange of quick and frequent messages. People post Tweets, which may contain photos, videos, links and up to 140 characters of text.

Twitters Mission: “To give everyone the power to create and share ideas and information instantly, without barriers”.


It’s agile, so current research and hot topics are discussed in a time relevant manner. You are following up to date practice. So try following professional nursing organisations, specialist organisations, publishers and the world famous gurus to see what they are up to.

Like any resource, it’s up to you as a professional to critique it’s merits.

The Eggtwitter-egg

For those who are unfamiliar with “the egg”, it’s the default avatar (picture) that Twitter gives to every new account. The advice is be brave and add a photo, add a brief bio, change the background and away you go.

Caution for nurses: You may not be able to add your employer details into your bio. Check with your organisation and their rules on social media. “Posts Are My Own And Not Necessarily Those Of My Employer”  is a common bio addendum.

Fantastic How To Guide

A Nurse’s Guide To Twitter by Paul McNamara (@meta4RN)

10 Things You Didn’t Know About Twitter 

Who To Follow?

Type in some keywords of areas of interest and see where you end up. Below are some people and #hashtags to follow.

Some Extra Tools

You can have more organised lists and manage followed topics using tools such as Tweetdeck or Hootsuite [guide here]

Happy Tweeting

Gaming: A Solitary Existence?

If we think of gaming for education purposes we think of World of Warcraft or a recreation of a hospital setting and the ability to interact and train in a safe environment. The learner can be immersed in this experience, and with virtual reality increasing in its development the potential is fast approaching for mainstream education opportunities.

Here it is….. the but. Is this method of training too isolated? If we think back to childhood games (maybe go back a generation or so, depending on your age) and the level of team play and interaction that was involved. Today the experience can be recreated but in a potentially isolating setting, and with a loss of real human interaction and managing the relationships that occur in day-to-day life could be missing in gaming. People are just unpredictable and the question is: how is this unpredictability recreated in a gaming situation for healthcare professionals?

“There is no right decision in life, because every decision we make is new and unpredictable.”  by M.F. Moonzajer

This need to network and connect for deeper learning must not be forgot in the advance of technology. Tacking in technology to a learning program will likely be a novelty, it needs to be embedded into the pedagogy.

“We’re stupid in dozens and dozens of ways. But human minds are plug-and-play devices; they’re not meant to be used alone. They’re meant to be used in networks” James Gee (Arizona State University). Games allow us to do that – they allow us to use what Gee calls “collective intelligence.” Collectively, we’re not so stupid.”

Keywords: Gaming, gamification, play, learning, networking, human mind


Maker Movement

What is the Maker Movement?

“The maker movement is about making things that you care about, things that are meaningful to you and others around you.” (Resnick, 2016).

It’s about being more than just a consumer, as we humans like to engage with objects. Dougherty (2012) highlights the tinkering skills of yesteryear and a trend to rediscover these skills, this is all part of the maker movement.

Creating such as cooking, mechanics, gardening, clothes making, pottery, woodwork, IT development, knitting and hacking all personify the maker movement.

Good for Learning?

“When you’re making something, the object you create is a demonstration of what you’ve learned to do, thus you are providing evidence of your learning” (Dougherty, 2012).

  • Learning hands on
  • Constructivism
  • Social learning
  • Participative
  • Networking:  collaboration of professions to bring an array of specialist knowledge.
  • Creative learning
  • Solves real world problems

Maker IT Tools


  • Learning: create it, understand it and develop it, rather than just understanding functionality. Especially important with technological advances and commonly our use of the interactive or front end part (ever opened up your phone to look at the inner workings?).
  • Imagine when creating a guideline or testing technology in your healthcare setting if a collaboration of IT, engineer, scientists, inventors and other specialists contributed to the idea generation and creation processes.


D. Dougherty (2012) The Maker Movement. MIT Press Journals.

The Edge (NHS): The Maker Movement: A Model for Health Transformation? .

Maker Culture (Wikipedia).

Resnick, M. (2016) The Maker Movement Isn’t Just About Making and Electronics. EDSurge.

Maker Movement Infographic

Ken Robinson: Creativity Expert

We believe Sir Ken is worthy of an individual post dedicated to his work alone. From books, Ted Talks, education policy adviser and media, this education guru is a creator and thinker on what teaching is and should be. Just transfer his discussion on education delivery from the school setting, into the hospital or higher education domain. The opportunity for creativity and imagination is the same. We adults have just forgotten how fun learning is or had it standardised out of us, during our own schooling.

France in XXI Century. School

Sir Ken Quotes

“If you’re not prepared to be wrong, you’ll never come up with anything original.” Ted Talk: Do Schools Kill Creativity?

“The problem with conformity in education is that people are not standardised to begin with” Creative Schools

“We stigmatize mistakes. And we’re now running national educational systems where mistakes are the worst thing you can make — and the result is that we are educating people out of their creative capacities.”

