Issue: Competence assessment and competency assurance of healthcare professionals.

CLIN ICAL NURSE SPEC IALI ST specialty nursing certifying organizations, The Pew Health Professions Commission, the Citizen Advocacy Center (CAC) (www.cacenter.org), the Council on Licensure, Enforcement and Regulation (CLEAR) (www.clearhq.org), and the Federation of Associations of Regulatory Boards (www.farb.org). The latter 3 organizations are resources for professional regulatory board members; as such, they do not represent a particular healthcare professional group. The CAC is a resource for the public members of regulatory boards and other governing bodies who serve as representatives of the public interest. The CAC advocates for change in the measurement of healthcare professionals’ competence, and, in 2004, published a road map of actions to achieve continuing competence assurance. The road map will be discussed later. The work of The Pew Health Professions Commission Taskforce on Health Care Workforce Regulation prompted the current debate about healthcare professionals’ regulation and continuing competence. Regarding all healthcare professions, the 1998 report identified major concerns about consumer protection, quality of care, and the competence of professionals to provide quality care. The taskforce observed that it is possible for a practitioner’s competence to diminish years after initial licensure, and, further, that continuing education hours, the most common requirement for continuing competence, do not guarantee competence. The report recommended that state boards should set not only competence standards for entry into practice but also require healthcare practitioners to demonstrate competence throughout their careers. Writing about the issue of continued competence, Lyon and Boland reported that nursing associations agreed with the basic premise that continued competence of healthcare practitioners is critical to a quality healthcare system but urged that documentation of competency be deferred to professional associations. Lyon and Boland defined the domains of competence as knowledge competence, technical competence, cultural competence, and communication competence. From the Yale University School of Nursing, New Haven, Conn.