By Suzanne Cleere, MSN, MSBA, RN, CENP; Consultant, Creative Health Care Management
Across the country there is a deep desire to elevate professional practice in nursing. It makes me wonder: Do we see the word “professional” as merely a label or does it help to define who we are? The age-old debate on “entry level into practice” surfaces in this conversation. But what I have discovered both in informal conversations and formal assessments in health care organizations across the nation is that even in organizations with a high percentage of bachelor-prepared RNs, there is a deficit of understanding nursing as a profession.
The Importance of Role Clarity
There are multiple strategies that have the potential to awaken professionalism in nursing including work in role clarity. Role clarity helps us to clearly define what it is that is nursing’s alone to own as well as to define the role of each individual nurse in each domain of practice. Within the profession of nursing we have three domains within which we function. They are:
- independent practice (separate from medical practice)
- interdependent practice
- delegated practice (which requires direction/decision making by another discipline)
Until we embrace that which is nursing’s alone to own (which can vary based on State Practice Acts), how can we appropriately enter into collaboration with individuals in any other discipline?
Standards of Practice for Nursing
It turns out that what we own is clearly articulated by the ANA in the ANA Scope and Standards of Practice (2010), along with the ANA Code of Ethics for Nurses with Interpretive Statements (ANA, 2001). Our professional organization provides us with firm ground to stand on and to build on. We own the nursing process. We own who we are in the provision of health care. As defined by the ANA, this is the work of the nurse:
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
Nursing’s boundaries are articulated by the ANA and the State Practice Acts. We are licensed to practice to the fullness of this definition, and we do this through the critical thinking model of the nursing process. Language has risen that describes our unique function, the interventions of nursing care, in Nursing Intervention Classification (NIC, 2013). Additionally we are called to a higher level of professionalism, well described in the 2nd Edition of Nursing, Scope and Standards of Practice:
The Standards of Professional Performance describe a competent level of behavior in the professional role, including activities such as quality of practice, education, professional practice evaluation, communication, ethics, evidence-based practice and research, resource utilization, environmental health, and leadership, appropriate to their education and position. Registered Nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers and ultimately to society. (ANA, 2010)
The scope of nursing practice can be overwhelming unless we take the time to reflect on what it means in our own professional practice environments and in our individual practices.
Questions Useful for Creating Role Clarity
Where do we begin? Clarity requires dialogue. It requires time to pause, to reflect. The first step in creating the role clarity necessary for professional practice to really happen is to ask yourself and your team these questions:
- How do we, in this department or this hospital, live out the standards of professional performance? Are there barriers to living the standards fully?How can I engage in personal professional development?
- Do I (regardless of my role) provide my team with a professional role model?
- Do I (as a leader) provide my team with opportunities to reflect and dialogue on professional development?
- How does my state practice act define my practice?
- Who are the patients we serve?
- What is the intensity of care that this population requires? What aspects of that care are within my independent domain, the interdependent domain, and the delegated domain?
- Who within the team is qualified to provide the care?
When I know who I am in the work, what I am responsible for, and what you are responsible for, we are better together, a stronger team. We raise the level of care given, we improve the outcomes and metrics achieved, and we secure our role and legacy as professional partners in health care.
Reflection and dialogue are valuable first steps in establishing role clarity. Teams seeking further guidance may choose to work with a role clarity expert. The process is comprehensive, and therefore rarely fast, but working with a consultant can ensure that your team does its role clarity work as efficiently and effectively as possible. The most common response I hear from individuals in organizations who commit to the important work of role clarity is that they can’t believe they waited this long to do it!
Fostering connections at work and creating teams have always energized Suzanne, who is a consultant at Creative Health Care Management. She has Master’s degrees in nursing and business administration and is nearing completion of her DNP program, where her capstone project will explore “Reflective Practice: A Mechanism to Improve Relationship with Self, and Improve and Enhance Relationships with Patients and Peers.” All of her academic background is connected to real-world experience: she’s been a leader at every level, from 20-person nursing teams to VP and CNO. In every organization she’s been a force for positive change, leading by example.
Sources
American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements.Silver Spring,MD: Author.
American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice (2nd Ed.). Silver Spring, MD: Author.
Bulechek, G., Butcher, H., Dochterman, J., & Wagner, C. (Eds.). (2013). Nursing interventions classification (NIC) (6th ed.). St. Louis, MO: Elsevier.
By Donna Wright, MS, RN; Consultant at Creative Health Care Management and author of Ultimate Guide to Competency Assessment in Healthcare
If you’re only using competency assessment just to assess skills, you have some missed opportunities. You can also use competencies as a way to articulate the current requirements of the job; it can be the second half of the job description.
