NR 500NP Week 4 NP Competency Mapping Write-Up Example

Competency Mapping Write-Up: Eleven Advanced-Level Person-Centered Care Competencies Sorted Against Eight Years of Emergency Nursing

Student Name

College of Nursing, Chamberlain University

NR 500NP: Foundational Concepts and Advanced Practice Roles

Instructor Name

Month Day, Year

Competency Mapping Write-Up: Eleven Advanced-Level Person-Centered Care Competencies Sorted Against Eight Years of Emergency Nursing

The Competencies and the Method

The competencies mapped here are the advanced-level, or Level 2, sub-competencies in Domain 2, Person-Centered Care, of the AACN Essentials, the national framework that graduate nursing programs are built on (American Association of Colleges of Nursing [AACN], 2021). I chose this domain because it is the one closest to the daily work of a family nurse practitioner. The domain describes person-centered care as focusing on the individual within multiple complicated contexts, and lists qualities such care should have, among them being holistic, just and suited to the person's stage of development.

Each sub-competency is quoted in its published wording and sorted into one of three piles against my eight years as an emergency department nurse: things I already do regularly that will not change much in the new role, things I do regularly whose meaning will change once I am the one who writes the plan, and things I have never done. The second pile is where the work of this course lies, because it is the easiest to overlook: it feels familiar.

Pile One: Performed Regularly, Largely Unchanged

2.5i "Prioritize risk mitigation strategies to prevent or reduce adverse outcomes." Triage is risk prioritization, and I do it every shift: sepsis screening, fall precautions, suicide screening, isolation decisions.

2.8h "Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management." I use brief motivational interviewing for patients who come in repeatedly with alcohol-related injuries, as our department trained us to do.

Both will continue in the new role in much the same form.

Pile Two: Performed Regularly, Meaning Shifts

2.3h "Demonstrate that one's practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice." I assess patients constantly, but my assessment in the emergency department is focused and time-limited, and its purpose is to decide urgency and inform someone else's workup. As a family nurse practitioner, the assessment becomes the basis for my own diagnosis, and in primary care it must be comprehensive across body systems and across time.

2.4f "Employ context driven, advanced reasoning to the diagnostic and decision-making process." I already reason about diagnoses; nurses in the emergency department anticipate them all night. The difference is that I have never had to commit. My reasoning has always stopped at "this might be a clot; I'll tell the provider."

2.4g "Integrate advanced scientific knowledge to guide decision making." I use pathophysiology to anticipate; I have not used it to choose between two treatments.

2.5h "Lead and collaborate with an interprofessional team to develop a comprehensive plan of care." I collaborate constantly. I have not led the development of a plan; the plan has always been the provider's, and my part has been to carry it out and speak up when it is not working.

2.5j "Develop evidence-based interventions to improve outcomes and safety." I follow evidence-based protocols; I have not developed one for an individual patient.

One Occasion, Not a Period

One night shows the shift in pile two more clearly than a summary could. A 41-year-old woman came in at 0300 with chest tightness and a racing heart, which she attributed to a panic attack she had had before. She was triaged as anxiety. As her nurse, I noticed that she had flown home from a long trip two days earlier, that one calf looked larger than the other, and that her oxygen saturation was 93%. I told the physician, who ordered a scan that showed a clot in her lung. I was right, and I was praised for it. But my reasoning ended with telling someone. As a nurse practitioner, it would have ended with ordering the scan myself, deciding what to do if it had been negative, and owning the decision either way. Competency 2.4f describes the reasoning I used that night. It does not describe the commitment I have not yet had to make.

Pile Three: Never Attempted

2.5k "Incorporate innovations into practice when evidence is not available." In a protocol-driven emergency department, I have not been in a position to do this.

2.8f "Develop strategies that promote self-care management." Emergency care rarely follows a patient home.

2.8g "Incorporate the use of current and emerging technologies to support self-care management."

2.8i "Evaluate adequacy of resources available to support self-care management."

2.8j "Foster partnerships with community organizations to support self-care management." These four describe the longitudinal side of primary care, which the emergency department is not built for.

Watching Is Not Choosing

The sort revealed one pattern I had not expected. Almost everything in pile two is something I have watched providers do thousands of times. It is tempting to treat watching as preparation. It is partial preparation at best. Watching a provider decide to discharge a patient teaches me what decisions look like; it does not teach me what it is like to be the one who decides with incomplete information at 0300. The Essentials' wording captures the difference: it asks the advanced practice nurse to "develop," "lead" and "employ" reasoning, not to observe it.

The same gap appears in pile three from the other direction. There, I have not even watched the work: emergency nurses rarely see what happens to patients after they leave, so the long-term side of care is almost invisible from where I stand.

A Development Plan With Edges

The plan has edges so that it can be checked. For 2.4f and 2.4g, in each clinical rotation I will write my own differential diagnosis and plan for at least three patients a day before my preceptor tells me theirs, and compare them, keeping the comparisons in a log my faculty can review. For 2.5h, I will ask to lead the plan discussion for one patient a week with my preceptor present. For the pile-three self-care items, I will request at least one rotation in a rural primary care clinic, where follow-up and community partnerships are part of the daily work, and I will build one self-management plan with a patient with diabetes, including the local resources available to them. By the end of my first clinical year, I expect the log to show my differentials agreeing with my preceptors' more often, and the reasons for disagreement to become more specific. That is the evidence I will bring to my faculty when we review this map again.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials