Competency standards for critical care nurses: do they measure up?

OBJECTIVE To determine the construct validity of the Australian College of Critical Care Nurses (ACCCN) competency standards as a tool for assessing the clinical practice of specialist level critical care nurses in Australia. DESIGN A comparative descriptive design was used to examine the relationship between the domains, competencies and elements of the ACCCN competency standards. Participants were sent a questionnaire and asked to describe on a 7-point Likert scale how closely each competency statement and related elements reflected their level of critical care nursing practice. SUBJECTS A systematic sampling method was used to randomly select 1000 critical care nurses from a prelisting of members of ACCCN. A total of 532 completed questionnaires were returned. MAIN OUTCOME MEASURE The purpose of this study was to determine the construct validity of the ACCCN competency standards by examining two structural models. The first examined how well the descriptive elements fit with their respective competency standard. The second model examined how well the competency standards group together under specific domains. RESULTS Statistically there was no support for the current structure for the ACCCN competencies because the elements did not fit uniquely to a single competency, but were multidimensional and loaded across several competencies. Competency statements also loaded across several domains. Modification of the current model resulted in the identification of a four-factor competency model, which demonstrated reasonable model fit. CONCLUSION Several issues are highlighted, resulting in concerns regarding the validity of the ACCCN Competency Elements and Standards as a tool with which to assess the practice of critical care nurses.