LEADING IN A NEW ERA:

1
LEADING IN A NEW ERA DO YOU KNOW IF YOUR STAFF
ARE COMPETENT?
Winnie Fritz RN, MSN, Ed.D. ,CNAA Chief Nursing
Officer Director, International Operations HCCA
International
2
OBJECTIVES 1. Define the four skill types which
are part of a comprehensive competency model 2.
Describe at least five strategies for assessing,
developing, and monitoring nursing staff
competency.
3
OUTLINE 1. Why be concerned about
competency? 2. What competencies do we want RNs
to possess? 3. How shall we assess and develop RN
skills? What are the needed People, Places,
Processes? 4. How shall we monitor and report our
nurses competencies?
4
Why Be Concerned About Competency?
Essential Outcomes for Healthcare Organizations
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Why Be Concerned About Competency?

• Pay-for-Performance (P4P)
• Core Measures
• Nurse Sensitive Indicators
• Risk Reduction Cutting Liability Costs

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Why Be Concerned About Competency?

• Public Reporting of Clinical Quality
• Evidence-based Practice
• Science, Not Habit

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Why Be Concerned About Competency?

• Our Nurses Are Diverse
• Different Educational Preparation
• Diverse Countries and Cultures
• Different Schedules and Commitment
• Improved Recruitment and Retention

Competent
Compensated
Cared For
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Why Be Concerned About Competency?

• Public Reporting of Patient Satisfaction
• Its the Right Thing to Do
• (Would I want this RN caring
• for my Mother?)

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What Competencies Do We Want Our Nurses to
Have in Their Practice?
RN Core Competencies Model
Dorothy Del Bueno Marie ORourke
Professional RN Role
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What Competencies Do We Want Our Nurses to
Have in Their Practice?
Key Factors

• RN Professional Skills
• High Risk Low-High Frequency
• Problem-Prone
• Satisfaction and Quality Report Trends

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What Competencies?
TECHNICAL

• Head-to-Toe Assessment
• I.V. Starts and Pumps
• Rhythm Interpretation
• Pain Management
• Medication Administration and Safety
• Keyboard Skills
• A.C.L.S.

12
What Competencies?
INTERPERSONAL

• Customer Service
• (Studer Principles)
• Calling Physicians (SBAR)
• Patient Teaching
• End-of-Shift Report

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What Competencies?
CRITICAL-THINKING

• Identifying and Managing Emergencies
• (Failure to Rescue)
• Prioritization/Time Management
• Coordination of Care
• Interdisciplinary Care Conferencing

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What Competencies?
PROFESSIONAL PRACTICE

• Managed Care Environment/P4P
• Case Management
• Costs/Patient/Day
• Nurse Sensitive Indicators
• Regulatory Environment
• The Joint Commission (TJC)
• Patient Safety Goals
• Practice Environment
• LPNs/CNAs/HUCs/MTs
• Day-in-the-Life

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How Shall We Assess and Develop RN Skills?
Processes
Knowles Adult Learning Blooms
Taxonomy of Learning
Places On-line Clinical Settings
The Learning Center
People Orientee/Staff Members Preceptors
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How Shall We Assess and Develop RN Skills?
PROCESSES
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How Shall We Assess and Develop RN Skills?
PROCESSES

• Knowles Principles of Adult Learning
• Incorporate Self-Directed Learning
• Build Upon Accumulated Personal and Professional
  Experience
• Create Learning that Matches Goals to Become
  Better at a Role, e.g. Parent, Nurse
• Provide Problem-Centered Learning,
• Not Subject-Centered.