Here is how you do it:
Competency assessment should reflect the current competencies needed in the job. It is not a static list of skills you repeat over and over again each year. An effective competency assessment is a dynamic, changing list that reflects what is New, Changing, High Risk, and Problematic (Wright, 2005*):
- New: new initiatives, procedures, technologies, policies, practices, patient/customer populations, etc.
- Changing: changes in procedures, technologies, policies, practices, patient/customer populations, etc.
- High Risk: High-risk job functions and accountabilities
- Problematic: problematic areas are identified by QI/PI data, patient surveys, staff surveys, incident reports, or any other formal evaluation process
This dynamic competency identification process can help you create a list of competencies that will reflect the current nature of the job and the technologies, knowledge, and concepts needed to successfully complete the work competently to ensure that patient and their families have the best experience and care possible.
When you have a dynamic system like this in place for your competency assessment, you also have achieved another aspect of performance management—articulating expectations. By stating what has changed and evolved in the job, you are explaining to an employee where their performance now needs to be. Our jobs are constantly changing; competency assessment can help leaders articulate these changes.
So now, competency assessment begins to be part of the job description. It is the dynamic, changing part of the job. If you think about it, the traditional job description is the basic part of the job that does not change much. It includes things such as do your basic job, come to work on time, be able to lift 25 pounds or more, etc. The second half of the job description should be current competencies that reflect the dynamic, ever-changing part of the job. In a way you are saying to the employees, “Now your job looks like this. You now need to know this piece of equipment, here is some new research that needs to be integrated into our work, and here is an area that we need to improve our outcomes by changing our practices in this way.”
When someone asks you if he/she can see a current job description, I recommend showing them two documents: the traditional job description and this year’s competencies. Next year if someone asks you the same thing, produce the traditional job description and that year’s identified competencies.
By using a dynamic competency identification process, you are automatically updating your job descriptions every year. You have created a wonderful performance management system that assesses competencies and articulates expectations at the same time.
Learn more about HealthStream's Competency Center and Performance Center.
A staff development specialist known for her irreverent wit, Donna brings a global perspective to her work. In this country and in the over two dozen others, Donna’s best known for the work she does based on two of her books, The Ultimate Guide to Competency Assessment and Relationship-Based Care (co-authored with several CHCM colleagues). The Ultimate Guide has become the industry standard for HR departments in establishing and assessing competency, and Donna specializes in setting up systems for organizations to ensure accountability and measure competency.
* Wright, D. (2005). The Ultimate Guide to Competency Assessment in Healthcare. Minneapolis, MN: Creative Health Care Management.
By Traci Hanlon MN, RN, Consultant at Creative Health Care Management
Health care organizations are now focused on achieving great clinical and financial outcomes in a value-based culture where service excellence and the patient experience play a significant role in how organizations are being reimbursed. Gone are the days of a fee-for-service culture.
This shift is transforming how health care organizations deliver care, prioritize organizational initiatives, and how we think about the patient experience. Savvy organizations understand there is a positive correlation between financial, clinical, and patient experience outcomes. Leveraging opportunities to become better in all areas using resources already available just makes good sense.
Preceptor Programs are Growing in Importance
It is well documented that preceptor programs have a positive financial return on investment for organizations. A study done by Beecroft et al (2001) estimates that the cost to orient a new graduate nurse is between $39,000 and $65,000 and that 30 percent of them will leave their place of employment within the first year. Fifty seven percent of new graduate nurses will leave within two years.
It is significant to note that poor training and lack of support systems are the main reasons nurses leave within that timeframe. (Patrick, 2000). Preceptor programs bridge the gap from transition to practice and have a positive financial impact on the retention rate of new graduate nurses.
Preceptor Programs and HCAHPS
What is not well studied or documented is the impact preceptors have on improving an organization’s HCAHPS scores.
Did you know that a significant number of preceptors who have been formally educated in precepting, and practice in organizations that have a formal precepting program, reported feeling more prepared to teach, and mentor nurses on practices that have been shown to improve the patient experience?
This qualitative information comes from focus groups I did with nurse educators and preceptors when exploring the influence preceptors have on transition to practice outcomes of new graduate nurses. It makes sense if you think about it. Formal preceptor programs demand the best of the best. Those selected to be preceptors are the individuals who are already engaged and active in culture changing initiatives and have had formal training in adult learning, communication, and the practice of creating healthy work environments.
