Construction of a Professional Competency Matrix of the nurse in emergency services

Abstracts

Objetivo:

Propor Matriz de Competência Profissional para o enfermeiro atuar em serviços de emergências.

Métodos:

Trata-se estudo descritivo que detalha aspectos quantitativos, nominais e conceituais das competências propostas. A criação da matriz de Competência foi realizada com base na experiência profissional das pesquisadoras, evidências empíricas e literatura especializada.

Resultados:

A Matriz de Competências Profissionais proposta foi constituída por oito competências básicas, sendo-lhes atribuídas 31 Competências Associadas.

Conclusão:

A matriz proposta direciona a prática do enfermeiro em nível de excelência, diante das premissas qualidade e acesso no atendimento dos clientes em emergências.

Enfermagem em emergência; Competência profissional; Enfermagem baseada em evidências; Pesquisa em administração de enfermagem; Papel do profissional de enfermagem; Recursos humanos de enfermagem no hospital/normas

Introduction

The model of managing people in organizations changed during the last two decades of the twentieth century, when concepts were reformulated, and tools were created to meet the needs of the globalized world. Merely seeking the right person for the right position, with little inquisitive behavior, is no longer sufficient for the current scenario. This scenario is modeled on a management system focused on organizational and individual competencies, in order to obtain the aggregation of values to the business. Thus, seeking a new autonomous, flexible and entrepreneurial professional profile, generates the need to demonstrate pertinent competencies in every professional field and in accordance with the intended client.

As a result, companies and businesses start to count on people capable of making contributions and commitments with the introduction of new technology and the constant improvement of the work process, and transforming agents of knowledge, skills and attitudes, characterized by individual competencies. To define them it is necessary to consider the particular organizational context, the strategic objectives to be achieved with them, and one’s own competencies.

In the segment of nursing, specifically for work in emergency services, the nursing professional develops multiple actions encompassed in professional competencies to ensure individualized, dignified and humane assistance for those seeking or requesting this type of care.(¹,²)

The understanding of each competency depends on the precise definition of concepts by the use of a system of standardized language. According to the literature the effective use of standardized language is necessary to clearly present its constituent elements and the possibility of measuring these elements.(³)

What competencies should a nurse have to ensure quality care of clients in emergency services?(⁴-⁸) To respond to this question, the current study aimed to propose a Professional Competency Matrix for the nurse working in emergency services.

Methods

This was a descriptive study about the establishment of minimum professional competency of the nurse for work in emergency services, developed in the period from April to October of 2013, in a public university in the city of São Paulo, in the southeastern region of Brazil.

The creation of the Competency Matrix was developed based on the professional experience of the researchers, empirical evidence, and specialized literature. The Competency Matrix is understood to be a set of minimum necessary competencies, characterizing basic and associated professional activities of nurses in emergency services.

In the construction of the Matrix, deductive and inductive reasoning was used for the definition of the Basic Competencies and for the Associated Competencies, always modeled on two key assumptions in the care of the clients in emergencies: quality and access. These assumptions are justified since overcrowding and the maintenance of quality of care are among the major challenges for the nurse to manage daily in emergency services.

Initially we determined the possible number of Basic Competencies and the name of each one and its respective concept. Thus we opted for:

Care Performance

Ability of the nurse to provide care individualized to the needs and expectations of clients in order to ensure a care modeled on his own scientific knowledge and in technical procedures essential for a quality result.

Teamwork

Ability to develop coordinated actions in the working group for the execution of work activities to achieve common objectives with an evident cooperative spirit.

Leadership

Ability to influence the attitudes and behaviors of people for the execution of work tasks in a particular plan of action, with the best use of the proposed strategy to achieve business objectives.

Humanization

Ability to give dignified attention to people in accordance with their culture, values and beliefs, in an environment with minimal conditions of attention and work.

Decision-making

Ability to choose a course of action among several reasonable alternatives for action in daily situations/conditions, considering knowledge, practices, limits and risks involved in the decision-making process.

Interpersonal relationship

Ability to interact with people on a daily basis, considering their needs and expectations and adding value to this relationship. It involves courteous, empathetic and professional contact.

