Nurse as Teachers

Module 2: Competency

2007 Rural Connection, Inc. 47www.nursesasteachers.org

Nurses as Teachers

Competency essentially, the goal of the precepting process. Competency involves a profi ciency in technical skills, interpersonal skills, and critical thinking skills. Developing competency is a process of assessing, planning, implementing, and evaluating an orientee. Validation of competency requires validation of a specifi c learning experience, providing honest and objective feedback, allowing for further opportunities for improvement, and achieving degrees of success. Rural facilities have unique challenges in competency development and validation due to high risk/low frequency events. Additionally, preceptors need to guide orientees through the stages of reality shock in order to provide an environment conducive to forging competency.

Introduction

Defi ne competency and explain the process to teach and validate competency.

Demonstrate the use of questioning in the implementation of competency development.

Demonstrate the use of feedback as a strategy for competency development and validation.

Defi ne competency and explain the proc

Th esaurus: Competence Capability, Ability, Skill, Fitness, Aptitude, Profi ciency,

Competency, Know-How, Experience

48 2007 Rural Connection, Inc. www.nursesasteachers.org

[ Module 2 ]Defi ning Competency

Activity: Look at each group of words, choose the word that closely refl ects the idea of competency. Why did you choose that word? Group One Group Two Group Three Group Four Group Five

knowledge forceful energetic engaged

original dexterity applicable dominant

casual imaginative expert skill

casual performance engaged routine

forceful ingenious defi ned expectationshabit

Competency is...

Th e eff ective application of knowledge and skill in the work setting. (del Bueno, 1990)

Th e ability to perform a task with desirable outcomes under the varied circumstances of the real world. (Benner, 1982)

Th e Joint Commission defi nitions speak more to the validation of competency...Assessing staff s ability to meet performance expectations. ...the systematic collection of practitioner-specifi c data to determine an individuals capability to perform up to defi ned expectations

Competency underscores what an orientee can DO and competency validation must be measured in a clinical or simulated setting. It is

essentially the goal of the precepting process!

2007 Rural Connection Inc wwwwww nnuurrsseessaasstteeaacchheerrss oorrgg

Nursing in rural areas is unique and there are several common threads in rural nursing, including: geographic isolation, scarce resources, and multiple practice roles (rural nurses wear many, many hats). As such, rural nurses must be highly autonomous and independent.

What are your orientees strengths? How might those strengths work well in the rural setting? How would you incorporate those strengths into building your orientees competency?

(SOURCE: Bushy, Orientation to Nursing in the Rural Community, 2000, p. 193)

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Only 35% of new RN graduates, regardless of educational preparation and credentials, meet entry level expectations for clinical judgement. - - Del Bueno, 2005.


[ Module 2 ] Reality Shock

Reality shock is the shock-like reaction that newly graduated nurses, students, and newly hired employees experience when they fi nd that the careers for which they have been preparing or transferred into do not operate with the same values and ideas that they learned in nursing school or experienced in their pervious practice setting.

Phase Ways to Assist Orientees

1. Honeymoon ~ Orientees are happy to be in clinical rotations, fi nished with school, starting a new job! Everything is probably going great.

Develop the initial bonds between preceptors and orientees, created by a mutual sense of trust, respect, and honor.Harness their enthusiasm for learning new skills and routines. Be realistic but do not stifl e their enthusiasm. Introduce them to new staff and coworkers.

2. Shock ~ Orientee begins to encounter weaknesses, discrepancies, and inconsistencies in the work environment.

Anticipate that orientees may experience some dissatisfaction with new positions, peers, or employers.Listen attentively. Model the ideals of professional nurses. Help orientees fi nd appropriate supplies and functional equipment when needed.Provide opportunities to vent frustrations in a constructive manner.

3. Recovery ~ Orientee begins to perceive the realities of the professional practice environment with a balanced view of both the negative and positives aspects.

Always treat orientees kindly. Help them view situations realistically. Ask them to keep a journal of improvements they would like to suggest and what outcomes they expect or would like to see.Help them recognize positive aspects of their current work settings, as well as areas where improvements might be made.Ease them into their roles and responsibilities. Do not release orientees to take full patient assignments until they are ready.Protect them in times of adversity. Always speak kindly about nurses and other healthcare providers. Help orientees regain their sense of humor.

