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Competency Based Practice


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									Competency Based Practice

Lisa Wright Eichelberger,
Education Consultant
Education/Service Liaison Committee
February 18, 2000
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
Current charge
• “Make a case for “competency based
• Reconceptualize the term “competency” to
  include beginning competency and
  continuing competency
• Assess the feasibility of using the job
  profiles developed by ONWR
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”
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
Competency Assessment
• National Council - 1984 Position Paper
  continuous since - History online
   – 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.
   – should be assess at regular intervals
National Council - cont.
• Continued Competence Position Paper
  – 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
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
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
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
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
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
• 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
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
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.
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
Our Charge - Beginning Vs
• 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
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
Or Beginning Competency
• Ability of the nurse upon graduation to
  perform the defined expectations as
  outlined in the Mississippi Competency
Continuing Competency
• Ongoing ability of the nurse to utilize the
  knowledge, skills and abilities necessary
  to produce safe and effective outcomes.
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
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
Competency based practice
• Must know the work that is done
• Establish outcomes based on desired
• Identify skills, knowledge and attitudes
  needed to accomplish the work
• Evaluate nurses skill set
• Identify level of congruence
Common Core
• Common core knowledge, core skills, core
  attitudes -
• Identify the competencies of the core
  – Setting, role and job specific analyzed through
    focus groups, job analysis, critical incidents
Core knowledge, Skill, Attitudes
• Where do we start?
• The Mississippi Competency Model
• Job Profile Analysis
Establishing Competency based
practice-    Work Groups
• 1 - Identify common skill set- NIC, Job
  Profiles, MCM
• 2 - Review Competency Based Practice
  – Saudi, Univ. of Memphis, Univ. of Colorado
  – Focus on cost benefit ratio, implementation
• 3 - Assessment Strategies
Competency Based Practice
• 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
• 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.
Competency Based Practice
• 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
• Sherman, K. (1997) Recruiting nurses based
  on competencies needed in the
  restructured environment. Recruitment,
  Retention, Restructuring. reprint 10, (3), 1-3
Competency Based Practice Model

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