“If you’re not prepared to be wrong, you’ll never come up with anything original.” The Element: How Finding Your Passion Changes Everything

Ted Talks

“Creativity expert Sir Ken Robinson challenges the way we’re educating our children. He champions a radical rethink of our school systems, to cultivate creativity and acknowledge multiple types of intelligence” Ted Talk

Do Schools Kill Creativity?

Bring On The Learning Revolution!

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Robinson, K., & Aronica, L. (2015). Creative Schools: The Grassroots Revolution That’s Transforming Education. Penguin.

Robinson, K. (2013). Finding your element: How to discover your talents and passions and transform your life. Penguin UK.

Robinson, K. (2009). The element: How finding your passion changes everything. Penguin.


Emergent Change

Journal Article

Luiking, M. L., van Linge, R., Bras, L., Grypdonck, M., & Aarts, L. (2015). Intensive insulin therapy implementation by means of planned versus emergent change approach. Nursing in critical care.


Prospective comparative study introducing a new insulin protocol in an ICU in the Netherlands. Measurement of compliance within two teams of nurses.


Looks at Emergent Change (EC) implementation versus Planned Changed (PC) implementation.

  • EC-implementation involves a new working method protocol with the nursing team driving improvements and change.
  • PC-implementation involves a new working method driven by management in a centrally directed “top-down” manner.


EC-implementation change process had improved nurse compliance and shorter time to achieve treatment objective.

Key Points

  • Translation of evidence base into practice and that nurses frequently need to change working practices.
  • Organisational culture of change.
  • Transformative change.
  • Engagement of the team is required for effective change implementation.
  • The team find ways to achieve goals and standards.


For those interested in the glucose control and insulin discussion, I would advise reviewing NICE-SUGAR and VISEP trials for current evidence based approach. This article was used for its fantastic change management merits.

For critiquing articles Joanna Briggs Institute and BestBets.

Facilitating Emergent Change in a Healthcare Setting: Dr. Peter Dickens

Adult Learning (Andragogy)

The science of adult learning (andragogy) involves the understanding and supporting of lifelong learning in adult learners, and also developing the teaching of adult learners (Knowles, Holton & Swanson, 2011). We will refer regularly to the work of Malcolm Knowles, the godfather of adult learning theory. Now I am sure we will be interchanging between terminology and using teacher, facilitator, instructor and many others, but let’s not get too caught up in the pedantic’s. In the end we want to discover different learning theory, strategies and appropriate forms of assessment to meet our learners needs.  

Knowles’ 4 Principles Of Andragogy

  1.  Enagagement: Adults need to be involved in the planning and evaluation of their instruction.
  2.  Experiential: The opportunity and learning culture to test, succeed and also make mistakes.
  3.  Work relevant: Adults are most interested in learning that has relevance and impact to their job or personal life.
  4.  Problem-centered: Learner focused with a facilitator guiding the learning as opposed to a traditional teacher delivered content-oriented delivery.

We will provide much of our focus on adult learning (andragogy), as this is our population we are training in nursing. But we will also visit school level education (pedagogy) to see new ideas and concepts that could be incorporated into our education approach. It’s always worth remembering the enthusiasm that children have for learning new things (reflect back to your school days) and why as adults we don’t always feel this same eagerness to learn. We have to question what is different? Motivation may well be a key factor in this.

Now this ‘gogy’ is post-Knowles, which is heutagogy (Greek for ‘self‘) which is self-determined learning and places the emphasis of learning on the learner, moving away from the traditional teacher/lecturer role as the focal point. Defined by Hase and Kenyon (2000) as “the study of self-determined learning”, where in an ever-changing world of work, study and life where information is readily accessible and learning aligns with this accessibility. This fits in with the approach for adult learners, bringing a wealth of knowledge and experience into the learning environment.

Looking at how knowledge is constructed (epistemology) and how we learn, can improve the learning experience and outcomes. Incorporating neurocognitive approaches to learning can aid the learning process. In the health setting we also have varied training and education requirements, including the non-negotiable work requirement training (hands up for those who get excited on completing the same yearly e-learning packages). How do we motivate our learners for this type of situation where training is mandatory and the motivation factors for participation are very different? As an educator we also need to be motivated and provide consistency in not only new teaching opportunities but the day to day core training (think repetitive basic life support or moving & handling). This emphasis on delivering quality reminds us of a story of a chef and the consistency of cooking the same dish for 30 years which is now considered the world’s best paella, and the effort in not only their dedication to the same dish but the replicability and standard setting. Health is constantly changing so we nurses are constantly evolving as part of lifelong learning, with that the education philosophy will also have to adapt. Technology will be major influencer on education and learning so nurse educators must understand and engage in these e-learning spaces.  

Spotlight on Malcolm Knowles

Adult Learning Theory - Knowles' Four Principles of Andragogy
Find more education infographics on e-Learning Infographics


Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2014). The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. Routledge.