Framework for assessing standards for practice for registered nurses, enrolled nurses and midwives

• Assessors are accountable to the public and to the profession to perform a valid and reliable assessment of nurse and/or midwife candidates. 
• Assessors are accountable for assessing nurse and/or midwife candidates as:
  • competent against the NMBA standards for practice, and 
  • suitable for registration
• Assessors will ensure that nurse and/or midwife candidates are assessed in the practice setting. 
• Nurse and/or midwife candidates who have not demonstrated competence in the practice setting should not be recommended for registration.

• Clinical competence is performance based. Assessors must therefore carry out the assessment in the context of the nurse and/or midwife/ interaction with the person receiving care. 
• Assessment of practice is a valid model of assessing core competencies for licensing nurses and/or midwives. This model is useful as a multipurpose procedure because it enables global assessment of the nurse and/or midwife candidate’s knowledge, skills, values, and attitudes. 
• Regulatory authorities have a responsibility to make sure the assessment model focuses on knowledge and performance that is closely related to the demands of the practice situation. 
• The NMBA recognises that the nature of professional nursing and/or midwifery practice is multifaceted and requires comprehensive knowledge; attempting to assess competence in a single and narrowly prescribed procedural model is a failure to recognise this.
  The context in which competence assessment occurs is an essential component in the competency standards assessment framework.

The practice setting involves many contextual factors including the environment, the relationship with people receiving care and the behaviour of others in the practice setting that cause the nurse and/or midwife candidate to act in a particular way. The assessment process should take these factors into account.

• Evidence-based assessment requires a model of evidenced-based professional judgement. 
• The process of assessing competence requires an accumulation of data or evidence about performance over a period of time and in a range of nursing situations. 
• The judgement about whether a nurse and/or midwife candidate has reached a satisfactory standard of performance is based on the interaction between the:
  • assessor’s comprehensive knowledge of the expected standard of performance, and 
  • interpretation of the assessment data, including the context within which they are collected.
• Assessors can obtain data to provide evidence of performance through:
  • self-assessment by the nurse and/or midwife candidate 
  • observation by the assessor of the nurse and/or midwife candidate 
  • interviews by the assessor with the other actors in the setting: peers, people receiving nursing care, supervisors, and 
  • analysis by the assessor of all relevant documentation.
• Assessors work with, and observe, the nurse and/or midwife candidate being assessed in the practice context. This enables the assessor to gather pieces of evidence about the nurse and/or midwife candidate’s practice in order to draw inferences about competence. 
• Assessors use professional judgement, which involves drawing inferences and using tacit knowledge to form a conclusion about a particular nurse and/or midwife’s competence. 
• Assessors should always check inferences to validate the assessment judgement. 
• For confident use of tacit knowledge as a basis for assessment, it is essential that assessors have a full understanding of the expected standard of performance.

• Clinical competence is performance based. Assessors must therefore carry out the assessment in the context of the nurse and/or midwife/ interaction with the person receiving care. 
• Assessment of practice is a valid model of assessing core competencies for licensing nurses and/or midwives. This model is useful as a multipurpose procedure because it enables global assessment of the nurse and/or midwife candidate’s knowledge, skills, values, and attitudes. 
• Regulatory authorities have a responsibility to make sure the assessment model focuses on knowledge and performance that is closely related to the demands of the practice situation. 
• The National Board recognises that the nature of professional nursing and/or midwifery practice is multifaceted and requires comprehensive knowledge; attempting to assess competence in a single and narrowly prescribed procedural model is a failure to recognise this. 
• The context in which competence assessment occurs is an essential component in the competency standards assessment framework.

• Performance assessment should be based on a participative and collaborative relationship between the assessor and the nurse and/or midwife candidate. 
• A principle of impartiality, confidentiality and declaration of any conflict of interest will underpin this participative and collaborative relationship. This will help to ensure that participants in the assessment process feel confident in the assessment methods. 
• Participation and collaboration in the assessment process involve high levels of communication, reflection and reinterpretation of performance. 
• Formalised review processes established by organisations undertaking assessments will address grievances held by nurses and/or midwives who are being assessed, and will assist in ensuring participation and collaboration between others in the assessment process. These processes also provide a mechanism for rigorous scrutiny of the assessment results.

The assessor is accountable to the profession and to an appropriate authority for:

• making a valid assessment of a nurse and/or midwife candidate’s performance, and 
• recommending that the nurse and/or midwife candidate being assessed meets the competency standards required.

Validity and reliability in the assessment process are essential to public interest and safe practice.

The assessor has a responsibility to keep confidential the information obtained in the assessment process or, when appropriate, to use proper channels to share information about the assessment. The assessor must declare any existing conflict of interest and, in cases where impartiality cannot be assured, withdraw from the assessment process.

NMBA standards for practice emphasise the assessment of total performance, which includes knowledge, skills and attributes. This differs from assessment procedures biased towards assessment of knowledge and the use of checklists in clinical settings.

Regulatory authorities are responsible for making sure the assessment model focuses on knowledge and clinical performance that relate closely to the demands of the individual’s scope of professional practice and the practice situation. Clinical competence is performance based and assessors must therefore carry out the assessment in the context of the practice setting.

The NMBA standards for practice are categorised into domains of practice relevant to nursing and midwifery practice. This categorisation will assist assessors in the assessment process.

Given the complex nature of nursing and/or midwifery practice, the NMBA standards for practice have been developed as broad holistic statements, interrelated as determined by the nursing and/or midwifery context.

The context in which assessment of competence occurs is essential to the competency standards assessment framework.

The practice setting involves many contextual factors that cause the nurse and/or midwife candidate being assessed to respond in a particular way. The relationship with the person receiving nursing and/or midwifery care and the behaviour of others in the practice setting can influence the performance of the nurse and/or midwife candidate.

It is important that assessors take contexts into account during the assessment processes.

The role of assessment is to arrive at a conclusion about satisfactory levels of performance; it must therefore be evidenced based.

Assessment of professional competence using standards for practice involves assessors using their professional judgement in deciding the competence of nurse and/or midwife candidates. This method of evidenced-based assessment is based on a model of evidence-based professional judgement.

The method involves recognising and using significant cues, which imply that a nurse and/or midwife is competent in a particular competency or a number of competencies. The process of assessing competence requires an accumulation of data or evidence about performance over a period of time and in a range of nursing and/or midwifery situations.

During assessment, the assessor makes inferences about performance and related knowledge, attitudes and skills of the nurse and/or midwife candidate. Inference entails judgement about the presence of a competency embedded in practice but not directly observed in specific behaviour. This process of drawing inferences and using tacit knowledge allows the assessor to form conclusions about the practice and subsequent competence of the nurse and/or midwife candidate.

In using tacit knowledge, the assessor is a human assessment instrument. The only ‘tool’ required by the assessor is a method of collecting data, for example using pen and paper for observation, documentation and reference to the competency standards when analysing the assessment data.

Judgement about whether a nurse and/or midwife candidate has reached a satisfactory standard of performance is based on the:

• interaction between the assessor’s comprehensive knowledge of the expected standard of performance, and 
• interpretation of the assessment data, including the context within which they are collected.

It is the assessor’s tacit knowledge that enables the judgement of quality.

Assessors of performance must be experienced in the profession and field of practice being assessed and in the assessment of competence. This assessment model relies on assessment judgements made using involving the use of:

• tacit knowledge 
• competency elements, and 
• cues, which are selected concrete examples of activities illustrative of the competency standard.