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  A concept analysis of competence and its transition in nursing  Joanne R. Garside ⁎ , Jean Z.Z. Nhemachena Department of Health Sciences, School of Human and Health Sciences, University of Hudders  󿬁 eld, Queensgate, Hudders  󿬁 eld, HD1 3DH, UK  s u m m a r ya r t i c l e i n f o  Article history: Accepted 14 December 2011Available online xxxx Keywords: CompetenceCompetenciesNurse educationContinuing professional developmentConcept analysis Competence is one of the most commonly used words in nursing internationally, yet is a nebulous conceptde 󿬁 ned in diverse ways by different healthcare practitioners. The slippery nature of the concept often existspurely in the eye of the beholder however, the universal principles are deeply rooted in the measurement of the Registered Nurse's (RN) ability to perform effectively. Competence is a simpler thing to de 󿬁 ne whenrecognising where it does not exist in the form of incompetence. The aim of this paper is to present  󿬁 ndingfrom a concept analysis that explored various facets of competence, particularly how it has been interpreted,applied and transformed over theyears withinnurse education intheUnited Kingdom. The analysisutilised asystematic review of contemporary evidence base based on theory construction by Walker and Avant (2005),a primary concern being to understand the underpinning conceptual principles that de 󿬁 ne the concept of competence and competency development and how these may be used to inform our understandings. Theanalysis identi 󿬁 ed how in 󿬂 uential academics and professional bodies have attempted to provide de 󿬁 nitionsand concluded that it may be the existence of so many of these de 󿬁 nitions, which has compounded theconundrum of what competence really is.© 2012 Elsevier Ltd. All rights reserved. Introduction The general public assumes the registered nurse (RN) to becompetent in the execution of tasks and duties expected of theprofession (Eraut, 1994). The term competence is a concept whichis internationally applied in reference to professional people of allkinds, but especially so in relation to nursing practice. It is consideredanessentialingredientwhenmeasuringa practitioner'sabilitytopro-vide effective nursing care (Watson, 2002). Competence however, isgenerally regarded as an elusive entity when it comes to its actualmeaning. Watson et al. (2002, p.422) argued that  “ competence is asomewhat nebulous concept which is de 󿬁 ned in different ways bydifferent people ”  and there is no universal de 󿬁 nition of competencealthough the concept is integral to the principles of many nurse edu-cational programmes (Milligan, 1998). Ambivalent de 󿬁 nitions of what genuinely comprises of competence are not solely a challengefor nursing, but have signi 󿬁 cance for many other professional groupssuch as teachers, solicitors and doctors (Eraut, 1994; Epstein andHundert, 2002).  Aims The aim of this concept analysis was to examine and critically an-alyse the available evidence base surrounding competence, the focusbeing to identify any signi 󿬁 cant in 󿬂 uences that inform professionalunderstanding, which in turn would in 󿬂 uence practical implementa-tion within contemporary nursing practice. Method A concept analysis may be rationalised for the purpose of theorydevelopment, understanding and operationalising of certain termsof which a variety of models exist (Paley, 1996). One adaptationcommonly used is Walker and Avant's (1988) systematic approach,it's objectives lay in identifying the concepts  ‘ de 󿬁 ning attributes ’ ,therefore advocates that the investigator follows eight steps so thatthe actual meanings of the concept may be explained. The eightsteps include: selecting the concept, determining the purpose of theanalysis, identifying the concept uses, de 󿬁 ning the attributes, identi-fying model cases, identifying antecedents and consequences andde 󿬁 ning empirical terms (Walker and Avant, 2005). Paley (1996) argues that the process is not necessarily ordered therefore, revisitingpreceding steps is necessary as the analysis progresses and deeperexploration takes place. Walker and Avant's (1988) approach simplyoffers a pragmatic and logical method on which to base a conceptanalysis for utilisation in the nursing profession. Search Methods A signi 󿬁 cant amount of the evidence for the review was generatedthrough a single entry portal, this resource gateway enabled access tolibraryresources,suchasdatabases, e-journals,e-books, web resources Nurse Education Today xxx (2012) xxx – xxx ⁎  Corresponding author. Tel.: +44 1484 473567. E-mail addresses: (J.R. Garside), Nhemachena). YNEDT-02159; No of Pages 5 0260-6917/$  –  see front matter © 2012 Elsevier Ltd. All rights reserved.doi:10.1016/j.nedt.2011.12.007 Contents lists available at SciVerse ScienceDirect Nurse Education Today  journal homepage: Please