alaska state hospital and nursing home association – ashnha€¦ · web view-suicide prevention...

RN Competency Form: Generalist

Competence Verification & Learning Guide: FacilityName (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.

Self-

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ent Required Competencies

Main categories followed by associated competencies and critical elements.

(Preceptor needs to verify learner capability for these items.)

Verification method& facility specific requirements

D—Demonstrated; T—Test; M—Module/class;

V—Verbalized

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IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following: Initiate life-saving/emergency measures consistent with

patient needs and protocols

IA 1

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

IA 2

Develop individualized plan of care that reflects current practice standards (RN only)

IA 3

Implement plan of care based on patient-related data and best practices

IA 4

Integrate developmental and age specific needs in approach to and delivery of care

IA 5

Use equipment based on age, weight and need

IA 6

Implement measures and precautions to insure patient safety and well-being

Complete restraint competencies as required.

IA 7

Promote increase in client independenceteach/assist patients with PT/OT/ST per protocolsmaximize client decision making

IA 8

Implement mental health & alcohol/substance abuse behavior protocols

IA 9

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.

RN Competency Form: GeneralistSe

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t Required CompetenciesMain categories followed by associated competencies

and critical elements. (Preceptor needs to verify learner capability for these items.)



V—Verbalized

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Manage patient on cardiac monitorplace leads correctlyinterpret rhythm correctlyintervene as needed

IA 10

Manage nutritional support - recognize needmanage tube feedings per protocoladminister total parenteral nutrition per protocol

IA 11

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

implement safe practice with high risk medicationimplement the “rights” of med administrationstate indications, contra-indications and side effects

(may use reference) administer IVPB solutionadminister IV push/bolus med (RN only)

complete procedural sedation competency if req’d

IB 1

Manage peripheral IV care consistent with protocolsverbalize pediatric and geriatric volume and dosage

precautions

IB 2

Manage central/PICC line consistent with protocolsuse correct flush solution and techniqueapply policy for clotted lineassess site for complications

NOTE: LPN’s limited to specific training per state regs

complete PICC competency if required

IB 3

Administer blood/blood products (RN only) per protocol

IB 4

Perform venipuncture on an adult &/or child or infant heel stick as applicable

IB 5

IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include: Integrate sterile technique into practice according to

agency policy

IC 1

Perform point of care testing per lab and unit protocols by completing all required competencies

IC 2

Utilize protocols and other references for unfamiliar or infrequently used procedures and equipment

IC 3

Administer oxygen safely as ordered

IC 4

Perform the following types of suctioning as apply:trach suctioningnaso or oropharyngealbulb, yankaur, olive tip

IC 5



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Manage a nasogastric tube per protocol

IC 6

Implement pain management protocolinitiate pain pump(s) used in unit (RN only)

IC 7

Manage patient pre-, during, and post-procedure per protocol

Also see separate comp for procedural sedation if applies

IC 8

Perform wound care consistent with protocols

IC 9

Incorporate regulatory requirements into practice

IC 10

Section II. The learner will incorporate relevant communication skills in all interactions to include the following: Document care given and patient response accurately in

health care record.

II 1

Interact in a respectful and collaborative manner with the healthcare team.

II 2

Report pertinent, concise information to team members per policy

II 3

Demonstrate verbal and nonverbal therapeutic communication with patients and staff

II 4

Section III. The learner will incorporate critical thinking skills in delivery of all nursing care to include the following: Analyze patient laboratory data to use it in clinical

decision making

III 1

Manage unit phone calls per policy

III 2

Prepare for moving a patient between levels of care within the facility or to/from another facility

III 3

Use resources effectivelyrespond to significant changes in patient status per

protocols and ordersnotify charge nurse or manager of significant

changes or needs on unit

III 4

Anticipate potential unit / patient crises and act to prevent them or minimize their impact

III 5



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Perform nursing role within scope of practice, unit limitations and individual competency

use reflective judgment in self-assessment &planningrecognizes own limitationscreate a plan for ongoing development of decision

making ability

III 6

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 issues with sensitivity

IV 2

Display empathy, compassion and respect to patients and families

IV 3

Maintain patient privacy and confidentiality at all times

IV 4

Assist colleagues with care delivery

IV 5

Incorporate cultural competence and respect for diversity into practice

IV 6

Provide palliative care as part of the continuum of care.

