Setting up Competency Program for Haemodialysis Nurse

Student's Name:
Student's ID:

Table of Contents
Introduction ..................................................................................................................................... 3
Importance of clinical Competence ................................................................................................ 4
Literature review ............................................................................................................................. 5
Importance in Nephrology .............................................................................................................. 7
Competency as a Level of Performance ......................................................................................... 8
Outcome competencies for nurses .................................................................................................. 9
Developing competencies ............................................................................................................. 10
Steps of competencies ................................................................................................................... 10
Responsibilities ............................................................................................................................. 12
Assessment .................................................................................................................................... 12
Resolving competency issues ....................................................................................................... 13
Competency usage ........................................................................................................................ 14
Competency statement .................................................................................................................. 14
Haemodialysis Training and skills ................................................................................................ 15
Work environment ........................................................................................................................ 15
Skills and Qualities ....................................................................................................................... 16
References ..................................................................................................................................... 17

Introduction
In this modern era of technology where the world is prospering by leaps and bounds there need
to be proper training programs for nurses in all the fields of medicine. As there are inventions in
means of equipments, advancements in medical procedure, there always has a need to update the
existing knowledge over the years. It can only be done by making sure that there are ample
number of training programs through which nurses can be benefited. And later they can
implement their learning in different situations. It is also important to provide them with the
modern equipment to make sure that they are well conversant with it and can use it
independently. This experiential learning can be in a variety of environments so as to make them
capable to cope with different scenarios.
These nursing residency programs can be a bridge between their bookish learning and
experiential learning. As things heard about seen in pictures and read about can be experienced.
Moreover, its a transition from study material to practical stuff.

Importance of clinical Competence

Clinical competency and management of multiple transitions not only affect the new graduate,
but also the care of patients and the healthcare organization. It takes at least one year for a person
to master a job because the health care culture emphasizes on specialization according to the new
technology and advancement in the field. After some professional work done the skills and
knowledge needed to better care and maximum quality work can be attained. It has been worked
out that after some months of nursing practice are critical to job satisfaction and success and
retention graduate nurses. Many organizations have decreased orientation periods in response to
economic pressures. Nurse residency programs were designed to establish a smooth transition
from student life into professional life. These programs seek to establish clinical competence,
provide emotional support after passing through various phases of training and allow providing
maximum facilities and job security for strong nurse beginners
Within New Zealand, nursing was established as an identified profession with the 1901 Nurses
Act, which regulated both the training and registration of nurses. Over the past one hundred and
four years nursing has evolved to reflect not only the major advances in health care but changes
within society itself. (Welding, 2011) state, The development of technology and its use within
critical care practice was spurred on by the 1952 polio epidemic when successful prolonged use
of intermittent positive pressure ventilation was documented for the first time. Within New
Zealand, intensive care as a specialist area was established within both larger tertiary and
secondary level hospitals by the late 1950s.
Nursing evolved from the art of comforting, caring for and nurturing the sick, to a synthesis of
this art with the science and technology of the contemporary age. Legislation of nurses on hand
experience, along with an increased need to access technology required for both diagnosis and
treatment, meant modern healthcare became centralized within a hospital setting. By the 1950s
it was identified that the sickest patients did better if they were positioned together within the
hospital setting, in closer proximity to nursing staff.

