Raising the bar for your nursing staff members

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Competency validation and performance evaluation are merging

Making sure nurses are competent in their skill sets is one of the most important responsibilities of a director of nursing. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessing competencies need to be examined in a new light.

“It has always been important to validate competencies, but how some institutions are choosing to look at it is taking a different spin,” says Sheila St. Cyr, MS, RN-BC, OCN, performance-based development system coordinator at the University of Oklahoma (OU) Medical Center in Oklahoma City. “Now we’re not just looking at technical skills, we’re validating interpersonal skills as well. It used to be more about the technical skills checklist. And that’s just not how it should be.”

With the recent shift in focus, directors of nursing must arm themselves with the necessary tools and information to think beyond simply validating skill sets.

A new look at competencies

St. Cyr says there are two main areas of assessment on which to focus: competency validation and performance evaluation. Recently, the shift has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a particular skill.

“Competency validation involves checklists,” she says. “A performance evaluation looks at the whole ability of a nurse that includes the identification of a problem. It’s a whole process, like reading a story from start to finish.”

Taking this big-picture approach when developing a competency assessment program will positively affect resident care and resident outcomes, as it assists nurses with critical thinking skills and helps them observe situations on a larger scope, says St. Cyr. The nurses will thus be evaluated as competent in means beyond skill sets, such as their ability to demonstrate that they will be confident and competent when faced with the unexpected.

Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRNBC, clinical nurse specialist in nursing education at the Bay Pines (FL) VA Healthcare System.

“Before competency validation can occur, there must be a clear definition of the term uniquely fitted for the organization,” says Swihart.

Some definitions of competency are broader and more complex than others, she adds, and they are usually tied to strategic plans, standards dictated by regulatory agencies, and levels of accountability.

“The goal,” says Swihart, “is to evaluate individual and group performances, meet regulatory agencies’ standards, address problematic or error-prone behaviors or situations, and improve performance reviews at hire, during orientation, and at varied times thereafter.”

Walk before you run

Getting momentum among your fellow workers is the first step in developing a new focus within your facility’s competencies program, says St. Cyr.

“Start with a committee that will determine the direction where you want to head,” she says. “And it’s important to have involvement at all levels.” 

So make sure you have involvement from higherups and that you ensure buy-in from the start, she says. And take action to get your staff nurses on board as well.

“Get everyone to understand the rationale of why,” St. Cyr says. “Tell nurses how this will positively impact resident care and resident outcomes.”

One of the key things to keep in mind during program development, says St. Cyr, is to take baby steps. “Start with something small, and don’t try to change the world at once,” she says. “Have a long-term goal, but set up processes to ease the transition. If you try to bite it all off at once, you won’t be successful.”

When you begin working with staff members to validate competencies, St. Cyr says one of the best strategies toward education is to play the what-if game. “Use a questioning technique with staff members,” she says. Give your nurses a scenario, then ask the following questions:

What complications can happen?

What are the signs or symptoms?

Would you need to call the doctor?

What assessments would you need to make?

How would you know if the resident was getting better?

This way, you’ll have confidence that if the nurses were being faced with a real problem, they would be able to handle it properly, says St. Cyr.

“It’s better than a yes or no question,” she says. “That doesn’t really tell you if they know.” Such questioning can also boost confidence in unsure nurses.

“You build confidence by saying things such as ‘You’re exactly right’ and ‘That’s exactly what you should do,’ ” says St. Cyr. “It can work with any personality type.”

Other methods for validation, adds Swihart, can include:

Case studies, which can help measure critical thinking

Quality improvement monitors, which are a strong determinant of competency because they reflect an individual’s overall performance

Mock events, which are useful in measuring cognitive knowledge

However, keep in mind that it is the individual nurse’s responsibility to obtain validation of his or her competencies, says Swihart.

“Our nursing staff members are using a wide variety of methods to validate their own competencies,” says Swihart, including return demonstrations, peer reviews, and reflection groups. “It changes the process and encourages commitment to improved resident care outcomes that are directly linked to competent, proficient healthcare providers.”

Confidence and competence

Be aware, says St. Cyr, that some nurses may feel more prepared than they truly are. “Some people are overconfident when they don’t always possess these abilities,” she says. “That’s why questioning is a good technique. You can find out immediately: Do they really know?”

Focusing on documentation, she adds, is crucial to success. “Unless you identify issues and document them somewhere, you don’t know that learning is taking place, and you’re not giving people the opportunity to improve their performance,” she says.

Keeping these steps in mind will ensure your staff members are confident and competent, says St. Cyr.