Healthcare reform is a driving force in the practice setting. Nursing executives value competency as the driver of quality, patient safety and cost of care. Improving nursing competency and advancing the profession are the goals of a clinical advancement program.
This presentation will describe how a large academic healthcare system used QSEN competencies to redesign a clinical advancement program for registered nurses. A twelve step process was used to build a competency-focused, clinical advancement program, or clinical ladder.
The first step was recognition and support from nursing leaders, the Nursing Credentialing Review Board (NCRB) and human resources. Step two was involvement of nurses at all levels in subcommittees to lead the design and process work. Step three was completion of literature review and benchmarking for current clinical ladders in healthcare. Step four was drafting the ladder in a categorized, competency-focused framework or “QSENizing” the design. Of note, graduate level competencies were used for higher levels within the ladder and an additional leadership competency was added. Step five was redesigning the process for applications and credentialing within the NCRB. Step six was to gain approval of the new ladder and process through various decision-making committees. Step seven was the completion of a comprehensive market evaluation for compensation practices with the new ladder. Step eight was building an education plan for rollout. Step nine was building the infrastructure for the electronic submission process of credentialing through portfolios. Step ten was educating leadership and nursing staff on the competency focused clinical ladder. Step eleven was building professional portfolios for over 500 nurses and step twelve was building new registered nurse job descriptions based on the clinical ladder.
Using QSEN as the framework helped to define the domains of nursing practice and now serves to provide definitions of higher levels of nursing professionalism within the practice setting.
In the practice setting, a comprehensive measurement of competency assessment is essential in initial orientation and ongoing education of clinical staff. This presentation will describe how a large academic healthcare system integrated, expanded, and sustained a clinical competency assessment model utilizing the Quality Safety Education for Nurses (QSEN) framework. As the Institute of Medicine (IOM) identified criteria for nursing to provide safe quality patient care, it became apparent the use of a traditional skills checklist was not an accurate measurement of competency. This shifted the thought process from measuring skills to a more comprehensive approach including knowledge, skills and attitudes.
A review of the literature was completed and QSEN provided the framework for the competency assessment model. In 2011, the basic competency assessment tool utilizing the six Institute of Medicine (IOM) criteria was developed. The new competency assessment tool included sections for learner self-assessment, method of instruction and validation of competency. This became the basic nursing competency assessment for all newly hired nurses. Phase two was the development of what is now a three tiered comprehensive competency assessment process that includes knowledge, skills and attitudes specific to patient populations. A formative evaluation was conducted with preceptors and new hires, which identified a knowledge gap about QSEN, as well as utilization of the new competency assessment tool. Phase three introduced the expansion of the competency tool to disciplines outside of nursing. Phase four was the creation of the sustainability process including a three year revision cycle.
The introduction of this innovative competency assessment process was a significant cultural change for the organization and presented many challenges including educational deficits. Ongoing education continues on QSEN, defining competency, and standardizing criteria across all three competency tiers to build on strengths of this model. Over the past four years this competency assessment work has flourished from a basic nursing assessment tool into an inter-professional framework. This work will continue to expand as we explore new opportunities.