The Search for the Holy Grail

Friday, 24 July 2015: 1:30 PM

Mary Chiarella, PhD, RN, LLB (Hons)
Sydney Nursing School, University of Sydney, Sydney, Australia


This presentation seeks to explore the interface between professional regulation and competence to practise, particularly in relation to performance of competence and to identify whether public safety can be assured through performance of competence (perhaps something of a holy grail), or awareness of competence, or indeed incompetence.

From the previous research that has been undertaken, the three common indicators of competence were agreed by nurses and regulators alike to be Continuing Professional Development (CPD), hours of practice and self-assessment against the competencies. However if these three indicators were a guarantee of competence, then arguably no-one would present as a notification for lack of competence, because all registrants are required to meet these criteria for registration renewal or recertification. The researchers therefore believe that there is a missing thread that is in reality competence awareness or insight.

Insight has been demonstrated to be the deciding factor for adjudicating bodies in relation to deregistration (Adrian & Chiarella, 2010; Vernon, et al., 2010; Vernon, 2013). Thus the questions that remain unanswered are; can insight be identified, measured and assured, and is this preferable to the measurement of competence in clinical performance at a given point of time or in relation to the current requirements for registration, or renewal of registration / licensure / certification?  As it is difficult to identify those who might have problems with performance competence until such time as the question is raised about this, this research begins at the moment of notification.


Analysis of case law in each of the selected regulatory authorities relating to complaints of unsatisfactory performance (how-so-ever defined), that have been prosecuted and adjudicated. Analysis was undertaken to identify what factors led to decisions either to retain or remove a nurse from the register. In addition, relevant country policies and legislation relating to requirements for competence assurance and CPD will be analysed, themed and reported.


This presentation will use a selection of (inter alia) disciplinary case studies to explore a number of questions related to recognition of both competence and incompetence in nursing practice, and the definition of insight. In particular, it will seek to explore questions related to these concepts with the audience.

1. What is the relationship, if any between CPD, recency of practice and performance competence?

2. Would remediation provide any guarantee of performance competence?

3. Is there any relationship between awareness/insight of competence and performance competence?

4. How are decisions made in relation to continuing registration, sanctions or deregistration when performance competence is the subject of notification and adjudication?


We believe that competence is related to safety and we believe that competence is related to continuing professional development and recency of practice.  In Australia and New Zealand these requirements are now mandated so surely there should be no notification for competency?