Unity with diversity: ICN's framework of competencies.

Abstract

Over a century ago, the International Council of Nurses (ICN) came into being, propelled by Ethel Bedford Fenwick's ‘International Idea’. In a history of the ICN, this idea was described as being ‘based on the need for nursing to be organized, and for nurses to have a recognized system of nursing education and method of control of the nursing profession. Principles would be the same in every country because the need for progress in nursing is the same for all people.’ (Quinn 1989). Today, this need is even greater. Global events contribute daily to the growing interconnectiveness of countries. It is hard to escape the impact on our lives of decisions made by regional trade pacts and international organizations such as the World Trade Organization (WTO). The growth of globalization reinforces the importance of international values, standards and competencies. Standards and competencies have long been key elements of ICN's regulation work. We have had two main foci: mechanisms for establishing a common understanding of definitions, standards and competencies for the profession; and the application of effective regulatory policies and practices, standards and competencies. The ICN Framework of Competencies for the Generalist Nurse (ICN 2003a) illustrates how ICN maintains its founding vision, and yet meets the needs of a transforming world. The Framework helps to clarify the role of nurses, and provide guidance regarding nursing's role and scope of practice in relation to healthcare. The competencies – professional, ethical and legal practice, care provision, management, and professional development – apply to a nurse who has completed the educational requirements for the full scope of practice as defined in that country. The widely used ICN Code of Ethics and definitions of nurse and nursing underpin the Framework. It has been formulated so that the competencies are broad enough to apply internationally, yet specific enough to be applied within countries. It is most important that the Framework is interpreted by each country so that whatever competencies are deemed essential for practice are sufficiently comprehensive and pertinent to the country's health needs and priorities. Thus, while the Framework expresses a core set of common beliefs about the nature of nursing practice everywhere, it is flexible enough for nursing everywhere. There is no ideal international framework of competencies, and no one approach to suit all nursing worldwide. A framework cannot be prescriptive. Rather, each country must take account of contextual factors affecting nursing and health care, the profession's stage of development and goals, and national health goals and policies. ICN is well aware of the limitations of competency frameworks. So, in its implementation model, ICN suggests a number of steps to link the competencies to the realities of practice in a country (ICN 2003b). Given the rapid advances in international standards development, ICN is anxious to ensure that nursing is not lagging behind as a global society develops. As ICN is recognized in the international arena as speaking for nursing, it is important that it provides authoritative guidance. ICN's position on regulation, which includes principles and policy objectives, has been widely used in countries seeking to update or develop regulatory systems. As well as the generalist nurse framework, ICN has developed standards for international telenursing services, and has recently published a framework of competencies for the family nurse (ICN 2003c). In these tools, world nursing has the means to promote more unified definitions and scopes of practice when articulating nursing's contribution to healthcare. The use of ICN frameworks, policies and positions can strengthen nursing's voice in international and regional negotiations to establish mechanisms to recognize education, experience, licensing or certification obtained by nurses in other countries. In addition, where nursing is at an early developmental stage, ICN materials can guide development, and inform decision-makers. The healthcare environment has changed dramatically over the past 20 years. We face new challenges in globalization. We have to heed an increasingly vocal public demand for health professionals to be more visibly accountable. There are inherent tensions in trying to improve and maintain service quality with shrinking finances, de-regulation, de-centralization and shrinking public expenditure. ICN's Framework acts as a blueprint for nursing, setting out the range of competencies that nurses internationally must demonstrate in their professional role. Finally, in publishing the Framework, and extending our relationships with WTO and other international intergovernmental organizations, ICN has more credibility and established our right to be at the table when international discussions affecting the role, scope and authority of nursing take place.