Nursing Skills Check-Offs for current RN's (not nursing students)

[jeangirl928]

I am curious how nursing skills check off are handled in various hospitals and clinics. I work in a hospital based oncology clinic. We are an outpatient clinic but since we are a part of the hospital we follow the hospital guidelines.

Each year we are required to do a skills check off day. Stations are set up and we are to demonstrate skills or verbally discuss skills and then our fellow nurses check each other off. So I can check someone off on port access and then they turn around and check me off on it. In my opinion I think someone in an upper nursing education role should check us off rather than us just checking off each other

The other thing I think is a little strange is sometimes the nurse running the check off station (like for blood administration) works in an area of the clinic that never even gives blood. I would question her competency herself in giving blood and she is checking me off on it when I am the one freq giving blood in the clinic.

I think our whole system is messed up and needs a "makeover" but I am not sure what to suggest.

So what do you do that works well in your clinic or hospital?

[AnonRNC]

If you have a clinic-based educator, I'd start with her. If not, then the facility's central education dept is managing your skills fair. In that case, I'd go to your manager with your concerns, say you have some ideas for improving the skills fair, and you're wondering if she can facilitate you working WITH the education dept to plan the next one. My guess is that the Ed Dept nurses would be happy to have your expertise.

[HouTx, BSN, MSN, EdD]

Nurse Educator here -- what are you 'checking off'? The practice of requiring nurses to prove that (despite demonstrating ongoing expertise) they haven't suddenly become incompetent is disrespectful to practicing nurses, very wasteful to the organization, and a very outmoded system in terms of nursing education. The annual 'check off' should be limited to only high-risk and problem-prone activities that are normally encountered. It doesn't make sense to include rarely performed skills... when these crop up, they should be assigned to a nurse who is proficient in that task. In order to maintain proficiency, the skill must be practiced regularly. There is just no way to expect all staff to become proficient in a task that they never have an opportunity to perform - complete waste of money and time.

Based on my experience, the peer checkoff method described by the OP very quickly degrades into a "you check me and I'll check you" exchange in which the original performance standards are forgotten. It puts staff nurses into a very difficult position - of having to critique their co-workers and expose themselves to the potential retribution of disgruntled staff. IF checkoffs have to be done, the "checkers" should not be peers working on the same unit. Their expertise must be established based on pre-determined criteria. The process must be absolutely standardized in order to be fair and valid... ex: no providing 'hints' during the demo, must start from the beginning if mistakes are made, etc...

IMO, the best process is to require nurses to maintain their own professional portfolios. These are records which provide evidence of their competence. It lists the number of times that they have performed the skills. It doesn't have to be fancy... a simple spreadsheet with dates & times of performance (in a way that can be verified if necessary) works just fine. Then, the manager or educator can simply review the portfolio and arrange for any additional training/development that is required... "I noticed that you have only used the blood warmer 4 times this year, and our standard for maintaining proficiency requires 5 times. Therefore, I will schedule a refresher class for you on this equipment"

[jeangirl928]

HouTx you just posted perfectly my thoughts on the current check off procedures at my clinic. The things we are checked off on are so stupid....how to use an IV pump, how to administer chemo or how to give blood which are the things we do ALL day! Really I need to show my coworker I can do this correctly? If i cannot it better be coming our prior to a yearly skills check off.

I am thinking about printing off your response and giving it to my manager and saying this is exactly how I feel to the T. I love the idea of having the log and am going to suggest it. Any other input is appreciated at well. Please climb on the soapbox again! Love your thoughts.

[AnonRNC]

Some "competencies" that are demonstrated at Skills Fair are JCAHO mandated. On my unit, we also DO review less-frequently seen skills. For example, we might have 6 chest tubes in a year, not enought to keep ONE nurse competent, much less the 80 we have on staff. So we review it at Skills Fair & when we get one, we utilize resources (other units) to make sure we are managing it well.