Delphi Study – Core Components of Competency Based ...



Delphi Study – Core Components of Competency Based Transition ProgramQuestions and recommendations made for modification or exclusion of program elements DATE \@ "M/d/yyyy" 4/6/2018Comments highlighted in yellow followed a recommendation of “Exclude”. All other selections of “Exclude” offered no recommendation or rationale for why to exclude the element. Elements related to Critical Thinking Question 7 - 1. Competency validation tool addresses elements of professional practice at various experiential levels, as based on role and clinical setting.Examples: To include, but not be limited to critical thinking, clinical judgement,?ethics, human caring, relationships, confidentiality, communication, leadership, etc.Recommendationsbeginner, novice, expert levels depending on experienceUnderstanding of human behavior and how to influence change - Human Factors vs. Human CaringSelf-careAdd additional information about EthicsThese elements must be present in the incumbent nursing staff first. Focus on developing them before the new nurse to attain a desired culture Based on job role and clinical settingConsider modification to clinical judgment (rather than critical thinking); add communication and safetyDefine these elements. A novice may be exposed to this but not really know what it is. I often ask if they know the difference between wisdom and knowledge.This should be an ongoing development; components could be built into competency but should not be a large focus of any competency checklist.Question 8 - 2. Incorporate strategic planning for critical thinking development Example: Engaging new hire with reflective learning, case scenarios, documentation tools, discussion, periodic meetings and/or problem solvingRecommendations?I have seen many nurses struggle with the development of critical thinking skills and I believe this would be a highly beneficial tool to add into the preceptorshipmight exclude weekly meetings - they are hard to accomplish - unless they were very short nuggets of time, \Limit excessive repetitive documentationStrategic guidance for a Ready Medical Force is less meetings, more focus on elements of readiness; modify to bimonthly or monthlysupport group, with monthly classes and cohort building around Core CompetenciesWeekly may be too often depending how many nurses you would be meeting with.Suggest multidisciplinary collaboration and the use of simulationMeetings may progress to being less frequent that weekly, particularly with specialty orientations which are longer in length.Biweekly meeting/monthly meetingsConsider student level when contemplating learning strategiesThere is no evidence base for frequency of meetings and in my experience weekly is too frequent and rarely attainable. Preceptor and guided clinical experience is the best of “critical thinking”. How do you define and measure it?Orientation competency or during nursing internshipsConcept Mapping, reflectionIf this is a new grad academy great but, if the RN is working the floor then I think short weekly meetings to discuss something they encountered at work would be sufficient.Consider addition of narrative reflection, simulationweekly meeting might difficultWhat time would be allotted for this during an orientation? Would each encounter be a different focus? Great idea on a quarterly basis - and some mandates for completing.Keeping this at beginning of orientation to the topic/area. Time does not always allow for ongoing meetings/class timeQuestion 9 - 3. The competency framework and tools clarify individual accountability for clinical practice and knowledge base as a professional nurse.Example: Accountability is an essential component of professional nursing practice and patient safety. The American Nurses Association Code of Ethics states that the definition of accountability is “to be answerable to oneself and others for one's own actions.” Accountability includes specialty specific implications as published. RecommendationsGREAT you mentioned ANA code of ethics--need to be included as reminder for both preceptor and transition nurseInclude the "how" to hold accountable for novice leadersMaybe a more clinical scenario or example?Nurses have had in school - just insert reference and incorporate as teachingIf there is an adapted code of ethics based on specialty area, would include that as well. For instance, AORN has developed perioperative implications for ANA code of ethics. Most nurses feel it is "education" that is responsible for this. It is important to emphasize accountability to one's own practiceIncorporate individual clinical performance peer review as part of competency possiblyIndividual accountability may different from professional accountability as related to nursing.May be a difficult concept for a novice nurse. The wording would need to be very cleat with explanation and examples.I believe this is part of curriculum during school Would emphasize that the orientee is practicing under own license and not that