Improve Care and Improve HCAHPS Scores
Let’s face it; none of us went into health care to improve scores. We wanted to make a difference in the lives of others. It just so happens that when you build healthy environments that nurture self, each other and the patient, scores across the board improve.
Preceptors are the point-of-care staff who role model therapeutic relationships and then as part of their formal teaching role, teach the specifics of how to build and sustain trust with their patients. This is the heart of the patient experience, and if done well, will not only improve an organization’s clinical outcomes, but will also improve HCAHPS scores.
Investing in preceptors and a formal preceptor program is a critical link to improving financial, clinical, and patient experience outcomes. More importantly, it’s the right thing to do for patients.
Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.
SOURCES
Altier ME, Krsek CA. Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. J Nurses Staff Dev. 2006; 22(2): 70-77.
Beecroft P, Kunzman L, Krozed c. RN internship: outcomes of a one-year pilot program. J Nurs Adm. 2001; 31 (12): 575-582.
Lindy CN, Reiter P. The financial impact of staff development. J Contin Educ Nurs. 2006; 37 (3): 121-127.
Myrick F, Luhanga F, Billay, D, Foley V, Yonge O. (2012). Putting the Evidence into Preceptor Preparation. Nursing Research and Practice.
Patrick, S. (2000). Managers shoulder burden of retaining staff. Retrieved April 20, 2013, from http://www.bizjournals.com/dallas/stories/2000/08/14/story7.html?page=all
Wolf, J., Palmer, S. (2012). Voices of Practice: Exploring the patient experience in action. Highlights from on the road with the Beryl Institute.
By Donna Wright, MS, RN, Consultant and Traci Hanlon, MN, RN, Consultant
Many of our techniques for competency assessment are geared toward technical skills, but critical thinking skills require other assessment methodologies.
According to the work done by Peter Facione, a leading expert in critical thinking, self-regulation is one of the core cognitive skills involved in critical thinking. Self-regulation is basically the ability to think about how we arrived at certain conclusions, to evaluate our own cognitive activities by self-examining, and then correcting our thoughts, actions, and perceptions based on information being filtered through the higher reasoning centers in the brain. The only way to effectively do this is to use the skill of reflection.
Reflective exercises are the only way to assess how a person came to a certain set of conclusions or judgments. Reflection requires an individual to think about data in relationship to their assumptions, biases, prior knowledge, and the environmental context of the data. Therefore, it is very logical to use “reflective” tools for assessment of critical thinking skills.
Here are the top three tools for assessing critical thinking:
1) Case Studies
The case study method presents the person being assessed with a scenario that describes a certain situation. The person being assessed should be given questions to help them explore their own problem-solving, prioritization, ethical responses, and assessment of the scenario. Case studies can be purchased or created by the assessor.
One of the mistakes made when using cases studies is the individual being assessed is asked to write his/her own case study. Although this may cause the individual to reflect on a past experience or to design something that best represents a type of patient he/she might care for, the goal of a case study should be to cause the individual to think through a set of pre-determined contexts and data and explain, based on the data presented, why he/she came to the conclusions he/she did. This will help the assessor get inside the “thinking” of the person being assessed and highlight a person’s ability to make clinical connections between multiple sets of data where an obvious connection is not always made.
To do this, every case study should have explicit instructions on how to respond. For instance, a patient scenario might include the following questions:
- Given the patient information presented, describe the top three priorities for this patient and why you prioritized them in the order you did.
- What interventions would you recommend to the physician and why?
- What clinical signs or symptoms are most concerning to you and why?
- Are there any environmental, social, or family issues you would take into consideration when prioritizing care? What are they? Describe how they are relevant to the care of this patient.
2) Exemplars
Exemplars can be an impactful self-reflection tool. The exemplar method asks the person being assessed to write or tell about a situation. The situation can be one he/she may have had or one that he/she may one day experience. For example, “Tell me about a time when you provided good customer service,” or “Describe a time when you de-escalated a patient or family member’s explosive behavior.”
Be sure to provide instructions that ask the respondent to be very specific in what he/she said, thought, and did. Responses such as: “I saw they were angry and de-escalated the situation enabling me to provide better care,” are too vague and do not get to the thinking or actions that help those assessing the exemplar determine whether or not the individual used good critical thinking skills.
The completed exemplar report can be given to unit practice councils or another group for peer review so they can weigh in on whether the criteria for competency is met. This is a better approach than just having one educator assess it alone.
3) Discussion/Reflection Groups
Your health care organization may be using discussion or reflection groups already. Are you doing a debriefing session after a code or mock event? This is a discussion/reflection group. They take some time to do, but they can be well worth it. Not only can they assess critical thinking skills, but they can also develop critical thinking skills.
