1. Competency Assessment Demonstrating Mastery of RPN Entry – to –Practice Competencies Loy Asheri – RN, MSc Case Manager Ruth Wojtiuk – RN, MEd Professional Practice Lead

2. CARE Centre for Internationally Educated Nurses
CARE Centre for Internationally Educated Nurses (IENs) created in 2001 to address a major gap in Ontario’s healthcare human resources strategy. 
Since 2001 over 3,500 nurses from more than 140 countries have accessed CARE’s array of services and supports for IENs.  
Today, 12 percent of the nursing workforce in Canada is comprised of IENs and in the multi-cultural GTA , IENs comprise more than 25 percent of nursing staff. 
A recent Conference Board of Canada report, Measuring Returns: Valuing Investments in Internationally Educated Nurses prove:
IENs are integral to the future of Canadian nursing, becoming quickly job-ready through bridge training, and pay back the investment of government support by bringing a wealth of global skills and experience to healthcare in this country.

3. Internationally Educated Nurses seeking registration in Ontario bring:
Background
Internationally Educated Nurses seeking registration in Ontario bring:
an average of 5 years international nursing experience
advanced degrees
HOWEVER
Frequently, available documentation is deemed insufficient to verify mastery of the required entry to practice competencies, leaving some IENs without suitable expectations and plans.

4. Registration National Nursing Assessment Service All internationally educated nurses (IEN) must set up an account with NNAS, and submit all required documentation before their application will be considered by any of the Canadian nursing regulatory bodies.
NNAS
Knowledge management- database
Consistent national approach
Document collection and management
Credential evaluation
The nursing registration process starts when you open a file with the NNAS.
Single application web portal
Bilingual customer care centre for IEN applicants
An international education programs database
A national IEN database
Common approach to initial
document collection,
authentication, validation
and fraud screening
Consistent assessment standard of the IEN
application file
Consistent format electronic advisory
reports to RBs to inform IEN eligibility
assessments
The NNAS will collect and verify the authenticity of all required documents as well as determine if your nursing education is equivalent to that of an Canadian educated nurse.
Once your account is opened with NNAS you will be provided a user name and pass word enabling you to monitor the progress of the assessment.
Once NNAS has completed their assessment the file will be forwarded to the Regulatory body in the province or territory you indicate.

5. NNAS RB 10 Major Steps in the IEN Registration Process 1. 10. 4. 5. 7.
IEN registers with NNAS, completes forms and pays fees
10.
Full registration awarded on successful completion of national exam 4.
NNAS assesses IEN file for comparability to Canadian standards for entry to practice, defines gaps and prepares an advisory report 5.
IEN picks up advisory report through NNAS web portal and formally applies to regulatory body/pays fees 7.
Letter of eligibility to write exam issued by regulatory body to IEN 9.
IEN writes national/provincial examination 2.
NNAS receives all required documents; IEN tracks progress online 6.
RB retrieves file/advisory report from NNAS; IEN proceeds with RB requirements to assess/ remediate any gaps to meet jurisdictional eligibility requirements
Proof of identity
Verification of education
Verification of registration
General suitability/safety to practice
Language proficiency 3.
NNAS determines validity/authenticity of documents 8.
Temporary registration granted when IEN meets requirements for safe practice
NNAS RB
This chart portrays the 10 steps in the IEN assessment process, designed to ensure a candidate's safety to practice as a nurse in the Canadian health care system. The National Nursing Assessment Service is responsible for Steps 1-4 as indicated by the red boxes.
Steps 5-10 I indicated by the blue boxes, are the responsibility of the regulatory body in the jurisdiction where an IEN is seeking registration. A regulatory body may require the IEN to go through some or all of these steps to determine eligibility for registration/licensure to practice in Canada. The order in which an IEN must proceed with these steps varies somewhat from one regulatory body to another.
This presentation will focus on Box #6 – demonstrating how the CARE - CAS workshop supports RPN applicant in their efforts to effectively demonstrate to the CNO mastery of the RPN entry to practice competencies.

6. In response to the needs of members
Workshop Rationale
In response to the needs of members
CARE – Centre developed, implemented and evaluated a three-day CAS workshop.
Licensure for IENs is lengthy and complicated, which delays or prevents many IENs from re-entering the nursing profession.
Failed applicants may apply for lower skilled occupations, leading to systematic de-skilling.( Walton-Roberts et al 2014).
While the principal role of professional regulators is protection of the public interest and client safety, they also have a duty to uphold immigrant access to the profession.
In keeping with this commitment to migrant access many Ontario RPN applicants are given the opportunity to address competency gaps identified by the CNO through the completion of a Competency Assessment Supplement (CAS).