4. Resolution ~ Orientees may adopt less than ideal beliefs to resolve confl icts of values and fi nd ways to fi t in with their coworkers.

Identify and manage any confl icts and confusions that persist. Assist them in constructive and creative problem-solving. Describe mechanisms and processes available to resolve perceived problems or confusion.Give simple, easy-to-follow directions for tasks. Help them combine the best aspects of their prior school or work expectations with their current work situations.Caution: Help orientees retain the positive aspects of their nursing values/belief systems from school and from the practicing nurses.

(adapted from Alspach-Grif, A Preceptor Training Program, 2006)


[ Module 2 ]Categories of Competency

; ; ; ; ; ; ; ; ; ; ; ; TECHNICAL SKILLS are tasks performed effi ciently and safely using the following:

cognitive skills knowledge psycho-motor skills and abilities technical understanding (ability to follow directions and carry out procedures)

Technical competence is the most familiar and objective skill domain. Elements are traditionally found on checklists and competency is measured by direct observation of psycho-motor tasks. Effi ciency components are oft en added to assess advanced competency.

; INTERPERSONAL SKILLS are tasks performed effi ciently and safely using the following:communication customer service confl ict management delegation facilitation collaboration respecting

directing others articulation (of expectations and boundaries) appreciating diversity team building listening caring

Interpersonal competence is the eff ective use of interpersonal communication when working with others. Th is competency, also, is oft en found on checklists and measured by direct observation of interactions and behaviors that consistently convey caring and courteous attitudes. Team building, confl ict resolution, and customer relations are the key elements of interpersonal competence.

; CRITICAL THINKING SKILLS are tasks performed effi ciently and safely using the following:

problem-solving time management priority-setting planning creativity ethics

fi scal responsibilities clinical reasoning refl ective practice learning / teaching dealing with change resource allocation

Critical thinking / Decision-making competence is the skill that addresses orientees abilities to apply principles of critical thinking, creative problem-solving, clinical judgement and decision-making to evidence-based practice: assess facts, recognize problems, identify alternative actions, anticipate outcomes, and make choices. To measure competencies in this skill domain, preceptors must be more creative in their verifi cation methods. Competencies are predicated on orientees abilities to recognize problems, identify alternative actions, anticipate outcomes, and make choices based on the most current best practices. Asking questions helps them get beneath the surface of problems, generate more questions, and increase the number of possible solutions.


[ Module 2 ] Categories of Competency

Consider the process for competency validation/orientation checklists at your facility. How are the concepts of technical skills, interpersonal skills, and critical thinking skills assessed in this process?

When individuals know what is expected of them and feel skilled in taking action, they are more able to participate in the change process. Th eir competency is developed when they are provided the education to expand their knowledge and skills.

CompetencyChange requires people to work together to achieve a shared goal. When individuals understand the part they have to off er, feel competent and confi dent in their abilities to accomplish the work, and respect the contributions of others, collaboration and teamwork thrive

Collaboration True commitment to accomplishing a shared goal comes from each individualss contribution, ownership for their part, and competence and confi dence in accomplishing the work in collaboration with others. When these conditions are in place, progress is steady, problem-solving is creative and proactive, and desired results are achieved.

Commitment

Precepting in Practice...an implementation strategy


[ Module 2 ]

Competency Module Case Study

ASSESS Questions:

What competency do I want to help my orientee develop? What does my orientee already know?

Assessment Tools:Orientation Checklists (varies in each setting) Competency Measurement Systems (PBDS, Hospital Specifi c Competency Checklists, Rural Connection Competency Toolkit)

Using these tools, a preceptor can assess an orientees competency by using a variety of verifi cation methods. Competency verifi cation methods are approaches to competency assessment that preceptors can use to complement the unique ways that orientees access and process information.

Activity: Using the competency verifi cation methods on the next page, think about the case study about starting an IV.

