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Entry-Level Competencies for Registered Nurses

Here at CRNNS, we need to ensure that entry-level registered nurses are able to function in today’s realities and are well-equipped with the knowledge and skills to adapt to changes within the nursing and healthcare environment. The Entry-Level Competencies for Registered Nurses outlines the competencies required for entry-level RNs to provide safe, quality care in any practice setting.

Its other primary use is to inform nursing education programs in their curriculum development and to create awareness among the public and employer about the practice expectations of entry-level RNs.

 


Entry-Level Competencies for Registered Nurses

Professional Responsibility and Accountability

Nurses demonstrate professional conduct and that the primary duty is to the client and to ensure safe, competent, compassionate and ethical care.

COMPETENCIES:

  1. Represents self by first and last name and professional designation (protected title) to clients and the health care team.
  2. Is accountable and accepts responsibility for own actions and decisions.
  3. Recognizes individual competence within legislated scope of practice and seeks support and assistance as necessary.
  4. Articulates the role and responsibilities of a registered nurse as a member of the nursing and health care team.
  5. Demonstrates a professional presence and models professional behaviour.
  6. Demonstrates leadership in client care by promoting healthy and culturally safe practice environments.
  7. Displays initiative, a beginning confidence, self-awareness, and encourages collaborative interactions within the health care team.
  8. Demonstrates critical inquiry in relation to new knowledge and technologies that change, enhance, or support nursing practice.
  9. Exercises professional judgment when using agency policies and procedures, or when practising in the absence of agency policies and procedures.
  10. Organizes own workload and develops time-management skills for meeting responsibilities.
  11. Demonstrates responsibility in completing assigned work and communicates about work completed and not completed.
  12. Uses conflict resolution strategies to achieve healthier interpersonal interactions.
  13. Questions unclear orders, decisions, or actions inconsistent with client outcomes, best practices, and health safety standards.
  14. Protects clients through recognizing and reporting near misses and errors (the RN’s own and others) and takes action to stop and minimize harm arising from adverse events.
  15. Takes action on recognized unsafe health care practices and workplace safety risks to clients and staff.
  16. Seeks out and critiques nursing and health-related research reports.
  17. Integrates quality improvement principles and activities into nursing practice.

Knowledge-Based Practice

Nurses have the knowledge from nursing and other sciences, humanities, research, ethics, spirituality, relational practice, critical inquiry and demonstrate competence in the provision of nursing care in the areas of: ongoing comprehensive assessment, health care planning, providing nursing care, and evaluation. The provision of nursing care is an iterative process of critical inquiry and is not linear in nature.

Specialized Body of Knowledge
COMPETENCIES:

  1. Has a knowledge base about the contribution of registered nurse practice to the achievement of positive client health outcomes.
  2. Has a knowledge base from nursing and other disciplines concerning current and emerging health care issues (e.g., the health care needs of older adults, vulnerable and/or marginalized populations, health promotion, obesity, pain prevention and pain management, end-of-life care, problematic substance use, and
    mental health).
  3. Has a knowledge base about human growth and development, and population health, including the determinants of health.
  4. Has a knowledge base in the health sciences, including anatomy, physiology, pathophysiology, psychopathology, pharmacology, microbiology, epidemiology, genetics, immunology, and nutrition.
  5. Has a knowledge base in nursing science, social sciences, humanities, and health-related research (e.g., culture, power relations, spirituality, philosophical, and ethical reasoning).
  6. Has a knowledge base about workplace health and safety, including ergonomics, safe work practices, prevention and management of disruptive behaviour, including horizontal violence, aggressive, or violent behaviour.
  7. Has theoretical and practical knowledge of relational practice and understands that relational practice is the foundation for all nursing practice.
  8. Has knowledge about emerging community and global health issues, population health issues and research (e.g., pandemic, mass immunizations, emergency/disaster planning, and food and water safety).
  9. Knows how to find evidence to support the provision of safe, competent, compassionate, and ethical nursing care, and to ensure the personal safety and safety of other health care workers.
  10. Understands the role of primary health care and the determinants of health in health delivery systems and its significance for population health.
  11. Understands nursing informatics and other information and communication technologies used in health care.