7. Workshop Objective
The development of a comprehensive CAS requires significant critical thinking and reflective work on the part of the applicant. This workshop is designed to provide guidance in the preparation of a thoughtful reflective document based on the IENs unique education and experience, that will demonstrate mastery of the entry level RPN competencies.

8. Workshop Agenda Objectives Learning Outcomes
Overview Assessment Process
Competency Assessment Supplement (CAS)
National Competencies
Scenario Structure
Scenario Evaluation
Individual Scenarios
Participants frequently register for the workshop expecting that the facilitator will “write” their submission.
It is emphasized that the instructor’s role is to help applicants:
unpack the competencies,
identify the elements included in the competency
Identify a significant event in their experience that demonstrates mastery
Plagsarism :
The act of presenting the words of someone as your own without giving them proper credit.
This is discussed in details to ensure applicants have a common understanding of the word and are aware of plagiarism repercussions.
Quotations from the Internet or any print document must always be attributed to the authors who actually wrote them.

9. Learning Outcomes Identify the competency elements.
Describe competency categories
Cluster competencies
Use the nursing process and critical thinking as a framework to structure scenarios.
Identify past experiences that can be applicable to a scenario.
Describe a rationale
Provide a rationale for each intervention in the scenarios.
Identify the competencies included in scenario.
Know the factors/questions to be considered in developing a scenario.
Identify the resources that can be used to address the competencies not included in the scenarios?
Develop scenarios

10. What Are Competencies?
What are competencies? Statements about the knowledge, abilities, skills, attitudes and judgment required to perform safely as you practice nursing in any practice setting. (CNO glossary page 21) What is the purpose of competencies? Describe what is expected of entry‐level registered practical nurses in order to provide safe, competent, ethical nursing care in a variety of practice settings. Serve as a guide for curriculum development and for public and employer awareness of the practice expectations of entry‐level registered

11. Why Are they Important
Mastery of competencies provides evidence of proficiency in the key elements of:
Communication
Critical enquiry/problem solving
Research
Leadership
Health Promotion
Assessment
Ethical/legal reasoning

12. Experience/education
Scenario Structure
Scenario
Experience/education
Competency Elements
Conceptual Framework
(APIE)
Competency Category
Rationale

13. Conceptual Framework Assessment Planning Implementation Evaluation
The conceptual framework organizes the competencies in to the 4 stages of the nursing process:
Assessment
Planning
Implementation
Evaluation

14. Competency Elements complex, ongoing, interactive
Communication
Critical Enquiry/Problem Solving
Research
Leadership
Health Promotion
Assessment
Ethical/legal
complex, ongoing,
interactive
the basis for building interpersonal relationship
listening, reading, oral, non verbal face to face telephone,
interaction clients members of the health care team
Critical Thinking
what to do in a specific situation.
knowledge and experience
nursing process gives structure to thoughts, judgments and decisions
 Critical inquiry
purposeful
reflective reasoning
examine ideas, assumptions, principles, conclusions beliefs actions
spirit of inquiry, discernment, logical reasoning, standards
Diligent systematic inquiry investigation to discover revise facts, theories, applications, Quantitative focuses on outcomes that are measurable
Qualitative examines the experience focusing on meaning
Leadership is more than management or supervision It is the ability to identify need, share vision and influence others to achieve the desired goal.
The science and art of helping people to discover the relationship between physical, emotional, social and spiritual health. Supporting them in changing their lifestyle to achieve optimal health. Participation is essential
Gathering information about the health status , analyzing the data, making decisions about nursing interventions evaluating outcomes. The nursing process begins with a complete assessment.
Principles of conduct. serve as a rule to guide and assist in taking consistent positions on specific issues. They provide a framework for ethical decision making

15. Competency Categories
Professional Responsibility & Accountability # Demonstrates professional conduct; practises in accordance with legislation and the standards as determined by the regulatory body and the practice setting; and demonstrates that the primary duty is to the client to ensure consistently safe, competent and ethical care. Ethical Practice # Demonstrates competence in professional judgments and practice decisions by applying principles implied in the ethical framework, and by using knowledge from many sources. Engages in critical thinking to inform clinical decision making, which includes both systematic and analytical processes, along with reflective and critical processes. Establishes therapeutic caring and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect Service to the Public # Demonstrates an understanding of the concept of public protection and the duty to practise nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public Self-Regulation # Demonstrates an understanding of professional self-regulation by developing and enhancing one’s competence, ensuring consistently safe practice, and ensuring and maintaining one’s fitness to practise.