Literature review
Early critical care areas relied on nursing observation and assessment skills to detect changes in
a patients condition. The development of technology and its use within critical care practice was
spurred on by the 1952 polio epidemic when successful prolonged use of intermittent positive
pressure ventilation was documented for the first time. In The country of New Zealand,
demanding profession of care as a dedicated area was established within both larger tertiary and
secondary level hospitals by the late 1950s. (Welding, 2011)
Many units were developed to get the output in form of better facilities providing to the patient
with better form of care and medicines. It has been almost immediately comprehend about the
therapeutic workforce there should be proper courses and certificates for the nurses to be cared
collectively in cooperation for the enduring people and the expertise regarding all the equipments
associated in care process with surveillance as well as for purpose of cure. In previous era
education given to nurse was considered very important and it delivered will proper managing
clinical setup which was near to realistic approach and practices frequently addressed by senior
medical staff. It has been observed now the importance level of nursing with practical approach
now education is delivered in small academic institutions rather than in hospital territory.
In a review of orientation processes, (Clark, & Springer, 2011) describe a situation where
orients dissatisfaction with an existing process resulted in poor retention of new staff. This led
to the development of a nurse residency program which involved sharing of the orientation
process between the Education Department and clinical preceptors. Assessment of certificates
and courses is based on mathematical facts and figures as well as scenario based techniques,
together with assessment and appraisal of nursing members leaving rates along with attentive
and group based discussions, accomplishment after occurrence. When assessment of job leaving
was performed between nurse habitation unit courses with the other unit who are availing nonspecify point of reference techniques demonstrating lesser quitting rate in the testing units. No
conclusions based on qualitative facts and figures can be presented, but a declaration
demonstrates to the information that the qualitative information and statistics gathered in the
group discussion programs were harmonizing with the quantitative statistics incarcerates in the
criticism comments. at the same time as this investigation ropes the perception of vigorous
participation surrounded by the development in addition to deliverance of direction, it donot

highlight the problems why this participation made such a differentiation to familiarize
knowledge.

Clarks worn different methods and techniques to investigate the connotation of erudition
intended for competent nurses responsibility along with significant cure regarding teaching and
learning program. Information compilation concerned with two ways of co of consultation. A
focus people discussion was apprehended instantaneously on achievement of the teaching,
pursue by personage deferred discussions, it almost complete three years to complete after
training process. The people who were involve in research compile and write down their
experiences who they gained during their research period. It was philosophical consisting all the
way through the psychoanalysis development. Information investigation, inaugurate with
dictation of the tape-recorded discussions, which were analyzed by classification along with
recognition of the universal topics within the transcription. These were subsequently ranked
correspondence to their happening and the connotation given to them
It has been analyzed to investigate the significance and importance of wisdom and scholarship
for competent care takers responsible for decisive and significant cure learning and awareness
courses and certificates program.
The two supplementary premises acknowledged were group discussion and the discussion asked
through questioning and answering session. The familiarity of erudition all the way through is
center of attention and quizzical which is distinctiveness of manifestation. It assists the
apprentice to amalgamate conjectural acquaintance into the real base situation.
In a subsequent manuscript, supplementary investigate the subject of technical proficiency and to
confer problems such as the expansion and enlargement of national fundamental competencies in
relative to the conclusion.
Maintaining clinical competencies is essential to operating a safe and efficient health facility
provider. Even though competency itself is a controversial term. (Cowan)
it is generally accepted that competency is a demonstrable skill, or observable behavior.
Importantly, it encompasses more than just knowledge itself, and includes values, components
The National Competency Standards for the Registered Nurse (ANMC, 2006) underpin these
broad and principles-based attributes and outcomes. Australian Nursing & Midwifery Council
6

(ANMC) defines competence as the amalgamation of on hand knowledge, working experience,

behavior at work place and a persons quality that underpin effective and/or superior
performance in a profession/occupational area. The dialysis service introduced skill assessments
in 2000 as a means of ensuring all staff possess and maintain the requisite skills to perform
dialysis. This skill assessment is delivered in three-year cycle where year one is a comprehensive
assessment of basic dialysis procedures via a practical and theoretical model. Years two and
three are various advanced learning modules and include diabetes, renal osteodystrophy, blood
pressure complications in dialysis patients, dialysis and the ageing population, and medication
and calculations. All staff complete year one either within three months of with the service, or on
the three-year cycle, with years two and three is being completed by all staff on the other years.
For effective learning and reflection of the learning can be assessed by staff are required to
achieve 100% for the basic module and in most cases 85% of the advanced modules. The
Medication and Calculation Competency was the exception, requiring 100% accuracy.