IV 7

Section V. The learner will incorporate management skills in all interactions to include the following: Plan shift to accomplish tasks and goals

organize workload effectivelyprioritize and reprioritize work as needs change

complete tasks or seek help

V1

Manage assignmentcomplete full patient assignmentask for advice and delegate as needed

V2



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Manage selfmanage personal professional development keep certifications, license & employee health

records current, wear appropriate attire and ID maintain calm, professional behavior during stressful

situationsuse correct body mechanics and resources to

prevent injuryIdentify area of interest in quality improvement

(committees, projects, workgroups, etc.)

V3

Section VI. The learner will incorporate leadership skills in all interactions to include the following: Complete Clinical Nursing Leadership Competence Complete leadership competency

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

VI 1

Supervise staffmonitor performance of supervised staffassist staff as neededprovide feedback to staff & management as needed

VI 2

Delegate work fairly and according to skill level and scope of practice

VI 3

Coordinate care with healthcare team

VI 4

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 consideration for age,

culture, educational background and home environment or setting

VII 1

Provide education to complete a successful patient discharge per policy

VII 2

Coordinate education to ensure the patient gets a consistent message

VII 3

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



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Identify care issues within the rural environment

VIII 1

Provide nursing care that is evidence based

VIII 2

Use all computer systems successfully

VIII 3

Accept teaching, coaching and mentoring to improve competence

VIII 4

Seek continued learning opportunities to improve practice

VIII 5

Comments/alternative learning plans:

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 consistent with

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

Review the following:-How to complete all intake forms & processes-How to complete assessment to identify primary needs of 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 reflects current practice standards (RN only)

Review care plan process and documentation requirements

IA 4 Implement plan of care based on patient-related data and best practices

Review priority setting practices and discharge criteria

IA 5 Integrate developmental and age specific needs in approach to and delivery of care

Review the following:-VS parameters -Communication techniques-Physical, developmental, spiritual & emotional needs

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

IA 7 Implement measures and precautions to insure patient

safety and well-being

Review the following:-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


RN Competency Form: GeneralistLEARNER GUIDE: Reference content in the right-hand column that needs review.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 abuse

behavior protocolsReview mental health policies re: suicide watch, behavioral management,

consultationsReview alcohol/substance abuse protocols and pathophysiologyReview process for transferring to other facilities

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

Review rhythm interpretation

IA 11 Manage nutritional support - recognize need Review protocols, available types of tube feeding, nutritional 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 accountingIntroduce to pharmacist and review pharmacy role and availabilityMust pass unit/hospital medication test if required before allowed to administer

medsReview limits to medication administration (formulary, restricted meds, high

alert meds)

IB 2 Manage peripheral IV care consistent with protocols Practice with related equipment (syringe pump, IV pump and corresponding supplies)

Review policies re: preparing IV meds, approved IV medication list per unitReview geriatric and pediatric considerations re: volume and dosages

IB 3 Manage central/PICC line consistent with protocolsNOTE: LPN’s limited to specific training per state statutes

Review policies on flushing, drawing blood, declotting, dressing change, removal and general care of all central catheters used in the facility (PICC, triple lumen, groshong, portacath, etc.)

Complete any specialty line competencies as required

IB 4 Administer blood/blood products (RN only) per protocol

Review blood bank and nursing policies and procedure for transfusion of blood products

Review actions to take if suspected reaction occursReview massive transfusion, autologous transfusion and giving uncross-

matched blood policies

IB 5 Perform venipuncture on an adult &/or child or infant heel stick as applicable

Review lab and nursing policies related to blood samplingReview 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 according to

agency policyIf not demonstrated in patient care, have learner simulate a sterile dressing

change, foley insertion or other sterile procedure.

