The Perfect Assessment: Competency

(This is a reposting of a thought piece by Paul Ross with the permission of the Nursing Education Network blog.  It’s a response to the Larissa Hattin’s two-part commentary on assessment in #CBME Read part 1 here and part 2 here -Jonathan (@sherbino))


By: Paul Ross (@ICUnurses)


Whilst working as a postgraduate course coordinator I regularly had discussions with students, nurse educators and the higher education team of the ‘ideal’ assessment. Everyone seems to have their own views and preferences on the correct method of assessment. This variability is matched by workplaces and universities assessing using an array of assessment methods for nurse training.

Education Question

You are the nurse educator and a nurse in your unit is struggling to meet the expected standards set by your nurse leadership team. The manager has asked you as the educator to spend time with the nurse and assess levels of competence. What is your approach to this situation and how are you going to assess this nurse?

Competence & Competency

“Competence is focused on the description of the action or behaviour, whereas competency is focused on the individual’s behaviour underpinning the competent performance.” (Tilley, 2008, pg. 63).

Example of national standards of nursing competence from NMC (UK):

“The standards for competence apply to all fields of nursing and are set out in four main areas of professional nursing practice. These are professional values, communication and interpersonal skills, nursing practice and decision-making, and leadership, management and team working. ”

Professional Competence: Multidimensional Model

The assessment may measure one, some or all of the following domains:

  • Knowledge
  • Skills
  • Attitudes
  • Decision making
  • Problem solving
  • Professional attributes (interpersonal skills)

Education Theory

Understanding and addressing how people learn using Bloom’s Taxonomy, includes the cognitive domain, the affective domain and the psychomotor domains for educational objectives. To guide the framework for assessment commonly the Bondy (1983) 5 point rating scale is utilised which provides a hierarchy of competence:

  1. Independent
  2. Supervised
  3. Assisted
  4. Marginal
  5. Dependent

Assessment Options:

  • E-learning package
  • Blended approach (e-learning & hands on assessment)
  • Objective structured clinical examination (OSCE)- Simulation
  • Oral case presentation: the hot case
  • Exam
  • Multiple-choice
  • Essay
  • Reflection
  • Self-assessment
  • Practice portfolio
  • Checklist skill task
  • Appraisal: formative and summative

McDonald (2014) states that “a multidimensional approach is essential to assess all aspects of behavior. This is especially true when assessing psychomotor skills, affective behavior, or higher-level cognitive ability such as critical thinking” (pg 7-8).

The correct assessment will be determined by the instructional process and intended learning outcomes.

Formative & Summative

An authentic form of assessment which requires ongoing development and a process of feedback. Formative (assessment for learning) and summative (assessment of learning) assessments provide an opportunity for self assessment and constructive feedback (Looney, 2011).

Qualities of Assessment

  • Validity
  • Feasibility
  • Fidelity to practice
  • Reliability
  • Practical considerations
  • Authenticity

“Reflect effective performance and can be evaluated against well-accepted standards” (Leigh et al, 2007).


Competence is difficult to define and lacks consensus. Is it assessing potential or ability?

Elements of subjectiveness exist if competence is judged by observing nurses’s performance. There is a lack of consensus on using a competency model for teaching and evaluating. And at what point does competency need measuring to move from general to specialised competency (Tilley, 2008). Is the capability framework approach more representative of ability and performance? One of the ongoing difficulties is agreement between employers and Universities in nurse education. Employers want work ready graduates, Universities want lifelong learners.



Anderson, L.W. (Ed.), Krathwohl, D.R. (Ed.), Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., Raths, J., & Wittrock, M.C. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s Taxonomy of Educational Objectives. New York: Longman. [example here]

Bondy, K, N. (1983). Criterion-referenced definitions for rating scales in clinical evaluation. Journal of Nursing Education. Vol. 22, no. 9, pp. 376-382. [example here]

Leigh, I. W., Smith, I. L., Bebeau, M. J., Lichtenberg, J. W., Nelson, P. D., Portnoy, S., … & Kaslow, N. J. (2007). Competency assessment models. Professional Psychology: Research and Practice, 38(5), 463.

Looney, J. W. (2011). Integrating Formative and Summative Assessment: Progress toward a Seamless System? OECD Education Working Papers, No. 58. OECD Publishing (NJ1).

McDonald, M., & Ovid Technologies, Inc. (2014). The nurse educator’s guide to assessing learning outcomes (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Tilley, D. D. S. (2008). Competency in nursing: A concept analysis. The journal of continuing education in nursing, 39(2), 58-64.