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Direct and Non-direct Care Providers

Abstract

Direct and non-direct care providers have specific core competencies. The definition of these competencies and their successful implementation ensures effective teamwork of the care providers and qualitative health care service as a result. Both direct and non-direct care providers should be competent in theoretical and clinical knowledge, communication and relationship-building, as well as in developing leadership skills. However, nurse administrators are not required to be competent in inpatient diagnostic or treatment, unlike adult-gerontology NPs. Similarly, direct health care providers should not be keen on business, marketing, or recruitment. Implementation of some competencies is similar for direct and non-direct health care providers, for example, developing actions for patient safety and risk assessment, as well as supporting tolerance for diversity as to gender and age, religion, race, or sexual orientation. However, leadership competence should be implemented differently. Nurse administrators develop leadership for managing staff and planning workforce, and adult-gerontology NPs implement it for health promotion, protection, and treatment.

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Introduction

Understanding core competencies is one of the key factors for the effective performance of advanced practice nursing (APN). According to Hamric, Hanson, Tracy, & O’Grady (2014), APNs should implement these competencies “to demonstrate the value-added component that they bring to care delivery and to ensure that advanced practice nursing is not confused with physician substitution” (p. xii). However, direct and non-direct care providers have similarities and differences in core competencies and their implementation depending on their role and specialization.

Core Competencies

Direct and non-direct care providers (adult-gerontology nurse practitioners (NP) and nurse administrators accordingly) have some common core competencies. According to The AONE nurse executive competencies (2005), core competencies of non-direct care providers include “communication and relationship–building”, “a knowledge of the health care environment”, “leadership”, “professionalism”, and “business skills” (p. 3). Adult-gerontology acute care nurse practitioner competencies (2012) specifies that within the role of a direct health care provider “the adult-gerontology acute care NP synthesizes theoretical, scientific, and contemporary clinical knowledge for the assessment and management of both health and illness states” (p. 13). Therefore, both care providers should be competent in theoretical and clinical knowledge of health care. Moreover, Hamric (2000) underlines that “core competencies of advanced nursing practice” are “leadership, consultation, research utilization and involvement” (p. 46). Thus, both nurse administrators and adult-gerontology NPs should be competent in leadership, communication, and relation-building or involvement.

As to theoretical and clinical knowledge competence, nurse administrators should “maintain knowledge of current nursing practice”, “utilize research findings for the establishment of standards, practices and patient care models in the organization”, and also “participate in studies that provide outcome measurements” (The AONE nurse executive competencies, 2005, p. 6). Similarly, adult-gerontology NPs “advance the level of knowledge of adult-gerontology acute care nurse practitioners to improve healthcare delivery and patient outcomes through presentations, publications, and/or involvement in professional organizations” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 23). So, both health care providers should constantly improve their clinical knowledge competence.

In regards to communication, non-direct care providers should be competent in “effective communication” to resolve conflicts, “relationship management” and “shared decision-making” to engage medical staff to cooperate (The AONE nurse executive competencies, 2005, p. 4). Direct care providers should be also competent in interpersonal communication as “it relates to therapeutic patient outcomes considering the cognitive, developmental, physical, mental, and behavioral health status of the patient across the adult lifespan” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 20). Thus, strong communicational skills are needed for both direct and non-direct healthcare providers.

Both direct and non-direct caregivers should develop leadership skills. Adult-gerontology NPs “demonstrate leadership of the healthcare team through teaching and coaching” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 21). In the same way, nurse administrators “address ideas, beliefs or viewpoints that should be given serious consideration” and also “demonstrate reflective leadership” (The AONE nurse executive competencies, 2005, p. 8). Therefore, developing managing skills is essential for both providers.

Despite many similarities in core competencies, direct and non-direct caregivers are required to develop different skills to fulfill their roles in health care. One of the specific core competencies for nurse administrators is developing business skills in “understanding of health care financing”, “human resource management and development”, “strategic management”, “information management and technology”, and “marketing” (The AONE nurse executive competencies, 2005, p. 10). Hence, competence in business is essential for non-direct care providers as they should be keen in accounting, charging, team management, and workforce planning, effectively cope with workers’ problems, use modern techniques for team motivating and stimulating, know and implement new recruitment strategies, conduct SWOT and marketing environment analysis, and design new marketing strategies (The AONE nurse executive competencies, 2005, p. 10). On contrary, adult-gerontology NPs do not need to be keen on marketing, recruitment, or financing.

