Introduction. Introduction Booklet. National Competency Framework for. Adult Critical Care Nurses

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1 Critical Care Networks- National Nurse Leads National Competency Framework for Introduction Adult Critical Care Nurses Introduction Booklet Providing Registered Nurses with essential Critical Care Skills

2 Name Mentor Lead Assessor Trust/Hospital Start Date List of Authorised Signature Role Print Name Signature Date Mentor Associate Mentor Lead Assessor Associate Assessor Practice Educator Appraiser Who this documented is intended for: Critical Care Registered Nurses Critical Care Practice Based Educators/Mentors/Assessors Critical Care Lead Nurses/Matrons and Managers Higher Education and other institutions who deliver post registration critical care nurse education programmes Commissioners of adult critical care nurse education programmes Developed on behalf of CC3N by the National Critical Care Competency Working Group 2012 Version 1 - review due 2015 Created for CC3N by Giraffics Ltd.

3 Foreword The importance of a skilled and educated workforce is well recognised by commissioners, providers and users of healthcare. It is also well recognised that adult critical care nursing is a demanding and highly skilled role, which requires in-depth knowledge of the subject and the ability to safely apply that knowledge into clinical practice. It is clear therefore that the training required by adult critical care nurses is a partnership that should include assessment of both theoretical knowledge and practical competence, as described in the Standards for Critical Care Nurse Education1. This framework is a collection of the core clinical competencies that have been identified as being fundamental to the effective performance of adult critical care nursing. These have been developed by a group of critical care leaders/ experts from nursing, including Practice Educators and lecturers who are actively involved in the delivery of academically accredited critical care nurse education programmes across the UK. The importance of competence within nursing is highlighted by its inclusion as one of the Chief Nursing Officers 6c s which make up the vision for developing a culture of compassion and care2. Competence is described in this document as having the knowledge and skills to do the job, and the capability to deliver the highest standards of care based on research and evidence, which is exactly where we would want all our adult critical care nurses to be. This framework focuses on the skills and knowledge nurses require to meet the needs of critically ill adult patients, their relatives and carers. Andrea Berry, Chair of CC3N. 1 National Standards for Critical Care Nurse Education; A framework to improve educational outcomes & quality of care. CC3N, Compassion in Practice, Nursing, Midwifery and Care Staff, Our Vision and Strategy. DH, 2012 Page 3

4 Contents Outcome competencies for nurses in Adult Critical Care Who are these competencies for? 5 How can I develop competence in Critical Care? 5 What are the Steps of Competence? 6 What competencies are included? 8 Personal Responsibilities 8 How will I be assessed? 8 Resolving competency issues 9 How can these competencies be used? 9 Learning Contract 11 Assessment & Development Plan Records 13 Assessment Record Summary Initial Assessment & Development Record Ongoing Assessment & Development Records Final Competency Assessment Annual Competency Review Page 4

5 Outcome competencies for nurses in Adult Critical Care Who are these competencies for? These competencies are designed for use by registered nurses embarking on a career working in a Level 3 critical care area. They should also be used by Higher Educational Institutes to support their adult critical care programmes of education. Critical care nurses play a pivotal role in the assessment, care and recovery of those patients who experience critical illness. Their experience, competence and knowledge allow them to work both on their own and in partnership with wider multidisciplinary healthcare teams. They use a range of skills, including: Assessing the complex patient Interventional application Communicating Information and knowledge management Leadership and risk management Decision making Rehabilitation and recovery planning Influencing and negotiating Engagement and facilitation These nurses are required to provide safe, high quality services for the public, and support improvements in the critical care environment so that the safety and quality of care is continually enhanced. The critical care environment is a constantly changing field with emerging technologies and therapies to aid patient recovery through the onslaught of often life-threatening illness. Nurses need to ensure they develop and maintain competence in practice to meet the challenges presented. How can I develop competence in Critical Care? You can use these competencies to inform your development. You might already be close to achieving all of these competencies, or might be a long way off and have a lot of development to undertake depending on your previous experience. The thought processes you need to go through and the actions you need to take will be similar, the difference will be in the amount of experience that is needed and the level of knowledge required in supporting further development along the steps of competence. These competencies describe what it is that an individual is expected and able to do when they are fully functioning as a competent safe practitioner at each step. Steps 2 & 3 will be undertaken during a level 6 or 7 academic programme of study which will provide you with the appropriate underpinning knowledge and understanding to inform your practice. Figure 1 - Critical Care Award National Standards for Critical Care Nurse Education 2011 National Competency Framework for Critical Care Nurses Credits Level 6 or 7 Step 2 & 3 Competencies Delivered by expert critical care Core Curriculum Exams, vivas & assignments Work based standardised clinical assessment Successful completion of academic programme Successful completion of academic competencies Validated and transferable critical care award Page 5

