Restructuring a competency-based orientation for registered nurses

A Competency-Based Orientation (CBO) Protocol Enhances Competency Among Newly Hired Perianesthesia Nurses

PURPOSE

The purpose of this quality improvement project was to develop a competency-based orientation (CBO) protocol based on the American Society of PeriAnesthesia Nurses Nursing Standards and CBO for perianesthesia nurses.

DESIGN

Feasibility study with pre-post survey design.

METHODS

A CBO protocol that included nursing care workflows for 11 common surgical cases was developed and used in orienting newly hired perianesthesia nurses. Newly hired nurses completed a pre-post self-assessment on their level of competency in caring for surgical patients.

FINDINGS

Using Wilcoxon signed rank test, improved competency was found in all service areas except for pediatric care.

CONCLUSIONS

Nursing competency in the perianesthesia area is critical in fulfilling one's role as a nurse. A robust CBO protocol for the perianesthesia nurse is important when integrating an employee into the organization and preparing the nurse for success.

A Tool to Guide Clinical Nurse Specialist Orientation, Professional Development, and Evaluation

PURPOSE/OBJECTIVES

Currently, orientation for clinical nurse specialists (CNSs) in the Baltimore region is based on past practices: facility-specific or position-specific. A Chesapeake Bay affiliate work group identified a need to develop a theory-driven, competency-based program and tool to guide orientation and ongoing professional development reflecting the scope of CNS practice.

DESCRIPTION OF THE PROJECT/PROGRAM

The tool incorporates Benner's concepts of novice-to-expert competence levels, guides progressive development of the CNS, and has relevant assessment metrics that highlight contributions to the patient, nurse, and system.

OUTCOME

The group developed a comprehensive orientation tool grounded in the spheres of influence and advanced practice competencies and specific, measurable behavioral statements related to competencies from the 2018 National Association of Clinical Nurse Specialists' draft. This program is adaptable to guide the practice of a CNS in any facility, validate competence, and relate to those with varied experience in the role.

CONCLUSION

In a method similar to the process for developing nationally recognized educational standards used to develop the competencies, the program was revised based on an iterative, stepwise process. It was distributed to the membership for evaluation and feedback, which was incorporated into the final version.

Said another way. Our obligation to float

TOPIC

Floating is one method that can help alleviate the burden and consequences of the nursing shortage.

PURPOSE

The devastating effects that occur as a result of the nursing shortage are discussed. As a result, floating is argued as a viable solution. The practice of floating is explored from an ethical approach.

SOURCES OF INFORMATION

Professional literature, electronic resources, nursing textbooks, from statements provided from the American Association of Colleges of Nursing, Joint Commission on Accreditation of Healthcare Organizations, Six Sigma, legal cases, and personal experience.

CONCLUSION

Although many nurses oppose the practice of floating, it remains not only necessary, but it is also our obligation. It is acknowledged that floating has its opposition, but the arguments posed are not justifiable when they are weighed against the consequences of not floating.

Perinatal nursing education for single-room maternity care: an evaluation of a competency-based model

AIMS AND OBJECTIVES

To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months.

BACKGROUND

Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published.

DESIGN

A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after.

METHODS

Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design.

RESULTS

Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant.

CONCLUSIONS

Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings.

RELEVANCE TO CLINICAL PRACTICE

An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care.

Preceptors' perceptions of a competency-based orientation

The purpose of this study was to describe preceptors' perceptions of a competency-based orientation. Results of a 26-item questionnaire that was distributed to all preceptors indicated the majority of preceptors agreed that 1. the identified core competencies were role- and unit-specific, and 2. competency-based orientation is an effective method of orientation. However, the majority of preceptors indicated that the length of time for completion of core competencies was insufficient; this may reflect in the new employee's ability to function as a competent practitioner. Learner-focused orientation programs that provide sufficient time for validation of competencies must be developed.

Developing emergency nursing competence

Developing and maintaining the competence emergency nurses need is an important function of emergency clinical nurse specialists (CNS), educators, and other members of the emergency department (ED) leadership team. A thorough orientation is the first and most important step in developing the competence of emergency nurses. After orientation, the challenge is to maintain currency of practice in the face of incessant change such as new medications, new equipment, and new therapies in emergency care. This article focuses on the orientation of emergency nurses. A related article in this issue addresses assessment of competency.

Competency program development across a merged healthcare network

Competency validation from initial entry through continued employment is essential to ensure nursing personnel provide safe professional practice. With hospital mergers it becomes quickly apparent that varying methodologies for competency verification exist. Nursing staff educators need a system-wide competency program to ensure a single high standard for the entire healthcare network. This article addresses one healthcare network's response to the challenge of developing and implementing a standardized competency-based program across a wide variety of settings.