Competency Development

Competency DevelopmentAssess - What competency do I want to help my orientee develop?- What does my orientee already know?Plan - How will I teach this?- What tools do I have or need?Implement - Am I using the right tools / methods eff ectively?Evaluate - How will I know if my orientee is competent in this skill?- How will I validate?

You are the preceptor of a newly hired RN who recently graduated. As her preceptor, you need to know if she knows how to start an IV and you will be validating her competency to perform this skill. You have the tool that your facility provides for this competency.


[ Module 2 ] Assess - Competency Validation Methods

Competency Validation Methods

99Tests/examsmeasure cognitive skills and knowledge only; they are for competencies that require an outcome of the retention or understanding of information. ~ written tests, quizzes, surveys, worksheets, calculation tests

99Return demonstrationsmeasure technical skills only ~ CPR, ACLS, use of new equipment, skills checklists, direct observation

99Evidence of daily workmeasure skills in the technical domain; assess the actions demonstrated on a daily basis to do the job ~ direct observation

99Case studiesmeasure critical thinking skills ~ performance-based interviews

99Exemplarsmeasure both critical thinking skills and interpersonal skills that are diffi cult or impossible to observe ~ customer service, learning on the fl y, professionalism

99Peer reviewsmeasure both critical thinking skills and interpersonal skills ~ professionalism, 360-degree assessments, customer service

99Self assessmentsmeasure critical thinking skills associated with values, beliefs, myths, and assumptions

99Discussion/refl ection groupsmeasure critical thinking skills; when linked with mock events, may measure technical and interpersonal skills ~ debriefi ng aft er a crisis intervention, discussions using case studies, root cause analysis aft er a sentinel event

99Presentationsmeasure knowledge and understanding ~ debriefi ngs, grand rounds, shift reports, journal clubs, review boards, inservices

99Mock events/surveysassess responses in daily work or practice; refl ect individual performance; important to debrief aft er mock events ~ simulations, mock codes, simulated disaster drills or other emergency situations, mock surveys for accreditation, mock surveys of proper equipment use and maintenance

99Quality improvement monitorscheck compliance with policies and protocols; benchmark desired outcomes and achievement of those outcomes ~ chart/documentation audits, medical records, compliance with policies and protocols, appropriate equipment set-up/tear-down/clean-up


[ Module 2 ]Plan

Plan How will I teach this? What tools do I have or need?

How will I teach this?What needs to be learned or experienced? How is the information/skill going to be used or implemented?How is the learning going to be evaluated? How would the orientee learn this best based on learning style?

What tools do I have or need?Does my setting have a pre-existing training methodology or tool for this skill? Am I the best person to teach this skill? When would be the best time to teach this skill?

Activity: Below are some examples of competency practice tools at your fi nger tips. Looking at the tools, in your facility, in what order would you have your orientee practice them?

______ DEMONSTRATE a skill with the orientee at your side______ Allow the orientee to SHADOW you or a co-worker with skill profi ciency______ Ask the orientee to ANTICIPATE what will happen next by creating scenarios______ READ hospital policy and procedures______ OBSERVE a procedure ______ VIEW videos or training manuals______ Skill SIMULATION______ USE the Rural Connection Competency Toolkit______ REVIEW the competency checklist with step-by-step instructions______ Have the orientee ASSIST you______ COMPLETE documentation and order entry for meds, therapy, diagnostic testing, etc.______ DO learning modules ______ DESCRIBE priorities, potential complications & expected interventions when executing a skill______ Have the orientee PRACTICE a skill or piece of equipment and off er feedback______ REVIEW charting, computer use, forms, fl owsheets, I&O______ SCAVENGER HUNT for supplies/equipment/information/people______ STUDY information specifi c to procedures and equipment use______ TOUR diff erent areas or parts of the building

Apathy can be overcome by enthusiasm, and enthusiasm can only be aroused by two things: fi rst, an ideal, which takes the imagination by storm, and second, a defi nite intelligible plan for carrying that ideal into practice.- - Arnold Toynbee


[ Module 2 ] Plan

In the case study starting an IV, to answer the questions How will I teach this? and What tools do I have or need?, you should fi rst fi nd out your orientees preferred learning style. How will you fi nd that out?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

From your assessment, you discover that your orientee is a novice who has never done this skill before. What is the primary characteristic of a novice learner?_______________________________________________________________________

How will that infl uence your learning sessions?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Your orientee is a kinesthetic learner. Which of the Plan strategies might be most eff ective and benefi tial to your orientee?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


[ Module 2 ]Implement

Implement Am I using the right tools / methods effectively?

