The nature of how competencies are defined and allocated to various cognitive domains, assimilated in clinical scenarios, and validated is a worthy topic for discussion.  The authors’ contend that there is the tendency for nurse educators to place too great an emphasis on the behavioral competencies without a well–defined assessment of the cognitive competencies that must be mastered in order for the nurse to perform the appropriate, differentiated behavioral or clinical response.

This article suggests that the curriculum revision process is an appropriate starting place for nursing educators to define the cognitive skills that lead to the effective application of behavioral skills; especially, when multiple problems – presented in a medical scenario – lead to multiple behavioral response options.  The ability of the nurse professional to “differentiate” the cognitive skill difference that results in the selection of the proper behavioral response is the “true” test of nursing proficiency, problem solving, and professional practice.