cite this article as: Garside, J.R., Nhemachena, J.Z.Z., A concept analysis of competence and its transition in nursing, Nurse Educ. Today(2012), doi:10.1016/j.nedt.2011.12.007   and catalogues. The most relevant and generative databases werethe Cochrane Library, Science Direct and Wiley Interscience. Other re-sources included searches through Google Scholar, Nursing and Mid-wifery Council (NMC) sources, Medline and Cinahl.To begin the search the term  ‘ competence ’  was used. The searchwas not restricted to nursing to reduce professional bias of the concept(Walker and Avant, 2005). The search was then re 󿬁 ned by addingterms  ‘ nurse ’ ,  ‘ healthcare professional ’ ‘ education ’ ,  ‘ competencies ’ , ‘ clinical practice ’ ,  ‘ patient ’  and  ‘ assessment ’ . To re 󿬁 ne the review, allevidence that did not link competence to education of nurses orother healthcare professionals were excluded and irrelevant evidence 󿬁 ltered out. The evidence was limited to English language paperswhich then allowed a full review to begin the concept explorationtherefore, providing a useful strategy to help de 󿬁 ne the most relevantquestionsthatwilllead toa decisionabouttherelevanceofaparticularreview (Burns and Grove, 2005).This concept analysis used a thematic method for presenting the 󿬁 ndings (Fink, 2005). The themes presented in the paper were identi- 󿬁 ed following the analysis. The  󿬁 ndings of the analysis are presentedusing the following themes and subthemes; nurse education, compe-tence in practice, post-registration nurse education, approaches tocompetence, competence transition, patients' view, competence de-scriptors and assessment of competence. Results Nurse Education In the United Kingdom (UK) the last two decades have seen allnurse education programmes transfer to Higher Education Institutes.Competence is  󿬁 rmly embedded in pre-registration nurse educationwhich has led to it becoming a controversial issue, particularly whenclinicalcompetenceandelementsofthemoreformaleducationalprep-aration appeared to be in con 󿬂 ict because of the stereotypical normand thegeneralperceptionwasthat universities prefer scienti 󿬁 c ratherthan professional knowledge (Barnett, 1994). Yet universities havehigh interest in their marketability and the structured production of academic modules that make students employable and the coursesthat are their commodity, had to adapt to the NHS requirement thatstudents should be  󿬁 t for purpose. This was something that wasbelieved tohave poseda threatto the universityas,  “ user derivedstan-dards threaten its hegemony ”  (Eraut, 1994, p.15). Modularised educa-tion systems emerged that supported the structured division of academic knowledge and clinical practice in the profession. Theseused many different learning strategies in their attempt to provide acoherent learning experience. Eraut (1994) recommended thattheoretical knowledge and pedagogical techniques be linked with thepractical side of professional clinical experience. But this ideal provedextremely dif  󿬁 cult to implement effectively, particularly because of the constraints within the university credit based systems. Neverthe-less responsibility for the academic credit lay with universities andnurse education providers had to work around that. The responsibilityfor the assessment of practical competence however, remained whollywithin the NHS, thus in one view  “ widening the gap betweenprofessional educators and their erstwhile professional colleagues ” (Eraut, 1994, p.99). It led to the call for nurses to go  ‘ back to bedpans ’ ,allegations that the emerging nurse was not  󿬁 t for purpose and notcompetent and the political momentum behind these suggestionsresulted in the then UK professional body setting the Commission forNurse Education (UKCC, 1999; Meerabau, 2001). The signi 󿬁 cance forthe debate about competence in nursingand its de 󿬁 nitionand applica-tion intensi 󿬁 ed and it  “ moved to centre-stage ”  when in 1999 thestatutory body launched the report  ‘ Fitness for Practice ’  (UKCC, 1999;Watson, 2002, p.476).The healthcare sector as an employer wanted diplomats or gradu-ates who could enter employment with minimal need for furthertraining (Burnard and Chapman, 1990). Somewhat in contrast, univer-sities aim to equip students with broad generic, transferable knowl-edge and skills in preparation for embarkation upon a path of lifelonglearning (Cowan et al., 2005). For entry to the nursing register the stu-dentis requiredto meet all academic and practice demandsin being 󿬁 tfor practice,  󿬁 t for purpose,  󿬁 t for award at the point of registration(NMC, 2005). Programmes often failed to recognise that differentstudents learn different things at different rates (Piaget, 1981) andcurricula designers produce restrictive programmes that meet the ge-neric need asopposedtoproviding 󿬂 exibilityand