Review the competency validations tools available in your practice.... then review the specifi c learning experience you need to validate. Th e following questions will help identify action-steps or gaps between where your orientee is and the tools you need to get them to where they need to be.

Questions Information Gained

What are we trying to achieve? When are we going to do it? How will we know when we have succeeded?

Clear objectives Agreed dates Measurement

What is happening right now? What are the consequences? What do we want to be diff erent?

Clear picture of current situation & actionsEff ect of current actions Gap between where we are and where we want to be

What can we change? What are the options? How can we change it? What are the risks? What are the barriers?

Identify possibilities Broaden vision Seek solutions Evaluate choices Obstacles to overcome

What steps are we going to take to achieve this?Who is going to do what? What is our time frame? What resources do we need to help us?

Clear action steps Agreed responsibilities Agreed milestones Determine support

What actually happened? Did we achieve the outcome we wanted? What went well? What have we learned? How can we improve?

Clarify outcomes Evaluate degree of success Discoveries made Establish further potential

(Adapted from Motivating People, T. Bently, pg. 99)


[ Module 2 ] Implement

For the starting an IV case study, imagine that your orientee has successfully started an IV in a simulation. Even though you are confi dent that your orientee is able to complete the procedure safely, you want to develop her ability to think critically about the procedure as it applies to a real patient and examine her own competency in this procedure. A method that will assist the orientee in both of these areas is questioning.

You have found an opportunity for your orientee to do an IV start on a patient with you at her side. Th e orientee approaches the patient, pulls back the covers and begins to look for a vein. Th e patient makes eye contact with you and looks frightened and questioning. You want to model how to make the patient comfortable while you are doing the procedure, so you introduce yourself and the orientee, as well as explain the procedure to the patient. During your explanation, the orientee goes to the nurse server and begins to put on gloves. You have discussed with the orientee during your previous teaching, the risks and complications of this procedure. So, during the procedure, the orientee begins to talk to you about the risks and possible complications. I sure hope I can fi nd a vein on the fi rst try....

Th e orientee performs the IV insertion safely, according to the directions you have provided. As she fi nishes, a call light sounds and she says to you, I need to get that. She removes her gloves and lays them on the counter and leaves the room. She has forgotten to remove the tourniquet. You make the patient comfortable, remove the tourniquet and dispose of the dirty supplies. Now you must give the orientee feedback on the procedure and validate the competency.

How will you employ questioning techniques in this situation with the orientee?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


[ Module 2 ]

Orientation provides a time for both performance development and validation. Th e process is intended to support the developing nurse in his/her transition to the role of the nurse in any new setting. Performance (competence) assessment/validation: is a critical component of the performance development process at some point, competence must be demonstrated requires specifi c and measurable criteria is a pass/fail process with pre-determined measurable criteria that must be met

Validation of a Specifi c learning experience

Remember... competence is the combination of skill, knowledge base, and critical thinking transformed into eff ective and relevant action. In most instances, the preceptor becomes the validator the person who signs off and verifi es the competence for the orientee. Th is signature indicates that there is evidence that the orientee has the ability to deliver a certain aspect of care or knowledge with a thorough grasp of:

TECHNICAL SKILLS, INTERPERSONAL SKILLS, CRITICAL THINKING SKILLS.

Evaluation method: Level of Competency Achieved Verbal explanation ;Demonstration ;Observation ;

Times completed successfully ;Practice exercise ;Interactive class ;

Beginner ;Intermediate ;Expert ;

Evaluate / Validate

evaluate1 : to determine

or fi x the value of 2 : to determine the signifi cance, worth, or condition of, usually by careful appraisal and study

validate1 a: to make legally valid : ratify b: to grant offi cial sanction to by marking c: to confi rm the validity of (an election); also : to declare (a person) elected2 a: to support or corroborate on a sound or authoritative basis, experiments designed to validate the hypothesis> b: to recognize, establish, or illustrate

the worthiness or legitimacy of validate his concerns

Evaluate / Validate How will I know if my orientee is competent in this skill? How will I validate?