6 What are the Steps of Competence? The National Standards for Critical Care Education (2011) has already described competence as: The combination of skills, knowledge and attitudes, values and technical abilities that underpin safe and effective critical care nursing care and interventions (page 14). The development of competence commences immediately the nurse is exposed to the unique environment of the critical care setting that cares for the most vulnerable of critically ill patients; however the critical care community recognises that competency in practice depends upon a number of factors including exposure to a range of experiences and opportunities to attain, develop and apply related theoretical knowledge. The figure below demonstrates the synergy of clinical practice and theoretical knowledge in moving along the steps of competence to develop the critical care nurse. Figure 2-Steps of Competence Step 1 Competencies should be commenced when a nurse begins in critical care where he/she has no previous experience of the speciality. They will not revisit the basic competencies achieved during pre-registration training but they will aid staff development during preceptorship 3 by consolidating learning to date and contextualise it to the critical care environment. It would generally be expected that staff will have completed Step 1 Competencies before accessing an academic critical care programme It is recommended that all Step 1 Competencies should be completed within 12 months Step 1 competencies are suitable for use in Level 2 facilities There may be local constraints or extenuating circumstance which mean you are not able to complete all of Step 1 competences within the 12 month timeframe. If this is the case it will be at the discretion of your unit manager to agree an extended timeframe based on your individual needs. However even with an extension Step 1 competencies should take no longer than 18 months to complete in full. Steps 2 & 3 Competencies should be completed during the period of an academic critical care programme where the learner will gain the necessary depth of related theory and knowledge. Step 2 competencies will allow the nurse to: Demonstrate skilled performance in the activity with enhanced theoretical knowledge and understanding giving rationale for practice Demonstrate application of knowledge and understanding in relation to relevant policies, procedures and guidelines Participate in problem solving through critical analysis and evaluation of more complex situations Develop more varied critical care experience with minimum supervision and guidance, attaining competence in related knowledge and skills 3 Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. DH, London Page 6

7 Step 3 competencies will allow the nurse to: Demonstrate competent performance in all the activities specified without direct supervision based upon relevant evidenced based knowledge, intuition and established practice Independently problem solve complex situations and offer solutions through critical analysis and evaluation Supervise and instruct others in a range of activities related to their role and responsibilities Apply knowledge, understanding and research to relevant policies, procedures and guidelines to critically analyse and improve practice What competencies are included? The competencies included in this document are set out against systems as shown in the table below. Table 1. Critical Care Competency Framework Content System Respiratory Cardiovascular Renal Gastrointestinal (including liver & biliary) Neurological Integumentary Additional Areas Medicines Management Admission & Discharge End of Life Care Rehabilitation Psychosocial Wellbeing Communication & Teamwork Infection Prevention & Control Inter & Intra Hospital Transfer Evidenced based practice Professionalism Defensible Documentation Leadership Your Responsibilities The Support Information document that accompanies this framework sets out the roles and responsibilities of organisations and individuals in supporting you through the Steps of Competence. As the learner you have specific responsibilities. If you are undertaking this programme you must meet the following requirements: Be a registered nurse working within a critical care environment Have completed a learning contract or agreement Can recognise and stay within the limits of your own competence Take ownership and responsibility for your own learning development Reflect on and respond constructively to feedback given by mentors/assessors Complete the step 1 competencies within the recommended timeframe (not usually longer than 12 months) Apply your acquired knowledge and understanding to care for the critically ill patient Perform all clinical skills in a professional, safe and consistent manner Further information of what to expect regarding Practice Educator, mentor and assessor support, assessment processes and learning opportunities can be found in the Additional Information to Support Implementation document. Page 7

8 How will I be assessed? Registered nurses aiming to achieve competence through all the Steps will be supported in the clinical area by the local Practice Educator/Lead Assessor or equivalent and suitably experienced competent colleagues and mentors. You will be allocated a Lead Assessor who will oversee your ongoing development, colleagues and mentors will assist you in achieving competence in practice. The use of Assessment and Development Plans will enable you, mentors, Lead Assessor and Practice Educator (or equivalent) to monitor your development needs and overall competence progression. Adequate time and supervision will be given to you as you progress through the steps and local areas may need to facilitate placements outside of the normal working environment if exposure to certain subject areas or treatments are limited. When assessing a critical care nurse against the clinical standard required, the sign off mentor or assessor is asked to specifying if the individual nurse can demonstrate competence in relation to each statement outlined within the document. Competence must be demonstrated through observation of your practice against the competency statements outlined. Your mentor or Lead assessor may however use a combination of the following techniques to support their decision: Discussion & probing questions Simulation Completion of associated workbooks Reflective practice Portfolio Record of achievements You can use the competency package to inform your professional portfolio (a requirement of the Nursing and Midwifery Council-NMC), by doing so you will be demonstrating your ongoing learning needs and evaluating your personal learning experiences. Resolving competency issues It is your responsibility to work in collaboration with your Lead Assessor and/or Practice Educator to discuss and agree your developmental needs in order to achieve competence in critical care practice. By following these simple rules it is hoped you will have a positive experience whilst developing yourself through the Steps of Competence : Have regular meetings with your Lead Assessor (at least 3 monthly) to assess your current level of competence and set a development plan for your progression Be realistic and not over ambitious Do not sign the Assessment and Development Plan if you are not happy with its contents You should bring failure of mentorship in practice and/or ineffective assessor reviews to the attention of the Unit Manager at the earliest opportunity Page 8

9 How should the competencies be used? The competencies are designed to be a multi-purpose tool that will underpin the provision of high quality, individualised patient care. The competencies will support and inform strategic planning, workforce development and management at strategic and unit level. They provide guidance for educational commissioning and structure the content of critical care education and training programmes. The competencies will enhance local accountability and support the role and development of current and aspiring critical care nurses and future leaders. Figure 3 - Competence for Critical Care Services Using the competencies at differing levels: Service and strategic level Service reviews Workforce/role design and profiling Education commissioning, planning and provision Unit and managerial level Recruitment and selection Staff appraisal Education, training and development planning and delivery Career development and advice Design of professional and vocational qualifications Individual and team level Career progression Self assessment and personal development planning Coaching Clinical supervision Professional revalidation/registration Page 9

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