Importance in Nephrology
Administering medications is a daily occurrence in dialysis units, thus staff need to be competent
in all aspects of drug and fluid calculations and administering medication. It is suggested by
(Clark, & Springer, 2011) that medication competence is not achieved once in a life time. Its
an ongoing process. They go on to say that medication competence is not only drug calculations,
but should include the individual's power of decision, and how the person reflects upon his
experiential learning.
This notion is supported by (Clark, & Springer, 2011) who suggest that nurses need to integrate
pharmacology and medication knowledge into clinical practice. Health professionals as a whole
have shown clear willingness to learn with a variety of technological tools (Clark, & Springer,
2011). Benefits of LMS include: flexible delivery; being able to deliver the content online saves
time spent in multiple in-service sessions at multiple sites; collaborative learning; cost-effective
once set up; and less travel. According to Kobs" if a person doesnt err, he cant achieve
competence. Lets suppose a person is successful in all his errands have been performing
successfully and there have been no variety of variant outcomes so less chances of competence.
However, this assumption presupposes that there are sufficient opportunities to sample skill
performance by observing practice in the clinical area and in the skill laboratory that are
7

performed frequently and have either potential or real risk. So the situations in which high risk
procedures which are infrequent need to be reviewed on a periodic basis to maintain the ability.
But in other terms new working situation along with varying skills and equipment, with different
circumstances provides a room for assurance of continuous competence. Yet, being competent
does not guarantee good performance as mentioned by (Burns & Poster, 2008), that competency
is an aspect of good performance and has no direct dependency. There are other many other
factors that should be taken into consideration besides motivation also plays an important role as
quoted by (Burns & Poster, 2008). Like work environment, duration of work and the gap
between two consecutive work days.

Competency as a Level of Performance

If competency is considered as the level of performance, then it has to be assessed by some
managerial aspect. It can also help to identify the lapses in knowledge and the requirement to
develop a way to cater the needs of a patient to a certain level and to satisfy all the areas
accordingly. (Burns & Poster, 2008). There is no basis for determining how frequently health
care practitioners should be required to demonstrate their continued competence (Burns &
Poster, 2008). It is important to acknowledge that competency assessment should not be unique
to the specified area of work. Different organizations adhere to provide maximum range of
facilities so that, the employs attain maximum knowledge and can polish their skills accordingly.
Modern research emphasizes on the fact that length of professional time doesnt ensure
competency. It is how much you have come across different situations with different kind of
people and how your power of decision has helped you cope the situation. Moreover the
assessment should be based on the actual practice and not on years of practice.
Midwifery Council (ANMC), 2009). Competence has been defined as effective performance
can be judged on parameters like motor skills, decision power and your abilities to work under
stressed situation. Continuing competence, therefore, is a nurses ability and responsibility to
demonstrate maintaining competency against the competency standards of a particular
jurisdiction (ANMC, 2009; Nursing Council). Renal Nurse (National Renal Qualification
Working Party, 1999) first defined Nephrology nursing as a specialized area of nursing practice
in New Zealand. (Welding, 2011)
8

In 2006 a National Renal Advisory Board (NRAB) scoping paper identified that the training of
"skilled nephrology nurse specialists/practitioners for the future" required an "agreed strategy"
Renal Society of Australasia (RSA) reported that only 21% of Registered Nurses working within
New Zealand Renal Units held any renal post graduate qualifications (Bennett, McNeill &
Polaschek, 2009). This led the NRAB to highlight the importance of progressing work on
specialty competencies for renal nursing to both ensure a skilled workforce and further develop
the specialty. Thus, in 2008 the RSA New Zealand (NZ) Branch Nursing Advisory Group
(NAG) responded to the requirement of a project to help the paramedics in professional
development for nephrology nursing in specific.

