Open Forum

Hello, I work with a large ambulatory healthcare system. We have over 600 care sites and are located in 52 counties throughout the state.

We are reviewing our Competency & Skills Checkoff protocols. We mostly have Medical Assistants & LPNs throughout our system with an occasional RN here and there. A lot of our practice managers and administrators do NOT hold a clinical license. 

How does everyone ensure that their RNs are checked off on competency and skills? Who is responsible for ensuring the RNs are competent?

Just looking for some insight on how others are regulating competency. I appreciate any feedback or tips anyone else has used.

Thanks,

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Brandi Miller BSN RN CNOR
Clinical Educator
OhioHealth
Columbus, OH
brandi.miller@ohiohealth.com

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Hi Brandi, 

This is a common question in ambulatory care. Often there is a single educator to ensure training and competency for a large staff across multiple counties if not states. The emphasis on inpatient educators as the priority needs to end. We have clinicians in ambulatory, RN, LPN, LNA, MA, ATC, who go without adequate training and competency assessment, this is putting patients at risk. 

We currently create 1-2 competencies and work with the nurse managers to oversee the sign off. We have changed the structure over the past decade to ensure that nurses are reporting to nurses even in our ambulatory space. The Donna Wright model is not very effective in the ambulatory division when there are so few educators and so many staff. We do not give them options for sign off, we have a single type of sign off. In addition, each clinic usually needs different competencies so it can be difficult to create ambulatory wide competencies. We have been working on our competency program for about 5 years, we don't have it perfect yet, it will continue to be a work in progress. Elsevier is helpful for skill based competencies, we have started to use the electronic checklist option to slowly move away from paper based sign off. 

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Susanna Gadsby MSN, MBA, AMB-BC, NPD-BC
Clinical Educator, Ambulatory
AAACN Certified
Nursing Professional Development Specialist
susanna.m.gadsby@hitchcock.org
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We have a staff development specialist who developed our onboarding competencies and skill checklists. She initially meets with all new staff (Nurse or MA) and then works with the manager to identify a preceptor. The initial orientation day is in a group with all new hires to our ambulatory clinics where general information is shared. She then works with the manager to schedule progress meetings to ensure onboarding is going as expected. We have nurse managers in many of our clinics but not all. The nurse managers work much more independently than others but overall the SDS is the source of expertise during the competency process. On going competency is also initiated by our SDS. She collaborates with the CNO, CNS, managers etc to determine annual training needs.  We also have specific needs identified in individual clinics thru incident reports, verbal need, new programs etc that she builds competency programming for.  It the overall responsibility of the immediate supervisor to ensure competency is completed but since is not their skill set we have a built a fairly collaborative program between the team members to ensure comptency. Annually we have validators (who must be nurses) trained specific to what the annual skills and competencies are.

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Patricia Hughes DNP RN NE-BC
Chief Nursing Officer, Ambulatory
UK HealthCare
Lexington KY
(859)323-4413
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In my experience, many of the hands-on skills are often validated by an educator during initial orientation, but ongoing (annual) competencies are more often validated by a qualified peer in the department. I personally found the Donna Wright model to work very well in ambulatory care, but we almost never used the educator as the validator. Instead, whomever in the department was most qualified by virtue of education, experience or training would serve as the validator for a specific skill. In the rare event that no one in the department was able to serve as validator, an educator could be pulled in to help.

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Elizabeth Fritz PhD RN NPDA-BC NPD-BC
RN Program Manager, Clinical Education
SSM Health
Watertown WI
(608)260-6467
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