ARN’s Competency Model for Professional Rehabilitation Nursing Sets Us Apart

Dr. Patricia Quigley's March 2021 President's Message highlights key aspects of ARN's history and role in establishing a competency model for rehabilitation nursing, as ARN prepares to issue an updated model later this year.

As shared in my January President's Message, ARN is celebrating 47 years of advancing practice, science, patient and nursing outcomes, and policy influence. As an enduring member, I have such pride for our legacy as a specialty organization, and I appreciate this opportunity to reflect on our history and journey. We have a wide range of members with varying durations of membership, and some members may not know all of our milestones—nor how our journey resulted in a comprehensive theoretic model of practice that has achieved national and international influence. ARN's journey has been one of progressive and deliberate dedication from extraordinary rehabilitation nurses to define our specialty practice, conduct research to quantify aspects of our roles and impact, detail core knowledge of the rehabilitation nursing specialty, and create a theoretical framework of our own practice—our competency model (CM) for professional rehabilitation nursing.  

Our Journey Toward a Competency Model for Professional Rehabilitation Nursing 

Prior to 1974, nurses practicing in rehabilitation settings were members of the American Nurses Association (ANA), a subgroup of the Division of Medical Surgical Nursing. In 1974, a core group of nurses formed our specialty under the leadership of Sue Novak, the first ARN president. Our specialty journal, Rehabilitation Nursing, launched in 1975. The first Standards for Rehabilitation Nursing Practice were created by ANA's Division of Medical Surgical Nursing in 1976 by a group of rehabilitation nurses who were members of both ARN and ANA. This was the same year that ANA recognized ARN as a specialty organization. Five years later, in 1981, ARN published its first Core Curriculum, a comprehensive compendium regarding this specialty. In 1982 and 1983, ARN conducted observational studies of the practice of rehabilitation nursing and job analysis, which set the stage for certification across multiple settings. Ten years after our formation, we conducted our first certification exam—a hallmark of ARN and rehabilitation nurses, recognized by ANA.

Throughout the years, our knowledge base, scientific contributions, and evidence-based practice continued to evolve. In 2013, the ARN Board of Directors commissioned a task force comprising experts representing clinical and academic settings to embark on a journey to develop an evidence-based framework that would guide professional rehabilitation nursing practice. Dr. Stephanie Vaughn, our 2016–17 president, was chair, and Dr. Jill Rye, now our current president-elect, was a member. The task force discussed, debated, and reviewed all facets of modern rehabilitation nursing. The resulting model was validated by member review and comment and was approved by the Board of Directors. 

2014 ARN Competency Model 

Just 1 year later, ARN released our first Competency Model for Professional Rehabilitation Nursing. This is the theoretical practice framework for the rehabilitation nursing specialty. The task force also published the methodology they used to generate and validate this model as well as its structure and applications to practice, education, and research (Vaughn et al., 2016). ARN's CM is depicted by a circle with the Professional Rehabilitation Nurse Role in the center surrounded by the domains and competencies for each domain. Our CM was developed to help nursing services where rehabilitation nursing is practiced, to establish core nursing competencies at the point of care, to develop position descriptions and performance standards, and to be infused into nursing schools' nursing curriculum and continuing education products, which again include our Core Curriculum.

The CM comprises four domains created to highlight and define the essential role competencies: Nurse-Led Interventions, Promotion of Successful Living, Leadership, and Interprofessional Care. The CM identifies 14 essential role competencies across these domains, with the competencies in each domain operationalized at three levels of proficiency—beginner (1–2 years), intermediate (3–5 years + CRRN), and advanced (5 years or more in varied roles, including educator, CNS, APRN, etc.). All competencies integrate rehabilitation nursing knowledge, skills, and core values and beliefs into rehabilitation nursing practice.

