Competence Verification & Learning Guide: Facility s1

RN Competency Form: Generalist

Competence Verification & Learning Guide: Facility Name (learner) Date Initiated Unit ☐RN ☐LPN ☐Recent Graduate ☐Experienced Nurse ☐New to Specialty ☐Traveling Nurse Note: for LPN practice guidelines, see state nursing statutes & regulations

The preceptor will initial each competency when he/she, as preceptor and colleague, feels safe in allowing the learner to deliver this aspect of care without direct supervision.

Self-Assessment: 1 – Identified Limitation (little or no experience); 2 – Capable (familiar but may need assistance); 3 – Independent - can perform these tasks safely; 4 – Proficient - extensive experience *For further information, see instruction sheet at end of this form.

Learning Guide follows competency pages and contains items for each competency that need to be reviewed based on learner’s experience and unit need, they include reminders of important teaching points that may otherwise be missed. t t s s # l l e

Required Competencies Verification method a References a e e i i m t t

Main categories followed by associated l m & facility specific i l n n s u i i a s

competencies

G r r e requirements e e o s and critical elements. t g t s n D—Demonstrated; T—Test; a n r p i a (Preceptor needs to verify learner capability for D - a e M—Module/class; n f r c l these items.) e a e e V—Verbalized L r e S P L IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:

Initiate life-saving/emergency measures IA 1

consistent with patient needs and protocols

Conduct initial assessment to identify IA 2

patient’s needs and priorities of care (full physical assessment--RN only, LPN’s may perform limited, targeted assessments)

Develop individualized plan of care that IA 3

reflects current practice standards (RN only)

Implement plan of care based on patient- IA 4

related data and best practices

Integrate developmental and age specific IA 5

needs in approach to and delivery of care

Use equipment based on age, weight and IA 6

Implement measures and precautions to IA 7

insure patient safety and well-being Complete restraint competencies as required.

Promote increase in client independence IA 8

teach/assist patients with PT/OT/ST per protocols maximize client decision making

Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model. Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved. Page 1 RN Competency Form: Generalist t t s s # l l e

competencies

G r r e requirements e e o s and critical elements. t g t s n D—Demonstrated; T—Test; a n r p i a (Preceptor needs to verify learner capability for D - a e M—Module/class; n f r c l these items.) e a e e V—Verbalized L r e S P L

Implement mental health & IA 9

alcohol/substance abuse behavior protocols

Manage patient on cardiac monitor IA 10

place leads correctly interpret rhythm correctly intervene as needed

Manage nutritional support - recognize need IA 11

manage tube feedings per protocol administer total parenteral nutrition per protocol

IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following:

Administer medication to assigned patients IB 1

implement safe practice with high risk complete procedural medication sedation competency if implement the “rights” of med req’d administration state indications, contra-indications and side effects (may use reference) administer IVPB solution administer IV push/bolus med (RN only)

Manage peripheral IV care consistent with IB 2

protocols verbalize pediatric and geriatric volume and dosage precautions

Manage central/PICC line consistent with IB 3

protocols complete PICC use correct flush solution and technique competency if required apply policy for clotted line assess site for complications NOTE: LPN’s limited to specific training per state regs

Administer blood/blood products (RN only) IB 4

per protocol

Perform venipuncture on an adult &/or child IB 5

or infant heel stick as applicable

IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include:

Integrate sterile technique into practice IC 1

according to agency policy

competencies

Perform point of care testing per lab and unit IC 2

protocols by completing all required competencies

Utilize protocols and other references for IC 3

unfamiliar or infrequently used procedures and equipment

Administer oxygen safely as ordered IC 4

Perform the following types of suctioning as IC 5

apply: trach suctioning naso or oropharyngeal bulb, yankaur, olive tip

Manage a nasogastric tube per protocol IC 6

Implement pain management protocol IC 7

initiate pain pump(s) used in unit (RN only)

Manage patient pre-, during, and post- IC 8

procedure per protocol Also see separate comp for procedural sedation if applies

Perform wound care consistent with IC 9

protocols

Incorporate regulatory requirements into IC 10

practice

Section II. The learner will incorporate relevant communication skills in all interactions to include the following:

Document care given and patient response II 1

accurately in health care record.

Interact in a respectful and collaborative II 2

manner with the healthcare team.