Area i) Ongoing Comprehensive Assessment: Incorporates critical inquiry and relational practice to conduct a client-focused assessment that emphasizes client input and the determinants of health.

COMPETENCIES:

  1. Uses appropriate assessment tools and techniques in consultation with clients and the health care team.
  2. Engages clients in an assessment of the following: physical, emotional, spiritual, cultural, cognitive, developmental, environmental, and social needs.
  3. Collects information on client status using assessment skills of observation, interview, history taking, interpretation of laboratory data, mental health assessment, and physical assessment, including inspection, palpation, auscultation, and percussion.
  4. Uses information and communication technologies to support information synthesis.
  5. Uses anticipatory planning to guide an ongoing assessment of client health status and health care needs (e.g., prenatal/postnatal, adolescents, older adults, and reaction to changes in health status and or/diagnosis).
  6. Analyzes and interprets data obtained in client assessments to draw conclusions about client health status.
  7. Incorporates knowledge of the origins of the health disparities and inequities of Aboriginal Peoples, Black Canadians of African descent, and French Acadians and the contributions of nursing practice to achieve positive health outcomes for these populations.
  8. Uses knowledge to address health disparities and inequities of vulnerable and/or marginalized populations (e.g., sexual orientation, age, poverty, persons with disabilities, ethnic diversity, homeless, racial diversity, language minorities) and the contributions of nursing practice to achieve positive health outcomes.
  9. Collaborates with clients and the health care team to identify actual and potential client health care needs, strengths, capacities, and goals.
  10. Completes assessments in a timely manner, and in accordance with evidence-informed practice, agency policies, and protocols.

Area ii) Health Care Planning: Within the context of critical inquiry and relational practice, plans nursing care appropriate for clients which integrates knowledge from nursing, health sciences and other related disciplines, as well as knowledge from practice experiences, clients’ knowledge and preferences, and factors within the health care setting.

COMPETENCIES:

  1. Uses critical inquiry to support professional judgment and reasoned decision-making to develop health care plans.
  2. Uses principles of primary health care in developing health care plans.
  3. Facilitates the appropriate involvement of clients in identifying their preferred health outcomes.
  4. Negotiates priorities of care and desired outcomes with clients, demonstrating cultural safety, and considering the influence of positional power relationships.
  5. Initiates appropriate planning for clients’ anticipated health problems or issues and their consequences (e.g., childbearing, childrearing, adolescent health, and senior well-being).
  6. Explores and develops a range of possible alternatives and approaches for care with clients.
  7. Facilitates client ownership of direction and outcomes of care developed in their health care plans.
  8. Collaborates with the health care team to develop health care plans that promote continuity for clients as they receive conventional, complementary and alternative health care.
  9. Determines, with the health care team or health-related sectors, when consultation is required to assist clients in accessing available resources.
  10. Consults with the health care team as needed to analyze and organize complex health challenges into manageable components for health care planning.

Area iii) Providing Nursing Care: Provides client-centred care in situations related to:

  • health promotion, prevention, and population health;
  • maternal/child health;
  • altered health status, including acute and chronic physical and mental health conditions and rehabilitative care; and
  • palliative care and end-of-life care.

COMPETENCIES:

