The purpose of this framework is to provide a resource for:
The framework comprises:
The aim is to guide the assessment of competence against the Nursing and Midwifery Board of Australia (National Board or NMBA) standards for practice for registered nurses, enrolled nurses, nurse practitioners and midwives.
Assessment against the NMBA standards for practice is an important measure to ensure initial and continuing competence of nurses and midwives. The assessment process determines the eligibility for registration of nurses and midwives who:
1Formally known as national competency standards.
The NMBA has identified five key principles to be applied when assessing practice standards for registered nurses, enrolled nurses, nurse practitioners and midwives.
The five principles are as follows:
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.
The following section identifies the critical issues in assessing performance against the NMBA practice standards. These issues underpin the principles of assessment within this framework.
The assessor is accountable to the profession and to an appropriate authority for:
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:
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:
Self-assessment by the nurse and/or midwife candidate provides vital data for the assessor. Self-assessment is a skill that is central to the nurse and/or midwife’s continuing professional development.
Observation by the assessor should be of sufficient duration and performed in a reasonable variety of contexts to achieve valid and reliable assessment.
Interviewing skills of the assessor should be highly developed. The assessor needs to establish relationships with other individuals in the practice setting in order to source adequate and essential information. This information is essential in validating assessor inferences and judgements about competence.
Documentation recording assessors’ observations and other evidence is necessary for analysis and interpretation and ultimately. This ensures a reliable and valid assessment judgement.
Enhancing the validity and reliability of assessment - Using the professional judgement of a person with experience in nursing and/or midwifery, and who possesses a comprehensive knowledge base to assess performance, enhances the validity and reliability of the assessment.
Validity in the assessment process is the extent to which assessment meets the intended outcomes. The assessment process therefore measures the performance of the nurse and/or midwife candidate against the NMBA practice standards.
Reliability in the assessment process refers to the consistency or accuracy of the assessment process outcomes. Assessors’ understanding of the expected standards and their knowledge and skill are the crucial elements that enhance the reliability of the assessment process.
Documented evidence should always support judgements assigned to the nurse and/or midwife candidate’s competence. The model of assessment, involving collection and documentation of data over a period of time and in a range of situations, allows for reflection on the:
As the assessor gathers new pieces of evidence about the practice of the nurse and/or midwife being assessed, they can reflect on and reinterpret previous data. This process of reflection and reinterpretation adds to the reliability of the assessment judgement.
Participation and collaboration - Establishing a participative and collaborative relationship based on confidentiality, accountability and impartiality between the nurse and/or midwife candidate and the assessor builds confidence in the assessment methods.
As an essential part of the assessment process, assessors should conduct interviews with nurse and/or midwife candidates being assessed. It is through this process that the important practice of reflection on and reinterpretation of performance and assessment judgements should occur, enabling judgements made by the assessor to be validated.
Organisations undertaking assessments should institute review procedures to address grievances held by nurse and/or midwife candidates being assessed.