Seattle

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Nursing Practice Demonstrating Continuing
Competency - Protecting the Public
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Continuing Competency Overview

• Chuck Cumiskey, BSN, MBA RN
• Nursing Practice Advisor,
• Nursing Care Quality Assurance Commission
• February 1, 2011

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On completion, you will be able to

• Identify the purpose of continuing competency
  requirements for all registered and licensed
  practical nurses in Washington State.
• Define the requirements for active practice and
  continuing education to maintain an active
  registered and licensed practical nursing license
  in Washington State.
• Explain active practice and acceptable
  documentation of active practice requirements.
• List and describe options available to nurses not
  meeting active practice requirements inactive
  license, expired license, and approved refresher
  courses.
• Describe the audit process and how to meet audit
  requirements.
• Describe technical assistance available to nurses
  not meeting continuing competency requirements.
• Describe the timeline of events implementing the
  continuing competency requirements and how this
  timeline will impacts licensure renewal.
• Explain continuing competency requirements to
  coworkers, supervisors, human resource personnel,
  and colleagues.
• Refer coworker, supervisors, human resource
  personnel, and colleagues to the Nursing Care
  Quality Assurance Commissions Website with
  resources and frequently asked questions on
  continuing competency.

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Continuing competency requirements for all RNs
and LPNs in Washington State.

• It is the purpose of the NCQAC to regulate the
  competency and quality of professional health
  care providers under its jurisdiction by
  establishing, monitoring, and enforcing
  qualifications for licensing, consistent
  standards of practice, continuing competency
  mechanisms, and discipline. (RCW 18.79.010)

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Continuing Competency

• Competency is the ongoing ability of a nurse to
  maintain, update, and demonstrate sufficient
  knowledge, skills, judgment, and qualifications
  necessary to practice safely and ethically in a
  designed role and setting in accordance with the
  scope of nursing practice. WAC 246-840-202(3)

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Continuing Competency

• Continuing competency is achieved
• Self-directed program that includes active
  practice, self assessment and reflection, and
  continuing nursing education WAC 246-840-202(3)

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Active Practice Requirement

• 531 hours over a three-year review period (paid
  or unpaid) starting in 2011 on your birthday
• Wide interpretation of nursing practice
• Nursing license is required or
• Nursing knowledge is necessary to do the job
• Examples
• CEO of Sisters of Providence SW Washington
  Service Area
• Regulatory Nurse or Patient Safety Officer
• Staff Nurse, Nurse Manager, or Nurse Executive
• Faculty member
• Consultant

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Options available to nurses not meeting active
practice requirements

• Inactive license
• Personal choice to move from active practice
• Expired license
• Let your license expire and reactivate within
  three years you will be audited and must provide
  documentation of 177 active practice hours and 15
  hours of CE upon renewal.
• Approved refresher courses required for expired
  licenses of 3 yr or more
• http//www.doh.wa.gov/hsqa/professions/Nursing/doc
  uments/refresher.pdf

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Refresher Course Requirements

• Philosophy, purpose, and objectives
• Philosophy, purpose, and objectives of the course
  shall be clearly stated and available in written
  form. They shall be consistent with the
  definition of nursing as outlined in chapter
  18.79 RCW.
• Objectives reflecting the philosophy shall be
  stated in behavioral terms, and describe the
  capabilities and competencies of the graduate.
• Faculty
• Must hold a current license to practice as a RN
  in Washington State.
• Must be qualified academically professionally
  for their respective areas of responsibility.
• Must be qualified to develop and implement the
  program of study.
• Must be sufficient in number to achieve the
  stated program objectives.
• The maximum faculty to student ratio in the
  clinical area shall be 1 to 12. Exceptions shall
  be justified to and approved by the Commission.

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Acceptable documentation of active practice
requirements

• W-2 or pay-stub
• Log book signed by employer
• Attestation signed by manager
• WAC 246-840-203 (2) Failure to complete the
  attestation every 3 years may be grounds to deny
  the license or place the license on expired
  status according to WAC 246-12-010 (11)(b) and
  Chapter 34.05 RCW.

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Continuing Education Requirement

• 45 CE contact hours in 3 years
• Continuing education hours should relate to the
  nurse's area of professional practice, or areas
  identified through self-assessment and reflection
  for professional growth and development. WAC
  246-840-203 (ii) (B)

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Audit Process Audit Requirements

• The 3-year review period starts on your birthday
  month in 2011 and you become qualified for audit
  on your birthday month in 2014 (up to 5 of RNs
  and LPNs will be audited)
• Have an accounting system to track, log, store
  practice hours worked (paid and unpaid)
• Have an accounting system to track, log, store
  CE hours

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The Audit Process

• You will go through the annual renewal process
• Pay fee
• Sign attestation stating that you are in
  compliance with continuing competency rules
• Starting in 2014, in your birth month after your
  license has been renewed, the audited nurse will
  receive a letter from the Commission stating that
  he/she has been chosen for random audit

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Technical assistance available to nurses not
meeting continuing competency requirements.

