Competence in nursing practice: a controversial concept--a focused review of literature.

The competency-based approach to education, training and assessment has surfaced as a key policy in industrialised nations. Following the transition of nurse preparation to the higher education sector the need to attenuate the tension of interests between employer and educator arose. While the competency-based approach has the potential to fulfil this, the application of competence to nursing is controversial and little consensus exists on definition. This paper synthesises a significant volume of literature relating to the acceptability and definition of the concept of competence with regard to nursing practice. Subsequent to a focused review of literature, problems inherent to the definition and utilisation of the concept of nursing competence are discussed. Because nursing requires complex combinations of knowledge, performance, skills and attitudes, a holistic definition of competence needs to be agreed upon and operationalised. This could facilitate greater acceptance of the concept and also underpin the development of competency standards and the tools required for the assessment of such.