A Comprehensive Interactive Competency Program Part II: Implementation, Outcomes, And Followup

A Comprehensive Interactive Competency Program Part II: Implementation, Outcomes, And Followup

Tatyanna Johnson

A comprehensive interactive competency program was successfully developed and implemented at Northwestern Memorial Hospital, a 750-bed academic medical center in Chicago. The department of medicine/oncology nursing introduced this program to establish a consistent process for competency assessment and to identify areas of priority for staff development prior to the planned move into a new state-of-the-art facility.

A core work group consisting of advanced practitioners CAPs), a clinical nurse manager (CNM), and a coordinator from the department of nursing development led the program. Other clinical experts were involved in content development as appropriate. The areas of competency measurement included: (a) vascular access devices, (b) chemotherapy administration, Cc) diabetes management, (d) emergency response, (e) pain management, (f) artificial airway management, and (g) critical thinking. Nurses’ competency with continuous ambulatory peritoneal dialysis was also included for specific units. Part I of this two-part series included the process of program development and the resulting framework for this program C Johnson, Opfer, VanCura, & Williams, 2000). Part II of this article includes the implementation phase of the

program, as well as the outcomes and followup.

Implementation

The implementation phase of the program was complex and involved multiple players and steps. It was clear that staff anxiety was high anticipating “testing.” In some cases, nurses had fears regarding job security if performance was below expectations. It was important to make clear to staff that the results of the program would be only one piece of data that the manager would use to evaluate each nurse’s performance. The staff nurse representatives from the departmental practice committee were chosen to assist with communications on the nursing units. A script was developed to aid them with their communication to staff. Key issues included explaining to staff the overall goals and components of the program, the dates and times of the event, how to register, the contents of the self-learning binder, and how each individual’s result would be communicated. Clinical experts were involved not only in the content development phase, but also in managing the clinical booths on the assessment days.

Competency binders were created for each unit participating in the program. The binders contained a list of all the competencies to be evaluated, with their associated performance criteria and learning options. Those printed learning options that were not currently available on the units were photocopied and placed in the binders as well.

The CNM representative in the core work group played a key role in facilitating support for the program from her peers. The CNM issues and concerns were brought forward in the planning of the registration process. Issues such as program times, location, and length of time to complete the program were important to consider to insure adequate staffing on the units. The CNMs and the practice committee representatives assured registration of an appropriate number of participants from each unit. The CNMs were informed of the eligibility requirements and the maximum number of participants to be registered from each unit. The registration process was managed centrally. The CNM group also showed their support in manning the various booths on the days of the program.

The implementation phase required coordination of many activities and many people by the core work group. Detailed planning was required for the (a) booth set up, Co) staff for each booth, (c) participant flow through the booths, and (d) final paperwork. Each booth was set up as a table with the necessary supplies/equipment, educational handouts, as well as copies of policies and procedures for reference. The critical thinking booth was stationed in a quiet area and was set up for group discussion with flip charts. The quiz booth was in a separate room to provide privacy and limited distractions for participants. Booth staffing was determined by clinical expertise within the department, as well as some clinical experts outside the department. Participants’ flow was managed through strict adherence to scheduled sign-up times, insuring adequate space for the program, and the use of a checklist by participants to assist in time management and completion of all booths. The final paperwork included a certificate of completion, and an evaluation tool.

Outcomes

In reviewing the overall results of the interactive competency program, several trends were identified regarding the strengths and weaknesses throughout the department. The hands-on demonstration of technical skills was a strength overall in which the majority of participants excelled. The scores on the quizzes were highly reflective of staff preparation. Individuals who had reviewed the learning options prior to the program were most successful. Participants identified that taking written quizzes after completing the skills booths was advantageous. Scores were higher in the clinical areas, such as pain management and vascular access devices, for which the staff had exposure to clinical practice programs and which are frequently practiced skills. The clinical practice programs are self-study packets that have been available to staff on nursing units for over a year prior to this competency program (Gaynor, Creamer, Reschak, & Clayton, 1999).

Individual unit profiles were given to each CNM. These profiles included each participant’s scores, unit average scores by clinical topics, and department averages for comparison. The unit scores were fairly consistent throughout the department. Identifying departmental strengths and weaknesses has led to the development of a department-wide inservice strategy. Prior to this program, APs and other nurse experts provided unit-based clinical inservices upon request. With the data from the program, the clinical leadership group for the department of medicine/oncology has identified clinical topics to be presented in a central location, offered twice monthly at varying times throughout the day. The priority topics are the areas of weakness identified in the program.

Each CNM was paired with an AP who met with staff to review results and identify action plans and timeframes. This was the most critical component of the program because it fostered a collaborative effort by all involved. The nurse was given the opportunity to review quiz answers and rationale and to identify personal goals.