of the preceptor.Would give them examples.Discuss this and then have leadership stress on the jobQuestion 10 - 4. The competency framework is designed to identify early those who are not suited to the specialty, who might pose a threat to patient safety, or who show accelerated performance. Example: those unable to manage the complexity within a certain specialty or one who will not acknowledge the limits of their knowledge or capability. RecommendationsNot sure - it just is not very clear to me what this meansinclude how to approach a fellow nurse who engages in these activitiesInclude not just a mechanism for early identification but an action plan with specific, measurable and time-specific objectives. Include preceptor, charge person, and manager in development of plan. And what would that mechanism be?Using just culture grids, and a standardized evaluation tool. Non biasedInclude unbiased audit/review of personal performance on random tasks/documentation that involves safety activities I was slow to catch on as a new grad; I would have been very disappointed to be labeled as failing to thrive. Each person learns at their own pace and own way. Meetings with preceptors should identify dangerous RNs. This is very important for the preceptor as many are hesitant to document how badly someone is doing. Methods need to be presented to help them with this type of documentation.Unsure who this education is for. Would like for managers to receive this education, or for those assisting with the orientation process.Question 11 - 5. The competency framework exists within a system that accommodates various learning styles and progressive development of work organization skillsRecommendations?vary preceptor as needed to allow different learning stylesIdentifying a learning style early on and focusing on it sometimes leads to limiting different learning opportunities, incorporating various learning styles instead of accommodating all styles allows for learners to build knowledge from several different styles to increase the depth of their knowledge and evolve their learning style based on new experiences. More information on how to incorporate this in practiceThis statement goes to a good match between the orientee and preceptor, and changing preceptors at time to offer their varied puter skills, basic and then a class or perhaps workshops how to incorporate all the new changes in care and documentation. Using multiple learning methods in approaches, yes; defining those as VARK-- no. Learning style and work organization seem to be two different principles.We utilize a learning styles assessment for all new hires so that the preceptor can be sure to teach in such a way that the orientee will have a higher probability to be successful.Preceptor should be aware of learning stylesThis would be best if presented to preceptors so that they can better assist the new hire in learning their roleQuestion 12 - 6. The transition or competency framework includes systems to ensure safe care and supervision of learners. ?RecommendationsBuilding systems is not an expected outcome of entry into practice transition programs, or should not be. If we spent as much time developing our incumbent nurses as we did our residents we would be further ahead.Collaborate with EMR informatics team to permit documentation critical thinking and alertsWe are already overwhelmed by EHR systems to ensure safe care. This is accountability.Built into system where they would workQuestion 13 - 7. Focus on the manner in which ‘care delivery’ occurs Example: views patient as a whole instead of targeting?tasks,?body systems, equipment or health problems as the focus of the toolRecommendationsNurses need to be aware of the environment in which they are giving care.... it is not always friendlyincorporate both overall picture as well as some specific tasks or body systems viewed individually to reinforce and work on detailsuses effective strategies to incorporate possible tasks, equipment, body system or health problems to provide holistic careInclude patient-reported outcomes in evaluation of success of meeting care deliver objectivesAbility to complete usual assignment for assigned unit, and function as team member on the unit. What are the organization’s expectations? Meeting length of stay targets. Tasks, body systems, equipment and health problems ate the building blocks to getting to the whole of the experience and must be accomplished. Care delivery must include transitioning from hospital to home, nursing home, SNIF, etc.Modifications MUST address generational differencesThis subject would depend, I believe on what degree program the RN went through. If BSN, they should have already learned these concepts in Nursing Theory. I don't believe that more "school" is the answer to transitioning to practice. Some high-risk skills may be necessary to identify separately (in addition to) from the more general whole patient approachGreat with simulation labElements related to Theoretical Evidence BaseQuestion 14 - 1. Apply