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

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

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

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

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

Joint Commission Reference Assessing Hospital Staff Competence (2007) The Joint Commission Guide to Staff Education (2002)  ISBN:  Order Code: SEG-100ACF  Price: $55 Managing Performance Measurement Data in Health Care  Order Code: SITHC-01ACF  Price: $55

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

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

New Hire Assessment License and certifications verification Samples of orientation packets  RNS incorporated (  Emergency Services Specific Competency (  3W Generic plus RN & LPN CBO’s  Madigan Army Medical Center Competency Verificaton Record – DEM

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

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

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

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

Clerks/Administrative Staff Equipment  Fax  Pager system  Xerox Phone Etiquette Unit management

Competency Databases PBDS EmpTrack 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):

Competency#1#2ERORRRICUTotal % of 100 Orientation % BLS % Zoll Defibrillator % Initial Competency Sample

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

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

CompetencyJulAugSepOctNovDecTotal % of 100 Blood Culture % Medication Administration % Zoll Defibrillator % On-going Competency Sample

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

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

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

Resources Books  Joint Commission – Assessing Hospital Staff Competence (  Competency Management for the Medical-Surgical Unit (  Wright, Donna – The ultimate Guide to Competency Assessment in Health Care ( Systems  Critical Check Lists ( or )  NurseTesting ( or  Orientation to Emergency Nursing (  PBDS (

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