Clinical Competencies

[jjasonsn1991]

Good morning ALL STAFF DEVELOPMENT NURSES,

Please let me know what you currently use for Clinical Competencies. I am asking as I am unsure if some competencies should continue to be done annually. I often believe that these competencies do not show us if a nurse is proficient at any given moment and I would like to teach nurses to recognize their own scope of practice and if something is new or beyond them it is their responsibility to seek out a policy or a supervisor for assistance. Please let me know your thoughts. I appreciate your input. This would not eliminate intial training for all nurses on new techniques or equipment, it would just mean not doing meaningless annual competencies that a nurse may not use at all during the year. Thanks!

[IVRUS, BSN, RN]

Oh JJ,

I really disagree with you. Assessing competencies yearly help nurses, LPN's and RN's alike, remain accountable and show that assessement is ongoing. Just by virtue of a nurse having an RN behind her name, or an LPN having certification in infusion therapy, for example, doesn't mean that that person is competent in administration and placement of infusion therapy practices.

It is really the best tool to use to determine whether or not the P&P of the employing institution is being followed and correct deficiencies if new policies have been made. Surveyors in Hospitals and LTC are assessing whether or not employees are competent. This cannot, or should not be assessed by looking at an initial hire assessment 5 years ago. Nor is it appropriate to rely on that employees self assessment of themselves ( What I'm a novice at, and expert at, etc. )

[jjasonsn1991]

Thank you for your response. Which competencies do you feel are most valuable annually? I have gotten so many varied responses from different settings, facilities, nurses, etc. It is difficult to narrow down what is necessary for all nurses. Let me know your thoughts. Also, are your cometemcies paper-based or simulation hands-on or a combination?

[IVRUS, BSN, RN]

Everything that is invasive definitely should be assessed yearly, but then other skills like performing EKG's should be assessed.

A simulated lab can do accomplish this task for the initial educational component, but then what I believe should happen, and what we do is when a pt needs an IV catheter, or a central line dressing change, or fluids/medications hung, then the educator does a 1 on 1 at bedside to assess whether the education resulted in that individual being competent. Every organization should have there own P&P in place which states for my organization my RN's must place three successful placements of a short term peripheral before having wings to "fly" independently. Now they may try 10 times, but aren't considered autonomous until three have been seen, verified and documented.

Again, it is the responsibility of each institution to set those parameters.

Does that help?

[jjasonsn1991]

That does help, thank you. The ones we currently do include checking g-tube placement, running the feeding pump, nebulizer treatments, IV's annually and suctioning and/or trach care. I am the director of staff development in a 290 bed facility. I'm thinking we can place the g-tube portion with the new nurses' mentor on hire. Would you suggest the g-tube competency annually? We already do the IV annually. What do you think?

[IVRUS, BSN, RN]

Are they reinserting them (ie. with a foley in the case of accidental dislodgement?) or is it the administration of medications via g-tube and care and maintenance. Reinsertion definitely, gets a yearly eval, but we also check yearly on proper medication administration too. You'd be surprised by how many individuals forget in a years time important tidbits which easily raise surveyor's hair on their neck!

[HouTx, BSN, MSN, EdD]

OMG - this is one of my favorite soapboxes.

In an ideal world, I would eliminate all of that annual checklist mania. For the most part, it is absolutely meaningless because it does not even consider proficiency. 'Lemme 'splain . .

With EHR systems, we can actually extract data that reveals exactly how many times Nurse X has performed the specified activity... If there is no information which indicates that Nurse X has had any problems with those activities, then why in the world are we hauling him into a classroom or skills lab like a trained primate in order to check his RECALL (not actual performance) of the procedure????? Doesn't make sense. Push your IT crowd to help you develop a system for ePortforlios to validate competency.

IF (big if) a nurse does not perform an activity often enough to achieve / maintain proficiency - then it may be necessary to set up an artificial 'checkoff'. But in these cases, I would also question the underlying logistics. Rather than go to the enormous expense of attempting to cure world hunger each year, it is much more efficient to choose one of the following 2 options:

1. Limit this training to a small number of employees so that they each have sufficient opportunities to maintain proficiency.

2. Provide an effective process for Just-In-Time training as needed. If performance immediately follows training, it is much more likely to be retained than our usual "build parking lots for the Christmas rush" approach.

I don't know about your organizations, but the weighted average salary for our licensed nursing staff means that one of our mid-sized facilities can easily chew about a million dollars off the bottom line with each 4 hour block or "mandatory" training. In light of the severe financial crunch that is enveloping our industry, we have an obligation to pare this down.

[IVRUS, BSN, RN]

Wow Hou... We definitely are on opposite sides of this issue... So, if a nurse has performed a procedure ten times in the last month, and has not had an adverse complication as a result.. She or he is Okay to go??? NOOOOOO!

First, without an assessment, you don't know if that individual is performing it according to YOUR P&P.. this is crucial, because if a surveyor comes in and is watching her, and policy isn't followed, guess what!

Secondly, the absence of complaints by patients, non-medical professionals, doesn't mean that what was done to that patient was appropriate.

Now, I do agree that specialized teams are your best bet.. ie, Vascular access teams have been shown to produce better outcomes. But even they should be diligently assessed to verify correct practice yearly.

I find that usually those who hate this practice are ones who hate being checked off!

[IcuSadie]

Very interesting system. What is EHR? and how does your system work? Sounds GREAT!

[Lunah, MSN, RN]

Very interesting system. What is EHR? and how does your system work? Sounds GREAT!

EHR = electronic health record.

We are moving to the Donna Wright competency assessment method where I am. Not entirely sure how that works right now, but I understand it's a little different than the usual checklist mania. :) For now we are still checking off our trauma nurses on various things like art line set ups, rapid infusion, traction splints, etc.