Report pertinent, concise information to II 3

team members per policy

Demonstrate verbal and nonverbal II 4

therapeutic communication with patients and staff

Section III. The learner will incorporate critical thinking skills in delivery of all nursing care to include the

competencies

G r r e requirements e e o s and critical elements. t g t s n D—Demonstrated; T—Test; a n r p i a (Preceptor needs to verify learner capability for D - a e M—Module/class; n f r c l these items.) e a e e V—Verbalized L r e S P L following:

Analyze patient laboratory data to use it in III 1

clinical decision making

Manage unit phone calls per policy III 2

Prepare for moving a patient between levels III 3

of care within the facility or to/from another facility

Use resources effectively III 4

respond to significant changes in patient status per protocols and orders notify charge nurse or manager of significant changes or needs on unit

Anticipate potential unit / patient crises and III 5

act to prevent them or minimize their impact

Perform nursing role within scope of III 6

practice, unit limitations and individual competency use reflective judgment in self-assessment &planning recognizes own limitations create a plan for ongoing development of decision making ability

Section IV. The learner will incorporate human caring & relationship skills in all interactions to include the following:

Advocate for patient and family needs IV 1

Assist patient/family with ethical and/or legal IV 2

issues with sensitivity

Display empathy, compassion and respect to IV 3

patients and families

Maintain patient privacy and confidentiality IV 4

at all times

Assist colleagues with care delivery IV 5

Incorporate cultural competence and respect IV 6

for diversity into practice

competencies

Provide palliative care as part of the IV 7

continuum of care.

Section V. The learner will incorporate management skills in all interactions to include the following:

Plan shift to accomplish tasks and goals V1

organize workload effectively prioritize and reprioritize work as needs change complete tasks or seek help

Manage assignment V2

complete full patient assignment ask for advice and delegate as needed

Manage self V3

manage personal professional development keep certifications, license & employee health records current, wear appropriate attire and ID maintain calm, professional behavior during stressful situations use correct body mechanics and resources to prevent injury Identify area of interest in quality improvement (committees, projects, workgroups, etc.)

Section VI. The learner will incorporate leadership skills in all interactions to include the following:

Complete Clinical Nursing Leadership Complete leadership VI 1

Competence competency form if required (charge nurse, manager, house supervisor, preceptor, etc.)

Supervise staff VI 2

monitor performance of supervised staff assist staff as needed provide feedback to staff & management as needed

Delegate work fairly and according to skill VI 3

level and scope of practice

Coordinate care with healthcare team VI 4

competencies

Initiate chain of command VI 5

Section VII. The learner will incorporate teaching skills in delivery of all nursing care to include the following:

Educate patients and families with VII 1

consideration for age, culture, educational background and home environment or setting

Provide education to complete a successful VII 2

patient discharge per policy

Coordinate education to ensure the patient VII 3

gets a consistent message

Section VIII. The learner will incorporate knowledge integration skills to include the following:

Identify care issues within the rural VIII 1

environment

Provide nursing care that is evidence based VIII 2

Use all computer systems successfully VIII 3

Accept teaching, coaching and mentoring to VIII 4

improve competence

Seek continued learning opportunities to VIII 5

improve practice

Comments/alternative learning plans:

Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model. Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved. Page 6 RN Competency Form: Generalist

All preceptors are to sign & initial below. Ideally new graduates should have only one to two preceptors for the entire orientation. Preceptor Signature Initials Preceptor Signature Initials

Signatures at completion of preceptorship/orientation:

Preceptee/orientee Date

Primary Preceptor Date

Manager Date

LEARNER GUIDE: Reference content in the right-hand column that needs review. IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following: IA 1 Initiate life-saving/emergency measures Review procedures for: consistent with patient needs and protocols -Correct response for all codes -Obtaining/interpreting an ECG -Emergency intubation -Allergic reaction (also latex allergy) -Seizure precautions including patient positioning/padding -Hyper and hypoglycemic episodes -Hyper and hypothermic episodes -Suicide prevention precautions -Nonviolent crisis intervention -Pediatric emergencies (including medication dosing and crash cart supplies -GI, post partum, other significant bleeds -Reporting abuse/neglect -Use of emergency equipment -Cardiac emergencies -Poison/overdose management

IA 2 Conduct initial assessment to identify Review the following: patient’s needs and priorities of care (full -How to complete all intake forms & processes physical assessment--RN only, LPN’s may -How to complete assessment to identify primary needs of perform limited, targeted assessments) patient -How to distinguish abnormal from normal signs and symptoms -How to address age specific needs -Immunization policies (Review vaccination database--VAK TRAK or other) -Policy for treatment of minors and at risk adults -Skin integrity assessment and protocols -Physical, psychological, social and spiritual aspects of assessment