Using open-ended questions (versus “yes/no” questions) will help the group stay focused and require them to think about their responses. For example, one organization we’ve worked with debriefed all falls with the entire team within minutes of a patient fall. Rather than the manager asking rote questions such as: “Did the patient have fall precautions in place?” she started the debrief huddle with: “What would have had to happen for this patient not to have fallen? and “What are some practices we can do that would make this patient safer?”
Case studies, exemplars, discussion/reflection groups all use the skill of self-reflection and therefore exercise “cognitive muscles.”
Many of these tools can both assess critical thinking skills and develop them. Give these methodologies a try, and you may create a more professional team environment.
Learn more about HealthStream's Competency Center.
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A staff development specialist known for her irreverent wit, Donna brings a global perspective to her work. In this country and in the over two dozen others, Donna’s best known for the work she does based on two of her books, The Ultimate Guide to Competency Assessment and Relationship-Based Care (co-authored with several CHCM colleagues). The Ultimate Guide has become the industry standard for HR departments in establishing and assessing competency, and Donna specializes in setting up systems for organizations to ensure accountability and measure competency.
Traci is a registered nurse with clinical experience that spans 20 years in critical care, PACU, telemetry, and med/surg. The past 10 years of her career have been spent in staff development with a focus on preceptor and leadership development. People who have worked with Traci as a facilitator are quick to describe her as inspirational and funny, and on further thought, they often point with appreciation to her deep foundation of knowledge and the fact that her work is so well grounded in research.
By Christopher Cowan, MBA, Product Manager, Talent Management, HealthStream
Do you use a paper-based system for Competency and Performance Management? What if you were asked to provide a report to assess the competency of the entire organization on a skill such as blood transfusion? How long would that take you? What if your manager asks you to identify only employees who ‘Did Not Meet Expectations’ for this competency? Even worse, what if she asks “How does this compare to last year?’ The inability to quickly access this type of data could significantly limit the potential of your organization. Automating the competency and performance management process will make these kinds of requests simple, provide more meaningful data, and allow you to work with greater efficiency.
Getting the most out of your talent management process means effectively utilizing tools such as HealthStream Analytics to support the achievement of your strategic objectives and promote positive organizational change. HealthStream Analytics™ is a powerful reporting solution included in the Competency Center™ and Performance Center™. HealthStream customers can choose from a library of 19 pre-built reports, customize data with drill-down filter capability, and save reports for future reference. Data can also be exported for use outside of the system in popular formats such as PDF, Excel, XML, or RTF. The following are 3 (three) ways that data will improve your business.
Enhance Organizational Awareness
You cannot change what you do not know. Decentralized reporting processes that are fragmented across the organization significantly limit the value of your data. Can you imagine the effort required to consolidate paper-based data from various facilities or departments? Centralized reporting using a tool such as HealthStream Analytics will make data visible across the organization and promote a proactive culture. Improving visibility of data will provide immediate value. It will take less time to report results because data is in one location. It will allow you to immediately assess how all departments within your facility are contributing to overall metrics. This could not be easily achieved using a paper process. A centralized reporting solution also means that you will no longer have to wait to the end of a performance cycle to gather data. Our reports are updated in real-time and available 24 hours a day. At any point during the process you can track the status of your assessments, identify employees that have been assigned development plans, and view outcomes reports to assess the success of your organization along the way. Improving awareness and access to data will promote a proactive culture that can respond quickly to business challenges.
Improve Decision-Making with Actionable Insight
Automation provides flexibility to gain access to relevant data and then take immediate action. This is actionable insight and it drives better decision-making and positive change in your organization. Real-time reporting and drill-down filter capability in HealthStream Analytics will allow you to access up to the minute data in thousands of permutations. For instance, you can drill down to a specific competency and rating level to identify employees that do not meet expectations. Highly targeted learning interventions can be assigned to only these individuals, which could potentially reduce educational costs. Deeper levels of insight can be achieved using different time periods and by isolating data for facilities, departments, and supervisors. Improved decisions supported by data from HealthStream Analytics are just a few clicks away.
Support Regulatory Compliance
Data from HealthStream Analytics will support your facility during all 3 phases of the accreditation process - preparation, review, and response. The preparation phase is all about ensuring the right data is in the system in the right place and adheres to specified criteria and deadlines. Reviewers will want to see the electronic employee file, which includes their initial competency assessment, 3 years of annual competency assessments, and 3 years of performance appraisals. This would be a daunting task for a paper-based process but only requires a couple of clicks with an automated system. Our pre-built report library will help you prepare for this likely scenario. In the months leading up to your review you could run demographic reports to update incomplete employee records, status reports to ensure assessments are complete, exception reports to identify employees without job descriptions or supervisors, and outcomes reports to assess specific competency ratings . HealthStream reporting capabilities will replace the need for costly and time consuming file reviews so your time can be devoted to survey preparation. Occasionally, there may be an incident that requires follow up and a formal response from your facility. Automated reports with accurate data will expedite the response and give you and the accrediting body confidence that you meet the requirements.