adaptabilityrequiredtomeetstudents'individuallearningneeds.Followingitsincorporationinto academia, the pre-registration nurse curriculum became notori-ously  ‘ top-loaded ’  and overcrowded with the infeasible expectationthat all the knowledge and skills thought appropriate for a lifetime inthe nursing profession could be acquired (Eraut, 1994). Competence in Practice Manynurseeducationprogrammesinternationally,structuretheirpractice assessment around Benner's (1984) proposition concerningthe stages of professional competence which she has termed  ‘ Noviceto Expert ’ , work predicated on that of  Dreyfus and Dreyfus (1980).Competence for Benneris a progressiveexperiencethatshe calibratesin  󿬁 ve distinct stages. Within Benner's taxonomy, when nurses haveachieved a  ‘ competent ’  level of performance, they are able to functionsafely, but as they gain more experience they develop a more holisticand complete awareness. So even the competent nurse has been con-sideredtolacktheexpertisetohandlethetotalspectrumofchallengesthat will confront them, perpetuated by Pearson (1984) who's viewrelated competence to a mid-point position on a  ‘ continuum ’  describ-ing the nurse the  ‘ competent ’  nurse as falling somewhere in the midrange of barely knowing anything to knowing something very well.Following the completion of nurse training, Eraut (1994 p.159)argued that  “ the professional nurse is competent appears to be statingthe obvious ” . Benner (1984 p.25), typi 󿬁 es the competent nurse as hav-ing been  “ on the job or in the same or similar situations for two orthree years ” . Benner's hypothesis provokes the very obvious questionregarding whether is it possible for the newly quali 󿬁 ed nurse to befully competent? What is not clear from Benner's assumptions iswhether the pre-registration clinical placements would be classed as “ on the job ”  because her work shows little acknowledgement of thenotion of transferable skills. Benner did however, publish this concep-tual model when the apprentice style of nurse training still existed inthe UK and where students were expected to be the backbone of theworkforce and were workers  󿬁 rst and learners second.Eraut (1994) contributed to the de 󿬁 nition of competence by de-scribingthecompetentpractitioneras “ tolerablygoodbutless thanex-pert ”  (p.160). In harmony with Benner, Eraut identi 󿬁 ed that evenwhen a practitioner is considered competent, there is still somethingmoreforthemtoattainbeyondwhichBennerreferredtoaspro 󿬁 ciencyand expertise, similarly, Eraut claims the competent professional to beas follows:A competent professional is no longer a novice or beginner and canbe trusted with a degree of responsibility in those areas within therangeofhisorhercompetencebuthasnotyetbecomepro 󿬁 cientorexpert.(Eraut, 1994, p.215)Competence in everyday nursing practice seems to mean beingslightly more than being newly quali 󿬁 ed and is only fully achievedonce the new nurse has gained the ability to be totally accountablefortheirprofessionalactions.Thisiscapturedwithinthestatutorypo-sitionin the UKwhere unquali 󿬁 ed nursesare notintendedto practiceunsupervised (NMC, 2008a). 2  J.R. Garside, J.Z.Z. Nhemachena / Nurse Education Today xxx (2012) xxx –  xxx Please cite this article as: Garside, J.R., Nhemachena, J.Z.Z., A concept analysis of competence and its transition in nursing, Nurse Educ. Today(2012), doi:10.1016/j.nedt.2011.12.007   It has been postulated that professional quali 󿬁 cations should bedesigned to indicate that the aspiring professional has completedthe initial training, describing quali 󿬁 cation as a  “ rite de passage ” that affects their status in society, thus reinforcing Benner's earlierpropositions (Eraut, 1994, p.159). Epstein and Hundert (2002) also add to the competence debate by recognising that competence is adevelopmental processandthatitis thesemorespeci 󿬁 c developmen-tal aspects that should be attained at different stages of training orcareer.Despite the convoluted discourse about what comprises compe-tence, most professionals hold a clear point of view about what orwhom they judge to be  ‘ incompetent ’  (Eraut, 1998). Watson (2002) discussed how we all have an inherent notion of what incompetentpractice is and that we know when we see it. For Watson, nursesmaybedeemedincompetentwhentheyhave notgainedasuf  󿬁 ciencyof experience to consider clinical circumstances holistically in a waythat provides an issue in prioritisation of the care they provide andthe ability to function effectively within their nursing role. He inter-estingly, further raises the question that because competence is sopoorly de 󿬁 ned and is so dif  󿬁 cult to articulate effectively in clinicalpractice, is what is being considered as competence,  “ often no morethan not being incompetent? ”  (Watson, 2002, p.477). Post-Registration Nurse Education Successful completion of pre-registration nurse education andgaining the