[ Module 2 ] Evaluate

Consistently functions with minimal need for supervision, safely performs patient care, incorporates nursing knowledge and patient care skills, applies nursing knowledge appropriately. Demonstrates a desire to learn more.

EXPERT

Usually functions with minimal need for supervision, usually performs patient care safely, and applies nursing knowledge appropriately. Has recognized the need to learn and improve skills.

COMPETENT

Requires direct supervision in all functions, fails to perform nursing care safely, does not recognize the need to increase knowledge or skill base and cannot independently use knowledge appropriate to nursing care.

NOVICE

Activity: Facilitating Competency - - Spinning Towards SuccessQuestioning tool for evaluating competency

Questioning techniques help gain more factual information and better insight into the situation.Instructions: Read and understand the following questioning techniques. Th en, spin the Spinning Towards Success pinwheel and test your ability to frame the diff erent kinds of questions...

Exploratory: Questions that seek to know what happened and gain a clear picture of the situationInformational: Questions that seek to clarify the outcomes, discoveries made, and other factors that may have infl uenced a situationRefl ective: Questions that hope to identify possibilities, broaden vision, and evaluate choicesRefl ective & Solution - Oriented: Questions that seek solutions and to identify persons and ideas for the futureAgreeing: Questions that hope to fi nd agreed timelines, measurement, and objectivesPlanning: Questions to prompt creation of a future plan, prioritization of problem, and to develop resolutionsOpen: Questions that generate awareness and responsibility during the learning processClosed: Yes or no questions that save people from having to think and close exploration

...continued on next page.

Level of Competency Archived...........3


[ Module 2 ]

Questioning tool for evaluating competency .... continued

Technique Question Information GainedExploratory / Open When did you fi rst form that

opinion?

What would work best for you?

Specifi cally, what was happening that resulted in the problem starting and when it happened.Persons preferred option and one they see they can achieve.

Informational / Open

What else was happening at the time?

Other factors that may have infl uenced the situation.

Refl ective & Solution - Oriented / Open

What ideas do you have for resolving this situation?

The persons ideas for resolving the situation.

Planning / Open What steps can we take to prevent this from happening again?

How will I know if there are any problems in the future that we need to discuss?

Responsibility & actions the person is willing to take in the future to prevent the problem recurring.Responsibility & actions the person is willing to take in the future to resolve the situation.

Closed Are you sure you know how to do this?

Yes or No opinion or answer.

Questioning

Questioning may compel the orientee to give a descriptive account of what they did (actions) and refl ect on:

what worked well and why what didnt work well and why what could be done diff erently next time to improve performance

In developing eff ective questioning skills, remember that open questions are much more eff ective for generating awareness and responsibility in the learning process. Closed questions save people from having to think and close the door to deeper exploration on the issue. Th e most eff ective questions for raising awareness and responsibility begin with words that seek to quantify or gather facts. Words Like: What........................? When.......................? Who.........................? How would................?

Evaluate


[ Module 2 ]

Feedback - - Honest and objective feedback about performance

Honest and Objective FeedbackSpecifi c Factual Information sharing Descriptive Based on mutual respect

Timed appropriately Sensitive to the orientee Constructive Directed at behavior Leads to positive outcomes

Know when to give feedback:Timing is everything. If possible, give feedback immediately, when the situation is still fresh so that learning can occur immediately. Preceptors need to consider the situation as a whole, not just from the aspects of their own needs. Make an appointment with the orientee, setting time, place and the agenda. Remember, no surprises. Encourage the orientee to evaluate own performance and share own observations.

POSITIVE FEEDBACK

Be clear about what you want to say. Be specifi c. Be descriptive. Dont use labels or exaggerate. Speak for yourself, give I-messages. Phrase the issue as a statement, not a question. Listen to the other persons response and discuss future strategies for handling a similar event.

