generic competencies for nurse and midwife...

GENERIC COMPETENCIES > FOR NURSE AND MIDWIFE MANAGERS

CONTENTS >

1 Promotion of evidence-based decision-making 2 Building and maintaining relationships3 Communication and influencing skills4 Service initiation and innovation5 Resilience and composure6 Integrity and ethical stance7 Sustained personal commitment8 Practitioner competence and professional credibility

Nursing services are now being delivered in a serviceenvironment characterised by

a) rapid rate of change

b) increasing levels and volume of service demand

c) a greater complexity in nursing tasks and duties

d) a greater complexity and interconnectedness in service delivery systems

e) services which are increasingly delivered through multi-disciplinary teams

f) an emphasis on resource justification in terms of the linking of service outcome with the activity levels andresources used by the service.

Although we worked with three distinct representativesamples at the different levels of nursing management,nevertheless the research indicated that there were anumber of core competency domains that are critical toeffective management across all three levels. We havedescribed these level-spanning competency areas as theeight generic competencies requisite for effectivenursing management.

The figure below conveys the message that nursingmanagers in all service areas are challenged to

a) demonstrate the value and highlight the contribution of the evolving nursing capability

b) organise and structure work to enhance effectiveness and efficiency of services

c) play a lead role in the facilitation of service co-ordination and clarity (for both inter-disciplinary colleagues and clients)

d) ensure that service standards and consistency are sustained.

These generic competencies for nursing managementcan be used in two ways:

1> as a core skill set which nursing managers will need to continuously refine and build on as they develop their careers

2> as an initial set of basic building blocks indicating the potential to pursue a career in nursing management.

With the increased opportunities for the development ofspecialist or expert practitioner nursing roles, front-linenurses will now have greater options in terms of careerpaths and developmental opportunities. These genericcompetencies will be helpful as a template against whichto assess or review suitability for progression along amanagement career path. They should also be used as adevelopmental framework so that capable nurses can begiven opportunities and guidance on the job thatdevelops their contribution in each of these criticalperformance areas.

Generic competencies for nurse managers

1> Promotion of evidence-based decision making

2> Building and maintaining relationships

3> Communication and influencing skills

4> Service initiation and innovation

5> Resilience and composure

6> Integrity and ethical stance

7> Sustained personal commitment

8> Practitioner competence and professional credibility

Practioner competenceand professional

credibility

Promotion of evidence-based decision-making

Building and

maintaining

relationships

Communicationand influencing

skills

Service initiationand innovation

Resilienceand composure

Integrity andethical stance

Sustainedpersonal

commitment

Professional credibility

Sustainability under pressure

Servicecontribution

Facilitationand enablement

of staff

>>

>>

GENERIC COMPETENCY 1 > PROMOTION OF EVIDENCE-BASED DECISION-MAKING

Definition Makes decisions in a well judged andtimely manner bringing all relevantinformation to bear when addressingproblems or issues. Uses logical analysisto break complex problems into theircomponent parts. Applies researchfindings to improve nursing practice and processes.

AREAS OF APPLICATION

> Evaluation of service needs and new service proposals > Allocation of scarce resources across multiple demand areas > Making judgements in complex disputes > Evaluation of adequacy of service provisions > Evaluating trends from service data > Integrating research findings into nursing practice > Problem solving in crisis situations > Finding solutions to complex client service issues > Makes unpopular decisions on the best evidence available > Day to day gathering of information in the clinical setting, accessing,

probing and observing behaviours and actions

GENERIC COMPETENCIES

>1 Promotion of evidence-based decision-making

> Uses analysis and logic in considering problems and issues

> Promotes and expects evidence baseddecision-making process to be used by allstaff

> Uses a wide range of information sourcesand knows how to access relevantinformation to address issues

> Can break complex problems down intocomponent parts and address these in asystematic fashion

> Takes an overview of complex problemsbefore generating solutions; anticipates“knock on” effects of different solutions

> Differentiates the critical features of anissue from the more minor or irrelevantand focuses attention on the essential nubof a problem

> Ensures that he/she consults widely ondifficult issues and probes the facts anddata presented, including looking at asituation from different perspectives

> Generates a number of options, often inconsultation with others, and evaluatesthese for adequacy before deciding on aparticular solution

