From competence to capability: a study of nurse practitioners in clinical practice.

AIMS AND OBJECTIVES This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. BACKGROUND The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. DESIGN A secondary analysis of data obtained from interviews with nurse practitioners working in Australia and New Zealand was undertaken. These data had previously been obtained in a study to identify nurse practitioner competencies. The analysis described in this paper investigated whether or not the components of capability would adequately explain the characteristics of the nurse practitioner. METHODS Fifteen nurse practitioners were interviewed from Australia and New Zealand. A secondary (deductive) analysis of interview data using capability as a theoretical framework was conducted. RESULTS The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. CONCLUSIONS This study suggests that both competence and capability need to be considered in understanding the complex role of the nurse practitioner. RELEVANCE TO CLINICAL PRACTICE The dimensions of capability need to be considered in the education and evaluation of nurse practitioners.