Learn more about our Competency Center.
Learn more about our Performance Center.
By Kathy Mercer, Director of Clinical Education, NurseCompetency
A recent report stated that patients often judge the quality of nursing care in a facility as being at the skill level of the least experienced and competent nurse. Take a moment to let that statement soak in, and think of the nurse on your unit to whom this applies. Is that nurse a brand new graduate? A nurse who graduated long ago and swore never to study again? Might this nurse be one who takes every possible opportunity to learn and grow, soaking up new education like a thirsty sponge and demonstrating excellent patient care?
Who is Your Least Competent Nurse?
If you found yourself cringing at the thought that nursing skill on your entire unit is perceived by patients as being equal to the nurse who is least competent, it is time once again to work with your nurses and improve their general competency level. It has become a matter of great urgency that nurses take a look at nursing care through the eyes of their patients and resolve never to stop improving.
Are Your Nurses Prepared to Provide the Best Possible Care?
Becoming a patient, even in the best of circumstances, can be a scary experience. If harm (or even a close call) results from healthcare workers charged with the responsibility of providing optimal care, being a patient can become not only scary, but dangerous. No true nurse wants to harm patients, but it is certain that if nurses do not keep up with the many changes in healthcare and the evidence base supporting these changes, they may be the unwitting providers of harm, rather than help.
In addition to the wide variety of specialty areas found in nursing, there are basic areas of healthcare in which nurses need to be competent. The Agency for Healthcare Research and Quality (AHRQ) has identified a list of patient safety strategies including hand hygiene, measures to reduce septicemia associated with central lines, interventions to prevent ventilator-associated pneumonia, the do-not-use list of hazardous abbreviations, as well as other strategies. The staff educator or clinical nurse specialist stands guard on busy nursing units, both teaching and demonstrating the standard of care that is expected of the nurses who work there.
Put the “Care” Back in Healthcare
The public should be able to expect that when they, their family, or friends encounter nurses in healthcare settings, they will be given high quality care and will not be harmed by negligence. Let it be your primary goal to spark interest in the career development of nurses for whom you are responsible, and in that way, become both a resource for the nurses and a public guardian. Together with your staff, put the “care” back in healthcare. Your patients deserve nothing less.
Learn About NurseCompetency’s CoreKnowledge Exam Library.
Learn About the HealthStream Competency Center.
Watch Our Video and Learn How to Enter Our Customer Drawing!
HealthStream is proud to announce today that we have implemented over three million subscribers to our learning management, SaaS-based application, the HealthStream Learning Center™ (HLC). The milestone was reached on February 4, 2013 as San Diego-based Sharp HealthCare and their approximately 15,000 employees were implemented on HealthStream’s platform to use the HLC.
Our three million implemented subscribers have been provided access to the HLC and its solutions through the healthcare organizations where they are employed, who typically contract with HealthStream in multi-year agreements for subscriptions, enterprise-wide. Approximately 3,000 healthcare organizations—primarily acute-care hospitals—are contracted with HealthStream to provide our solutions in their organizations, making the HLC the most adopted Internet-based learning management application in the healthcare industry.
Through HealthStream’s learning and talent management solutions, healthcare organizations are creating safer environments for patients and increasing the clinical competencies of their workforces. HealthStream offers solutions for some of the most urgent issues facing healthcare organizations today, including the need to improve patient safety, fulfill government compliance requirements, facilitate workforce onboarding processes, effectively train employees on the new ICD-10 coding system, and improve clinical skills—like those that improve resuscitation rates.
HealthStream offers a healthcare-specific range of innovative SaaS-based solutions to meet the unique workforce development needs of healthcare organizations through its emerging eco-system. Approximately 130 industry-leading partners and their content, our robust platform with a diverse array of healthcare-specific workforce development and talent management applications, and the collective data emanating from three million subscribers comprise HealthStream’s eco-system—an innovative approach that, we believe, is unmatched in the industry in its ability to meet these business and clinical needs.