Outcome competencies for nurses

These abilities are intended for utilization by Registered Nurses setting out on a professional
working in the basic forethought environment. They ought to additionally be utilized by Higher
Educational Institutes to backing their basic consideration projects of instruction.
Basic Care attendants assume an essential part in the appraisal, forethought and recuperation of
those patients who experience discriminating disease. Their experience, capability and
information permit them to work both all alone and in organizations with more extensive
multidisciplinary medicinal services groups.
They utilize a scope of abilities,
-

Assessing the complex patient

Decision making

Interventional application

Rehabilitation and recuperation arranging

Communicating

Influencing and arranging

Engagement and help

Leadership and danger administration

These attendants are obliged to give sheltered, excellent administrations for the general
population, and help enhancements in the discriminating consideration environment so that the
well being and nature of forethought is constantly upgraded.
9

The basic forethought environment is an always showing signs of change field with developing
innovations and treatments to support understanding recuperation through the assault of regular
life-undermining disease. Medical attendants need to guarantee they create and keep up ability in
practice to meet the difficulties displayed.

Developing competencies
You can utilize these skills to educate your advancement. You may as of now be near
accomplishing these skills, or may be far off and have a considerable measure of advancement to
attempt relying upon your past experience. The manners of thinking you have to experience and
the moves you have to make will be comparable, the distinction will be in the measure of
experience that is required and the level of learning obliged to support that further advancement
along the steps of ability.
These capabilities portray what it is that an individual is relied upon and ready to do when they
are completely working as a skillful safe expert at each one stage.

Steps of competencies
The National Standards for Critical Care Education (2011) has effectively portrayed capability
as:
"The blend of aptitudes, information and mentality, qualities and specialized capacities that
underpin protected and compelling basic forethought nursing consideration and mediations"
The improvement of ability initiates quickly the attendant is presented to the novel environment
of the basic consideration setting that watches over the most powerless of basically sick patients;
however the discriminating forethought group perceives that competency in practice relies on
various elements including introduction to a scope of encounters and chances to achieve, create
and apply related hypothetical information. (Burns & Poster, 2008)
The figure beneath exhibits the collaboration of clinical practice and hypothetical learning in
moving along the steps of capability and creating the basic consideration medical caretaker.

10

Step 1
Capabilities ought to be initiated when a medical caretaker starts with the basic consideration
where he/she has no past knowledge of the fort. These capabilities can support staff the
advancement amid preceptor ship.
It would for the most part be normal that staff will have finished Step 1 capabilities before
getting into a scholarly basic foresight program in a college setting. All Step 1 capabilities ought
to be finished in 12 months.
There may be neighborhood imperatives or palliating situation which mean you are not ready to
finish all of Step 1 abilities inside the 12 month time allotment. In the event that this is the
situation, it will be at the watchfulness of your unit directly to concur a broadened time period
focused around your individual needs. However, even with an augmentation Step 1 skills ought
to take no more than a year and a half to finish in full.
Steps 2 & 3 capabilities ought to be finished amid the time of a scholastic discriminating
consideration program where 'the learner' will pick up the vital profundity of related hypothesis
and information.

Step 2
Skills will permit the attendant to:

Demonstrate talented execution in the action with improved hypothetical learning and
comprehension, giving, method of reasoning in practice
Demonstrate application of learning and seeing in connection with applicable
arrangements, strategies and rules
Participate in critical thinking through discriminating examination and assessment of
more mind boggling circumstances
Develop more changed discriminating forethought involvement with less supervision
and direction, accomplishing skill in related information and skill

Attendants working in basic consideration offices inside the Independent Sector offering Level 2
forethought just will need to passageway the system on fulfillment of all Step 2 skills.