• Technical assistance will be provided to the
  audited nurses who do not meet compliance
  standards
• Technical assistance includes mentoring and
  guidance so that the nurse can comply with the
  standard

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What do I submit if audited?

• Proof of 531 hours of active practice
• (paid or unpaid)
• Proof of 45 CE contact hours
• You do not submit your self assessment and
  reflection

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Nursing Care Quality Assurance Commissions
Websites resources and frequently asked
questions on continuing competency.

• http//www.doh.wa.gov/hsqa/professions/Nursing/con
  tinuecomp.htm
• http//listserv.wa.gov/cgi-bin/wa?SUBED1nursing-q
  acA1
• Continuing Competency Web-link
• Tools for tracking hours and CEs
• Examples of self assessment and reflection tools
• Links to continuing education offerings
• Checklist of program essentials as audit
  preparation

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Sample Active Practice Log

• List
• Location of active practice
• Category of active practice
• Dates and hours of active practice

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CE Log to attest to practice hours

• List
• Continuing Education Topic or Title
• Category of Continuing Education (class, courses,
  publications, independent study, mentorship,
  presentations, specialty certification)
• Dates and Hours of Continuing Education

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Reflection Based on Professional Responsibility

• Be familiar with current laws and rules relating
  to the nursing profession.
• Take responsibility for gaining new knowledge and
  skills to advance your nursing practice.
• Participate in professional activities that
  contribute to your nursing knowledge and skills.
• Incorporate new knowledge into your practice and
  evaluate its impact on your nursing practice.
• Support and help to create an environment in
  which learning, professional growth, cooperation,
  and mutual respect can occur.
• Make patient safety a priority for patients and
  patient populations.
• Incorporate patient-specific risk-factors and
  standardized approaches to reduce the risk of
  adverse outcomes fall-reduction programs,
  hand-off communication, and infection control
  techniques.

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Reflection Based on Knowledge-Based Practice

• Use evidence such as research findings current
  standards of practice to base decisions relevant
  to practice.
• Encourage active involvement of patients in their
  own care as a patient safety strategy.
• Promote effective communication among caregivers
  use data gathered from all members of the team to
  optimize patient outcomes.
• Promote the assessment of education needs of
  patients families make sure appropriate
  education is incorporated into plans of care.
• Use techniques to reduce the risk of health
  care-associated infections ensure good
  hand-washing techniques for all.
• Identify alternate approaches to overcome
  obstacles maximize health outcomes for
  patients.

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Reflection Based on Legal Ethical Practice

• Understand your duty to report unsafe or
  substandard nursing practices to the Nursing
  Commission know mandatory reporting includes
  unprofessional conduct, boundary violations, and
  criminal convictions.
• Promote a patients right to privacy by
  protecting confidential information use patient
  information only for legitimate healthcare
  purposes.
• Review the Uniform Disciplinary Act (UDA) and
  nursing law related to boundary violations and
  sexual misconduct your relationships with
  patients and clients should be therapeutic and
  professional.
• Understand your responsibility to restrict your
  practice if you are not able to perform essential
  functions safely, including physical, emotional,
  or mental conditions, or other stressors.
• Seek advice when you are unsure if actions
  expected exceed your legally recognized scope of
  practice.
• Be familiar and know how to use the Nursing
  Commissions Scope of Practice Decision Tree.

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Test Yourself

• Why is the Commission doing this?
• What is the 3-year practice requirement?
• What is the 3-year CE requirement?
• When does the 3-year timeframe begin?
• When is the earliest an RN or LPN will be
  audited?
• If audited what must be submitted?
• What happens if you do not comply with the audit?
• How many nurses will be audited annually?
• If you let your license expire, when must you
  take a refresher course?

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Questions?

• Chuck Cumiskey BSN, MBA, RN
• Nursing Practice Advisor
• Washington State Department of Health
• Nursing Care Quality Assurance Commission
• 310 Israel Road SE, Tumwater, WA 98501
• Chuck.Cumiskey_at_doh.wa.gov
• 360-236-4725
• Fax [phone]
• For more Practice Information please see our
  website at
• http//www.doh.wa.gov/hsqa/professions/Nursing/def
  ault.htm
• Please sign-up for the Nursing Commission
  list-serve http//listserv.wa.gov/cgi-bin/wa?SUBE
  D1nursing-qacA1
• "Public Health - Always Working for a Safer and
  Healthier Washington