  1. Provides nursing care across the lifespan that is informed by a variety of theories relevant to health and healing (e.g., nursing; family; communication and learning; crisis intervention; loss, grief, and bereavement; systems; culture; community development; and population health theories).
  2. Prioritize and provide timely nursing care and consult as necessary for any client with co-morbidities, and a complex and rapidly changing health status.
  3. Provides nursing care to clients with chronic and persistent health challenges (e.g., mental health, problematic substance use, dementia, cardiovascular conditions, strokes, asthma, arthritis, and diabetes).
  4. Incorporates evidence from research, clinical practice, client perspective, client and staff safety, and other available resources to make decisions about client care.
  5. Supports clients through developmental stages and role transitions across the lifespan (e.g., pregnancy, infant nutrition, well-baby care, child development stages, family planning and relations).
  6. Recognize, seek immediate assistance, and help others in a rapidly changing client condition affecting health or patient safety (e.g., myocardial infarction, surgical complications, acute neurological event, acute respiratory event, cardiopulmonary arrest, perinatal crisis, diabetes crisis, mental health crisis, premature birth, shock, and trauma).
  7. Applies principles of population health to implement strategies to promote health as well as prevent illness and injury (e.g., promoting hand washing, immunization, helmet safety, and safe sex).
  8. Assists clients to understand how lifestyle factors impact health (e.g., physical activity and exercise, sleep, nutrition, stress management, personal and community hygiene practices, family planning, and high risk activities).
  9. Implements learning plans to meet identified client learning needs.
  10. Assists clients to identify and access health and other resources in their communities (e.g., other health disciplines, community health services, rehabilitation services, support groups, home care, relaxation therapy, meditation, and information resources).
  11. Applies knowledge when providing nursing care to prevent development of complications (e.g., optimal ventilation and respiration, circulation, fluid and electrolyte balance, nutrition, urinary elimination, bowel elimination, body alignment, mobility, tissue integrity, comfort, and sensory stimulation).
  12. Applies bio-hazard and safety principles, evidence-informed practices, infection prevention and control practices, and appropriate protective devices when providing nursing care to prevent injury to clients, self, other health care workers, and the public.
  13. Implements strategies related to the safe and appropriate administration and use of medication.
  14. Recognizes and takes initiative to support environmentally-responsible practice (e.g., observing safe waste disposal methods, using energy as efficiently as possible, and recycling plastic containers and other recyclable materials).
  15. Performs therapeutic interventions safely (e.g., positioning, skin and wound care, management of intravenous therapy and drainage tubes, and psychosocial interaction).
  16. Implements evidence-informed practices of pain prevention and pain management with clients using pharmacological and non-pharmacological measures.
  17. Prepares the client for diagnostic procedures and treatments; provides post-diagnostic care; performs procedures; interprets findings, and provides follow-up care as appropriate.
  18. Provides nursing care to meet palliative care or end-of-life care needs (e.g., pain and symptom management, psychosocial and spiritual support, and support for significant others).

Area iv) Evaluation: Monitors the effectiveness of client care to inform future care planning.

COMPETENCIES:

  1. Uses critical inquiry to monitor and evaluate client care in a timely manner.
  2. Collaborates with others to support involvement in research and the use of research findings in practice.
  3. Modifies and individualizes client care based on the emerging priorities of the health situation in collaboration with clients.
  4. Verifies that clients have an understanding of essential information and skills to be active participants in their own care.
  5. Reports and documents client care in a clear, concise, accurate, and timely manner.

Ethical Practice

Nurses demonstrate competence in professional judgment and practice decisions guided by the values and ethical responsibilities in the Code of Ethics for Registered Nurses. Engages in critical inquiry to inform clinical decision-making and establishes therapeutic, caring and culturally safe relationships with clients and the healthcare team.

