Factoring consumers' perspectives into policy decisions for nursing competence.

Health care delivery competence and accountability have typically been defined from providers' perspectives, rather than those of consumers as purchasers of services. In 1999, in the face of broad public concern about nursing competence the Alabama Board of Nursing developed an accountability model that established consumers at the center of the model and placed accountability for competent nursing practice at all levels of providers including regulatory agencies, health care organizations, educators, and licensees. The Board then authorized two research projects involving first, consumers perceptions on nursing competence and regulation, and second, comparing their perceptions with those of licensees, nurse educators, and organizational leaders (N = 1,127). Comparative data evidenced significant differences between consumers' and other participants' perceptions. This article highlights how policy implications derived from research resulted in regulatory changes for nursing competence. Five years of progress in policy changes made in the interest of public safety are summarized.