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How Shall We Assess and Develop RN Skills?
PROCESSES

• Best Practices
• Match the Media/Mode with Message
• Always Focus on Critical-Thinking
• Three Key Questions
• Whats going on here?
• What shall I do? Whom shall I call?
• Why?
• 3. Design Individualized Competency-Based
  Education. Once RN demonstrates a Competency,
  let him/her move on
• 4. Use Journaling for New Orientees and Those On
  Performance Improvement Plans (PIPS)

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How Shall We Assess and Develop RN Skills?
PROCESSES
Best Practices (cont.) 5. Seldom have Groups of
Staff in Lectures for Teaching Facts. Give
Pre-Work to Learn Facts. Have Groups Solving
Problems 6. Have Written Orientation Plans with
Weekly Goal-Setting Sessions 7. Include
Critical-Thinking in All Education Patient
Scenarios, Simulations, Skills Fair, Vignettes,
Film Clips, Failure-to-Rescue Events,
Problem-Solving 8. Conduct Grand Rounds Use
Walking Rounds for End-of-Shift Reports.
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How Shall We Assess and Develop RN Skills?
PROCESSES
Best Practices (cont.) 9. Require Travelers and
Per Diem or Internal Float Pool RNs to move with
a Passport 10. Have Orientees Work through
Continuum of Care 11. Have New Nurses and New
Grads in Ongoing Support Groups 12. Consider
Residency program Know that Orientation
Days Have Increased throughout U.S.
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How Shall We Assess and Develop RN Skills?
PEOPLE (PRECEPTOR ORIENTEE)

• Best Practices
• Assign No More Than Two Preceptors
• Dont Always Select Best Clinician to Teach
  Pick an Educator Prepared to Precept Pick a Role
  Model
• Have Preceptor Present Welcome Letter and an
  Agreement
• Work Same Shifts
• Plan Specific Learning for Infrequent Events,
  Such as Codes and Sentinel Events
• Introduce Orientee to Team and Resource Persons.

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How Shall We Assess and Develop RN Skills?
PLACES
ON-LINE

• Best Practices
• Have Policies and Procedures On-line at
  Unit-Based Terminals
• Offer On-line Assessment and Education LMSs and
  Courses
• Have Screen-Savers on All Terminals Provide
  Reminders of Education Events and New Equipment.

23
How Shall We Assess and Develop RN Skills?
PLACES
CLINICAL SETTING

• Best Practices
• Inform Team of the Written Orientation Plan and
  Weekly Goals
• Conduct Regular Grand Rounds
• Use Walking Rounds for End-of-Shift Report
• Review Journal at Least Weekly
• Have Staff Involved in Unit-Based Evidence-Based
  Research, e.g. Nurse Sensitive Indicators

(Transforming Care At The Bedside, RWJ)
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How Shall We Assess and Develop RN Skills?
PLACES
The Learning Center

• Best Practices
• Re-Commission Education Department to Be a
  Learning Center with-
• Computers On-line and DVDs
• Simulators and Simulations
• Videotaping of Learning For Feedback
• Assure Educators Are Effective Teachers

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How Shall We Monitor, Trend, and Report
Competency?

• Best Practices
• Trend by Specialty, Department and Skill Category
  (at minimum)
• Have Data Reported By Learning Center At Least
  Quarterly
• Use Education Committee to Develop Action Plans
  To Improve The Top Three Priorities.

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How Shall We Monitor, Trend, and Report
Competency?
A SAMPLE
HCCA Nurses Performance Evaluations By Skill
Type For 90 Day and Annual Evaluations
Technical Interpersonal
Critical-Thinking U.S. Practice
Legend 1 Advanced Beginner 2 Competent 3
Independent 4 Resource
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How Shall We Monitor, Trend, and Report
Competency?
A SAMPLE
HCCA Nurses Performance Evaluations By Skill
Type By Country of Origin, 90 Day
Technical Interpersonal
Critical-Thinking U.S. Practice
Legend 1 Advanced Beginner 2 Competent 3
Independent 4 Resource
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OUTLINE 1. Why be concerned about
competency? 2. What competencies do we want RNs
to possess? 3. How shall we assess and develop RN
skills? What are the needed People, Places,
Processes? 4. How shall we monitor and report our
nurses competencies?
29

• OBJECTIVES
• Define the four skill types which are part of a
• comprehensive competency model
• 2. Describe at least five strategies for
  assessing, developing, and monitoring nursing
  staff competency.