IA 3 Develop individualized plan of care that Review care plan process and documentation requirements reflects current practice standards (RN only) IA 4 Implement plan of care based on patient- Review priority setting practices and discharge criteria related data and best practices IA 5 Integrate developmental and age specific Review the following: needs in approach to and delivery of care -VS parameters -Communication techniques -Physical, developmental, spiritual & emotional needs

IA 6 Use equipment based on age, weight and Review the use of equipment (scales, pumps, restraints, lifts, need etc.) in regards to age and weight.

LEARNER GUIDE: Reference content in the right-hand column that needs review. IA 7 Implement measures and precautions to Review the following: insure patient safety and well-being -Wandering & fall prevention protocols -Patient identification measures -Restraint and seclusion policy including: assessing need for continued restraint, using least restraint necessary, and monitoring for complications/patient needs -Infection control policy including hand hygiene, personal protective equipment, patient isolation (respiratory, wound, neutropenic, etc.) and contaminated waste policies -Nosocomial risks: delirium, UTI’s, central line infections, pressure ulcers, etc. -Unusual occurrence reports

IA 8 Promote increase in client independence Review physical, occupational and speech therapy procedures, introduce to PT/OT/ST team, review resources & equipment available and methods to support family involvement

IA 9 Implement mental health & alcohol/substance Review mental health policies re: suicide watch, behavioral abuse behavior protocols management, consultations Review alcohol/substance abuse protocols and pathophysiology Review process for transferring to other facilities

IA Manage patient on cardiac monitor Review procedures and monitoring equipment and policies for 10 handling abnormal rhythms Review rhythm interpretation

IA Manage nutritional support - recognize need Review protocols, available types of tube feeding, nutritional 11 supplements and diets. Introduce to dietary personnel

IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following: IB 1 Administer medication to assigned patients Review medication administration policies and reference materials including med reconciliation and narcotic accounting Introduce to pharmacist and review pharmacy role and availability Must pass unit/hospital medication test if required before allowed to administer meds Review limits to medication administration (formulary, restricted meds, high alert meds)

IB 2 Manage peripheral IV care consistent with Practice with related equipment (syringe pump, IV pump and protocols corresponding supplies) Review policies re: preparing IV meds, approved IV medication list per unit Review geriatric and pediatric considerations re: volume and dosages

LEARNER GUIDE: Reference content in the right-hand column that needs review. IB 3 Manage central/PICC line consistent with Review policies on flushing, drawing blood, declotting, dressing protocols change, removal and general care of all central catheters NOTE: LPN’s limited to specific training per used in the facility (PICC, triple lumen, groshong, portacath, state statutes etc.) Complete any specialty line competencies as required

IB 4 Administer blood/blood products (RN only) Review blood bank and nursing policies and procedure for per protocol transfusion of blood products Review actions to take if suspected reaction occurs Review massive transfusion, autologous transfusion and giving uncross-matched blood policies

IB 5 Perform venipuncture on an adult &/or child Review lab and nursing policies related to blood sampling or infant heel stick as applicable Review blood culture protocol

IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include the following: IC 1 Integrate sterile technique into practice If not demonstrated in patient care, have learner simulate a according to agency policy sterile dressing change, foley insertion or other sterile procedure.

IC 2 Perform point of care testing per lab and unit Review testing and quality control for the following as apply: protocols by completing all required rapid strep, glucometer, urine chemistry strip, occult blood, competencies urine pregnancy tests, iStat, Ferning test

IC 3 Utilize protocols and other references for Review how and where to access all procedures, manuals and unfamiliar or infrequently used procedures instructions. and equipment Infrequent procedures may include post-mortem care, organ donation, and many others Equipment may include heating or cooling devices, fluid warmers, and many others

IC 4 Administer oxygen safely as ordered Review types of O2 equipment (cannula, NRB, BVM, ventimask and aerosol mask, tanks, etc.) Review O2 monitoring and signs of toxicity Set up and use pulse oximetry Review peak flow measurement

IC 5 Perform the following types of patient Review procedures for suctioning including safety suctioning as apply considerations

IC 6 Manage a nasogastric tube per protocol Review protocols including how to assess placement/proper function Practice insertion as needed

