A Sisyphean task: Developing and revising public health nursing competencies

Abstract

Background Competencies are intended to enhance the public health workforce's skills. Competencies used to evaluate public health nursing (PHN) practice and education have been promoted by several nursing organizations. Having multiple sets of competencies raises questions about redundancies and their usefulness in evaluating PHN, as well as the central question about the value of the competencies themselves. Methods A literature review of psychometric evaluation research of the competencies was performed. Qualitative content analyses were conducted of seven documents: Association of Community Health Nursing Educators’, 2000 and 2010 essentials; Quad Council Coalition's 2004, 2011, and 2018 competencies; and the American Nurses Association's, 2013 and the 2021 draft of PHN scope and standards of practice with respect to competency definition, conceptual basis, and use of an established taxonomy. Results No psychometric evaluations of the competency sets were found. Textual content analysis revealed inconsistent and or missing competency definitions and theoretical frameworks with competencies proliferating over time. Taxonomy analysis identified minimal competencies at higher complexity levels according to Bloom's revised taxonomy. Conclusions Analyzed competencies lack reliability and validity testing, making assessment difficult for PHN educators and practitioners. Multiple and competing competencies further erode PHN's visibility, even among public health nurses. With unending revisions of PHN competencies and lack of supporting evidence regarding their effect and their integration into education or practice, recommendations for future efforts are offered.

Why a singular set of competencies will strengthen the Public Health Nursing workforce

“…Recent literature outlines the unintended outcomes associated with the existence of multiple competency sets with the PHN specialty. Canales and Drevdahl (2022) found that adding more competency sets to PHN practice had done little to address overall problems with competencies leading to unclear definitions and unreliable taxonomies for measurement. Rather than supporting the role of the Public Health Nurse, multiple sets of competencies led to further role confusion, poor translation to practice and inconsistent expectations of the individual.…”

“…As the number of new and revised PHN competency sets grows, two Executive or Senior management PHN leader at an organizational or systems level of practice. This feature may prove beneficial for measuring the progression from novice to expert but may be confusing in career development and planning since it does not follow the trajectory of skills that employees gain during their career progression and does not align with specific practice levels (Campbell et al, 2019) This strength also generates a problem in that multiple competency sets generate confusion, lack translation to practice, and set inconsistent expectations of the workforce (Canales & Drevdahl, 2022).…”

“…PHN practice is multifaceted and occurs in very heterogenous settings, leading to a lack of clear understanding of the work public health nurses do (Canales & Drevdahl, 2020; Kneipp et al., 2022). Multiple competency sets exacerbate that lack of understanding.…”

“…Scholars have long debated both the contributions and the confusion these competing competency sets have created within a profession that already struggles to fit a defined mold within the public health space and nursing sphere. It is imperative that the profession move past development and revision of proliferating competencies and begin to implement one clear and relevant set of competencies that connects to what Public Health Nurses do in their multifaceted roles and practice areas (Canales & Drevdahl, 2022).…”

Community and public health nursing: looking to the future

“…In turn, Purdue University, in the United States, points out 10 important lines of research in nursing, for 2022, of which we highlight telehealth and technology in health care, the need for self-care in nursing, and increased specialization. But it should be noted that, regarding the review and development of public health nursing competencies, it continues to be said that it is even more important to demonstrate how public health nursing improves the health of populations 5 .…”