Principles of providing feedback:Positive: Whenever possible, provide positive feedback.Constructive: When necessary, provide constructive feedback.Negative: Unless an emergency situation arises, avoid giving negative feedback.

Feedback

Small opportunities are oft en the beginning of great enterprises.- - Demosthenes

Opportunity is missed by most because it is dressed in overalls and looks like work.- - Th omas Edison


[ Module 2 ]Feedback

Activity: Positive FeedbackRemember, part of your role as a preceptor is to act as a role model and demonstrate how to give eff ective feedback to the learner about performance.

What is positive feedback? Give an example.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the long-term benefi ts of positive feedback?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Describe a time when positive feedback made a diff erence in your learning experience?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Evaluating performance / competency involves both sending and receiving information and both parties feeling valued and understood, even though they may hold diff erent values or opinions. Feedback needs to encourage the orientee to engage thinking and get involved.

TYPES OF NEGATIVE FEEDBACK

Personalized criticism: Negative comments about the persons abilities. Th is usually results in loss of confi dence and self-esteem. It also blocks the learning process and the orientees future performance becomes worse rather than better.Judgmental comments: Negative comment about the work itself. Although directed at the work and not the person, it lessens confi dence and belief in own abilities. It off ers no information as to what needs improvement. Unspecifi ed Comments: Talking in very general terms without specifying exactly what was good or what needed changing. Person still uncertain what and how to improve.Giving Advice: Telling the person what to do and how to do it better next time. Telling usually meets with resistance and excludes the person from the relationship and thinking for oneself.Body language: and words or tone of voice dont match.


[ Module 2 ]

What is negative feedback? Give an example.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the long-term drawbacks of negative feedback?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Describe a time when negative feedback made a diff erence in your learning experience.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Feedback should recognize the degree of success achieved

Evaluations should be affi rming and future-oriented. It is important to identify things that are positive and encouraging. You will also want to identify what has been accomplished and suggest ways to build on those areas in the future. Evaluations should be educational and enhance self-esteem. Always recognize the good Encourage Defi ne what is expected and whats been achieved Recognize skills & abilities Recognize & acknowledge eff orts Allow the orientee an opportunity to learn from trial & error Recognize team work Find a quiet, controlled environment without interruptions. Maintain a relaxed but professional atmosphere. Put the orientee at ease. Review specifi c examples of both positive and negative behaviors. Discuss future needs and goals. Express confi dence in the orientees ability to do the work. Be sincere and constructive in both praise and criticism. Ask the orientee how you, as a preceptor, can improve the learning experience.

Based on the evaluation feedback, what could the orientee do to improve the learning experience?

Feedback


[ Module 2 ]

When you sit down with an orientee for an evaluation, do the following:

In the IV insertion case study, the fi nal steps are feedback and validation. Is there something you might do diff erently or something that might be more helpful for your orientee? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Feedback

2007 R l C i I wwwwww nnuurrsseessaasstteeaacchheerrss oorrgg

Would my orientees performance improve if I... gave more encouragement? provided more feedback about what is expected? listened more to staff concerns about the job? let orientees try new ways to achieve their goals? recognized their skills & abilities more oft en? recognized & acknowledged their eff orts more oft en? allowed them more opportunity to learn from trial & error? provided more training & a more supportive learning environment? asked them more about how I could best support them? role modeled best practice better? gave more examples of best practice? encouraged team work more? used problem solving processes with them more? gave better feedback? set defi nite objectives & followed through better?

(adapted from the Vermont Nursing Internship Program).

___________________________________________


When not to give feedback:[ You dont have suffi cient information about the situation.[ You dont care about the person.[ Th e time, place or circumstances are inappropriate.[ You do not have time to fully discuss the events with the person. Its unfair to give hit and run feedback.[ Th e person has no power to prevent the situation happening again. [ Th e other person seems low in self-esteem.[ You are low in self-esteem.[ Your purpose is not really improvement, but to demonstrate how much smarter or responsible you are.