> Able to process a lot of material, eitherwritten, oral or quantitative data, quicklyand accurately in order to evaluate anissue or a situation

> Can make decisions in a timely manner ina crisis and will be comfortable making adecision with incomplete information(albeit not necessarily a final one)

> Most of own solutions and suggestionsturn out to be correct and accurate whenjudged over time. Is often sought out byothers for advice and solutions

> Intervenes quickly when there is a problemwith direct reports and is able to makedifficult or negative decisions when allother efforts fail

> Demonstrates a sound knowledge ofprocedures and protocols in operationalmatters

> Shows the confidence to take decisionsup to own level of discretion but will alsorecognise when to take an issue to thenext level.

Indicators of MORE effective performance



>1 Promotion of evidence-based decision-making

> Tends to be overly intuitive or jump toconclusions

> Is unclear in own expectations ofsubordinates in terms of howsystematically they address problems and issues; allows too much intuitive and non-evidenced decision-making from subordinates

> Tends to take ‘the given’ as correct andmay be somewhat uncritical in approachto the information or situation that is presented

> Has difficulty breaking down complexproblems and may miss significant sub-components or points when doing so

> Tends to jump into solutions withoutadequately evaluating their implicationsand knock-on effects

> Finds it difficult to ‘see the wood from thetrees’ in complex problems and can getdistracted into dealing with the peripheralor largely irrelevant while neglecting thecore issue

> Tends to see a situation only from oneperspective and may neglect to consultpeople who would have relevantinformation or a important perspective onthe situation

> Generates a single option and neglects toevaluate it fully before coming to aconclusion

> Slow to make decisions, will tend to dither.Requires an excessive amount of time orcan be inaccurate when consolidating andevaluating management-level information,be it written or quantitatively presented(NB one would expect individuals to haverelative strengths and weaknesses withinthis indicator)

> Tends to dither or refer to others in a crisissituation; may become disorganised inresponse to a crises and own responsesmay lack coherence

> Shows a track record of inconsistency interms of qualitative decision-making.Tends to be disregarded by others whenthey need advice on complex issues

> Takes too long to intervene when there isa problem with direct reports; finds itdifficult to assert self sufficiently to makenegative or tough decisions regardingsubordinates, seen as ineffective inhandling trouble makers

> Has significant knowledge gaps in termsof operational procedures and protocols,which adversely affect quality or speed of decisions

> Takes too many problems or issues to thenext level of manager when they shouldbe dealt with at this level.

Indicators of LESSeffective performance


GENERIC COMPETENCY 2 > BUILDING AND MAINTAINING RELATIONSHIPS

Definition Forms strong positive workingrelationships across all areas of theservice, builds on a commonunderstanding. Demonstrates a supportiveand reciprocating work style includingstrong empathy with service users.


> Building reciprocal working relationships at all levels and across service areas

> Providing support to staff and service users in distress > Being accessible to others with sensitive issues > Handling employee relations issues and conflict diplomatically > Provision of support in service setting to nursing staff, other healthcare

professionals, management and service users


>2 Building and maintaining relationships

> Relates well to people of differing stylesand at all levels in the organisation

> Has strong empathy and puts self intothe shoes of the other person

> Helpful and offers support to colleagueson a regular basis

> Reads people well and can access howthey are feeling and thinking

> Makes it easy to be approached andtalked to; builds rapport and is a patientlistener

> Demonstrates a strong understanding ofwhy groups do what they do, is good at‘early sensing’ of agenda in terms ofpositions, intentions and needs

> Uses diplomacy and tact in fraughtsituations and can diffuse tense situationscomfortably

> Addresses conflict situations positively,showing respect, listening to the involvedparties and achieving common ground inmost cases

> Shows self-awareness in terms of howpeople are coming across and also as tohow well they are working with significantothers

> Shows personal concern for directreports, is interested in them as ‘wholepeople’. Spends time on their concernsand questions and is available to listen toproblems

> Anticipates and listens to staff worriesand concerns and follows them through.