professional registration denotes the formal  ‘ learning ’ stage of a nurse's career. Having achieved registration marks asigni 󿬁 cant decline in the amount of time allocated for learning, butshouldnot ideallysignify a breakin learning processitself. The formalpriority of development in nursing is given to pre-registration nurseeducation years, there is awareness that the pre-registration yearsare just a beginning and there is a need for Continuing ProfessionalDevelopment (CPD) (Eraut, 1994). CPD as an entity has been criti-cised for its poor integration with clinical practice with ill de 󿬁 nedoutputsand theempirical evidence about its effectiveness andoverallin 󿬂 uence on clinical practice is often scanty and frequently it is main-ly negative rather than positive in nature (Eraut, 1994). The UK'sNursing and Midwifery Council (NMC) has however, acknowledgedits importance and has provided post-registration education andpractice (PREP) standards; a CPD framework designed to provide ahigh standard of practiceand care,althoughits advice oncompetenceis less than clear because it includes an opt out clause that the PREPstandards are  “ not a guarantee of competence ”  (NMC, 2010a, p.2).  Approaches to Competence There have been a variety of different conceptual interpretations of competence in nursingincludingthebehaviourist and generic or holis-tic approaches. The behaviourist approach to competence focused ontasks and skills. Competence assessment using this method is commonto nursing programmes and often relies on direct observation of thestudent's performance. To achieve overall competence within the be-haviouristphilosophydepends ontheindividualachievingasatisfacto-ry level of performance in each component of de 󿬁 ned task (Watson etal.,2002; McMullan et al., 2003). This interpretation has beencriticisedasbeingreductionist and to be more concerned about what people candoratherthanwhattheyknowandofdisregardingotherkeyattributesthat contribute to nursing care, such as communication and critical judgement. Competence is a normative concept often related to thespeci 󿬁 cs of what a competent person is able to do in speci 󿬁 c circum-stances (Eraut, 1994). It is important therefore, to ask not only howcompetence is de 󿬁 ned in general, but also how it is de 󿬁 ned under spe-ci 󿬁 cconditionsandcircumstancesthatarepartofthenurserole(Eraut,1994). Nursing embraces a diversity of dimensions that cannot beeasily reduced to a mechanistic list of competencies. It encompasses awide repertoire of skills that change according to the demands of each clinical speciality where nursing care is being carried out andthus is context dependant. Epstein and Hundert (2002) discussed thisalong with the practitioners  ‘ scope ’  of competence which must berelated to the clinical context in which it occurs. Suf  󿬁 ce to say that anurse may be fully competent within a speciality in which they haveworked for many years yet might have to work in a less familiar envi-ronment where their competence might be more dubious. Evidencetells therefore, that it is not adequate to ask only how competence isde 󿬁 ned in general but how it is de 󿬁 ned in particular contexts (Eraut,1994).The holistic approach to competence identi 󿬁 es broad clusters of general attributes which are considered essential for effective perfor-mance. These underlying attributes provide the basis for transferableskills in delivering care (McMullan et al., 2003). The holistic slant as-sesses competence as more than the sum of individual competencies.Attributes of holistic competence include motives, personal interests,perceptiveness, receptivity, maturity and aspects of personal identity(Cowan et al., 2005). Eraut (1994) discussed holistic competence as a generic quality to a person's overall capacity and competency toenable the practitioner to ful 󿬁 l a role and these attributes are oftentaken into account within job selection processes and appraisalsystems (Epstein and Hundert, 2002). Competence Transition Competence has always been a principle aspiration within UKnurse education but how this has been de 󿬁 ned and the speci 󿬁 city of that de 󿬁 nition have seen a marked transformation in recent years.In2002, theNMC de 󿬁 ned competenceas  “ the skills and ability to prac-tise safely and effectively without the need for direct supervision ” (NMC, 2002, p.38). This de 󿬁 nition focused on the  ‘ know how ’  and re-ferred to the practical elements required to independently implementnursing care. It provided very little reference to the knowledge base,the  ‘ knowing that ’  or the theoretical underpinning of effective nursingcare (Ryle, 1949). Gonczi et al. (1993) described the attributes that make competence as knowledge, skills and attitudes. Hand (2006) ad-vanced this idea re 󿬂 ecting that, having the skill without the underpin-ning rationale renders the practitioner unsafe. Similarly, having