The International Nursing Stage 

In 2018, ARN President Michele Cournan was in attendance at an ANA meeting when ANA's President Ernest Grant, PhD, RN, FAAN announced that the World Health Organization (WHO) was planning to convene a task force to develop an international rehabilitation competency framework to be used around the world—WHO's Rehabilitation Competency Framework Task Force: Rehab 2030. It was a call to action, and Dr. Cournan responded to this call. WHO convened in Geneva in 2019, including a task force of 21 members from around the world. Drs. Cournan and Vaughn were appointed to participate and were the only nurses in the group. ARN was positioned to contribute and lead by example, already having ARN's CM to influence WHO's global product for rehabilitation across disciplines.

Also, in 2019, ARN Past President Dr. Barbara Lutz and the Board of Directors created a new task force to review the 2014 CM and revise it to reflect current rehabilitation nursing. Drs. Rye and Vaughn led this task force. Based on communications with Dr. Vaughn, I learned that the revised model revision will include the addition of a competency to Domain One, Nurse-Led Interventions, that focuses on the understanding of the worldview of individuals who are culturally different, reflecting rehabilitation nursing's multicultural approach and global reach. You will soon learn about additional revisions to the CM and its planned release this year!

The National Nursing Stage 

ARN is an Organizational Affiliate (OA) of ANA, one among 39 specialty nursing organizations that hold organizational-level membership with ANA. By working together, nursing organizations share information and collaborate in finding solutions to issues that the nursing profession faces, regardless of specialty. ANA convenes two OA meetings each year, inviting OAs to add to the agenda. After submitting an agenda request for the November 2020 OA virtual meeting, ARN was placed on the agenda to present ARN's CM and allowed 5 minutes. OA members learned about the timeline of ARN's high-level achievements—our nursing standards, core curriculum, certification, and competency model—over our 46-year legacy of defining, advancing, and advocating for rehabilitation nurses and our specialty role in caring for those living with chronic disease and disabilities, frailty, vulnerability, their families and care givers, within settings and across transitions of care.

OA members visualized our model, learned about the four domains, three levels of expertise, and task force currently updating the model. Additionally, OA members learned of ARN's response to ANA President Dr. Grant's WHO invitation, which elevated our influence on the international level, key model updates, and projected date for completion. All OA members were invited to learn more about our competency model, visit our resources, read the 2016 publication, and seek our assistance to develop their competency model. Yes, given only 5 minutes, every word counted. 

2021 ARN Competency Model and YOU 

With much anticipation, ARN's updated CM will be released this year, likely just in time for ARN's 2021 Rehabilitation Nursing Conference in November. I've heard about many key revisions from Dr. Vaughn, though I've shared only one to keep you in suspense for the release of the updated model. This model is our Theoretical Model for Practice. ARN is linking the model and competencies to all of our education initiatives to ensure that our educational offerings fully cover content related to all the practice competencies in our model for our rehabilitation nurses today and tomorrow. ARN provides so many resources for you to integrate this model into your practice and will continue to do so with the updated model. It is YOU who gets to take the model to the next level—to integrate the model into your practice, your rehabilitation nursing orientation programs, position descriptions, performance evaluations, competency skills checklists, and more. It is YOU who gives life to this model at the point of care, and to share your success with others. You can take pride in the legacy of ARN's achievements, visibility, and influence. Colleagues, not all specialty nursing organizations have a theoretical practice framework.

As ARN was congratulated at the OA meeting, all of our ARN members, past and present, are to be congratulated, as well. Today, WE, as members, shape ARN's future influence as an organization that continues to affirm our specialty practice, influence, and impact. I ask you to fully integrate your CM into your organization's practice and share with others your program tools and successes. We serve together to further integrate/enhance rehabilitation nursing concepts, principles, competencies, and practices within and across roles and settings of care. 

Patricia A. Quigley, PhD ARNP CRRN FAAN FAANP FARN

President, Association of Rehabilitation Nurses

Vaughn, S., Mauk, K., Jacelon, C., Larsen, P., Rye, J., Wintersgil, W., Cave, C., & Dufresne, D. (2016). The competency model for professional rehabilitation nursing. Rehabilitation Nursing, 41(1), 33-41.