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Legislating Competence? Bills Focus on Continuing Competence

Publish Date: February 15, 2012

Both California and Georgia are considering bills this year that would require demonstration of competency for professional registered nurses. These bills reflect a trend toward competency-based practice as hospitals and other health care facilities move away from practice hours toward more valid measures of continuing competence. 

In California, Senate bill 554 would require every direct care registered nurse to have current demonstrated and validated competency for the specific needs of the patient population in a unit or clinical area before the RN may be assigned to patient care for that unit or clinical area. Current competency may only be demonstrated and validated by observation by another direct care RN who has previously demonstrated current competency in the relevant patient population. Self assessments are prohibited, and the observing RN must directly observe and assess for a minimum of five standard nursing shifts. 

California’s bill is sponsored by the California Nurses Association, which cites concerns that despite existing requirements that acute care hospitals validate the competency of their RNs, RNs have been accepted into clinical areas where they are not competent, particularly when hospitals contract with outside agencies for RNs. The bill would require all direct patient care staff, including per diem and temporary staff and new hires, to receive an objective competency assessment, specific to the care unit in which they will be working, before assuming patient care responsibilities. 

California’s bill is opposed by the California Hospital Association, which states that rules already exist to address both the competency of RNs and the orientation of temporary staff. The hospital association believes that passage of this bill would increase the cost of engaging a traveling or registry nurse by $3,600 per nurse. 

In contrast to the specificity in California’s bill, Georgia’s Senate bill 368 would simply require applicants for renewal of their nursing license to meet such continuing competency requirements as the board of nursing may require by rule or regulation. If Senate bill 368 passes, the Georgia board of nursing would presumably develop continuing competency requirements in its rules and regulations. 

AORN does not have a position on the above two bills, but AORN does believe that developing, maintaining, and evaluating competent behaviors is essential for the nursing profession and patient care. Check out AORN’s Perioperative Job Descriptions and Competency Evaluation Tools if you need help establishing competency evaluation tools in your facility. Also look for a new product coming soon from AORN, Ambulatory Surgery Center Resources, an infection prevention tool for use in Ambulatory Surgery Centers that includes job descriptions and related competencies.