| The United States currently has no reliable and valid model for assessing entry-level autonomous prescriptive competency for advanced practice nurses, despite a decade of legislative expansion in scope and autonomy. Klein and Kaplan (2007) surveyed Washington and Oregon nurse practitioners with prescriptive authority, clinical nurse specialists with and without prescriptive authority; and nurse practitioner students, their preceptors and faculty about the relative importance of prescribing specific competencies(n=180). The original survey used an instrument from the Oregon State Board of Nursing, titled Clinical Practicum in Pharmacological Management Evaluation, containing 31 competencies. The present study used mixed methods to further confirm essential entry-level outcomes used to meet requirements for autonomous prescriptive authority. Three steps of analysis were conducted to determine final domain and competency recommendations: content analysis of original survey comments, principle component analysis (PCA) of competency ratings, and final Q-Sort of revised competencies using Subject Matter Experts (SMEs) with prescriptive authority licensed as CNSs, NPs, or both. PCA of the 31 original competencies identified 4 factors containing 30 items accounting for loadings of .40 or greater for all items. Removal of 1 competency as suggested by content and factor analysis resulted in a Cronbach's alpha of .959, indicating item internal consistency. Two contextually similar items were combined for the final Q-sort analysis resulting in the final 29 competencies in 4 domains titled: Safety, Patient Specific Assessment, Clinical Reasoning, and Clinical Management. Q-Sort by SMEs clearly placed 8 competencies into the Safety domain, 3 between Safety and Patient Specific Assessment, 7 into Patient Specific Assessment, 1 between Patient Specific Assessment and Clinical Reasoning, 2 into Clinical Reasoning, 3 between Safety and Clinical Reasoning, 1 into Clinical Management and 4 in more than two categories. SMEs confirmed item validity but did not confirm discrete domain placement for 11 competencies, indicating a need for further analysis and revision of domain categories in order to confirm regulatory sufficiency. |