the concept of sampling to determine what content is required within orientation Example: Validates sample set of performance to extrapolate overall competence - as NCLEX exam doesRecommendationsleave room for exceptions - sometimes more is neededA sampling of patient situation and possible solutions and outcomes?validates performance on those items identified as priorities or serious safety concernsWould have to be unit/specialty specific and may have to be individualized based on patient/acuity mix and experience of provider. . NCLEX already does this.More information on sampling, current curriculum is fairly vagueWork performance requires ability to successfully complete a defined set of actions. There is no evidence about what an adequate sample would be for a defined job.Include more soft skill and critical thinking skillsAfter research and development to identify appropriate sampling strategies; would need to be different for each specialty areaWe have used PBDS and Prophecy in the past and it seems that, sooner or later, the results begin to get "watered down" by workarounds.Perhaps for the unit specific orientation, but I believe all staff should receive the same key elementsClarify the description. I think you are talking about competency-based orientation, but it's not clear from the statement.Not sure how you would obtain this information since orientation is not set up like NCLEX examsdo not know what this meansQuestion 15 - 2.?Engage reflective practice and reflective learning? Example: Includes specific questions, time, tools, planning for reflective learning and critical thinking developmentRecommendationsMust have time set aside for this. must have support of leadership to allow preceptor to choose assignment based on preceptee's needsJournalingThis would need to be included considering the time restrictions that we have in the acute care setting. Should be included as part of actual patient experience and assignments, not so much in classroomYes, Already did this type of assignment while doing clinical rotations? This could be individualized per RN. If RN is struggling then this could be a job aide.Build time into schedule to allow for thisInclude for new Nurses (graduate nurses) but not necessary for transitioning nurses to new practice setting.Reflection can be very brief at the end of learning opportunities and should not be separate learning tool.During beginning of training when learning is at its most abundantQuestion 16 - 3. Prioritize equipment, skills and procedural competence using a comprehensive checklistRecommendationsIf the comprehensive checklist has the skill or task combined as the whole skill. Like if it is on obtaining a EKG, then the list has understanding and interpreting the EKG, not a step by step guide on how to place the leads, get the equipment, run the EKG, remove leads, put on chart. That the nurse is using critical thinking skills and understands it is more like interpreting the EKG, what to do and follow-up.often, people use text book verbs "verbalizes understanding, demonstrates..." when step by step, #1 do this, #2 do this and so on helps maintain focus and simplifies. Also, skills/procedure check lists should never say: Needs to Improve. The person is not validated until they do it correctly. Allow practice if need be but the old "needs to improve" and list of blanks the preceptor or validator must sign sets up for what we call zip lines and frustrations. Sure, give them the steps but each step should not be a check off like they encountered in school. critical components only- Such as a checklist with a return demoInclude all 3 components of competency with this-knowledge/skills/attitudes and judgement, not just psychomotor part.Standardized skill guidelines not checklistThis would totally depend on the skillI struggle with the word "prioritize." Perhaps "include?"If the skills are high-risk and are expected to be performed independently upon completion of orientation period; yes.While some type of checklist is needed to show competence on equipment, it is also important that the orientee know when to utilize these components. Some type of marriage between the two is needed.unit based to allow time to learn the necessary skillsThis seems inconsistent with the statement in the previous set that talked about focusing on the overall manner of care delivery. Also, checklists can be overused. I would shy away from stating categorically that a comprehensive checklist must be used and that procedures and equipment must be prioritized. That notwithstanding, procedures and skills are important and checklists can be valuable tools when used within proper limits.Build checklist off of procedure/policy/critical thinkingQuestion 17 - 4. ?Present both initial and ongoing performance expectations within the orientation or competency validation tool?RecommendationsInitial performance expectations are daunting enoughshould be online, should be standard across the networks, If concept-based, this may work; if not, the two categories