Outcomes orientation

Ability to perform the work focused on the outcomes and supported by action plans in which the objectives, tasks and responsibilities are previously defined and aligned to the availability of sufficient resources.

Proactivity

Ability to maintain one’s focus in situations/conditions linked to daily work activities that can that can actually be solved by one’s interference, directing one’s efforts to anticipate actions before problems occur. Encompasses awareness and responsibility in the decisions and considers possible consequences of one’s choices. Aims to achieve the best possible outcome by acting swiftly in a certain time frame to obtain it.

In addition to the Basic Competencies, the Associated Competencies were established as necessary support for the development of each Basic Competency, qualifying the actions of the nurse in emergency services. Again a process of choosing the Associated Competencies and their respective concepts was presented:

Accepting challenges

Ability to overcome obstacles that are manifested in the work process without impeding the development of ideas and changes, maintaining balance and seeking ways to deploy appropriate solutions for each of them with control of the risks involved.

Welcoming

Ability to listen, meet and understand each other’s needs, assuming a stance that is able to give the most adequate response to the client with the establishment of effective communication so that he feels included in the process.

Time management

Ability to set objectives and establish priorities for the development of planned work actions to control the use of time, to avoid waste. It is understood to include the constant monitoring of these actions in order to know the minimum time required for its execution.

Attention

Ability to be attentive to various stimuli surrounding the individual that are outside the norm, to be with people, equipment or the environment, responding with appropriate corrections and adjustments to tackle existing gaps.

Autonomy

Ability to identify and use freedom of action, based on one’s own choices in a rational manner. The use of this freedom implies respecting the applicable laws and doing no harm to others.

Commitment

Ability to assume and fulfill the obligations and responsibilities for which one is responsible, and is not restricted only to performance, but includes the concern about how to do it. Searching to engage oneself in activities, forming ties with the organization.

Communication

Ability to transmit a message using one or more means of transmission in a way that the receiver decodes with clarity and trustworthiness. Or it can be the ability to convey a message through any means available, ensuring its reception without distortion. It is essential for the learning and sharing of information between people.

Reliability / Credibility

Ability to construct an image of a person in whom one can believe, due to the transparent, honest and responsible behavior obtained without pre-judgment in the relationships.

Control of risk

Ability to identify one or more causative agents of harm to people / equipment / environments, to analyze the probability of aggressions of these factors and to determine the measures necessary to minimize or eliminate them.

Cooperation

Ability to spontaneously provide assistance to one or more people in everyday life, aimed at achieving common objectives in the development of actions.

Courage

Ability to have energy, perseverance and moral fortitude in the face of difficulties and dangers present in everyday life to confront them with respect and consistency of one’s principles, without fearing the consequences of one’s actions, always open to asking for help when the complexity of the situation requires it, and maintaining higher morale when facing setbacks.

Dialogue

Ability to exchange ideas and share meanings in effective communication. It permits the resolution of problems and the establishment of harmony between people.

Discernment

Ability to recognize and differentiate between potentialities and limitations of people and things in the performance of work.

Efficacy

Ability to achieve the expected result facing that which was planned to meet the needs and desires of the work.

Efficiency

Ability to perform the work with higher yield with existing resources at any given time. It deals with how to do things and what not to do. In work relationships it is synonymous with productivity.

Emotional Balance

Ability to have attitudes and behaviors with emotional control to react to adversity or changes in the work. It is not an easy task, but it is essential for a healthy relationship, both in personal and professional environments. The individual does not repress his own emotions, however, he is able to manage them.

Entrepreneurial spirit

Ability to use the opportunities arising in the organization to dare, to transform and to discover new ideas applicable to what exists, giving them greater value. Entrepreneurship includes developing actions that modify reality to go beyond the traditional toward a future direction.

Flexibility

Ability to adapt rapidly to unexpected situations, respecting physical, mental and emotional boundaries with ease to find new solutions to resolve problems and adversities. The proposed adjustment process should not generate conflicting behaviors.

Initiative

Capacity to conceive of one or more useful ideas to complete the work and spontaneously put one of these into practice in the appropriate moment to improve business results.

Innovation / Creativity

Ability to introduce what is new and / or improve on what exists. Thus creativity is the ability to have new ideas with the use of thought by one or more people, and innovation is the implementation of new things with an intrinsic value in its wake.