[ Module 2 ] Whats Next...? Competency Validation Quick Action Plan

Does one skill have you and your orientee at a crossroads in learning a specifi c competency? Try having the orientee complete the following form...

Quick Action PlanAction Plan Discussion Points Comments / Actions NeededObjective:

What skill or ability do you want to change or improve? (It must be specifi c, attainable, and measurable.)

Goals Achieved: How will you know what you have accomplished? (Be specifi c)

Problems: What barriers, resistance, or obstacles might you anticipate?

Solutions: How do you plan to avoid or deal with these problems?

Resources: What people, time, equipment, and materials will you need?

Benefi ts: Whats in it for you and for the organization?


[ Module 2 ]

Competency..... thats not on your checklist.Kristen Swanson: Five Caring Processes

Maintaining Belief Maintain a fundamental belief in persons and their capacity to make it through events

and transitions and face a future with meaning. Practices include having faith and maintaining a hope-fi lled attitude, going the extra mile.

KnowingStrive to understand an event as it has meaning in the life of the other. Understand the lived realities of those served. Practices include avoiding assumptions, centering on the

other, thoroughly assessing, seeking cues and expertise from other colleagues.

Being with Be emotionally present to the other. Practices include being there, enduring, listening,

attending, disclosing, not burdening.

Doing forDo for the other what they would do for themselves if it were possible. Practices include preserving dignity, protecting, comforting, and performing competently.

Enabling / InformingFacilitate the others passage through life transitions and unfamiliar events. Practices include explaining, informing, generating options, supporting, advocating, validating,

anticipating and preparing for future needs.

Source: Swanson, Kristen (1999). Effects of Caring, Measurement, and Time on Miscarriage Impact and Womens Wellbeing. Nursing Research, 48, 288-298.

Swansons Five Caring Processes


[ Module 2 ] Competency Validation - Case Study

Jeremy is a people person. He quickly adjusted to the organizational climate. He has already made a few friends on the unit and treats coworkers, patients, families, and visitors with respect. He is very profi cient with the computer documentation systems and completes his notes and reports in a timely manner. During your review of his patient care records, you note several discrepancies with care procedures that are not in accordance with established unit policies and procedures. How would you evaluate Jeremy and provide him with feedback on his performance?

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Britney has been a very enthusiastic orientee. Her customer service skills are well developed. She takes extra time with her patients, readily anticipating their needs and meeting them. Her competency verifi cations are complete. She fi nished her competency skills checklist. She consistently demonstrates increasing knowledge of unit policies and procedures. Yesterday, she fi lled out all the proper forms for a patient transfer to another health care facility. Her only problem is organization. Despite having given her feedback and recommendations several times during orientation, she is frequently late in completing assignments and leaving her shift . Youre starting to be concerned about the amount of overtime Britney has accumulated due to her lack of organizational skills.

How would you evaluate Britney and provide her with feedback on his performance?

Britney has been a very enthusiastic orientee H


[ Module 2 ]Case Study for Competency

You are a preceptor in a 10 bed rural hospital in which you have very limited support services. In addition to providing nursing care to a variety of patients, nurses are also expected to provide most of the RT, OT, PT, social work and pharmacy services (mixing IVs, dispensing emergency meds, etc.) especially on nights and weekends. Your orientee is an experienced RN from a large urban medical center who is angry about performing the non-nursing functions and seems overwhelmed. On several occasions she has asked other nurses on the fl oor to complete these tasks for her and its starting to create some tension amongst the staff who is gossiping about why this outsider came to town. Your orientee is married to your sons baseball coach and you attend the same church.

Are there symptoms of Reality Shock going on with this new RN?

How will you approach this nurse in social/community situations when you are not in the workplace?

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Consider how developing and maintaining competency might be unique in a rural facility. Nurses in rural facilities work in many diff erent areas as Expert Generalists and with this comes the challenge that rural nurses must also be competent in a multiplicity of skill areas. Furthermore, whereas an urban facility might see certain types of high-risk specialty cases with some regularity, these might be seen infrequently in a rural facility. Th ese high-risk, low-frequency cases pose signifi cant challenges to maintaining competency. How might a preceptor in a rural facility work with an orientee in developing competency in a high-risk, low-frequency skill?

