Measuring the 6 Nursing Core Competencies

April 1, 2021
April 1, 2021

This blog post begins our series about measuring nurse competency.

Competency and competency measurement are now essential elements of the nursing profession. They establish the framework for professional expectations and work to define professional development and learning plans that will help assimilate new nurses into practice and experienced nurses into new specialties. The American Nurses Association (ANA) defines competency as an expected level of performance that integrates knowledge, skills, abilities, and judgements.

Nurse competency is a broad topic and includes more than just the expected clinical skills. It encompasses:

  • Patient Care
  • Medical/clinical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communication skills
  • Professionalism
  • System-based practice

Defining competency has been an evolving process and so has the means by which it is measured.

Measuring Competency

Just as the list and scope of competencies has evolved since their introduction, the optimal means of educating and measuring around competency has also evolved.

While the Accreditation Council for Graduate Medical Education (ACGME) model was designed primarily with physicians in mind, it is easily adaptable to continuing education for nurses. Competency-based education is characterized by the following characteristics:

  • Inclusion of individualized learning tailored to the unique needs of the learner is a key component. Education is customized to the nurse’s educational background and level of practice and further defined by the nurse’s role and work setting.
  • Feedback to the learner is an essential component.
  • The primary emphasis is on outcomes—defined levels of proficiency—rather than program admissions or selection criteria. An integrated model that includes practice and education will have a positive impact on patient safety and outcomes.
  • A systematic approach is required to establish and manage milestones and measure outcomes. Both practice settings and nursing education should support individuals as they move through the system.
  • Training is modular and specific to each competency.
  • Both the learner and the learning program have accountability for success.

Beginning in 2013, ACGME has required assessments based on key milestones within each of the core competencies as a key component of the ACGME NEXT Accreditation System. They have defined milestones within each competency along an educational continuum. The milestones serve as a framework for learners and educators to define the observable behaviors that represent development. Success is evaluated through an evaluation of knowledge, attitudes and behaviors as well as observable skills.

Building Competence with Technology and Intentional Practice

Developing nurses that can provide safe, skilled, and competent care is the goal of virtually every nursing program. The path to competency has been a bit more difficult to identify. ACGME’s Milestone program provides an excellent framework, but how do educators ensure competency—particularly in regards to clinical skills? More and more the answer can be found in the world of simulation and artificial intelligence (AI). Repetitive practice and immediate feedback provided either by instructors or the simulation equipment itself can help build confidence as well as competence.

The efficacy of this kind of training is no longer in question. There is ample evidence that simulation is effective in teaching and in improving and retaining clinical skills. This type of intentional practice helps students apply interventions in a consistent way while simultaneously allowing them to practice and maintain specific skills.

Lastly, competency measurement should address:

  • Knowledge – the cognitive aspects of competency; demonstration of a grasp of nursing roles and responsibilities
  • Ability – the application of knowledge to specific skills
  • Skills – includes psychomotor skills related to specific activities as well as those skills related to communication
  • Judgement – includes critical thinking and reasoning related to ethical, legal and regulatory issues

Our blog series about measuring nurse competency was developed to bring attention to all the attributes that contribute to truly competent nursing. In addition to this post, others will address:


  • Patient Care
  • Systems-based practice
  • Medical clinical knowledge
  • Practice-based learning and improvement
  • Professionalism
  • Interpersonal Communication

Ensure Competency of Nursing Staff at Every Level

In today’s value-based healthcare environment, it is more important than ever to be able to eliminate guesswork and develop a standard level of competency across the entire organization. Utilizing proven data to identify development needs is not just a nice-to-have. It’s a must-have. Learn more about HealthStream solutions for nurse competency management.