Competency assessment begins at orientation

Action words, task-oriented descriptions are key

To provide quality patient care, a good place to start a competency assessment program is at orientation, says Sonia Barness, RN, BSN, CNOR, nurse manager of the Same-Day Surgery Center at Fairview Southdale Hospital in Edina, MN. Barness is the author of a chapter on competency in the Association of periOperative Registered Nurses (AORN) publication, Ambulatory Surgery Principles and Practices. (For more information, see resource box, p. 45.)

"Use a competency-based orientation plan for all new staff members so you can document what they were taught and how well they demonstrated competence in each area of their job," she explains. Not only does a competency-based orientation help a same-day surgery manager document competencies, but it also reinforces a competency-based job description that will be the basis for the employee’s ongoing evaluations, adds Barness.

After orientation, competency assessment can take different forms, she says. Training for new products or equipment can be conducted by demonstration or self-study method, but someone needs to observe the staff member using the item correctly, she says. The observer can be a manager, supervisor, nurse educator, or even another staff member who has been trained as an instructor on that piece of equipment or supply.

"You do need a paper document for the employee’s file for the initial orientation and for new equipment or supplies, but you don’t need to fill out a piece of paper for every time you assess competence," says Barness. She recommends using the employee’s annual evaluation to document the competencies you’ve noted during informal observations.

At Southwest General Health Center in Middle-burg Heights, OH, competencies are measured on a monthly basis by co-workers. The information contained on the monthly forms is used by the manager for the employee’s annual evaluation.

"Our competency tracking tools clearly identify job-specific competencies for each employee, and the forms are easy to complete," says Holly Klinger, RN, CNOR, preceptor for the surgical department at Southwest General Health Center. (See Performance Review and Competency Tracking Tool, inserted in this issue.)

The first evaluations by co-workers introduced at Southwest were multiple pages and contained redundant information, says Klinger. Now, the evaluation form is a single page and focuses on the most important aspects of each person’s job, she says. For example, an RN’s job-specific competencies include safe medication administration and patient assessments, while a surgical technician’s competencies include activities that contribute to case planning and intra-operative efficiency.

In addition to job specific competencies, Southwest’s assessment tools also evaluate organizational competencies that include safety, support of working relationships, communication, total quality management, and customer satisfaction, says Klinger.

Asking co-workers to evaluate each other was a cause for concern among staff, she says. "We still have a small percentage of the staff who don’t like evaluating their co-workers or being evaluated by co-workers, but the majority of people like the opportunity." Staff are not given an option as to whether they participate in the peer evaluation, says Klinger. "To be effective, everyone must participate. Most staff members now understand that peer review is significantly more accurate and more insightful than review by supervisors only."

The assessment form does allow the reviewer to write comments to explain different ratings. These comments are given to the employee at the time of the annual performance review in a typewritten, anonymous report. "We want to make sure employees understand how colleagues view them. We also find the comments by colleagues explain how the final evaluation was developed," adds Klinger.

Initially, only the professional staff evaluated other professional staff, but now any staff member may conduct an evaluation for another staff member. "We just tell people to evaluate the areas they can reasonably judge," says Klinger. "If an administrative staff member can’t judge a surgical technician’s competence in tissue handling, then only the organizational competencies such as communication or support of working relationships should be evaluated."

The best way to ensure success of your competency assessment program is to be efficient, says Barness. "Keep extra paperwork to a minimum, use existing tools required for universal precautions, fire safety, and CPR certification instead of creating extra forms to complete," she suggests.

Use action words and specific task descriptions to remove the subjectivity from the process, recommends Klinger. "Also, make sure your job descriptions, orientation forms, and evaluations all use the same language."

To avoid paying extra for overtime, be flexible about how you will assess competency on new processes or equipment, says Barness. "Use a variety of teaching and evaluation methods when determining competency. Videos, demonstrations, articles, and classes will break up the monotony so that staff members don’t feel like they are doing the same thing over and over."

Be sensitive to your staff’s schedule, suggests Barness. "We have to remember that not all staff members are full-time. We are dealing with part-time employees who may not be on site if we schedule only one or two demonstrations" of new equipment, she explains.

For more information about staff competency assessment, contact:

Sonia Barness, RN, BSN, CNOR, Nurse Manager Same-Day Surgery Center, Fairview Southdale Hospital, 6401 France Ave. S., Edina, MN 55435. Telephone: (612) 924-5858. Fax: (612) 924-5390. E-mail: sbarnes@fairview. org.

Holly Klinger, RN, CNOR, Preceptor, Surgical Department, Southwest Health Center, 1869 E. Bagley, Middleburg Heights, OH. Telephone: (440) 816-6121. Fax: (44) 816-6263.

To receive a copy of the publication that includes a chapter on competency assessment for same-day surgery programs, contact:

Association of periOperative Registered Nurses, 2170 S. Parker Road, Suite 300, Denver, CO 80231-5711. Telephone: (800) 755-2676 or (303) 755-6304. Web: Ambulatory Surgery Principles and Practices/1999 (Item #MAN-262) costs $35 for nonmembers and $30 for members. Orders of $50 or more can be billed with an authorized purchase order.