Objectivity

Ability to expose ideas or positions impersonally based on real facts, generating the ease of people to understand what is being exposed with greater possibility of acceptance.

Insight

Ability to perceive reality clearly and rapidly, separating between truth and error. It implies the ability to easily understand the things around you, in order to use this observation and its power intelligently to analyze situations to resolve problems.

Persuasion

Ability to obtain agreement about what should be done by the induction of someone to accept an idea / attitude / action being proposed by another. It should be supported by coherent arguments or conducts always based on stimuli to reason and for emotion.

Potential negotiator

Ability to obtain agreements arising from the dialogue between the parties to have a balance of results with the maximum attention possible to the legitimate interests of those involved. A good negotiation lends credibility to those who participate and creates good relationships.

Resolution / resolubility

Ability to find satisfactory solutions to problems, finishing the work by attending to the needs and desires of the clients. It arises from the efficiency and efficacy of actions, with the treatment of situations with a focus on possible solutions and not on the problem itself. The resolute action should aim to reduce the service time of the client.

Respect

Ability of the person to accept differences, desires and the right to privacy of others with attitudes and behaviors manifested in everyday life.

Responsibility

Ability of the individual to answer for his actions and those of others, conscious of his social and professional role in fulfilling his obligations, regardless of his place in in the organization.

Listening

Ability to learn to listen and understand each other without pre-judgment. This only happens when the one who listens has learned to listen to himself in his desires, expectations and needs. Whoever listens to himself knows to demonstrate that listening to the other is very important and that he is interested in attending to your requests.

Sense of readiness

Ability of a person to act promptly when an activity or task is presented, demonstrating ease of understanding and its immediate implementation.

Sense of urgency

Ability to perform activities quickly and on time, taking calculated risks and immediately correcting errors.

Technical execution

Ability to perform nursing procedures, from basic to advanced, using methods, techniques and resources with a scientific foundation, for the skilled and systematic care of the needs of customers, both of a clinical, surgical and traumatic nature.

Finally, the associated competencies were indicated to be indispensable to the relationship of each Basic Competency, as minimum support to professional practice at a level of excellence. In the construction of the Matrix there was a constant concern to guarantee the interrelationship and interdependence of the competencies involved.

The development of the study followed the national and international standards of ethics in research involving human beings.

Results

The Professional Competency Matrix for the nurse working in emergency services is based on eight Basic Competencies for nurses working in emergency services. As to the 31 Associated Competencies, it is considered that these concepts will be assigned to one or more Basic Competencies, totaling 56 in the Matrix. Graphically the Basic Competencies are horizontal and the Associated Competencies are vertical (Figure 1).

Figure 1
Professional Competency Matrix of the nurse in emergency services

Discussion

This matrix details each element of which it is composed and how they interrelate. Its construction is due to the fact of the nonexistence in nursing of a proposal aimed at competent performance of the nurse in emergency services available in the Brazilian literature, thus it is not possible to compare it with similar studies. It is based on Basic Competencies and respective Associated Competencies, underpinned by the description of its concepts within a standardized language. Each Basic Competency is unique and there is no one that is more important than another. The Associated Competencies are attributed to more than one Basic Competency, with the value of this composition unquestioned for its development with the desired amplitude.

The adopted composition is justified when considering that no concept that expresses competencies can be used alone, it is necessary for it to always be coupled to another complementary concept to give meaning to behavior in the performance of any action. As for the chosen language, describing the required delivery clearly and as objectively as possible achieves the challenge of creating a scale for measurement of that delivery. Also the competencies need to be specific to indicate the desired trajectory of the professional in the reality of work in which he operates, and to define the degree of complexity to be affected by the impact of actions and decisions, including autonomy and required job responsibilities. In addition, one should take into account that to be able to assess competency is a development tool for professionals in expanding their competency profile, with the indispensable matrix for this review to occur.