IC 7 Implement pain management protocol Review policies Assess and reassess every patient for pain For epidural, and PCA: specifically review equipment manual, pain management techniques, teaching, troubleshooting and documentation Review role of anesthesiology dept for epidurals

LEARNER GUIDE: Reference content in the right-hand column that needs review. IC 8 Manage patient pre-, during, and post- Review pre-op preparation and paperwork including site check procedure per protocol Review protocols (including time out) for procedures performed in the unit (thoracentesis, paracentesis, spinal tap, etc.) Review protocols for post-op/unit procedure recovery & potential complications

IC 9 Perform wound care consistent with protocols Review procedures and equipment (wound vacc, drains, etc.) Introduce to any resource personnel (ostomy/wound care nurse)

IC Implement regulatory requirements into National patient safety goals, CMS guidelines, Joint 10 practice Commission, core measures, etc.

Section II. The learner will incorporate relevant communication skills in all interactions to include the following: II 1 Document care given and patient response Review charting policy, forms, and computer programs. accurately in health care record. II 2 Interact in a respectful and collaborative Meet team members and review roles and responsibilities of manner with the healthcare team. each

II 3 Report pertinent, concise information to team Review hand-off report, info to share with charge nurse, members per policy manager, MD’s, etc. Review how to reach team members (pager, phone, etc.)

II 4 Demonstrate verbal and noverbal therapeutic Review care models for the organization (rounding, family communication with patients and staff driven care, etc.) Review organizational behavior standards

Section III. The learner will incorporate critical thinking skills in delivery of all nursing care to include the following: III 1 Analyze patient laboratory data to use it in Review lab norms and reports including fluid and electrolyte clinical decision making management and critical values

III 2 Manage unit phone calls per policy Review telephone triage policy (RN only) Review Health Aide roles and capabilities Review types of calls, scope of practice and information sharing limitations

III 3 Prepare for moving a patient between levels Review ground and air transfer policies and logistics of care within the facility or to/from another Review EMTALA and medivac protocols facility III 4 Use resources effectively Review order sets and protocols and notification process Review after hour protocols, acuity process, supplies, etc.

III 5 Anticipate potential unit / patient crises and Review frequently occurring unit patient intervention needs act to prevent them or minimize their impact Review unusual occurrence reporting system Discuss failure to rescue Review rapid response team role if available

III 6 Perform nursing role within scope of practice, Review ANA and specialty standards, nurse practice act unit limitations and individual competency Review limitations of unit and competency process

Section IV. The learner will incorporate human caring & relationship skills in all interactions to include the following:

LEARNER GUIDE: Reference content in the right-hand column that needs review. IV 1 Advocate for patient and family needs Review policy for patient complaints, advocacy and ethics

IV 2 Assist patient/family with ethical and/or legal Review policy and resources for patient rights, advocacy, code issues with sensitivity status, living wills, POAs, etc.

IV 3 Display empathy, compassion and respect to Review customer service guidelines and mission statements patients and families IV 4 Maintain patient privacy and confidentiality at Review confidentiality procedures for medical records, unit all times privacy, HIPPAA, and private places to talk

IV 5 Assist colleagues with care delivery Review teamwork behaviors

IV 6 Incorporate cultural competence and respect Discuss local cultural beliefs and practices that impact for diversity into practice healthcare, interpreter procedures, pastoral care, social services, etc.

IV 7 Provide palliative care as part of the Review guidelines on pain and other symptom management continuum of care. Review education and support systems that help patients live as actively as possible until death Introduce to team and team approach to address needs of patients and families, including bereavement counseling

Section V. The learner will incorporate management skills in all interactions to include the following: V1 Plan shift to accomplish tasks and goals Review unit shift expectations and time management techniques

V2 Manage assignment Review position descriptions and capabilities of other staff on the unit

V3 Manage self Review unit and hospital requirements, lift policies, employee safety process, dress code, etc. Review quality process used in facility

Section VI. The learner will incorporate leadership skills in all interactions to include the following: VI 1 Complete Clinical Nursing Leadership Review policies along with the competence form including Competence staffing, acuities, disaster management, etc.

VI 2 Supervise staff Review position descriptions

VI 3 Delegate work fairly and according to skill Introduce to all unit staff and describe their job responsibilities level and scope of practice and limitations

VI 4 Coordinate care with healthcare team Introduce to all professional and support team members, review their roles & contact procedures

VI 5 Initiate chain of command Review organizational structure and situations requiring notification

Section VII. The learner will incorporate teaching skills in delivery of all nursing care to include the following: VII 1 Educate patients and families with Review teaching principles and local culture and resources consideration for age, culture, educational background and home environment or setting

LEARNER GUIDE: Reference content in the right-hand column that needs review. VII 2 Provide education to complete a successful Identify community resources for the patient patient discharge per policy Review discharge policy and procedures (pharmacy, standardized teaching materials, etc.)

