A universally accepted list of complementary therapy core competencies for nursing has yet to be developed. However, the close alignment of nursing with holistic and integrative health care provides solid justification for moving forward. Booth-LaForce and colleagues (2010), Chlan and Halcón (2003), and Kreitzer, Mann, and Lumpkin (2008) have advocated for an integrated curriculum grounded in holistic, patient-centered care beginning at the baccalaureate level. These authors have suggested several core competencies, including:

1. Awareness and assessment of therapies and practices

2. Evaluation of the evidence base underlying therapies and practices

3. Skill development in therapies and practices

4. Self-awareness and self-care, and

5. Awareness of the theoretical basis underlying therapies and practices.

These competencies are evident in the scope and standards for practicing nurses. The American Nurses Association (ANA), in the book Nursing:
Scope and Standards of Practice (ANA, 2010), spelled out the practice parameters and responsibilities for all RNs in the United States. The practice standards of assessment, diagnosis, outcome identification, planning, implementation, and evaluation allow for an individualized plan of care that is sensitive to diverse health care practices for all patients. The professional performance standards of quality of practice, practice evaluation, education, collegiality, collaboration, ethics, research, resource utilization, and leadership commit nurses constantly to improve knowledge, skills, and competencies appropriate to the nursing role.

The ANA’s Scope and Standards of Practice (2010) indicated that nurses must be knowledgeable about and sensitive to a range of health practices so that holistic nursing care can be provided. The document does not identify specific therapies that nurses may or may not incorporate into nursing practice. The Nursing Interventions Classification (Bulechek, Butcher, & Dochterman, 2008), however, provides a comprehensive listing of treatments that nurses can perform. This list includes the following complementary therapies, which are within the realm of nursing given the appropriate training or certification: acupressure, animal-assisted therapy, aromatherapy, art therapy, biofeedback, massage, music therapy, self-hypnosis facilitation, and therapeutic touch. Although the knowledge base for many complementary therapies may be part of the educational program, performance proficiency is often not achieved during an undergraduate or even graduate nursing education. Therefore, even though nurses can perform these therapies, they should perform them only with the appropriate training and certification.

Complementary therapy education expectations are also evident in various Boards of Nursing (BON) documents within the U.S. states and territories that regulate nursing practice to ensure patient safety. Of 53 BONs surveyed in 2001, 47% had statements or positions that included specific complementary therapies or examples of these practices, 13% had them under discussion, and 40% had not formally addressed the topic but did not necessarily discourage these practices (Sparber, 2001). Although this survey has not been repeated, the percentage of BONs with formal position statements is likely to rise. BONs are increasingly aware of and supportive of the integration of complementary therapies into nursing practice, and they are continuously clarifying what is within the scope of nursing practice and identifying basic education and competencies required for nursing practice. Because the interpretation of the nursing scope of practice can vary based on the different state or territorial BONs, nurses must be aware of their own state’s position regarding complementary therapies, must have the documented knowledge and competencies to perform the therapy, and must adhere to licensure and credentialing regulations.

Internationally, similar nursing regulatory agencies have articulated the role of the nurse in understanding and practicing complementary therapies. The Nurses Board of Western Australia has published Guidelines for the Use
of Complementary Therapies in Nursing Practice (2003). The guidelines indicate that “nurses are responsible for acquiring and maintaining their complementary therapy knowledge and competence and for being aware of the limitations of their knowledge and competence in relation to complementary therapies” (p. 1). Selection of the educational program in the specific complementary therapy is the responsibility of the nurse. The Nurses Board of Western Australia cautions that the course must be of adequate quality, be accredited or approved as appropriate, confer the appropriate qualifications and level of practice, and build on the prior learning of the nurse.

Similarly, the College and Association of Registered Nurses of Alberta published the Alternative and/or Complementary Therapy Standards for Registered Nurses (2006) to provide “guidance to registered nurses in making decisions about providing care that involves complementary or alternative health-care therapies and natural health products as an adjunct within their nursing practice” (p. 2). These standards require adequate knowledge, skills, and licensure when appropriate to provide the specified alternative/complementary therapy through relevant educational or certificate programs. The provision of such therapies must fall within the current scope of nursing practice for Canadian RNs, if the treatment is being provided under the RN license.

Specialty organizations have also weighed in on the debate about what nurses with specialty certifications can and should perform. The American Holistic Nurses Association (AHNA) and the American Nurses Association (ANA) have jointly developed the Scope and Standards of Practice for Holistic Nursing (2007), which includes a core curriculum for integrative health care practice infused with the principles of complementary and alternative therapies and competencies consistent with holistic nursing practice. The certification is not routinely required as part of the nurse’s prelicensure or advanced education; however, it offers important insights as to the expectations of holistic nursing practice.

The specialized training required to safely and effectively practice specific complementary therapies is not typically found in general nurse education programs. Increasingly, however, nursing programs are attentive to helping student nurses to better understand the role of complementary therapies in patient health. Multiple authors have suggested specific content applicable to the undergraduate and graduate nursing curriculum (Cuellar, Cahill, Ford, & Aycock, 2003; Gaster, Unterborn, Scott, & Schneeweiss, 2007; Kligler et al., 2004; Lee et al., 2007). The following is a compilation of suggested student learning outcomes that address the necessary dimensions for educating students within general nursing practice:

Lee and colleagues (2007) recognized that the integration of complementary therapies in nursing education requires little or no shift in philosophical paradigm because issues like wellness, prevention, and holistic health have long been at the core of nursing practice. There is ample evidence to suggest that nursing education programs, albeit inconsistently, are already attending to the knowledge base needed and to understanding the role of complementary therapies in health care. For example, multiple studies have confirmed that nursing faculty and students believe that complementary therapies must be integrated into the nursing curriculum and that nurses must be prepared to advise patients regarding best practices in integrative health care (Al-Rukban et al., 2012; Avino, 2011; Cutshall et al., 2010; Halcón, Chlan, Kreitzer, & Leonard, 2003; Keimig & Braun, 2004; Kim, Erlen, Kim, & Sok, 2006; Kreitzer, Mitten, Harris, & Shandeling, 2002; Kreitzer et al., 2008; Nedrow, Istvan, et al., 2007; Öztekin, Ucuzal, Öztekin, & Issever, 2007; Uzun & Tan, 2004). A few of these studies also determined that nursing students, on graduation, did not feel prepared to integrate complementary therapies and that more education was desired (Keimig & Braun, 2004; Kim et al., 2006; Uzun & Tan, 2004). More recently, Avino (2011) reported students were open to the health benefits of complementary therapies, although they did not want to be overwhelmed with information or trained to personally provide each therapy.

Dutta and colleagues (2003), Fenton and Morris (2003), and Richardson (2003) sampled nursing schools across the United States to determine the extent to which the schools integrated complementary and alternative modalities into their curricula. For all three studies, a large percentage already included complementary therapies in the curriculum (49%-85%) and almost all of the programs were planning to incorporate additional complementary therapies in the future. The same appears to be true for family nurse practitioner programs (Burman, 2003). Very few of the responding schools had a separate required course on complementary therapies (11%-15%); whereas most offered a separate elective course
(37%-84%) and about one third of the schools offered a continuing-education option. The most commonly included therapies were spirituality/prayer/meditation, relaxation, guided imagery, herbals, acupuncture, massage, and therapeutic touch.