>2 Building and maintaining relationships

> Has a ‘one size fits all’ style or hassignificant difficulty relating to differenttypes of people

> Tends to see things from ownperspective; struggles to understanddifferent view points

> Is very transactional in style, only offershelp on an opportunistic basis. Tooengrossed in own concerns

> Has difficulty ‘sensing’ how people are. Avoids feelings and remainssomewhat distant

> Is difficult to access due to ‘business’.May be aloof or status conscious, overlyformal style puts off others

> Doesn’t understand group dynamics well.May stereotype groups or avoid dealingwith them

> May take difficult situations too personally or may be too uncomfortablewith expressed negative emotions. Gets anxious

> Avoids conflicting situations until they areinescapable, may take on overly pushystyle or accommodate too easily

> Doesn’t think about (or care) how he/she affects others. Doesn’t care about the needs of others. Has a one-way benefit style

> Works with direct reports on a moreformal basis. Devotes insufficient time totheir issues and to offering support

> No open channels of communication tostaff. Distances self from staff.



GENERIC COMPETENCY 3 > COMMUNICATION AND INFLUENCING SKILLS

Definition Gets a message across fluently andpersuasively in a variety of different media(oral, written and electronic). Makes acompelling case to positively influencethe thinking of others. Is strategic in howhe/she goes about influencing others;shows strong listening and sensing skills.


> Making a proposal for resource allocation or new services > Presenting at national or local fora on professional topics > Arguing the case on a complex service issue > Making motivational presentations and selling new ideas to staff > Briefing of staff and other professions > Explanation of complex and sensitive information to service users and

their families > Writing formal correspondence and reports > Will be a member of influential committee/task group


>3 Communication and influencing skills

> Marshals information cogently to make apersuasive case; communicatesinformation clearly in the spoken word;makes well-structured and persuasivepresentations

> Can communicate in a rational, emotionalmode as appropriate in order to engenderenthusiasm in the audience. Can makememorable interventions

> Thinks in advance who and how toinfluence; puts in place a communicationstrategy for complex issues; shapes oradjusts message to suit the needs of thetarget audience

> Builds and uses networks across sectorsand disciplines; regularly builds coalitionsof interest around new proposals

> Is comfortable using more than onemedium to present a message; is skillfulin adjusting the level of communication tosuit the audience

> Has strong two-way listening skills; isable to elicit information from others in anon-threatening way and can readbetween the lines

> Writes authoritatively and clearly in termsof memos, directives and reports

> Develops fluent and cogent writtenproposals and papers to suit a variety ofaudiences (i.e. professional, managerial,general public and service)

> Can put a message across to the public media in a confident, clear andcomposed way; is comfortable yet astute in dealing with the media onsensitive issues

> Chairs meetings with structure, clarityand strong positive facilitation; can usehumour and ensures meetings achieve apurpose or result

> Able to use body language appropriately,e.g. eye contact, having a strong physical presence

> Able to articulate needs of client clearlyand passionately. Is a strong advocate.




>3 Communication and influencing skills

> Presents a case in a poorly structured orincoherent way

> Makes presentations in an overly factualor formal way; lacks impact and the abilityto grab attention in presentation style

> Doesn’t think about the audience inanticipation of presentation orcommunication; fails to anticipateaudience requirements

> Tends to use formal channels in a moreconservative and conventional way;neglects to build interdisciplinaryplatforms for proposals

> Has significant weaknesses in at leastone of the main communicationmodalities (spoken, written, or electronic);has difficulty adjusting the level ofcommunication to suit the audience

> Tends to have too much of a ‘push’ stylein communication; does not listencarefully or closely enough to others andmisses vital nuances

> Writes memos, directives and reports inan overly laborious or confused manner.Memos lack structure or have either toomuch or too little detail to suit therequirements of the issue

> Lacks confidence when fronting for theorganisation and dealing with the media;lacks fluency or seems disjointed and illat ease when dealing with sensitiveissues in public fora; can be indiscretewhen dealing with sensitive publicrelations issues

> Has difficulty writing formal papers in afluent way; written work is dull anduninspiring in tone and content

> Chairs meetings in a poorly structured orinadequately assertive way; does notachieve clear results from meetings

> Lacks awareness of how to project animage non-verbally – does not maintaineye contact, e.g. reads notes duringformal presentations

> Relies heavily on hierarchy to force anissue. Lacks the confidence to assert theclient needs.