"We are grateful to our customers for helping us to reach the milestone of three million implemented subscribers," said Robert A. Frist, Jr., chief executive officer, HealthStream. "Our vision has always been to improve the quality of healthcare by assessing and developing the people who deliver care—and it is an honor to do that for the dedicated healthcare professionals who use our solutions to improve patient care."
See the Video Here.
The U.S. healthcare system has been engaged in significant quality-focused activity over the last decade, as hospitals responded to numerous mandates aimed at improving patient outcomes and safety. The healthcare quality movement began in earnest with The Institute of Medicine (IOM) Report “To Err is Human,” which highlighted the high number of medical errors occurring in U.S. hospitals. Now 2010’s Affordable Care Act is motivating and requiring hospitals to pursue new and focused methods of shoring up gaps as the Centers for Medicare & Medicaid Services (CMS) and private insurers start to make serious inroads on tying quality and patient safety outcomes to reimbursement. Hospitals are taking this latest reform move seriously. In a recent HealthLeaders Media survey of 244 healthcare leaders, more than 90 percent said not only is patient safety one of their top five priorities, it is “an integral part of their organization’s strategic plan.”
High-Performing Hospitals Make Education a Priority 
With so much at stake, how can hospitals move the quality needle in a meaningful direction? While most healthcare organizations already have a quality agenda, getting specific initiatives to cascade down to frontline staff continues to be a challenge. Increasing evidence shows, however, that hospitals are driving quality and patient safety improvements through exceptional education programs. In fact, these high performers share one common habit: they consistently count workforce education and training initiatives among their organization’s highest goals. A 2007 Commonwealth Fund report on hospital quality improvement strategies found that those organizations consistently raising quality of care have deployed improved educational and training materials for clinical staff in key quality areas, including error reduction, hand-washing, and infection prevention. Yet another survey reviewing quality improvement trends across 470 organizations several years after the IOM report found that those “hospitals with high levels of perceived quality … fostered staff training and involvement in QI methods.”
Training Can Lead to Powerful Hospital Improvements
Hospital learning programs that are tied to organizational quality goals and aimed at physicians--physician assistants, nurse, allied staff, and frontline workers--may result in improved patient outcomes in key areas such as mortality, readmission, and infection rates. They also may lead to highly engaged and satisfied employees; stronger physician alignment; improved patient satisfaction; and ultimately higher reimbursement.
This white paper includes:
- The Urgent Need for Innovative Training Programs
- Four Key Trends Impacting Workforce Learning
- Nurse Education and the Widespread Benefits of High-Impact Training
- Creating Targeted Learning
- Case Study: Capella Healthcare
- Case Study: Portneuf Medical Center
- Preparing for the Future, Using Training
Download the White Paper.
By Elease Caracci, Co-Founder, CFO, EVP of Nurse Competency
A guest blog from HealthStream Partner, NurseCompetency. Learn more about NurseCompetency in a free Webinar.
It might surprise many to know that the Agency for Healthcare Research and Quality has reported that one out of every 25 patients in US hospitals are said to have been harmed by medical care. This stunning statistic accentuates the need to develop a clinical staff that is providing optimal care at all times.
In order to reduce risk and ensure optimal patient outcomes, it is important to be able to assess a clinician's skills, abilities, and knowledge, as well as to help remediate and increase competency in areas that may show deficiencies. Developing a well-rounded and capable workforce requires a diverse array of methods, and clinical competency testing can be an important tool to help assess and develop the necessary level of competency of hospital clinical staff.
Protect Patients AND Staff
In addition to evaluating clinical competency, most organizations see tremendous value in providing their staff with educational materials that help reduce the risk of on the job injury and increase compliance with outside organizations such as OSHA and TJC.
According to OSHA, healthcare workers have one of the highest rates of work related injuries. These injuries can take many forms such as exposure to blood and air-borne pathogens, musculoskeletal lifting injuries, and needle stick injuries. Developing tools to educate employees about issues that affect workplace safety and compliance with industry standards, is recognized as a necessary part of staff development and risk management.
Most hospital organizations understand the need for both testing and on-going education and many opt to develop these materials in-house. However, this can be a costly, labor-intensive process that may not always be managed in a way that will ensure both valid and reliable results.
Questions to Ask About Your Testing
It is important for hospitals to evaluate their current programs and ask themselves if there might not be a better way to manage their current process for measuring employee competency. In order to help assess the efficacy of current methods, hospital educators might ask themselves the following questions:
- What processes do you use now to measure a clinical employee's technical competency?
- Could clinical competency tests help with employee development? Could this development lead to greater patient outcomes and safer patient care?
- Are your clinical education staff developing competency testing materials? How often are these materials updated? Are they current and clinically relevant?