theknowledge but not the skill may lead to incompetence also and alltherefore, lead to the conclusion that knowledge and skill in equalmeasure are prerequisites to informed nursing practice. Hence nursingis not purely about the practice delivery but the knowledge base thatunderpins it. Ryle (1949) summarised the position describing the ‘ knowing that ’  and the  ‘ knowing how ’  should be united and appliedto  ‘ process knowledge ’ . This was later reinforced by Eraut whodepicted  “ knowing how to conduct the various processes that contrib-ute to professional action ”  (Eraut, 1994, p.107).Drawing on Watson's (2002) discussions, the theoretical proposi-tionofcompetencewasrecognisedindetailandwithintheNMCpolicyin 2008. It built descriptors into the de 󿬁 nition, describing competenceas:Abringingtogetherofgeneralattributes — knowledge,skillsandat-titudes. Skill without knowledge, understanding and the appropri-ate attitude does not equate with competent practice. Thus,competence is the skills and ability to practise safely and effectivelywithout the need for direct supervision.(NMC, 2008b, p.3)In 2010 theNMC published  ‘ Standardsfor pre-registration nursingeducation ’ , in it nurse educators were alerted that new registrantsmay not be as competent as they might be supposed. In this recentNMC iteration, (adapted from the Queensland Nursing Council,2009) of what comprises competence, the statutory body identi 󿬁 ed 3  J.R. Garside, J.Z.Z. Nhemachena / Nurse Education Today xxx (2012) xxx –  xxx Please cite this article as: Garside, J.R., Nhemachena, J.Z.Z., A concept analysis of competence and its transition in nursing, Nurse Educ. Today(2012), doi:10.1016/j.nedt.2011.12.007   it as:  “ The combination of skills, knowledge, and attitudes, values andtechnical abilities that underpin safe and effective nursing practiceand interventions ”  (NMC, 2010b, p.45). This de 󿬁 nition extends thework of  Gonczi et al. (1993) that conceptualised competence as thebringing together of several attributes in a way that speci 󿬁 callyaddresses the detailed needs of those undergoing an educationalexperience for their profession.In comparison with nursing, the medical profession has beensomewhat more emphatic and Epstein and Hundert (2002) identi 󿬁 edthe medical attitude to competence that was described as follows:Professional competence is the habitual and judicious use of com-munication, knowledge, technical skills, clinical reasoning, emo-tions, values and re 󿬂 ection in daily practice for the bene 󿬁 t of theindividual and community being served.(Epstein and Hundert, 2002, p. 288) Patients' View The advent of greater patient and public involvement in the NHSin this century has seen reference competence being something onwhich patients should have a view (Milburn, 2003). Little empiricalwork exists from the patients' perspective but Calman (2006) under-took a small-scale qualitative study with 27 service-users andinvesti-gating their views of nurses' competence. They described thefoundations of competent nursing practice to be technical care andnursing knowledge. The service-user saw it a priority for these quali-tiestobe demonstratedasa signofnursingcompetence.Anemphasisby them was also placed on the ability to protect and safe guard pa-tients in their care. Such was the concern for  technical competency that it surpassed in the respondents estimation, the emphatic andinterpersonal skills of the nurse in its ranking of importance. Competence Descriptors While competence has a deep traditional place within nurseeducation, it has been suggested that other descriptors such as  ‘ per-formance ’  and  ‘ capability ’  provide a more sophisticated de 󿬁 nition of what should be sought in the qualifying practitioner (Eraut, 1994).Both performance and capability clearly relate to competence andthe terms are often used interchangeably and this has been some-thing observed to be semantically confusing (Watson et al., 2002).Performance is concerned with the demonstrated ability to  ‘ do ’ something and should be directly observable (Gonczi et al., 1993).Performance may be required to demonstrate competence but thedebate whether performance may wholly demonstrate competenceremains an unresolved conundrum on which the jury is still out(Eraut, 1998). Underpinning knowledge has been recognised as asigni 󿬁 cant feature in most de 󿬁 nitions of competence, thus, indicatingthat competence requires the integration of and collaborationbetween theory and practice ( Jarvis et al., 2003). Assessing cognitiveprocesses, by de 󿬁 nition, cannot be visually observed and therefore,other mechanisms than the naked eye are required to assess perfor-mance and the evaluation of professional practice. Competence issimilarly, not directly observable. It therefore, may be only partlyinferred from performance (Gonczi et al., 1993). Consequently, it isargued that the