Step 3
Skills will permit the medical attendant to:

Demonstrate skilled execution in all the exercises determined without immediate

supervision based upon pertinent confirm based information, instinct and made
practice

11

Independently issue explain complex circumstances and offer arrangements through

discriminating investigation and assessment
Supervise and teach others in a scope of exercises identified with their part and
obligations
Applicable information, comprehension and exploration of significant approaches,
strategies and rules to discriminating break down and enhance

Responsibilities
The 'Extra Information to Support Implementation' record that goes hand in hand with this
structure sets out the parts and obligations of associations and people in supporting you through
the Steps of Competence.
As the leaner you have particular obligations. In the event that you are embracing this system
you must meet the accompanying prerequisites:

Be a Registered Nurse working in a discriminating consideration environment

Have finished a neighborhood learning contract or assignation
Recognize and stay inside the points of the confinement of your own fitness
Take possession and obligation regarding your learning advancement
Reflect on and react usefully to input given by guides/assessors
Complete the step 1 abilities inside the prescribed timeline (not typically more than
12 months)
Apply procured learning and understanding to watch over the discriminatingly sick
patient
Perform all clinical abilities in an expert, sheltered and predictable way

Additional data about what's in store in regards to Practice Educator, tutor and assessor help,
appraisal courses of action and learning open doors can be found in the 'Extra Information to
Support Implement.

Assessment
Registered Nurses planning to accomplish ability through all the "Steps" will be upheld in the
clinical region by the nearby Practice Educator/Lead Assessor or identical and suitably
accomplished able associates and guides. You will be allotted a Lead Assessor who will manage
your progressing advancement; partners and guides will help you in attaining competency in
practice. The utilization of Assessment and Development Plans will empower you, coaches,
Lead Assessor and Practice Educator (or proportionate) to screen your advancement needs and
general competency movement. (Welding, 2011)

12

Satisfactory time and supervision will be given to you as you advance through the "steps" and
neighborhoods need to encourage situations outside of the typical workplace if introduction to
certain branches of knowledge or medicines are constrained.
At the point when evaluating a discriminating forethought medical caretaker against the clinical
standard obliged, then close down guide or assessor is inquiring as to whether the individual
attendant can show capability in connection to every announcement delineated inside the record.
Capability must be shown through perception of your practice against the competency
explanations sketched out. Your tutor or Lead assessor might, however, utilize a blending of the
accompanying methods to backing their choice:

Discussion & testing inquiries

Simulation

Completion of related workbooks

Reflective practice

Portfolio

Record of achievement

It is a necessity of the Nursing and Midwifery Council (NMC) that you keep up a portfolio. This
is a method for exhibiting your progressing adapting needs and assessing your individual
learning encounters both formally and casually and such records can be utilized as proof of
showing ability. (Welding, 2011)

Resolving competency issues

It is your obligation to work as a team with your Lead Assessor and/or Practice Educator to talk
about and concur your formative needs so as to attain ability in basic consideration hone. By
taking after these basic standards it is trusted; you will have a positive knowledge of creating
yourself through the Steps of Competence:

Have consistent gatherings (no less than 3 month to month) to evaluate current level
of fitness and set an improvement plan for movement

Be practical and not over aggressive

13

You ought to acquire disappointment of mentorship practice and/or insufficient

assessor surveys to the consideration of the Practice Educator (or proportionate)
and/or Nurse-in- Charge at the most punctual opportune

Competency usage
The capabilities are intended to be a multi-reason apparatus that will underpin the procurement
of high caliber, individualized patient forethought. The skills will help and illuminate vital
arranging, workforce advancement and administration at key and unit level. They give direction
to instructive dispatching and structure the substance of discriminating consideration instruction
and preparing projects. The capabilities will upgrade neighborhood responsibility and backing
the part and improvement of present and yearning basic forethought medical caretakers and
future pioneers. (Welding, 2011)
Utilizing the abilities at varying levels:
Administration and key level

Service surveys
Workforce/party plan and profiling
Education authorizes, arranging and procurement