IC 2 Perform point of care testing per lab and unit protocols by completing all required competencies

Review testing and quality control for the following as apply: rapid strep, glucometer, urine chemistry strip, occult blood, urine pregnancy tests, iStat, Ferning test

IC 3 Utilize protocols and other references for unfamiliar or

infrequently used procedures and equipment Review how and where to access all procedures, manuals and instructions. Infrequent procedures may include post-mortem care, organ donation, and

many othersEquipment may include heating or cooling devices, fluid warmers, and many

others


RN Competency Form: GeneralistLEARNER GUIDE: Reference content in the right-hand column that needs review.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 toxicitySet up and use pulse oximetryReview peak flow measurement

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

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

IC 7 Implement pain management protocol

Review policiesAssess and reassess every patient for painFor epidural, and PCA: specifically review equipment manual, pain

management techniques, teaching, troubleshooting and documentationReview role of anesthesiology dept for epidurals

IC 8 Manage patient pre-, during, and post-procedure per protocol

Review pre-op preparation and paperwork including site checkReview 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 10 Implement regulatory requirements into practice National patient safety goals, CMS guidelines, Joint 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 accurately in

health care record.Review charting policy, forms, and computer programs.

II 2 Interact in a respectful and collaborative manner with the healthcare team.

Meet team members and review roles and responsibilities of each

II 3 Report pertinent, concise information to team members per policy

Review hand-off report, info to share with charge nurse, manager, MD’s, etc.Review how to reach team members (pager, phone, etc.)

II 4 Demonstrate verbal and noverbal therapeutic communication with patients and staff

Review care models for the organization (rounding, family 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 clinical

decision makingReview lab norms and reports including fluid and electrolyte management and

critical values

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

III 3 Prepare for moving a patient between levels of care within the facility or to/from another facility

Review ground and air transfer policies and logisticsReview EMTALA and medivac protocols

III 4 Use resources effectively Review order sets and protocols and notification processReview after hour protocols, acuity process, supplies, etc.

III 5 Anticipate potential unit / patient crises and act to prevent them or minimize their impact

Review frequently occurring unit patient intervention needsReview unusual occurrence reporting systemDiscuss failure to rescueReview rapid response team role if available


RN Competency Form: GeneralistLEARNER GUIDE: Reference content in the right-hand column that needs review.III 6 Perform nursing role within scope of practice, unit

limitations and individual competencyReview ANA and specialty standards, nurse practice actReview limitations of unit and competency process

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

sensitivityReview policy and resources for patient rights, advocacy, code status, living

wills, POAs, etc.

IV 3 Display empathy, compassion and respect to patients and families

Review customer service guidelines and mission statements

IV 4 Maintain patient privacy and confidentiality at all times Review confidentiality procedures for medical records, unit privacy, HIPPAA, and private places to talk

IV 5 Assist colleagues with care delivery Review teamwork behaviors

IV 6 Incorporate cultural competence and respect for diversity

into practiceDiscuss local cultural beliefs and practices that impact healthcare, interpreter

procedures, pastoral care, social services, etc.

IV 7 Provide palliative care as part of the continuum of care. Review guidelines on pain and other symptom management 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 Competence Review policies along with the competence form including staffing, acuities,

disaster management, etc.

VI 2 Supervise staff Review position descriptions

VI 3 Delegate work fairly and according to skill level and scope of practice

Introduce to all unit staff and describe their job responsibilities 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 consideration for age,

culture, educational background and home environment or setting

Review teaching principles and local culture and resources

VII 2 Provide education to complete a successful patient discharge per policy

Identify community resources for the patient Review discharge policy and procedures (pharmacy, standardized teaching

materials, etc.)

VII 3 Coordinate education to ensure the patient gets a consistent message

Review standards for patient education

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


RN Competency Form: GeneralistLEARNER GUIDE: Reference content in the right-hand column that needs review.VIII 1 Identify care issues within the rural environment Discuss general rural care issues & those specific to each rural 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 2 Provide nursing care that is evidence based Review computer/library resources, local experts and classes

VIII 3 Use all computer systems successfully Obtain computer systems training

VIII 4 Accept teaching, coaching and mentoring to improve competence

VIII 5 Seek continued learning opportunities to improve practice

Review resources available for learning

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.


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