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Tying Needs Assessment to Competency

Publish Date: 9/19/2012

The OR nursing team at the Magnet-designated Children's Hospital Los Angeles saw their annual evaluation process as static and limited in its application of shared governance, evidence-based practice, and adult learning theory. In addition to annual education demands of regulatory bodies, they were often asked to turn on a dime to accommodate learning new equipment, new therapies and procedures, new medical discoveries and new policies. It was a tough environment that could be a bit frustrating, but perhaps more importantly, their annual competencies process didn't tie staff experience directly to common OR issues and patient care objectives.

Dawna Willsey, RN, MSN, CNOR, Education Manager of Perioperative Services at CHLA said the demand to keep up with change led to hasty and reactionary means for meeting annual competency requirements. "There was a lack of staff involvement in the development of annual competency, limited application of adult learning theory principles and, overall, a competency assessment process which was void of meaning and lasting knowledge gain."

As a Magnet-designated hospital, a leadership council was already in place to help evaluate the existing assessment process and define critical components of a revised program. Council representatives, leads and coordinators suggested the competency development process include:

  • Identification (Initial vs. Annual)
  • Needs Assessment
  • Methods and Measurement, and incorporation into the
  • Annual Education Plan

They also used a shared governance approach to identify necessary competencies. Coordinators and Leadership Council committee members identified needs based on:

  • New procedures, policies, equipment initiatives; changes in procedures, policies, equipment, initiatives
  • High Risk and/or time sensitive aspects (anything that would cause harm, death, legal action)
  • Problematic or unique aspects (Identified through Quality Data, Event Reports, CalNoc and NDNQI Surveys, Diagnosis Related, Cultural or Age-Specific population, etc.)
  • Regulatory yearly educational requirements

Applying principles of Adult Learning Theory to measurement methods, the committee members determined measurement methods for each chosen competency. "We wanted staff to say what they thought they needed and how they'd like to see peers' practicing," said Willsey about the approach change. "When we keep competencies relevant and meaningful and give staff different ways to demonstrate their understanding, the retention improves."

At CHLA, the competency process includes:

  • Self-Direction and Respect providing two to three options for meeting each competency
  • Practical directly applicable to current practice
  • Relevancy Oriented incorporate critical thinking within each measurement
  • Ensure teaching and learning content is current and evidence-base
  • Appraise search results for validity and usefulness
  • Find the best evidence and provide literature references
  • Apply findings to clinical practice and evaluate

Willsey provided examples of measurement methods and pointed out the individual's chosen competency often lends itself to a clear measurement method related to quality patient care practice. She also suggests:

  • Case Studies
  • Exemplars
  • Return Demonstrations
  • Obtaining Contact Hours on Topic
  • Participation in Mock Events
  • Member of Performance Improvement or Committee Group involved with topic
  • Preparing and giving a presentation on topic, i.e., In-service, Poster, or How-to-Guide

Executives, council representatives, coordinators, and leads were presented with the idea to change the current process. The new process was mapped out, responsibilities delineated, and a policy on annual competencies developed. "Staff's main goal is to provide quality patient care," said Willsey. "They understand the importance of everyone's role in demonstrating this through annual competencies. They also know best our daily practice challenges."

The "Annual Competency" presentation was given to staff within the unit and followed by an open group discussion to prioritize and determine their choice of 5-10 annual competencies based on the Needs Assessment items. The intraoperative nursing team of 60 nurses and 33 surgical technicians has been using the self-appraisal annual competency program for a little more than two years, seeing positive results in staff engagement and accountability.

Dawna Willsey cautions educators to be accountable to the process. "Make sure you keep on track with the staff's needs. You're working with adults, but you still need to prompt and remind, and be consistent on what your recommendations are. Be accountable to it yourself."

More resources:
"Competency Assessment: Keeping it manageable and meaningful" by Donna Wright.

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