Unit and managerial level

Recruitment and choice

Staff examination
Education, preparing and advancement arranging and conveyance
Career advancement and counsel
Design of expert and professional capabilities

Individual and group level

Career movement
Self appraisal and self-awareness arranging
Coaching
Clinical supervision
Profession

Competency statement
The attendant has been surveyed against the skills inside this record and measured against the
meaning of fitness underneath by discriminating consideration partner, guides and assessors and
is viewed as a skillful safe expert inside the basic forethought environment.
"The mix of abilities, learning and mentality, qualities and specialized capacities that underpin
protected and viable discriminating consideration nursing forethought and mediations".
14

As a feature of value certification the medical attendant is required to keep up an arrangement of

practice as a major aspect of NMC regulations to help continuous capability and announce any
preparation improvement needs to their line trough or appropriated other. Competency will be
evaluated yearly as a component of staff self-awareness plans. Where important destinations will
be set to further create any developing competency needed to work securely in the discriminating
consideration environment. (Clark & Springer, 2011)

Haemodialysis Training and skills

Dialysis attendants are masters in different types of dialysis, incorporating hemodialysis (in
which a machine is utilized to clean the blood) and peritoneal dialysis (in which an uncommon
liquid is infused into the individual's stomach depression to ingest poisons). Notwithstanding the
kind of dialysis, these medical attendants painstakingly screen the tolerates condition, sometime
recently, amid and after the methodology and counsel with doctors and experts as required. Since
kidney infection is unpredictable, dialysis medical caretakers work nearly with experts from
numerous controls, including doctors, dietitians, social laborers and specialists. They additionally
help patients comprehend their disease and treatment alternatives and demonstrate to them
proper methodologies to deal with their sickness through attention toward oneself and solution.
After a kidney transplant, a patient keeps on living up to expectations with a dialysis attendant
while acclimating to the new kidney. The medical caretaker looks for indications of
contamination or organ dismissal and rides a patient to look after himself securely at home.
Numerous dialysis medical caretakers catch up with their previous patients to perceive how they
are getting along and to verify they are taking required prescriptions.
For humane individuals with fantastic expository abilities, a vocation as a dialysis medical
caretaker is amazingly compensating. Dialysis medical caretakers see their patients a few times
each week and frequently create close associations with them. They have the fulfillment of
boosting the spirit and personal satisfaction for people and families confronting a genuine
ailment.

Work environment
Dialysis attendants work in many settings,

Clinics
Outpatient treatment focuses
Transplant projects
Home social insurance offices
Hospice and palliative forethought administrations
Nursing homes and long haul, mind offices

The calendars of dialysis attendants differ crosswise over settings. Attendants working in
outpatient centers are more inclined to have general business hours with incidental night or
weekend arrangements. In clinics, medical attendants work pivoting moves that incorporate
15

nights, weekends and occasions. Dialysis medical caretakers who give in-home mind for the
most part timetable around the needs of the patient. In 2010, around 20% of enrolled medical
attendants (counting dialysis attendants) worked low maintenance.
Most dialysis medical attendants work in clean, well-lit clinical settings, however, some
additionally make a trip to patients' homes. Clinic attendants use the vast majority of the
workday on their feet and often curve, stop and stretch. These experts must be solid enough to
lift and move patients.
Dialysis medical attendants have regular contact with unsafe substances, including needles,
blood and other natural liquids. They take after strict wellbeing precautionary measures to avoid
harm and contamination. (Clark & Springer, 2011)

