Competency Based Practice

1. Competency Based Practice Lisa Wright Eichelberger, Education Consultant Education/Service Liaison Committee February 18, 2000

2. Meeting - December 2, 1999 Reason part of Grant- assist in development of competent workforce Strategy chosen - development of a template or guide for the process of evaluating and validating competency

3. Current charge �Make a case for �competency based practice� Reconceptualize the term �competency� to include beginning competency and continuing competency Assess the feasibility of using the job profiles developed by ONWR

4. Competency Movement Every major organization, legislatures, public calling for assurance of competence -education and practice JCAHO mandates assessment upon hiring and at �regular intervals� knowledge and skills �93 Defend data collection and measurement systems used Led to �competency based orientations� �skills days�

5. Agencies and Organizations Call for Competency in Practice Taskforce on Health Care Workforce Regulation -Pew Commission - 1995, 1998 Rec #3 - Practice acts should be based on demonstrated initial and continuing competence. ANA- involved in legislation, NOLF NLN research priorities for 21st century 1999 No. 1 -Competencies of graduates for practice AACN Synergy Model 1998 for certified nursing practice core concepts, pt needs, competencies

6. Competency Assessment National Council - 1984 Position Paper continuous since - History online http://www.ncsbn.org/files/publications/positions/ Seen as regulatory responsibility Position Statement Defined competence - application of knowledge and the interpersonal,decision-making, and psychomotor skills expected for the � role within context of public health, welfare and safety. 1996 should be assess at regular intervals

7. National Council - cont. Continued Competence Position Paper 1984 the ongoing ability to render safe direct nursing care or the ongoing ability to make sound judgment upon which that nursing care is based (1996) knowledge, skills and abilities (KSA�s) used as essential standards for evaluating professional competence while admitting broader- attitudes, judgment, physical and sensory capabilities

8. Competency Based Practice Term adopted by this group- Definition - patient care delivery system that is outcome focused emphasizing the nurse�s ability to provide safe, effective care when their performance is measured against valid, reliable and objective evaluation criteria Focuses on outcomes of practice and interventions not predicated by degrees or credentials.

9. Competency Based Practice Assures stakeholders that personnel delivering care has been evaluated against predetermined criteria and met or exceeded the standards. Standards of Performance for Nurses Deficits identified and remediated

10. Competency Based Practice Allows you to recruit right individuals Promote them Target type of training needed Identify similar values and attitudes Basis for evaluation Sherman 1997

11. CBP Vs Performance Appraisals Outcome oriented - performance based Proficiency level pre determined Clarifies safe minimums and expectations of competent caregivers Provides direction for orientation and CE Evaluation objective and consistent

12. Definition of Competency Controversial JCAHO Competence or competency: A determination of an individual�s capability to perform up to defined expectations. (1999) pg.. 285 Alspach, 1984 �a simultaneous integration of the knowledge, skills, and attitudes that are required for performance in a designated role and setting� pg 655

13. Definition Parry- �a cluster of related knowledge, attitudes, and skills that affects a major part of one�s job; that correlates with performance on the job;and that can be measured against well-accepted standards.� page 58

14. Beginning VS Continuing National Council discusses concept of beginning and continuing competence - not defined. Define competence as the �application of knowledge and the interpersonal, decision-making and psychomotor skills expected for the nurse's practice role, within the context of public health, welfare and safety.� 1996 Standards of competence must be applicable to every nurse in every role at all levels of experience. 1996

15. Competency Work National Council - Assessment accomplished through variety of means - through self reports, employer reports and discipline checks. Initial Competence Kn. Ok. TX. Kentucky using graduation, passing nclex and effective communication in English as requirements for initial competence.

16. Competence work Continued competency is measured by no history of disciplinary action and earn CE Legislation introduced 2000 regulate competency validation OK and TX task forces on what constitutes basic competency and valid reliable measurements

17. Our Charge - Beginning Vs Continuing MCM defined competency as �a performance standard including skills, knowledge, abilities and understanding that went beyond specific tasks and was guided by commitment to ethical and scientific principles of nursing practice�. Koerner, 1992 MCM established knowledge, skills, attitudes upon graduation in Mississippi IF so� Beginning Competency has to be defined based on that knowledge, skills, attitudes

18. Beginning VS Continuing Beginning competency is the knowledge, skills and attitudes present upon graduation from an approved nursing program and passage of the licensing examination. ( Mississippi Competency Model)

19. Or Beginning Competency Ability of the nurse upon graduation to perform the defined expectations as outlined in the Mississippi Competency Model.

20. Continuing Competency Ongoing ability of the nurse to utilize the knowledge, skills and abilities necessary to produce safe and effective outcomes.

21. Assessing Competency Assumption - competence is observable, measurable and can be evaluated How? Beginning Validation of graduate�s achievement of the MCM competencies/standards through faculty verification and employer evaluation Passage of licensing exam Others- observation, testing, reporting etc

22. Assessing Competency Continuing Competency Outcome focused Based on the work that is being done Role and setting specific �Defining the work� - job profiles nursing incident studies job analysis nursing intervention classification

23. Competency based practice Must know the work that is done Establish outcomes based on desired product Identify skills, knowledge and attitudes needed to accomplish the work Evaluate nurses skill set Identify level of congruence

24. Common Core Common core knowledge, core skills, core attitudes - Identify the competencies of the core pieces Setting, role and job specific analyzed through focus groups, job analysis, critical incidents

25. Core knowledge, Skill, Attitudes Where do we start? The Mississippi Competency Model Job Profile Analysis

26. Establishing Competency based practice- Work Groups 1 - Identify common skill set- NIC, Job Profiles, MCM 2 - Review Competency Based Practice Models Saudi, Univ. of Memphis, Univ. of Colorado Focus on cost benefit ratio, implementation issues 3 - Assessment Strategies

27. Competency Based Practice Model Key having staff capable of doing the work willing to do the work with right institutional values What are the core competencies that will create the conditions for competent performance

28. References 1999 Hospital Accreditation Standards, Joint Commission on Accreditation of Healthcare Organizations 1999, Oakbrook Terrace, Illinois pg. 285 Alspach, J. (1984) . Designing a competency based orientation for critical care nurses. Heart & Lung, 13 (6), 655-662 Parry, S. B., Just what is a competency? Training. 35 (6), 58-64.

29. Competency Based Practice Model Core competency is any knowledge, skill or attitude essential to perform the work and differentiates safe, effective care from unsafe, incompetent or ineffective care. Common core competencies exist in nursing with unit specific competencies defined by the type of client served and setting where service provided

30. Sherman, K. (1997) Recruiting nurses based on competencies needed in the restructured environment. Recruitment, Retention, Restructuring. reprint 10, (3), 1-3

31. Competency Based Practice Model