Defining specialist practice through competencies: the notion of the general and specialist children's nurse.

The principle intention of this study was to define children's nursing from experts in the field.   A multi-method comparative design incorporating a case study approach was used that included a nominal group technique, focus groups, a Delphi survey and semi-structured interviews.  Two phases of data collection were undertaken concurrently with children's nurses (n=146) and specialist children's nurses (children's cancer nurses, n=37) from a number of centres. The holistic competencies developed following data collection exposed characteristics of knowledge, skills, abilities, values and qualities displayed within the context of professional work for both groups of nurses.  A classification of competencies was inductively developed from the data by the researcher and an independent researcher.  The resulting hierarchy of competencies and sub-competencies illustrates relationships between a children's nurse and specialist children's nurse.  Although untested the classification provides a detailed definition of children's nursing and specialist children's nursing through the labelling, defining and ordering of competencies. The relationship between the two types of children's nurses leads to the following conclusions.  There is a significant common element in these two areas of nursing practice and that generalist preparation is the foundation of specialist practice.  In addition, generalist knowledge and skills are expanded in specialist practice.  There is also evidence of specialty practice that is beyond the scope of general nursing practice.  Evidence provided through the data collected successfully addresses and resolves the debate that children need appropriately educated nurses and that this education needs to begin at the level of generalist children's nursing preparation.  The focus of further work will be to design suitable studies to support or refute the definition and through testing to confirm that a relationship does exist between general and specialist children's nursing.