Competency Testing

January 30, 2009

This week is the week that I approach with trepidation every year. It is the week of RN competencies.

This week is the week that I approach with trepidation every year. It is the week of RN competencies. Being one of the oncology educators, it is not only my role plan what we will be covering in competency testing, but to be one of the persons who facilitates and carries out the testing process. Competency testing is a strange entity in itself. First, you have the things that you have to cover. The Joint Commission (TJC) has set standards for hospitals in the areas of orientation, critical thinking, psychomotor skills, and interpersonal skills, as well as maintenance and improvement of competency. TJC standard HR 4.2 states you must have ongoing in-service and other education and training to maintain and improve staff competence. Many hospitals have now developed competency days in order to meet this standard. The competencies include the mandatory education required by hospital policy and regulatory agencies such as fire-safety, infection control, and hazard communication. At my institution, most of those competencies are online and are completed before our testing day. But there are other things that we are required to do such as patient lift equipment and point of care testing. So those are automatic. Next we will add any new policies or procedures. This year it was the use of syringes in our IV pumps to administer stem cells. And the final area is designed to help nurses to maintain and improve their oncology specific skills. These topics are chosen based on data that show a need for improvement, changing role expectations or “issues” that have been identified by the staff or leadership.

There is never a disagreement that these competency days are necessary and provide great opportunities for education. So why do I dread them so much? There are weeks of planning. There is trying to work with everyone’s schedule and making sure everyone arrives at his or her scheduled time slot. There are the hours of saying the same thing over and over and trying to remember what you did or did not tell one group as opposed to another. And there is the stretch of resources. As in every work area these days, resources including staff and money are stretched thin. We used to have 4 hours to do our competency testing. This year we have 1½. We used to be able to have staff nurses and nurses from the leadership group come and assist with the testing on their time off. Now, no extra paid time. It’s tiring and it’s frustrating to know that we are told that something is important and necessary but then to get stretched so thin.

Even given all of that, once the week comes, do I think it wasn’t all worth it? Absolutely not. With all headaches it brings, it also brings great discussion, great opportunities for education and great access to staff that you might not otherwise have. During discussions of chemotherapy case studies you get to hear what the nurses are experiencing themselves with similar situations and how they handle them. You can dispel erroneous information on how or why something is done and educate nurses on the evidence behind particular processes and interventions rather than just how or what to do. You can encourage them to use their own experiences to critically think about what to do the next time they are faced with similar situations.

So the week is long. We haven’t really managed to keep it to 1½ hours but we’ll have to figure that out when budget time comes. The way I see it, the use of ½ of time to support, encourage, educate, and yes, competency, our staff is worth much more in the long run.