(Source: Bigbee (1993) Th e Uniqueness of Rural Nursing, p. 139)

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[ Module 2 ]

Growing into the Preceptor you want to be...Incorporating the Nursing Process - - assess, diagnose & plan, and treat - - develop a teaching strategy to use with orientees that combines an understanding of learning styles and generational diff erences, and integrates Benners Model of Nursing Clinical Competence and the concepts of adult learning.

I. Assess

What is your learning style? ___________________________1.

What is your orientees learning style? ________________________2.

Where is the orientee on Benners Model of Nursing Clinical Competence? ____________________3. Youll need to assess the orientees previous experience and competencies in order to assess learning needs.

Does the orientee have any non-learning needs? 4. ____________________________________________________________

___________________________________________________________________________________________________________________

Note: Learning needs are gaps between an orientees present level of competence, performance, knowledge, or abilities that result from the need for additional instruction or practice. Non-learning needs are when there are gaps in competence, etc., that result from something other than additional instruction or practice. Th ey are situations that ought to be addressed during the preceptorship and include:

personal or family problems health problems (including lack of sleep) attitude problems (lack of motivation or desire to learn)lack of resources confl icting demands on time or attention

environmental factors (stress or anxiety, cluttered work areas, noise or other distractions)use of drugs or alcohol unrealistically heavy patient assignments

5. Determine the priority of the learning needs.

Ask the orientee to prioritize learning & non-learning needs As the preceptor, develop a prioritized list of the orientees needs - - some needs should take priority because they represent:- essential aspects of care (CPR performed correctly)- safe patient care (proper medication administration)- elements of care for all patients (proper documentation)Negotiate the prioritization list with the orientee until consensus is achieved. Remember, for the adult learner, it is important to allow the orientee to have some discretion in this as well.Write the list out for future reference.

Developing a Teaching Strategy


[ Module 2 ]

II. Diagnose & Plan

Establish a plan for how the preceptorship experience will meet the learning needs of the 1. orientee. One strategy is to divide the list into groups to be achieved over a period of time.

Identify a period of time each day where the orientee will be in clinical. Be specifi c about the learning needs that should be met during each period. Record the progress of the orientee at each objective.

Establish goals and objectives for the preceptorship. Ensure that there is enough time during 2. the preceptorship to reach these goals and objectives. Be realistic about the time it will take.

Determine what activities will help to meet these goals and objectives. Select teaching methods that are 3. appropriate for the learning needs and are compatible with the orientees learning style.

III. Implement

Precepting clinical staff involves more than helping them with technical and psycho-motor skills. Clinical competencies require knowledge of theory, principles use, interpersonal and communication skills, and an appropriate disposition or attitude towards the preceptorship and the patients being cared for during the clinical experience.

Prioritize the objectives weekly.1. Take advantage of low-volume procedures.2. Use the entire patient population, not just a specifi c group.3. Let others know of learners needs.4.

IV. Evaluate

Providing feedback to orientees is essential.

Measure the behavior Compare the behavior against an established standard Appraise whether the observed behavior meets the standard Base your decision and recommendation on that appraisal.

Adapted from Swihart, D. (2007). Nurse Preceptor Program Builder. HCPro, Inc.

Developing a Teaching Strategy


[ Module 2 ]

As a preceptor, how do you respond to these Whats next...? situations or statements?

1) Your orientee comes to you and asks, What do you think I should do about Mrs. Jones chest pain? She says it feels like it did when she had her heart attack.Whats next...?

2) You have a new graduate who has no clinical work experience beyond his student learning. Th is is your fi rst meeting. It is the beginning of your shift .Whats next...?

3) You are a preceptor for a new graduate who has diffi culty discussing patient needs / concerns with physicians. She has just successfully convinced an MD to talk to a patient who is concerned about her diagnosis.Whats next...?

4) Your orientee is in his third week of orientation. He successfully completed his clinical assignment for medication administration. He comes to you in a panic saying, I just gave Mr. Smith the wrong medication. Whats next...?


Whats next...?


[ Module 2 ]

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Nurse as Teachers

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