Indicators of LESS effective performance


GENERIC COMPETENCY 4 > SERVICE INITIATION AND INNOVATION

Definition Drives to achieve positive results at alllevels of the service. Takes initiatives tomove the service forward and shows awillingness to try out new ideas.


At top-management level > Promoting new service initiatives > Promoting new applications for professional skills > Broadening and deepening the contribution of nursing > Initiating quality systems, audit and interdisciplinary initiatives

At middle-management level > Develops a new project team to address a specialist need within

the service > Creates new expanded roles to develop team members > Organises multidisciplinary ‘think tank’ to address waiting-list problem

and uses problem solving techniques with the team > Gets clients ideas/suggestions as to ways the service might be improved

At front-line level > At the forefront of clinical practice leading the team in new areas of

innovative treatment and care


>4 Service initiation and innovation

> Puts focus of energy into a few coreareas or initiatives, doesn’t getoverloaded by too many issues.Personally ‘champions’ a small number ofsignificant projects or service initiatives

> Promotes nursing as a significantcontributor or leader in interdisciplinaryservice improvement projects or constantlychallenges and questions how nursing canadd more value to service provision

> Looks to nursing managers (at both frontand middle level) to develop serviceimprovement and quality initiatives

> Sees the research-based practice and newspecialty developments as positiveopportunities for the contribution of nursing

> Shows strong project management skillsin developing new ideas. Personallytracks and monitors progress towardproject/initiative goals

> Brainstorms with team on a regular basisto develop solutions to service issues and problems

> Uses patients’ suggestions to look atissues in a fresh way. Tries out new ideasand ways of working. Has a flexibleapproach and welcomes change

> Is actively sought out as a good ‘ideas’person for working parties and projectteams. Comes up with many ideas forservice improvement.

> Gets swamped or overloaded anddoesn’t use role or position of powersufficiently to push new ideas or serviceinitiatives forward

> Has a more steady state andconventional image of nursing;concentrates totally on current models ofservice provision; liable not to take risk(no matter how well justified)

> Allows nursing to play a subsidiary or peripheral role in new initiatives; leaves interdisciplinary leadership to other disciplines

> Is slow to originate new practices orapply new techniques; plays safe in termsof own service contribution

> Doesn’t put sufficient structure into newservice initiatives, overloads the operationalsystem with extra demands. Leaves projectprogression to others without checking onprogress; allows projects to losemomentum

> Authoritarian approach with team and doesnot involve them in brainstorming solutions

> Does not seek patients’ views unless havingto deal with a complaint. Tends to stick tothe tried and trusted. Rigid in the face ofchange and dislikes being out of routine

> Tends to be overlooked when setting upnew projects and is not regarded as an‘ideas’ person. Comes up with few ideas for service improvement.



GENERIC COMPETENCY 5 > RESILIENCE AND COMPOSURE

Definition Maintains a disciplined and professionallevel of performance under sustained or situational pressure. Can bounce back from adversity or setbacks. Shows persistence and flexibility inachieving goals.


> Maintaining calm and providing leadership in a crisis > Handling a wide variety of demands in a time-limited environment > Maintains composure in pressurised negotiations for resources when

confronting service accountability issues > Dealing with negative emotions when confronting poor performance or

other contentious issues > Dealing with irate clients or other stakeholders in highly charged

situations


>5 Resilience and composure

> Acts coolly in a crisis situation andretains composure; gives staff theconfidence of being led in a crisis

> Puts coherence and a structure on the response to crisis situations; calms down other staff and models a composed response

> Maintains an objective and detachedstance when dealing with conflict. Doesnot become defensive or irritated whendealing with conflict or a negativepresentation from others

> Is usually turned to or counted on to hold things together during difficult times or crises

> Deals with unexpected situations or crisisin a flexible and fluent way; isn’t knockedoff balance by the unexpected

> Maintains composure and calm outlookwhen one’s efforts or initiatives areresisted or blocked; takes stock beforereacting on an emotional level

> Bounces back from setbacks and will persist with efforts even againststrong resistance

> Puts time into supporting and coachingone’s staff on how to react appropriatelyin crisis or difficult circumstances;promotes a professional response intimes of stress

> Can sustain an exceptional degree ofperformance and effort for a considerableperiod of time under pressure but alsorecognises when it is time to take abreak; knows how to recognise andmanage own stress levels

> Knows how to switch off from stressfulwork situations; tries to achieve a positivebalance and quality of life between workdemands and overall life experience; paysdeliberate attention to own stressmanagement.