16. Competency Clusters Assess 11 66 84 105 Plan 22 71 88 112 Implement 46
The following table demonstrated how competencies can be grouped into clusters based on the nursing process
Competency Category
Professional Responsibility & accountability
(see CNO sample)
Ethical Practice
Service to the Public
Self-regulation
Assess 11 66 84
105
Plan 22 71 88
112
Implement 46 73 91
116
Evaluate 59 82 99
120

17. CNO Sample
There are different types of conflict, such as conflict between nurses, nurse and client, nurse and families, and nurses and doctors. Conflict starts when there is a difference of opinion.
For example, when I was working in the ICU, a nurse I was working with was always late for her shift. I was working the night shift and wanted to leave after giving my report. When she came to work her shift, she always had an excuse for why she was late. This upset me and I did not feel that she respected me as a colleague (#11). Knowing that I was tired, it was not a good time to resolve the issue because I would have exploded.
I asked my teammate if I could meet her for coffee before the next shift and talk about something that was bothering me. She agreed. I knew that I needed to address the behaviour and not yell at the person. I knew that I had to let her know how I was feeling when this happens. I know that I needed to listen to her explanation (#22).
So we met for coffee in a quiet place, just the two of us. I told her how I felt when I could not leave my shift on time and how I was scared to go home because I was so tired. I asked her if there was a reason for her lateness. Then I was quiet and let her talk. She told me her story about her daycare problems. Then we came up with a plan that would be good for both of us. We agreed to try it out for two weeks and come back to see if it works (#46). At the end of two weeks, we met again and the plan we had was working out nicely, and I thought about my approach and how we were both happy with the outcome (#59). 

18. Rationale
A nursing rationale is a stated purpose for carrying out a nursing intervention.
Through dialogue with peers participants develop their ability to clearly identify the rationales for interventions described in their scenario.

19. Scenario Development Stage 1
Describe an experience, event or change in your practice setting that was significant to you.
Outline the “story” using APIE
Cluster competencies
Scenario Development Stage 2
Having grouped your unmet competencies into clusters identify those included in scenario
Identify competency elements of the cluster groups
Write the scenario

20. Factors to Consider in Developing a Scenario
Review the required Entry to Practice competencies related to Physical Health Assessment.
Reflect on your nursing experience to determine which patient you will use to develop your scenario.
What was your patient’s primary health problem?
Did you use the nursing process to identify and treat the actual and potential health problems of your patient?
The phases of the nursing process serve as a guide for providing individualized care for patients throughout the life span and in all settings.
Have you collected the objective data e.g., your observation, physical examination findings, information from health records, results of clinical testing
Have you collected subjective data about your patient? E.g., health history, including reports and the patient’s perception about his/her condition. Have you clustered the data to establish themes, patterns and common relationships. What data is missing?
What is your clustering telling you? Does your clustering reflect normal or abnormal findings?
Does the cluster enable you to have some idea of what the health issue is?
Have you documented your findings?
Have you discussed your findings with the client and provide an opportunity for the patient to identify what his/her goals for care?
What resources are required to meet the patient’s needs? Have you written a nursing care plan? Types of nursing intervention include ongoing assessment, education, referral, support, therapeutic communication.
Did you evaluate your interventions? Did you determine if there were areas for collaboration with other health care providers?
Review your scenario for completeness.

21. Scenario Evaluation Clear? Concise? Persuasive?
Comprehensive Assessment
Identified Priorities
Realistic Achievable Plan
Preferred/Actual outcomes
Concise?
Edit, edit, edit
Brief but complete – DO NOT MAKE ASSUMPTIONS
Persuasive?
Easy to read
Rationale evident
Competencies clearly addressed

22. Conclusion
A phenomenological view of caring when combined with a comprehensive understanding of the entry to practice competencies enables IENs to describe their caring practices.
80% of the CARE CAS workshop participants demonstrated, to the satisfaction of the CNO, that they were to prepared to work as RPNs in Ontario (CARE – 2016).
This intervention enhances the IENs likelihood of meeting the CNO educational requirement and of achieving the credential required to practice and work in Ontario.

23. Resources Ethics Canadian Health Care System  
Canadian Health Care System
CNO Learning Modules