Competency: An Overview of Resources

1. Competency: An Overview of Resources Diane L. Paulson, RN, MSN, MAJ (Ret)

2. Competency is… “A determination of an individual’s skills, knowledge, and capability to meet defined expectations”

3. Joint Commission says… • HR1.2 – Define and verify • HR2.1 – Orientation • Mission and goals • Safety and infection control • Cultural diversity and sensitivity • Patient’s rights and ethics

4. Joint Commission says… • HR 2.2 – Patient & environmental safety • HR 2.3 – On-going education • HR 3.1 – Competency assessment • Systematic & measurable • Based on: • Evaluations • Performance improvement • Needs assessments

5. Joint Commission Intent • Orient staff BEFORE they provide direct care • Base evaluations on job descriptions • Tailor age-specific knowledge and skills • Utilize professional associations • Prioritize initial competencies • HIGH-RISK and PROBLEM-PRONE processes • Reassess • Per hospital policy • Based on learning needs

6. Joint Commission Reference • Assessing Hospital Staff Competence (2007) www.jcinc.com/889/ • The Joint Commission Guide to Staff Education (2002) • ISBN: 0-86688-725-3 • Order Code: SEG-100ACF • Price: $55 • Managing Performance Measurement Data in Health Care • Order Code: SITHC-01ACF • Price: $55

7. Goals of Competency Assessment • Evaluate individual performance • Meet regulatory standards • Address problematic issues • Enhance performance review process

8. Assessment Strategies • Orientation • Newcomer’s Orientation • Department of Nursing Orientation • Unit Specific Orientation • On-going assessment • Skill Fairs • Online programs • Self-study packets • Unit specific requirements

9. New Hire Assessment • License and certifications verification • Samples of orientation packets • RNS incorporated (www.rnsonline.com) • Emergency Services Specific Competency (www.ena.org) • 3W Generic plus RN & LPN CBO’s (dpaulson@acutecareed.com) • Madigan Army Medical Center Competency Verificaton Record – DEM (dpaulson@acutecareed.com)

10. Format Possibilities • Definition statement • Skill list • Self-assessment • Evaluation method • Age-specific skills

11. New Graduate Orientation • Start with the orientation checklist provided by the School of Nursing • Same checklist, but lengthen the time • Steady preceptor

12. Floating Nurse • Standardize processes between floors • Documentation • Admission process/paperwork • Discharge process/paperwork • Medication schedules • Focus on high-risk, problem-prone issues for each floor • Provide time for orientation prior to need

13. Agency Nurse • Joint Commission on orientation • HR.3.10 • The hospital needs to provide orientation to the organization and any department specific and job specific information and training • Joint Commission on competency • Letter from contractor • Information from past and current employers • Peer recommendations • Validating specialty certifications • Ongoing performance data collection • Skills observation

14. Clerks/Administrative Staff • Equipment • Fax • Pager system • Xerox • Phone Etiquette • Unit management

15. Competency Databases • PBDS www.pmsi-pbds.com • EmpTrack www.empxtrack.com • Dumpe, M., Kanyok, N., & Hill, K. (2007). Use of an Automated Learning Management System of Validate Nursing Competencies. Journal of Nurses in Staff Development. July/August, 23 (4): 183-185.

16. Initial Competency Sample

17. Disciplinary Actions • Switch preceptors • Provide avenue for retraining or lengthened orientation process • Consider other work locations more suitable for the staff member skills • Set policy guidelines for dismissal

18. On-going Assessment • New machines • Low volume, high risk procedures • Evidence based changes in practice • Changes in policy • Sentinel events • New patient populations • Problematic issues

19. On-going Competency Sample

20. On-going Assessment • Focus on proficiency • What skills make a difference • Performance improvement initiatives • New procedures/technologies • New policies • Based on survey results

21. Verification Methods • Test/exam • Return Demonstration • Evidence of daily work • Case Studies • Exemplars • Peer Review • Self Assessment • Discussion/reflection groups • Presentations • Mock events/Surveys • Quality improvement monitors

22. Competency: More than a checklist • Include Joint Commission specifics • Based on job description • Skill development • Skill maintenance • Remediation • Redevelopment

23. Resources • Books • Joint Commission – Assessing Hospital Staff Competence (www.jcrinc.com) • Competency Management for the Medical-Surgical Unit (www.hcmarketplace.com) • Wright, Donna – The ultimate Guide to Competency Assessment in Health Care (www.amazon.com) • Systems • Critical Check Lists (www.decisioncritical.com or www.4nursingmanagers.com ) • NurseTesting (www.nursetesting.com or www.4nursingmanagers.com) • Orientation to Emergency Nursing (www.ena.org) • PBDS (www.pmsi-pbds.com)

24. References • www.jointcommission.org • Whelan, L. (2006) Competency Assessment of Nursing Staff. Orthopaedic Nursing, May/June 2006, 25(3), pp. 198-202. • Wright, D. (2005) The Ultimate Guide to Competency Assessment in Health Care, 3rd ed. Creative Health Care Management, Inc., Minneapolis, MN.