assessment of performance should take place in anatural or near natural setting as required for the job (Eraut, 1994).This raises the challenge to nurse educators that assignments and ex-aminations demonstrate knowledge and reasoning ability but thatthey may be capable of only partially assessing clinical performance.So without performance evidence, judgements of competence maybe thought unreliable and to lack credibility. Competence therefore,should be the combination and integration of performance andcapability. Capability may provide a basis for developing future com-petence and is concerned with the knowledge and skills to enableperformance potential in a wider range of situations than thosedirectly observed. Essentially capability is  “ knowledge in use ”  thequality of being  “ capable is almost synonymous with competencewithout the normative connotation ”  (Eraut, 1994, p.208).  Assessment of Competence Competence in nursing is traditionally assessed through observa-tion of the student in clinical practice however, the key questionbeing, what level of performance is to be demonstrated before thestudent achieves competence? Watson et al. (2002) reinforce thisand concur that the challenge within assessment, given the variedde 󿬁 nition of the concept, concerns the selection of assessment tools.The multiple instruments that are used for competence assessmentraises the potential issue of each instrument's reliability and validity(Schoene and Kanusky, 2007).Reliability is determined if an assessment accurately and consis-tentlyevaluatesthestudentsperformanceorcompetence.Forthewrit-ten assessment to be reliable, it must remain at a consistentlyacceptable level over time regardless of how many people judge it.An assessment in the clinical setting, however, is a unique and compli-catedeventthatlivesonlyinthememoriesofamentorandthestudentbeing assessed (Nicklin and Kenworthy, 1996). Some judgementsabout professional practice to be reliable are dif  󿬁 cult to justify inconcrete terms and this is why student appeals against a judgementof failure is often upheld.Validity concerning the assessment of competence answers thequestion; does the particular mode of assessment measure what itset out to measure? This relates naturally to the sensitivity that thestrategy has to the particular outcomes that it is attempting tocalibrate. This may even be within this process a paradox in thisquest for validity whereby the  󿬁 delity of the assessment, may resultin a reduced demonstration of related performance or capability(Eraut, 1994). Dreyfus and Dreyfus (1980) identi 󿬁 ed what theytermed  ‘ the situational experience premise ’ . They claim that skilledperformance can be partially achieved through principles and theorylearned in a classroom but that the critical context-dependant judge-ment can be acquired only in  ‘ live ’  clinical practice. Written examina-tions and essays are only guaranteed to assess knowledge and thistype of academic assessment it is argued, can rarely be capable fullyof assessing practical competence (Eraut, 1994). In addition, the tra-ditional maxim in academia is to specify a pass mark andgrading criteria to judge levels of knowledge but this becomes amore thorny issue when the process is used to assess competence.Most institutions consider the calibration of practice in this to be in-feasible and settle for a straight pass or fail decision.The assessment of applied knowledge and skills is an importantrequirement for competence of the RN yet there are concerns thatexist about the extent to which CPD include and assess ongoing clin-ical competence (Manley and Garbett, 2000; Watson et al., 2002). Inthe UK in 2004, the Knowledge and Skills Framework (KSF) waslaunched (DH, 2004). This required all NHS non-medical, registeredpractitioners to demonstrate their ongoing professional updatingand their ability to practice by demonstrating this ability against setcompetencies. The limitations of this in terms of its intentions anditseffect onequitableremunerationhavebeenquestionedandimple-mentationof these polices hasproduced “ a gap betweentheintendedpolicy and the actual practice of KSF in the NHS remainsunacceptablywide ”  (Brown et al., 2010, p.131).Competence is a context and time speci 󿬁 c idea that requires theRN to be continually exposed to the particular area of competence,enabling them to maintain their claim to it. Eraut (1994) suggestedthat serious consideration should be given to  ‘ date-stamping ’  quali 󿬁 -cations linked to a system of 5 – 10 year updates. Continued  ‘ exposure ’ 4  J.R. Garside, J.Z.Z. Nhemachena / Nurse Education Today xxx (2012) xxx –  xxx Please cite this article as: Garside, J.R., Nhemachena, J.Z.Z., A concept analysis of competence and its transition in nursing, Nurse Educ. Today(2012), doi:10.1016/j.nedt.2011.12.007 


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