- Could your educators' time be better used in other ways?
- Are you able to collect and analyze data on tests to see how your staff performs against national averages?
- Is your organization meeting regulatory mandates; empowering your employees with the knowledge and skills they need to ensure delivery of safe, quality care and services?
- Might education and training reduce your workers’ compensation liability (e.g., back injuries, needle sticks, etc.)?
Employee assessment and education tools can be an integral part of achieving a goal-oriented program for improvement and quality assurance if managed in a way that ensures both valid and reliable results. However, achieving this may not be an easy task. Because hospital educators are entrusted with a multitude of tasks most find it difficult to implement a steady, on-going process to create new materials, evaluate, revise, and validate this content. Difficult or not, ensuring a quality workforce is more important now than ever and having a solid process in place for assessing and improving employee performance can mitigate liability and improve the overall quality of patient care.
The NurseCompetency-HealthStream Partnership
NurseCompetency is proud to announce our new partnership with HealthStream,which will become the exclusive distributor of our competency exams and skills checklists to hospitals and health networks in the U.S. Over half of all U.S. hospitals trust HealthStream to provide them with innovative solutions for the acute-care market, and we are very excited to have been selected as a partner of choice for web-based competency testing.
The key to NurseCompetency’s success has been our dedication to providing our customers with valid and reliable tests and our commitment to the expansion and development of our test library. To date, we offer over 70 different clinical and non-clinical tests, as well as 25 different industry-compliant education topics to ensure compliance with outside organizations such as OSHA and the Joint Commission. By mid 2013, we will have added an additional 20 new clinical tests to our library, making ours one of the most extensive in the marketplace today.
In addition, we offer our customers the peace of mind that comes with knowing that the materials they are using are reviewed and updated annually and have undergone a rigorous 6-step validation process to ensure statistical reliability as well as compliance with EEOC UGESP guidelines.
The Advantages of Using NurseCompetency Assessments
Together, HealthStream and NurseCompetency offer acute care organizations several distinct advantages when choosing a competency testing program:
- A competitive pricing model
- Robust library of healthcare specific content
- Our commitment to providing current, valid an reliable content
- Effortless implementation. NurseCompetency will be seamlessly integrated into the existing HealthStream platform that customers are already very familiar with, making the prospect of adding on this new program very easy-- with minimal additional training required for implementation
- Assists with industry compliance
- Allows for quick initial and on-going assessment of employee's clinical knowledge
- Aids in risk management and employee development
- Customers can rely on the excellent customer support that they have come to expect from HealthStream
We are confident that HealthStream customers will find the NurseCompetency Exam Library to be a value-added workforce management tool that is both cost-effective and results oriented.
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By Kenneth W. Dion, MSN, RN, MBA, Vice President and Chief of Nursing Informatics, HealthStream and Mary Smolenski, EdD, APRN, BC, FAANP, CAE, former Director of Certification at the American Nurses Credentialing Center
You can think of an electronic professional portfolio as being similar to an electronic health record. An electronic health record captures all the clinical conditions and interventions over the course of a patient’s life. An electronic portfolio captures all professional development data and supporting documents over the course of a nurse’s career. A professional portfolio—whether electronic or paper— contains a summary of education, licensure, and employment history, just as a résumé does. But a portfolio also contains supporting documents, such as copies of educational transcripts, licenses, and letters of recommendation. Subjective documents, such as case logs and exemplars that show competency, also go in the portfolio, as do narratives reflecting on your nursing practice.
Why an E-portfolio?
In the days of paper portfolios, advocates recommended placing all documents related to professional development in a shoebox. But floods, tornadoes, and other surprises can destroy a shoebox filled with paper in the blink of an eye. An electronic professional portfolio is safe from such natural disasters and, if you regularly backup your files, your portfolio will also be safe from electronic disasters, such as viruses. To create an e-portfolio, scan all important documents that aren’t in an electronic format, including licenses, certifications, and transcripts. Save these documents and those already in an electronic format, including your résumé or curriculum vitae, patient teaching materials, case studies, and reflective documents, on a portable electronic medium, such as a compact disc. Place one electronic copy in a safe deposit box.
Why a web-based portfolio? 
For a more flexible approach, develop a web-based portfolio. Using the Internet allows you to capture professional development data in real time, decreasing the risk that you’ll omit important activities. Capturing data in real time also aids reflective journal keeping and ensures that your information is always up to date. Your web-based portfolio allows you to quickly select information for specific purposes and share it. Just as an artist selects works that are appropriate for a particular show, you can select the professional development activities that are appropriate for a particular event, such as seeking a promotion or new position. Keep in mind that your web-based portfolio is more than a repository of information. It’s a living document you can use to set up alerts and reminders for events, such as licensure and certification renewal. Plus, you can use your portfolio to track your progress on a roadmap, such as a clinical ladder.
