This paper by Levett-Jones and Lathlean (2009) continues the practice of JCN to publish papers on the development of nursing students – one by the present authors – [Björkström et al. (2008), Lauder et al. (2008), Myall et al. (2008), Reid-Searl et al. (2008), van Leeuwen et al. (2008), Wu et al. (2009)], especially in the field of clinical competence [Bradshaw and Merriman (2008), Gardner et al. (2008), Lauder et al. (2008), van Leeuwen et al. (2008)]. My own interest in this area is intense and it began with two reviews of competence (Redfern et al. 2002, Watson et al. 2002a), some empirical work (Calman et al. 2002, Norman et al. 2002, Watson et al. 2002b) and the opportunity to comment on the preparation of nursing students in the UK and internationally (Watson 2002, 2006). The main issue with competence is that it is hard to define; incompetence is relatively easy, on the other hand. The secondary issue with competence, which follows from the difficulty in defining it, is that it is very hard to measure.
This paper (Levett-Jones & Lathlean 2009) is interesting because it conceptualises competence in a different way from the usual ‘knowledge, skills attitudes’ mantra and looks at it as the peak of a developmental pyramid which has as much to do with the process of socialisation of nursing students as it has to do with the above components. As such, it is ‘Maslachian’ in the sense that the achievement of competence is dependent, hierarchically, on the attainment of other attributes or states, one of which is ‘belongingness’. The multidimensional nature of competence and the subservient dimensions is acknowledged in the fact that the model is pyramidal and not simply triangular. The beauty of hierarchical models is that they are testable. Levett-Jones and Lathlean (2009) do not suggest this specifically and their study was qualitative. However, hierarchical scaling methods based on item-response theory, for example, Mokken scaling, could be applied here. These methods have recently been applied successfully to some common psychological inventories and, for the purpose of this competence model, what would be required would be the development of an appropriate set of questions related to the pyramid of competence.
One question remains in my mind about competence, however, and that is its sufficiency as a concept in nursing education for clinical practice. The Levett-Jones and Lathlean (2009) present a pyramid and, usually, there is nowhere to go from the point of a pyramid; it looks like the end. I wonder if they envisage the achievement of competence, as they envisage it, as the ultimate goal. I have been a proponent for several years of the inadequacy of competence as the goal of nursing education in favour of a capability model (Watson 2002, 2006) as envisaged by Stephenson and Yorke (1998). In this model, competence is subsumed within capability; it is a necessary step on the way to capability but capability is the preparation for the unusual and unexpected in unfamiliar situations. Competence prepares people for the usual and the familiar and is akin to training as opposed to education.
Levett-Jones and Lathlean (2009) are to be congratulated on their model and on their attention to this difficult area of nursing education. I look forward to further development of their model and its potential application to nursing education.