Finally, the proposed competency matrix is not intended as unanimous among the professionals for whom it is intended, since competencies are peculiar to the core of the business, the different profiles of the region, services and the population which will be a reference for skilled nursing practice. Thus, the competencies can be adapted to the best local evidence to meet the different needs of those involved in different emergency situations.(⁹) To obtain better performance and to have more competencies in practice is essential for the construction of a nurse in emergency services for caring for clients in the present day.(¹⁰)

Conclusion

The proposed Professional Competency Matrix, for the nurse working in emergency services, directs professional practice toward a level of excellence within two essential premises in emergencies: quality and access in the care of the clients.

Acknowledgements

This research was conducted with the support of the Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (National Council for Scientific and Technological Development - CNPq), process number 483.449/2013-0.

Corresponding author Flávia Lilalva de Holanda Napoleão de Barros street, 754, São Paulo, SP, Brasil. Zip Code: 04024-002 [e-mail]

Conflicts of interest: there are no conflicts of interest to declare.

Collaborations

Holanda FL; Marra CC and Cunha ICKO declare that they contributed to the development of the Professional Competency Matrix; review of the manuscript; critical revision of the intellectual content and final approval of the version to be published.

Referências

• ¹
  Shirey MR. The nursing professional portfolio: leveraging your talents. Clin. Nurse Specialist. 2009;23(5):241-4.
• ²
  Kendall-Gallaher D, Blegen MA Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care. 2009 Mar;18(2):106-13.
• ³
  Santos JL, Lima MA, Pestana AL, Garlet ER, Erdmann AL. [Challenges for the management of emergency care from the perspective of nurses]. Acta Paul Enferm. 2013; 26(2):136-43. Portuguese.
• ⁴
  Carvalho EC, Cruz DA, Herdman TH. Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem. Rev Bras Enferm. 2013;66(Spe):134-41.
• ⁵
  Brasil. Ministério da Saúde. Conselho Federal de Enfermagem. Lei nº 7498, de 25 de junho de 1986. Dispõe sobre a regulamentação do exercício profissional da enfermagem e dá outras providências. [Internet]. Brasília (DF); 1986. [citado 2013 Fev 19]. Disponível em: http://novo.portalcofen.gov.br/lei-n-749886-de-25-de-junho-de-1986_4161.html.
  » http://novo.portalcofen.gov.br/lei-n-749886-de-25-de-junho-de-1986_4161.html
• ⁶
  Brasil. Ministério da Saúde. Portaria nº 1.600, de 7 de julho de 2011. Reformula a Política Nacional de Atenção às Urgências e institui a Rede de Atenção às Urgências no Sistema Único de Saúde (SUS). [texto na Internet]. Diário Oficial da República Federativa do Brasil, Brasília (DF); 2011 [citado 2011 Nov 11]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/ prt1600_07_07_2011.html.
  » http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/ prt1600_07_07_2011.html
• ⁷
  Brasil. Ministério da Saúde. Portaria nº 2.395, de 11 de outubro de 2011. Organiza o componente hospitalar da rede de atenção às urgências no âmbito do sistema único de saúde. [texto na Internet]. Diário Oficial da República Federativa do Brasil, Brasília (DF); 2012 [citado 2012 Jan 21]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2395_11_10_2011.html.
  » http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2395_11_10_2011.html
• ⁸
  Brasil. Ministério da Saúde. Conselho Federal de Enfermagem. Resolução nº 423 de 9 de abril de 2012. Normatiza no Âmbito do Sistema Cofen/Conselhos Regionais de Enfermagem, a Participação do Enfermeiro na Atividade de Classificação de Riscos. [texto na Internet]. Diário Oficial da República Federativa do Brasil, Brasília (DF); 2012. [citado 2013 Fev 19]. Disponível em: http://novo.portalcofen.gov.br/resoluo-cofen-n-4232012_8956.html.
  » http://novo.portalcofen.gov.br/resoluo-cofen-n-4232012_8956.html
• ⁹
  Harding AD, Walker-Cillo GE, Duke A, Campos GJ, Stapleton SJ. A framework for creating and evaluating competencies for emergency nurses. J Emerg Nurs. 2013;39(3):252-64.
• ¹⁰
  McCarty G, Cornally N, O`Mahoney C, White G, Weathers E. Emergency nurses: procedures performed and competence in practice. Int Emerg Nurs. 2013;21(1):50-7.

Publication Dates

• Publication in this collection
  Aug 2014

History

• Received
  5 May 2014
• Accepted
  11 June 2014