New ways to look at competency validation at your facility
Training your nurses and ensuring that they are competent in their skill sets are two of the most important responsibilities of educators. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessment need to be examined in a new light.
“It’s 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, but 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 competency focus, staff developers must arm themselves with the necessary tools to think beyond simply validating skill sets.
Competencies: The new wave
There are two main areas of assessment to focus on, says St. Cyr: competency validation and performance evaluation. Recently, the movement has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a 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 process, like reading a story from start to finish.”
Taking this big-picture approach when developing a competency assessment program will positively affect patient care and patient outcomes, as it assists nurses with critical thinking skills and helps them to 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 when faced with the unexpected. (See p. 5 of the PDF of this issue for a sample form.)
And developing such a program can foster big benefits. According to a recent article in the Journal of Allied Health, “competencies in education create an environment that fosters empowerment, accountability, and performance evaluation [that] is consistent and equitable.”
Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRN-BC, clinical nurse specialist in nursing education at the Bay Pines (FL) Veterans Affairs 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.”
Steps to take at your facility
Getting momentum among your fellow workers is the first step, says St. Cyr. “Start with a committee that will determine the direction you want to head,” she says. “And it’s important to have involvement at all levels of the organization so that from the start you’re not just doing something from the staff education level.”
So make sure you have involvement from your upper management team and 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 patient care and patient 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,” she says, “and don’t try to change the world at once. 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 questions such as:
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 patient was getting better?
This way, you’ll have confidence that if the nurses were being faced with a real patient, they would be able to care for them 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 nurses. “You build confidence by saying things such as ‘You’re exactly right’ and ‘That’s exactly what you should do,’ ” says St. Cyr.
Other methods for validation, adds Swihart, can include:
- Case studies, which can help measure critical thinking
- Quality improvement monitors, which are a strong determiner of competency as they reflect an individual’s overall performance
- Mock events, which are useful at measuring cognitive knowledge
Keep in mind, though, 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 patient care outcomes that are linked to competent healthcare providers.”
Hurdles to jump
When it comes to analyzing competencies, educators can sometimes be a little too nice, says St. Cyr.
“Educators never want to say anything bad about people because they want people to like them or they think they will get someone in trouble,” she says. “But remember that if you look at weak areas, those are areas for improvement. And if you never address them, how can anyone improve?”
Also 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, or do they really not know?”
Keeping these steps in mind will ensure that your staff members are confident and competent, says St. Cyr.
“With nursing, we have to learn to do things more efficiently and more effectively, and in today’s healthcare, we need to focus on someone’s performance, not just the technical skills,” she says.
Verma, S., Paterson, M., and Medves, J. (2006). “Core competencies for healthcare professionals: What medicine, nursing, occupational therapy, and physiotherapy share,” Journal of Allied Health 35(2): 109–15.