Do your competency evaluations measure up?
Experts offer 5 tips on skills testing
Many home care agencies have difficulty creating competency evaluations that truly measure staff’s skills, accreditation agency officials say.
Managers do not clearly think through which areas they need to measure and which areas need repeated testing, the experts add.
"Some competencies are very superficial," says Maryanne Popovich, RN, MPH, director of home care accreditation services for the Joint Commission on Accreditation of Healthcare Organizations of Oakbrook Terrace, IL.
"An agency might not look to see what the staff actually is doing," Popovich adds.
For example, Popovich says, a manager might have a goal of measuring a nurse’s competency in checking for vital signs. This is a very simple skill that might not require testing. But at the same time, they might forget to test nurses’ competency at some more difficult skills, such as setting up IVs.
"Do a prioritization of what the staff and supervisors feel are the most complex tasks they have to do, or which tasks could have the most serious repercussions for patients," Popovich advises.
Home care agencies also sometimes fall into a habit of assuming the nurses have been trained already in many different skills, and they fail to test how they handle the skills they use less frequently, says Terri Ayer, MS, RN, CNAA, president of the Community Health Accreditation Program (CHAP), a subsidiary of the National League for Nursing of New York City. CHAP accredits about 250 agencies nationwide.
"There’s a real danger, especially with a smaller agency, for managers to think a nurse is a nurse is a nurse, and if you’ve got that license, they expect you to be able to do anything," Ayer says.
However, sometimes a nurse might not perform a particular technique for years. An example might be to test a nurse’s skill at irrigating urinary catheters, which are common in hospitals but not in home care, Ayer points out.
"It’s really important that organizations are never stagnant in what their staff is doing and the new skills they’re learning, and new procedures, new equipment," Popovich says.
"It’s not just enough to train staff on new procedures; the issue also is you have to make sure they’re competent to provide that particular procedure," she adds.
Ayer and Popovich offer the following suggestions on what education managers can do to create better measurements of staff’s skills and to avoid some common pitfalls:
1. Look at your agency’s call log to see what kind of complaints are most common.
Sometimes nurses are unsuccessful in teaching patients how to use medical equipment. So patients might call to ask a nurse to visit them between regularly scheduled appointments because they’re having trouble with the equipment.
If this problem continues to crop up in the call log, then the agency needs to test nurses’ competency in patient teaching.
2. Use a scoring sheet that the supervisor can follow to add consistency to the competency evaluations.
"Our primary objective is to make sure the agency has in place a mechanism to ensure competency of their staff, through written tests, oral tests, case conferences, joint visits, and a combination of those," Ayer says.
The scoring sheet and competency evaluations should cover more than technical nursing skills, she adds. "Look at the case management skills, the communications skills, and how they interact with staff."
3. ever rely on a self-assessment.
"The self-assessment done by the employee is absolutely not acceptable," Popovich insists. "Some agencies use that as a starting point, but we do not accept that as evidence of competency."
4. Retest nurses for the more technical skills.
"In the more technical areas, we expect to see more regular testing," Ayer says.
"That is not to say it has to be a written test," Ayer adds. The agency could use a skills checklist, or the nurse could go through a certification program that is renewed regularly.
"We also look to see if an IV nurse is certified through the Intravenous Nurses Society," she adds.
Popovich says the Joint Commission expects to see retesting of infrequent skills, such as setting up ventilators.
"I’d really want that activity re-evaluated because they’re not going to have the experience of doing it day in, day out, like they would a blood draw," Popovich says.
The more common skills, such as simple dressing changes and checking for vital signs, do not have to be retested unless there’s a patient complaint or another red flag that suggests a nurse is having problems with the skill, Popovich says.
5. Create a checklist of the competency evaluations you perform.
The experts suggest education managers write down all of their competency evaluations and which skills they measure. Each employee who has passed a particular competency evaluation could be checked off.
The education manager should keep that checklist on hand so when the agency has an emergency need for a nurse who has a certain rare skill, the managers will know exactly who was recently found competent to perform that skill.
Popovich gives an example of a problem that might arise: "Some organizations have one team of nurses visiting patients who have a specific diagnosis. So those nurses become very proficient and competent in those areas."
But then suddenly there’s a flu outbreak, and the agency’s nurses who usually handle these patients are out sick. So what would an agency do?
"Make sure you have enough nurses who are competent to do those skills," Popovich says. The checklist should give the education manager a good idea about whether there are enough nurses trained to handle certain skills. If the agency is seeing an increase in patients who need nurses trained with a particular skill, then the education manager should train more nurses to perform that skill.
"If you have an appropriate listing of these competencies, then you shouldn’t have to go back and keep re-inventing the wheel," Popovich advises.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content