Data were compiled from the evaluation tool to determine how effectively the objectives were met. Individual items were rated on a five-point Likert scale with “5” being the high point on the scale. Some open-ended questions were also included. The participants consistently rated the program as highly effective with a mean score for the overall usefulness of 4.45.

The booth managers provided feedback during a less formal round table discussion. Topics varied from availability of supplies, equipment, staffing, and participant flow. This feedback will be integrated in future planning of competency programs.

Patient satisfaction data will continue to be monitored for trends. With the recent move into the new facility shortly after the completion of the competency program, many variables are being considered in evaluating program effectiveness.

The core work group was highly satisfied with the outcome of the program. Five sessions were planned over 3 days. The program was offered at various time intervals to capture all shifts, as well as weekend staff. Staff were scheduled in time slots of 4 hours, which allowed nurses to share an 8-hour shift of patient care on nursing units. Although a weekend session was offered, some concerns were raised regarding the start time of the session. This may require more flexible weekend scheduling for program times in the future. The mean completion time was 3 hours, 18 minutes. Eighty nurses attended the program, 77% from staff nurse positions, which met the attendance goal. The majority (over 55%) of attendees had between 1 and 8 years of experience.

Future Considerations

After evaluating the data, three questions were identified as issues for future planning of the Comprehensive Interactive Competency Program (CICP).

How frequently should the program be offered? The issue of the frequency of the program is three fold: (a) for new staff members or those who did not attend the previous program, Co) for those staff nurses whose performance at the program did not meet the criteria, and (c) for those whose performance was satisfactory. The first question was raised to address the influx of new nursing staff into the department. The issue of individuals whose performance did not meet criteria and repeating the competency program is less clear and debatable. Since the CICP was an assessment of the competencies, one may argue that the staff nurse and the CNM have the information required to develop goals/action plans for performance improvement. On the other hand, some may argue that there were many factors that led to the nurse’s unsatisfactory performance at the program (novelty of the program, fatigue, and anxiety). These issues will be determined on an individual basis with input from the CNMs and APs. If all criteria are met, nurses may not need to participate annually in a CICP assessment day unless there is new or revised content. It is proposed to offer the CICP twice a year with an attempt to address the above issues.

What content should be revised or added? The ever-changing technologic advances in health care often drive the changes in the scope of practice for nurses. As we embark on a new millennium in a new state-of-the-art hospital, the scope of practice for nurses will broaden to reflect these advances. Based on that, future competency programs may include telemetry monitoring, managing patients requiring chest tubes, and tube feedings.

Should we include additional units? The first competency program included staff nurses from six medical units, two oncology units, and one subacute unit. To assess the competency levels of all nurses in the department, the hemodialysis and hospice/palliative care units may be included in the future. It is also proposed to develop and include specific competencies (in addition to the core competencies) to address skills pertinent to these units.

Summary

The Comprehensive Interactive Competency Program was a valuable learning opportunity for all those involved. The staff nurses were able to assess their skill levels in an environment that promoted learning, interaction, and enthusiasm. The APs, as the key coordinators of the programs along with the coordinator of nursing development, developed abilities to identify and clearly define performance criteria, establish frameworks, delegate activities, provide guidance to small work groups, and manage the logistics of an entire departmental program. The collaborative efforts of the APs and the CNMs were especially important in planning and implementing the program and in establishing staff professional development activities. The enthusiastic learning atmosphere was contagious. As the CICP progressed over the 3 days and others heard about the activity, personnel from various departments came to observe the CICP, the learning environment that was fostered, and the wealth of resources made available to the staff nurse. The Comprehensive Interactive Competency Program was not only a developmental opportunity that reached staff nurses, managers, clinicians, and educators, but also served as a model for instituting excellence in patient care and impeccable clinical practice at Northwestern Memorial Hospital.

Acknowledgment: The authors wish to acknowledge Nanne Finis, MS, RN, former Director of Medicine Oncology Nursing, Northwestern Memorial Hospital, for her support of the program and contributions to the manuscript.

References

Gaynor, S., Creamer, J.L., Reschak, G.L.C., & Clayton, H.A. (1999). A model clinical practice program at Northwestern Memorial Hospital. MEDSURG Nursing, 8(2), 123-126.

Johnson, T., Opfer, K., VanCura, B.J., & Williams, L. (2000). A comprehensive interactive competency program part I: Development and framework. MEDSURG Nursing, 9(5), 265-268.

Tatyanna Johnson, MSN, RN, is Advanced Practitioner, General Medicine Northwestern Memorial Hospital, Chicago, IL.

Kathryn Opfer, MS, RN, AOCN, is Advanced Practitioner, Medicine/ Oncology, Northwestern Memorial Hospital, Chicago, IL.

Barbara J. VanCura, MEd, RN, C, is Coordinator, Nursing Development, Northwestern Memorial Hospital, Chicago, IL.

Lisa Williams, MS, RN, ACRN, is Advanced Practitioner, HIV/AIDS, Northwestern Memorial Hospital, Chicago, IL.

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