Competency. How to measure it. Sheryl Oakes Caddy RN JD MSN CNE. March 2017

Transcription

1 Competency How to measure it Sheryl Oakes Caddy RN JD MSN CNE March 2017

2 Today. Develop a working definition of competence Briefly discuss the legal ramifications of competence Determine how and what we measure to determine competence Identify long term implications on practice

3 Competency Before we can measure it we need to define it.

4 Justice Stewart Potter in I know it when I see it Jacobellis v. Ohio (1964).

5 NCLEX CEUS Practice Hours Minimal competence may be established in these fashions singularly and in combination Competency Is that good enough?

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7 OSBN Division 45 (b) Client means individuals, families, groups, communities, organizations, and populations who are engaged in a relationship with the nurse in order to receive the services provided by the nurse s application of nursing knowledge and skill in practice; (c) Comprehensive Assessment means the extensive collection and analysis of data for assessment involves, but is not limited to, the synthesis of the biological, psychological, social, sexual, economic, cultural and spiritual aspects of the client s condition or needs, within the environment of practice for the purpose of establishing nursing diagnostic statements, and developing, implementing and evaluating a plan of care; (d) Context of Care means the cumulative factors which affect the manner in which nursing care will be provided for a client. These factors may include, but are not limited to, the practice setting; the urgency of the situation; knowledge, beliefs and abilities of the client; the surrounding environment; and community and industry standards; MISSING? The clear definition of Competency OSBN (2017)

8 Nuggets in 0070 (4) Conduct related to achieving and maintaining clinical competency: (a) Performing acts beyond the authorized scope or the level of nursing for which the individual is licensed. (b) Failing to conform to the essential standards of acceptable and prevailing nursing practice. Actual injury need not be established. (c) Assuming duties and responsibilities within the practice of nursing for direct client care, supervisory, managerial or consulting roles without documented preparation for the duties and responsibilities and when competency has not been established and maintained; and (d) Performing new nursing techniques or procedures without documented education specific to the technique or procedure and clinical preceptored experience to establish competency. OSBN (2017).

9 In the OSBN Interpretive Statement on Practice Hours Requirements states accrual of 960 practice hours over a five year period as a measurement of the licensee s competency for continued practice OSBN (2017)

10 ANA Position Statement - Reaffirmed 11/12/2014 The public has a right to expect registered nurses to demonstrate professional competence throughout their careers. ANA believes the registered nurse is individually responsible and accountable for maintaining professional competence. The ANA further believes that it is the nursing profession s responsibility to shape and guide any process for assuring nurse competence. Regulatory agencies define minimal standards for regulation of practice to protect the public. The employer is responsible and accountable to provide an environment conducive to competent practice. Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders. (emphasis added) ANA (2014)

11 Professional Nursing Organizations Set practice standards for specialized nursing practice Provide ongoing education to provide evidence-based practice Certification for specialty signifying expert knowledge Typically practice hour requirement

12 So. A working definition. Nursing competence is the ability to synthesize large amounts of information specific to the care environment and the client while providing care that is within the nurse s scope of practice. Additionally, the nurse has documentation of preparation, skill acquisition, and practice for new and/or specialized techniques of client care

13 Why do we need to assure competence in nursing staff? Competence and how we measure it is implicated in: Labor Law Employment Law Tort Law Administrative Law Worker s Compensation

14 Labor and Employment Law Grievances Hours of work Required competencies Professional Development funding Termination

15 Tort Law Negligence Retention Supervision Practice

16 Administrative Law. Regulatory Board Scope of practice Knowledge of NPA Violation of rule Practice hours requirements / CEUs Maintaining competency

17 Workers Compensation Staffing shortages Low morale Injury Equipment failure Patient injury Negligence claims

18 Competency A bit of a moving target How do YOU measure it?

19 Be Clear On What You are measuring.

20 Determine your outcomes of the assessment. Objectives should represent the expected outcome of the learner at the completion of the exercise All objectives should be measureable Objectives should be worded generally in order to allow for variance in performance (while meeting standards of care) Oermann and Gaberson (2009)

21 The basics: Consider the domains of learner - professional Cognitive: Knowledge, Comprehension, Application, Analysis, Synthesis, Evaluation Affective: Receiving, Responding, Valuing, Organization and Characterization of Value Psychomotor: Imitation, Manipulation, Precision, Articulation, Naturalization Oermann and Gaberson (2009)

22 Tools. Continuing Education Mandatory CEU s Self-evaluation 360 Peer reviews Skills days Performance observation

23 Partner with other areas to identify what activities to demonstrate competency Risk Management Clinical Engineering / Purchasing Pharmacy Individual Department/Unit Manager Nursing Staff Customer Service Laboratory* Unusual Occurrence trends Patient Complaints New equipment/supplies Adverse Medication Events Specialized needs: Hi-risk; Low volume events Self- Evaluation Patient/Client Feedback Blood bank, lab issues/inconsistencies

24 When do you measure? Beware of High Stakes types of testing/measuring. Think of frequency, makeup time/plan, notification, remediation

25 What do you base the frequency of competency measuring on? Hi risk / low volume New Equipment/Policies Same content/ different domain? New graduate v. seasoned nurses

26 Long-term considerations in competency measuring Think of leveling Provides a learning trajectory Assist with determining remediation needs and success. Creates a sense of reasonableness to expectations as well as quantifying them Creates expectations and encourages engagement

27 Example.. Central Line Dressing Competency New Graduate The Nurse will be able to explain the use of sterile technique in performing a CL dressing change. The Nurse will be able to follow the policy and procedure to perform a dressing change Nurse working in IV Therapy for two years The Nurse will demonstrate the use of sterile technique in performing a CL dressing change The Nurse will carry out (accurate and timely) the CL dressing change

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29 References American Nurses Association (November 12, 2014). Professional Role Competence. Retrieved from: Resolutions/ANAPositionStatements/Position-Statements- Alphabetically/Professional-Role-Competence.html Oermann, Marilyn H. and Gaberson, Kathleen B. (2009). Evaluating and testing in nursing education. (3rd ed.). New York, New York: Springer Publishing Company, LLC. OSBN (February 15, 2017). Division 45: Standards and scope of practice for the licensed practical nurse and registered nurse. Retrieved from: ml Disclosure: All information is not legal advice but serves as a topic for discussion. No attorney-client relationship exists.