  1. Demonstrates honesty, integrity, and respect in all professional interactions.
  2. Takes action to minimize the potential influence of personal values, beliefs, and positional power on client assessment and care.
  3. Establishes and maintains appropriate professional boundaries with clients and the health care team, including the distinction between social interaction and therapeutic relationships.
  4. Engages in relational practice through a variety of approaches that demonstrate caring behaviours appropriate for clients.
  5. Promotes a safe environment for clients, self, health care workers, and the public that addresses the unique needs of clients within the context of care.
  6. Demonstrates consideration of the spiritual and religious beliefs and practices of clients.
  7. Demonstrates knowledge of the distinction between ethical responsibilities and legal obligations and their relevance when providing nursing care.
  8. Respects and preserves clients’ rights based on a code of ethics and an ethical framework.
  9. Demonstrates an understanding of informed consent as it applies in multiple contexts (e.g., consent for care, refusal of treatment, release of health information, and consent for participation in research).
  10. Uses an ethical reasoning and decision-making process to address ethical dilemmas and situations of ethical distress.
  11. Accepts and provides care for all clients, regardless of gender, age, health status, lifestyle, beliefs, and health practices.
  12. Demonstrates support for clients in making informed decisions about their health care, and respects those decisions.
  13. Advocates for safe, competent, compassionate, and ethical care for clients or their representatives, especially when they are unable to advocate for themselves.
  14. Demonstrates ethical responsibilities and legal obligations related to maintaining client privacy, confidentiality and security in all forms of communication, including social media.
  15. Engages in relational practice and uses ethical principles with the health care team to maximize collaborative client care.

Service to the Public

Nurses demonstrate an understanding of the concept of public protection and the duty to provide nursing care in the best interest of the public.

COMPETENCIES:

  1. Enacts the principle that the primary purpose of the registered nurse is to practise in the best interest of the public and to protect the public from harm.
  2. Demonstrates knowledge about the structure of the health care system at the:
    1. national/international level;
    2. provincial/territorial level;
    3. regional/municipal level;
    4. agency level; and
    5. practice setting or program level.
  3. Recognizes the impact of organizational culture on the provision of health care and acts to enhance the quality of a professional and safe practice environment.
  4. Demonstrates leadership in the coordination of health care by:
    1. assigning client care;
    2. delegating and evaluating the performance of selected health care team members in carrying out delegated nursing activities; and
    3. facilitating continuity of client care.
  5. Participates and contributes to nursing and health care team development by:
    1. recognizing that one’s values, assumptions, and positional power affects team interactions, and uses this self-awareness to facilitate team interactions;
    2. building partnerships based on respect for the unique and shared competencies of each team member;
    3. promoting interprofessional collaboration through application of principles of decision-making, problem solving, and conflict resolution;
    4. contributing nursing perspectives on issues being addressed by the health care team;
    5. knowing and supporting the full scope of practice of team members; and
    6. providing and encouraging constructive feedback.
  6. Collaborates with the health care team to respond to changes in the health care system by:
    1. recognizing and analysing changes that affect one’s practice and client care;
    2. developing strategies to manage changes affecting one’s practice and client care;
    3. implementing changes when appropriate; and
    4. evaluating effectiveness of strategies implemented to change nursing practice.
  7. Uses established communication policies and protocols within and across health care agencies, and with other service sectors.
  8. Uses resources in a fiscally-responsible manner to provide safe, effective, and efficient care.
  9. Supports healthy public policy and principles of social justice.

Self-Regulation

Nurses understand the requirements of self-regulation in the interest of public protection.

COMPETENCIES:

  1. Distinguishes among the mandates of regulatory bodies, professional associations, and unions.
  2. Demonstrates understanding of the registered nurse profession as a self-regulating and autonomous profession mandated by provincial/territorial legislation to protect the public.
  3. Distinguishes between the legislated scope of practice and the registered nurse’s individual competence.
  4. Understands the significance of professional activities related to the practice of registered nurses (e.g., attending annual general meetings, participating in surveys related to review of practice standards, and membership on regulatory committees, boards, or councils).
  5. Adheres to the duty to report unsafe practice in the context of professional self-regulation.
  6. Understands the significance of fitness to practice in the context of nursing practice, self-regulation, and public protection.
  7. Identifies and implements activities that maintain one’s fitness to practice.
  8. Understands the significance of continuing competence requirements within professional self-regulation.
  9. Demonstrates continuing competence and preparedness to meet regulatory requirements by:
    1. assessing one’s practice and individual competence to identify learning needs;
    2. developing a learning plan using a variety of sources (e.g., self-evaluation and peer feedback);
    3. seeking and using new knowledge that may enhance, support, or influence competence in practice; and
    4. implementing and evaluating the effectiveness of one’s learning plan and

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