Proficiency Levels

AMSN volunteers worked with competency experts to develop an evidence-based competency model for registered nurses in the med-surg setting. AMSN’s competency model used job analysis methods (Brannick et al., 2007) and several general competency models to guide the identification of KSAOs. These models included the Dreyfus and Dreyfus model, the National Institutes of Health Competencies Proficiency Scale model, and Miller’s Prism of Clinical Competency (Dreyfus & Dreyfus, 1980; Miller, 1990; National Institutes of Health, n.d.). The Dreyfus and Dreyfus competency model measures competency in five categories: novice, advanced beginner, competent, proficient, expert. Other competency models have condensed Dreyfus and Dreyfus model from five categories to three: novice/advanced beginner, competent/intermediate, proficient/expert.

The medical-surgical nurse subject matter experts (SMEs) determined three levels of proficiency or competency were sufficient, and renamed the above categories to the following:

  • Category 1: Novice/Advanced Beginner = Emerging
  • Category 2: Competent/Intermediate = Established
  • Category 3: Proficient/Expert = Expert

All AMSN nursing continuing professional development (NCPD) has been categorized into the appropriate proficiency level to assist you in selecting relevant professional development to meet your competency-based learning needs.

There are three domains in the competency framework and twenty-eight subdomains. The first domain measures clinical competency in practice and patient management, with 16 competency subdomains. The second domain measures professional competency, and contains 12 competency subdomains. The third is a non-cognitive assessment of five personality traits that provides insight into how your personality impacts your professional competencies. Further, the competencies are linked to patient, organizational and individual nurse outcomes so you can see the impact of your competency.

The competency framework can be used to assess overall competency, certification readiness and as a gap analysis tool to guide ongoing professional development. To assist in your professional development, all AMSN nursing continuing professional development (NCPD) is now tagged with the competency subdomains and proficiency level for ease of identification and learning plan development.

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Adheres to rules and plans; Requires guidelines for action; Has no discretional judgement; Common knowledge of basic techniques and concepts; Use experience gained in classroom and/or as a trainee on the job; Requires help sometimes to complete tasks from other experts.


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Deliberately plans; Standardizes and routinizes their procedures to accomplish tasks; Requires minimal guidance/help from other experts.


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Decisions are less labored; Views situations systematically and strategically; Views deviations from normal patterns; Uses maxims for guidance but no longer relies on rules, guidelines, and maxims; Intuitive grasp of situations; Deep tacit understanding; Requires no guidance from other experts; Provides guidance/coaching to others; Involved in leadership discussions and decisions; Assists in developing references and resources; Provides recommendations to improve processes and practices.