Please help, the horror of JC documentation in orientation

[nurse2033, MSN, RN]

I'm an educator at a level II trauma center. Due to JC requirements we currently use a form we call Competency Based Orientation (CBO) to verify competency during orientation. It is long, really long. It includes things like, "welcomes the patient" as well as IV starts, burn care and so on. One of these forms has over a hundred checkoffs. There are a number of problems with this system.

A. It almost never gets completed. My precepters tell me they are too busy training to spend hours documenting on this form. I tell my orientees they are responsible to have their preceptor check them off as they complete items, but it often gets lost in the bustle of a busy ER.

B. There are many low occurance items that they typically don't see during orientation, like the malignant hyperthermia policy, for example.

C. Some orientations, like travelers, are only a few days.

Does anyone have a better system? I am struggling to manage this system, any help would be appreciated.

[llg, PhD, RN]

Here are a few tips:

1. Don't blame The Joint Commission. They did not design the form, nor do they require it. They simply require that you document competence. You and your hospital are free to choose how you do that. There is lots of flexibility allowed. Recognize that poor choices have been made by previous/current educators at your hospital that have resulted in an impractical form/system. Putting the responsibility where it belongs will help you navigate the politics of improving the situation.

2. You are going to need political support from your hospital's educational leadership and administration in order to change your system and form. Get that support before you invest a lot of time and energy designing something new. Do your managers and fellow educators agree that there is a problem and that a change is needed? If not, start there. You'll need their support.

3. Do what you have started to do here. Contact other hospitals (preferably once that your key stakeholders know about and respect). Ask them to share information about how they document new employee competence and re-affirm it annually.

4. Review the literature on competency assessment and documentation. It's a common problem and you should be able to find articles, etc. on the topic.

5. Form a committee to design a new system. A committee will give you credibility and help your political position - especially if you get the right people to serve on the committee. You want people who will help with the work ... but you also want people whose endorsement of the committee's products will help you politically.

What you have is more of a political problem than an educational practice problem. Designing a new, shorter and easier form is the easy part. Selling it to both the administration and the staff is the bigger challenge. Get you "political ducks in a row" and then let the new form/system evolve from the work of the committee you establish.

[nurse2033, MSN, RN]

Wow, thanks!

[nurse2033, MSN, RN]

I tracked down the source of the current form to a previous educator. You were right, that it was more difficult than necessary. I will be extensively revising it, thanks for your help.

[classicdame, MSN, EdD]

Suggestion: Purchase a copy of Donna Wright's book "The Ultimate Guide to Competency Assessment in Health Care". Loads of great ideas there.

[nurse2033, MSN, RN]

My boss just handed it to me! Well, you know, earlier like yesterday. I like asking for help.... it works.

[classicdame, MSN, EdD]

JC does not require a competency check list on everything a person could possibly do. Is there one for using copier or fax or lightswitch?? They are looking for competencies that your facility says in policy must occur. We just quit saying them. We now follow Donna Wright's guidelines - not all competencies are lists!!