VII 3 Coordinate education to ensure the patient Review standards for patient education gets a consistent message Section VIII. The learner will incorporate knowledge integration skills to include the following: VIII Identify care issues within the rural Discuss general rural care issues & those specific to each rural 1 environment site Problems common in frontier areas: older population, socioeconomic status, access, transportation and financial issues, employee benefits, fewer practitioners Rural nurse generalist concepts: isolation and distance, lack of anonymity, old timer/newcomer and insider/outsider, informal networks, rural concepts of health, definition of health, possibly delayed treatment seeking, self reliance, cultural issues, boundary expansion and pinch hitting, “practicing medicine” without a license, family centered care, career development and education, accessing patient care information on the fly

VIII Provide nursing care that is evidence based Review computer/library resources, local experts and classes 2 VIII Use all computer systems successfully Obtain computer systems training 3 VIII Accept teaching, coaching and mentoring to 4 improve competence VIII Seek continued learning opportunities to Review resources available for learning 5 improve practice Other facility specific items to cover:

REQUIREMENTS: All nurses will complete these competencies upon hire. Some competencies may be reviewed annually. This form follows the Competency Outcomes and Performance Assessment (COPA) model.

PRECEPTEE/LEARNER INSTRUCTIONS: Complete self-assessment: Rate your skill in each area to identify the areas where you need additional experience, access to teaching resources, and/or lab practice. Discuss your results with your preceptor to help establish a plan and goals for your learning experience and to aid in choosing patient assignments. Scoring per instructions at the top of page 1.

PRECEPTOR INSTRUCTIONS: A. Review self-assessment with preceptee/learner to establish plan. B. Required Competencies: The specialty area competency forms are required for independent practice on this unit. This column represents the Alaska Statewide required competencies per ACE-HC and should not be altered. The preceptor will sign each one off when he/she, as preceptor and colleague, feels safe in allowing the preceptee/learner to deliver this aspect of care without direct supervision. C. Verification Method & Agency Specific. Document comments/check marks for the competency and any agency specific requirements. Verification methods include: 1. Demonstration – Preceptor watches learner perform task/procedure in safe, capable manner in a simulated lab or computer setting or as part of direct care performance. The expectation for new graduates is that they demonstrate as many of the competencies as possible. 2. Test – Learner passes a test provided by the facility to measure competence for this skill. (Minimum passing grade indicated. Initial only after test passed.) 3. Module –Learner has completed a training tool (computerized or written module, class, video, etc.) provided by the facility to measure competence for this skill. 4. Verbalization - Learner explains to the preceptor the process and/or planning that evidences safe, reliable knowledge base. This may include case scenarios, discussion, and/or description of plan. NOTE: some competencies may have the verification method specified per facility guidelines (e.g. “test only”) Record N/A and initials only for items that never apply to this learner’s role or performance. D. Sign-off: Sign and date when all elements of the competency are met. If unable to sign off an area due to patient population issues or learner needs more time, document a plan in the comments section at the end of the form. Discuss alternative ways of meeting the requirement(s) as well as any additional time needed with the nurse manager and/or nurse educator. All preceptors assisting in orientation of a new staff member/intern must sign and initial in the signature chart at the end of this document. E. References: Competencies should be met in accordance with these. Add your facility approved references here. F. Learning Guide: These are memory ticklers. The amount of time spent on each of them depends on the learner’s experience. New graduates will likely need time on almost all of the areas listed.

REFERENCES COLUMN: List foundational documents to support the learning experience and to use as the official measure by which the competencies are assessed. The ACE-HC group recognizes the following as sources for evidence based practice that can be included in the reference list along with local policies, procedures and forms: Perry & Potter, Elsevier/Mosby, Lippincott, Kozier & Erb, ANA, nationally recognized hospital related regulatory organizations (CLIA, CDC, CMS, JC, etc.), and specialty nursing organizations’ scope, standards and core curricula. This column’s content may be changed to be facility specific.

NOTE: ACE-HC competency forms are intended to be used between facilities within Alaska.

Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model. Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved. Page 15