may need to be separated. For record-keeping, the initial may be less expensive than the ongoing, perhaps?Initial performance expectations need to be covered with the ongoing expectations being covered later in orientation. Otherwise it is too much information for them to take in. Question 18 - 5. Ensure that competency criteria are written in a patient centered mannerRecommendationsadditionally addressing the learning needs of the orienteepatient & family centered and team-centeredNot sure what this means. This is artificial. Equipment is equipment. Include professionalism criteria Competency should be based solely on the performance of the RN and should be clear. Policies are written in a patient centered manner. Patient and family centered (in the case of pediatrics)Perhaps this should be nurse-centered in his/her ability to have the KSA to care for a population of patients. Communication, safety, leadership, advocacy, etc. isn't just to patients, but members of the care team.I think competency verification should be completed in a nurse-centered manner. Patient care should be delivered in a patient-centered manner.Question 19 - 6.Ensure that the model and tools adhere to the?principals of adult learningRecommendationspreceptors need education and time for learning especially during first few times they are a preceptor Principles!Does performance in the workplace adhere to the principles of adult learning? Vary the methodology Include generational differences; nurses from other culture learning styleprinciples, not principalsBut don't make it obvious to the user.Question 20 - 7. Provide clear and measurable competency criteria?RecommendationsThis is so important. Criterial should be objective rather than subjective. Although this is much more difficult than it soundsExtremely importantPreceptorship Delivery Model Question 21 - 1. ?Include an effective delivery system within program structureExample: Trained and prepared preceptors; classroom or simulation components; policy defining process/roles; etc.?RecommendationsCurrently use and would continue to use VNIPSometimes, the "best" nurses make the worst preceptors. Preceptors need to allow and encourage orientee’s to think things through, and to actually take care of the patients. Some of the best preceptors I have ever worked with were nurses who had successful raised teenagers, and perhaps taught them to drive. Support of administration is critical for success of onboarding-suggest this be added.What evidence that these elements do actually impact outcomes?This is a wonderful concept but, not always practical due to budgetary constraints. I agree with the statement, but the wording seems vague. How do you know the delivery system is effective? What makes it effective? Consider changing "effective delivery system" to "evidence-based delivery system".Currently our structure is not effective and we have gaps in the level of competency of nurses because of the lack of structure. Clear time should be allotted for both preceptor/preceptee to validate competencies.Question 22 - 2. ?Focus on the preceptor’s crucial role of collecting evidence of clinical performance capability RecommendationsNot sure how this is accomplished aside from using skills validation checklist and/or observed measures of performance? What is defined as evidence?It should be focused on the preceptee. But on the preceptor end, there needs to be an evaluation to ensure that each preceptor is teaching the same information, on the same page so that each preceptee gains the same knowledge from all the preceptors.Yes, but the preceptor is also teaching/coaching on the institutions policies and procedures. They are building relationships with the new associates. Not collecting evidence. That sounds like a detective. Not sure that bedside preceptors have the capabilityPreceptor AND Clinical Trainers Meet with the preceptors regularly to get their input on the orienteeGive them some help, please. e.g., comparative statements that help preceptors elucidate their evidence of the orientee’s capabilityShould be reviewed with the NPDSPreceptor class would need to be updatedAscertain the preceptor is qualified to objectively collect dataI believe that preceptors should be trained and held accountable for performance but, ultimately, the new RN needs to be responsible for their own practice and clinical performance. This "evidence" would need to be clearly defined. I'm not sure I understand the intent of this statement.Preceptor validation and other team member validationWhile this is an important component for the preceptor, there also needs to be the role of teaching and being a guide for the orientee.This is certainly part of the preceptor's role, but not a major focus area.This should be a focus and I would purport if you allot time for the preceptor to be a preceptor aside from daily work/tasks this item would be met.Question 23 - 3. Emphasize appropriate assignment, appropriate supervision provided by the preceptor?RecommendationsSome preceptors feel