>5 Resilience and composure

> Gets flustered or disorganised in a crisis;gives impression of lack of leadership incrisis situations

> Reacts incoherently in a crisis situation;has a contagious confusing effect onother staff and is unable to reassure

> Becomes overly defensive or personallyupset when dealing with negative viewsor emotion from others. Fails to maintainan objective and detached stance

> Tends to get bypassed or sidelined whenthere are difficult times or crises to bedealt with

> Is easily thrown off balance or knockedout of stride by the unexpected situation;is slow to readjust to new circumstances

> Easily shows frustration when blocked orinitiatives are rebuffed; takes it personallywhen does not get initiatives acceptedand will show this in an easily read orpublic way

> Is easily put off own goal or intentions bystrong resistance; gets discouraged ordemotivated when efforts are resisted or rebuffed

> Does not support staff in a structuredway when there is a crisis or difficultsituation to be dealt with; doesn’t keepclose enough to staff or colludes indysfunctional responses

> Will persist with effort under stressfulconditions for too long without taking abreak; does not recognise or monitor ownstress levels and demand systems

> Fails to achieve a reasonable balancebetween demands of work and quality oflife; allows him/herself to get into a stressrut and fails to develop a range of stressmanagement techniques.



GENERIC COMPETENCY 6 > INTEGRITY AND ETHICAL STANCE

Definition Holds an appropriate and effective set ofprofessional and managerial values andbeliefs and behaves in line with these.Promotes and consistently supportsethical and value-based staff practices.


> Ensuring that professional ethics and values are disseminated through all levels of thenursing service

> Articulating an ethical and values-driven stance at corporate level

> Contributing to the formation of organisational ethics and values

> Dealing with complex ethical client and service dilemmas

> Acting as a role model for other staff in the handling of complex or sensitive issues


>6 Integrity and ethical stance

> Makes a positive contribution to thedevelopment of ethics and values at bothprofessional and organisational levels;ensures that there is an active andongoing debate in these areas

> Tries to ensure that personal values areconsistent with those of the organisationand will strive to air and reconcile anysignificant differences; will positivelyaddress possible compromise of valuesdue to organisational needs or exigencies

> Makes efforts to develop and promote aset of organisational values and theclimate that is consistent with these; is achampion and articulator of values atorganisational level

> Is looked to for guidance on standards,norms and values by others; stays solidon values during crises or other closecalls on ethics; seen to project aconsistent set of values

> Articulates client needs and the primacyof positive client services over and incounter-balance to a service needs driven agenda

> Always follows through on issues andbehaves in a manner that is consistentwith own and the organisation’sespoused values and practices; willcheck back to others where there arevalue or integrity issues

> Shows fairness and consistency indealing with direct reports and otherstaff; doesn’t generally operate hiddenagendas and doesn’t give preferentialtreatment

> Is able to treat personally sensitiveinformation with confidentiality; is carefulnot to speak in an indiscrete or hurtfulway about others

> Admits mistakes and is willing to takeresponsibility when things go wrong as aresult; doesn’t misrepresent self forpersonal gain

> Is generally honest and truthful in dealingwith individuals; elicits trust from otherson this basis.




>6 Integrity and ethical stance

> Tends to go along with whatever ethics orvalues are currently in place, eitherorganisationally or professionally, withoutquestioning or evaluating these seriously;doesn’t see ethics as a high priority forpersonal role

> Will allow self to be compromised by values and conflicts withoutaddressing these

> Allows ethics and values to bedowngraded in importance when a crisisarises; tends to be sidelined or avoidedby others when there are serious ethicalissues to deal with; would be seen byothers as inconsistent in personal set ofvalues and practices

> Tends to operate primarily from a servicedriven agenda and will subordinate theclient experience to service expediency at times

> May be inconsistent in living up to own orthe organisation’s espoused values andpractices; may tend to hid difficult issues,sweep them under the carpet and notrefer back to relevant parties

> Tends to treat direct reports and otherstaff inconsistently; shows favouritismtowards some staff and may operateinconsistent or hidden agenda

> Shows poor judgement in terms ofmaintaining confidentiality; may beindiscrete or talk inappropriately in a waythat affects others

> Tries to avoid the blame when things gowrong; may try to direct the blametowards others inappropriately and maymisrepresent situations for personal gain

> Can be evasive and less than truthful onmany occasions; may not be widelytrusted as a result.