Dazzling prospective employers
Today, many institutions and nurse leaders want to develop and maintain a cultural climate of continuing professional competency. When you seek a job in an organization with such a climate, using your e-portfolio will indicate that you are a “cultural fit” and give you an advantage over those who submit résumés.
Renewing your license and certifications
The days of simply obtaining continuing education credit for license renewal are drawing to a close. State legislatures and boards of nursing are taking a fresh look at the processes used to evaluate continuing professional competency. And in several states, one component of a revamped re-licensure process may soon be portfolio evaluation. The International Society of Genetics in Nursing grants certification based on the professional portfolio, and other professional organizations are considering this approach. Professional organizations with limited memberships may replace periodic examinations as a means of renewing credentials with the professional portfolio. Several organizations—including the Wound, Ostomy, Continence Certification group and the Credentialing and Competence Institute—already use portfolios for certification renewal. Using e-portfolios for credentialing review benefits both the credentialing boards and nurses, such as advanced practice nurses. With e-portfolios, both the application process and the ongoing review process become much less burdensome.
Recruiting and retaining nurses
Healthcare organizations also see the benefits of the electronic professional portfolio. Today, many nursing educational programs require portfolios to better position students for employment after graduation. The portfolios allow hiring managers to evaluate candidates by reviewing subjective data in the portfolio, such as case logs and presentations. This approach provides greater insight into the candidate and should result in improved hiring and decreased turnover. Organizations are always looking for retention strategies to lower the cost of nursing turnover. Implementing an e-portfolio system—that is, a single repository for all professional development activities—can reinforce an organization’s commitment to a climate of continuing professional competence and thus improve retention.
Magnet™ recognition and accreditation
A comprehensive e-portfolio system can also help organizations on the Magnet journey. In most institutions, the documents needed for Magnet review are stored in several areas or systems. Pulling the information together can be time-consuming and cumbersome, even when all the information is in an electronic format. Organizations that implement an e-portfolio system greatly decrease the effort needed to gather certain information, such as “highest degree obtained or highest level of degree.” Also, such information is likely to be up to date because each nurse can easily check and correct the information in his or her personal e-portfolio, which feeds the system. As with data needed for Magnet recognition, the data needed for institutional accreditations often reside in several areas or systems. But if an institution has implemented an e-portfolio system, required data can be collected at a surveyor’s request with a few clicks of the mouse.
Teaching by example
Nurse-educators should use e-portfolios for a couple of reasons. First, they are in a great position to demonstrate their commitment to life-long learning by using their own portfolios as examples. Second, educational programs require accreditations, and an important component of the process is a faculty review. Educational programs can achieve the same benefits as healthcare organizations by implementing an e-portfolio system. Educators can also use students’ e-portfolios to make decisions about placing students in clinical settings. Feedback from instructors and mentors at clinical sites should be included in the student’s portfolio. Documentation of experience that might provide course equivalency— significant involvement in the National Student Nurses’ Association, for example—also goes in the portfolio.
Benefits for all
All nurses and the nursing profession can benefit from e-portfolios. Whether it’s a nurse’s individual e-portfolio or a healthcare organization or educational program using an e-portfolio system, the benefits are the same: an ability to quickly and accurately demonstrate life-long learning and continuing professional competence.
Learn More about the HealthStream Professional Portfolio.
Selected references
Bell SK. Professional nurse’s portfolio. Nurs Adm Q. 2001;25(2):69-73.
Corcoran J, Nicholson C. Learning portfolios—evidence of learning: an examination of student’s perspectives. Nurs Crit Care. 2004;9(5):230-237.
Credentialing and Competence Institute. Available at: http://www.ccinstitute.org/cert_cnrc.aspx. Accessed August 4, 2008.
Dennison-Donohoe R. What goes in your professional portfolio and what you’ll get out of it. Am Nurse Today. 2007;2(3):42-43.
Jackson R. Behold the power of the portfolio. Nurs Manage. April 2004;35(Supp1 1):12,14.
Monson RB. Genetics Nursing Portfolios: A New Model for Credentialing. Silver Spring, Md: American Nurses Association; 2005.
Serembus JF. Teaching the process of developing a professional portfolio. Nurse Educ. 2000;25(6):282-287. Wound, Ostomy, Continence Certification Board. Available at: http://www.wocncb.org/recert/. Accessed August 4, 2008.