Skills and Qualities

Dialysis attendants depend on their incredible interpersonal aptitudes when working with
patients and different experts. Their common compassion and sympathy helps them to inspire
their patients to stay with treatment and roll out essential improvements. Dialysis nurtures
likewise need to be cooperative people who function admirably with individuals from numerous
diverse orders.
Since they work extend periods of time around extremely debilitated patients, dialysis attendants
need brilliant organization toward oneself aptitudes. They must be candidly developmentally and
steady with a specific end goal to help enduring patients without getting to be overpowered them.
To secure their own particular prosperity, attendants ought to likewise rehearse great thinking
ahead toward oneself, including activity, sustenance, rest and extra help when required.
Numerous dialysis patients experience the ill effects of extra incessant conditions, including
coronary illness, diabetes, hypertension and medication compulsion. Dialysis medical attendants
depend on their tender loving care and solid explanatory abilities to securely deal with a few
conditions immediately. This is particularly valued in the region of solution security.
Accomplished dialysis narrators frequently have practical experience in the consideration of
specific populaces, for example, pediatric, grown-up or elderly patients. Others manufacture
their mastery in a clinical territory, for example, transplantation, persistent renal substitution
treatment or palliative forethought.
Dialysis medical attendants may be elevated to supervisory positions, for example, attendant
supervisor, organ recuperation facilitator or transplant organizer. Others leave the clinical setting
to enter educating, behavior research or serve as specialists in the social insurance, therapeutic
supplies and pharmaceutical commercial ventures.
Dialysis attendants who hold a graduate degree or doctorate regularly seek after accreditation as
progressive practice medical caretakers. This permits them to serve as essential forethought
suppliers of individuals with kidney ailment. In numerous states, progressed practice medical
caretakers compose solutions and perform a considerable lot of the same capacity as a doctor.
16

Some accomplished dialysis medical attendants move into nephrology case administration. In
this part, they give tolerant backing and guarantee congruity of administering to patients living
with kidney malady. (Clark & Springer, 2011)
The livelihood of enrolled medical attendants (counting dialysis attendants) is required to
become by 19% somewhere around 2012 and 2022, as per the US Bureau of Labor Statistics.
This above-normal development is generally because of the maturing of the Gen X-er era, which
is required to expand the interest for various sorts of social insurance benefits in the following
few decades. Since more established individuals are more inclined to experience the ill effects of
kidney disappointment, the quantity of individuals experiencing dialysis is relied upon to climb.
Interest will be most prominent for dialysis attendants who:

Are broadly ensured

Hold a progressed degree
Have some expertise in a key clinical zone.
Are eager to migrate

References
Aiken L. H., Clarke S. P., Cheung R. B., Sloane D. M., Silber J. H. (2003). Educational
levels of hospital nurses and surgical patient mortality. Journal of the American
Medical Association, 290, 1617-1623

17

Al-Shehri, A.M. (2010). E-learning in Saudi Arabia: To E or not to E, that is the question.
Medical Education, 17(3), 147150.
Billings, D.M. (2007). Understanding the challenges of e-learning. Nursing, Jan; 37 Supply
Career: 36-37.
Brosky J., Scott R. (2007). Professional competence in physical therapy. Journal of Allied
Health, 36 (2), 113-118.
Budzinski-Braunscheidel M., Whalen-Espin S. J. (2010). Professional development. In
Laughlin C.B. (Ed.), Core curriculum for ambulatory nursing (3rd ed., pp. 177-187).
Pittman, NJ: American Academy of Ambulatory Nursing.
Burns, P., & Poster, E.C. (2008). Competency Development in New Registered Nurse
Graduates: Closing the Gap between Educationand Practice. The Journal of
Continuing Education in Nursing, 39(2), 6773.
Clark, C. M., Springer, P. J. (2011). Nurse residents first-hand accounts on transition to
practice. Nursing Outlook, 60 (2012), E2-E8
Goode, C. J., Lynn, M. R., Krsek, C., &Bednash, G. D. (2009). Nurse Residency Programs:
An Essential Requirement for Nursing Economics, 27(3), 142-159.
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning:
Necessary or nice? Applied Nursing Research, 21 (2008)75-83
Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase
Clinical Competence. MEDSURG Nursing, 20(1)

18