GENERIC COMPETENCY 7 > SUSTAINED PERSONAL COMMITMENT

Definition Is personally committed to achieving endgoals and the continuous improvement ofthe service. Shows enthusiasm and ahigh level of motivation in leading andcompleting projects. Highly committed tothe nursing profession and keeps abreastof current issues.


> Continuous improvement focus on personal role and that of the service > Champions and promotes nurse education throughout the service > Initiates systems to capture learning and debrief staff > Attends conferences, meetings and other professional fora


>7 Sustained personal commitment

> Takes a positive view of nursing andits future

> Personally committed to, and activelyworks on, self-development andperformance improvement

> Ability to work hard, showing drive andpositive energy in bringing the serviceand staff to a higher level

> Sets realistic but challenging goals andconstantly reviews these

> Constantly challenges and questions howand what nursing ‘can do’ to improve andbetter the service

> Has a vast amount of clinical knowledgeand expertise. Continuously updates andshows willingness to share this

> Shows a strong degree of self-awareness, seeking feedback from colleagues

> Accepts both negative and positivecriticism

> Learns quickly from experience. Ability toreflect on incidents and situations and todebrief self and others in order to learnand find better ways of doing things

> Sees new developments in nursingpractice and research as opportunities for developing the nursing servicesand profession

> Works well with others and enjoysfacilitating learning, mentoring orcoaching others. Will use a variety oflearning resources.

> Actively sees nursing as involving and leading interdisciplinary services to improve and better the service as a whole.




>7 Sustained personal commitment

> Holds a negative view of the futurenursing profession and articulates same

> Self-development and performance revieware low on the list of personal priorities

> Finds it difficult to maintain a sustainedeffort. Is less focused on serviceimprovement and bringing staff to ahigher level

> Only sets comfortable targets and goalsfor staff

> More comfortable in a steady state wherethere is no element of risk taking.Concentrates on the here and now

> Limited amount of knowledge andexperience. Does not impart this to others and thus neglects keeping others informed

> Lacks self-awareness and avoids/doesnot actively seek feedback from others

> Finds it difficult to accept any criticism

> Too busy focusing on the next task. Doesnot stop to look at what is happening orspend time reflecting on incidents. Avoidsseeking new approaches

> Sees research and practice initiatives asthreatening the status quo. Will play safein terms of developing the service

> Avoids teaming up with others andfacilitating learning. Will leave this to theformal systems that are in place

> Allows nursing to retain peripheral to theinterdisciplinary services, leaving otherdisciplines to lead.



GENERIC COMPETENCY 8 > PRACTITIONER COMPETENCE AND PROFESSIONALCREDIBILITY

Definition Has the functional and technicalknowledge and skills to make a crediblecontribution to nursing practice.


> Applicable as an underpinning foundation for most core activities at alllevels of nursing management


>8 Practitioner competence and professional credibility

> Demonstrates a sound grasp of corenursing issues from a functional ortechnical perspective

> Shows sound professional judgement indecision-making on functional areas

> Shows the capacity to follow a moredetailed presentation on a particularfunctional area

> Picks up on functional or technical points quickly

> Is good at learning about new practicedevelopment or technical knowledge

> Takes steps to regularly updateprofessional knowledge base

> Has a track record of making asubstantial professional contribution.

> Shows a lack of understanding in corefunctional or technical areas

> Makes marginal or poor judgements due tolack of professional knowledge

> Loses the thread of an issue once it getsinto functional or technical detail

> Is among the last to learn or adapt new technologies

> May be stuck in past skills and technologies

> May show no interest in functional ortechnical areas

> Lacks the credibility of a substantialpractice achievement or contribution.

Indicators of MOREeffective performance


26 Harcourt StreetDublin 2tel 01 475 4044fax 01 475 4066email [email protected] www.officeforhealthmanagement.ie

generic competencies for nurse and midwife...

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