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On the other hand, direct health care providers should be competent in “assessing the individual’s health status”, “risk stratification, disease-specific screening activities, diagnosis, treatment and follow-up of acute illness, and appropriate referral to specialty care” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 13). Thus, adult-gerontology NPs should know how to diagnose a patient and design a plan of care and treatment by “stabilizing the individual, minimizing physical and psychological complications, maximizing the individual’s health potential” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 17). In contrast, nurse administrators should not be competent in conducting a diagnosis or elaborating a treatment plan for a patient.

Competencies Implementation

Direct and non-direct health care providers can differ or cross in core competencies implementation depending on their roles.

Implementation of knowledge competence, for example, requires nurse administrators to maintain “current knowledge of patient care delivery systems and innovations” in order to “determine when new delivery models are appropriate, and then envision and develop them” (The AONE nurse executive competencies, 2005, p. 6). Likewise, adult-gerontology NPs should be competent in “managing and negotiating healthcare delivery systems” in order to improve the results of health care (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 23). Hence, both providers should develop a healthcare delivery system to ensure its high performance.

When implementing communication and relationship-building competence, nurse administrators should “assess the current environment and establish indicators of progress toward cultural competency” and “define diversity in terms of gender, race, religion, ethnicity, sexual orientation, age” (The AONE nurse executive competencies, 2005, p. 4). Similarly, adult-gerontology NPs “identify one’s personal biases related to culture, aging, gender, development, and independence that may affect the delivery of quality care” and “promote equity in health and health care for peoples of diverse cultural, ethnic, and spiritual backgrounds” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 24). Thus, direct and non-direct health care providers should develop and promote impartiality and open-mindedness.

Furthermore, the implementation of professional competence of both direct and non-direct caregivers is “evidence-based” (The AONE nurse executive competencies, 2005, p. 8). Nurse administrators, for example, should “teach and mentor others to routinely utilize evidence-based data and research” (The AONE nurse executive competencies, 2005, p. 8). Similarly, adult-gerontology NPs “participate in the design and/or implementation, and evaluation of evidence-based, age-appropriate professional standards and guidelines for care” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 22).

Although both direct and non-direct health care providers agree with some implementations of leadership competence, they also differ in some aspects. Nurse administrators should “promote nursing management as a desirable specialty” and “conduct periodic organizational assessments to identify succession planning issues and establish action plans” (The AONE nurse executive competencies, 2005, p. 8). Moreover, a non-direct health care provider should “utilize change theory to plan for the implementation of organizational changes” (The AONE nurse executive competencies, 2005, p. 8). Adult-gerontology NPs, though, implement this core competence by demonstrating “leadership to promote improved health care outcomes for the adult–older adult population in practice, policy, and other venues” and “provides leadership to coordinate the planning, delivery, and evaluation of care by the healthcare team” (Adult-gerontology acute care nurse practitioner competencies, 2012, p. 19). Consequently, leadership competence for non-direct health providers should be implemented mainly by staff management and planning. However, direct health care providers should implement their leadership competence by health promotion, protection, and treatment.

Conclusion

To deliver high-quality health care service for a reasonable price, it is essential for direct and non-direct care providers “to rely on a core set of role expectations” (Hamric et al., 2014, p. xii). Thus, the implementation of core competencies according to their roles will allow health care givers to work as an effective and successful team.

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References

Adult-gerontology acute care nurse practitioner competencies. (2012). Washington, DC: American Association of Colleges of Nursing.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach. (5th ed). St. Louis, MO: Saunders.

Hamric, A.B. (2000). WOC nursing and the evolution to advanced nursing practice. Journal of Wound, Ostomy, and Continence Nursing, 27(1), 46-47.

The AONE nurse executive competencies. (2005). Chicago, IL: The American Organisation of Nurse Executives.

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