that they need to tackle the worst patient on the unit with the preceptee which may not be the best choice for the preceptee to start with. Build on the foundation and then tackle the larger assignment.assistance from all nurses and OICs to allow, encourage the preceptor to make assignments so the preceptee is getting the experience they need to show there competency in specific areasUnit managers, Clinical Trainers, Charge RNs, and Preceptors should be given a guideline to follow and be held accountable for inappropriate assignments continued training for preceptors beyond basic workshophow to advocate for preceptee when the nursing model does not allow/or if there is pushback for when assignment/supervision is not appropriateThe orientee cares for the patients, the preceptor is there to guide and teach the orientee. No preceptor should be in charge while precepting. Except for perhaps the first day of orientation, the orientee/preceptor pair should care for a NORMAL patient care load. How is the orientee to learn time management skills if she is only caring for one pt. at a time, when that is not the normal pt. load?more information about how to overcome time restraints while teaching and caring for patientspreceptor classBe sure to emphasize the need for the preceptor/orientee team is counted as one person and not separate them because "we are busy".Question 24 - 4. Define process for protection of patient while supporting experiential learning?RecommendationsAlso Pt information.Not sure about this, what is an example of how you would define that process? It seems inherent in the preceptor experience.This should be identified in facility procedure. The competency should reference policy/procedureQuestion 25 - 5. Integrate formative feedback in an ongoing mannerExample: Formative assessment gathers feedback that can be used by the educator and learner to guide improvements in the ongoing teaching, learning and practice context?RecommendationsThe educator has to be actively "engaged" in the process, not hand out a paper or say look it up on the internet.Suggested timeline and how to provide constructive feedbackNeed to be more specific in what is meant by thisallow time in the orientationI believe in gathering feedback but, this must be done in a way to avoid any shaming or appearance of bullying. Question 26 - 6. Develop preceptor role and capabilities?Recommendationsthis area needs a lot of time and not all nurses should be involved as preceptors, their evaluation process may need to change as precepting is an area in their evaluationAbsolutely! Many do not have adult education concepts nor generational understanding for positive outcomes and collaborationInclude regular preceptor informational meetings/updates/ training to improve outcomes. Standardizing the preceptor/orientation program would be helpful so all preceptors are on the same page Mandatory education for preceptors annuallyEspecially tools for giving constructive feedback. YESShould be competency basedRole and responsibilities classEither through career ladder or by well-defined preceptor orientation program; would be for preceptor competencyQuestion 27 - 7. Ensure feedback and ongoing development for preceptors?RecommendationsDevelop a standardized protocol for preceptors, if criteria is not met, hold preceptor accountable as well as orientee- both can learn from the process and it would help growth and development of both as professionals Include supportToolStandardization and/or Customization of Model and Elements Question 28 - 1. Be adaptable for use within the full continuum of care?RecommendationsIt would be good to have a competency program that is standardized for overall healthcare, then more specific/adaptable for unit or departmental needs (med/surg vs psych)There are too many distinct differences on onboarding new staff to different areas. Focusing more on the aspects relevant to the new position will allow for greater success than adapting the same program to different areas that may not seem as relevant to a new learner. The full continuum of care requires many different competencies. This is not school, focus should be on competencies required for role. This is a dissatisfier for participants in my experience. This is a fine goal, but not strictly necessary for a great onboarding program. Needs to be flexible to allow for adaptation for OR, Ambulatory, and Home Health settingsQuestion 29 - 2. Be consistent and standardized across the organization from unit to unitRecommendationsThere should be a baseline of standardized knowledge, but this needs to be modified when addressing nursing specialties.with a section that allows for unit specific competencies/policiesSir - not sure if this is what you are asking - but I hate things like WMSNI that try to standardize things that don’t really fit specialty areas - i.e. critical standardized to med surg - I would prefer standardized across MEDCOM to like areas/specialtiesAlthough consistent and standardized, specific enough to capture the critical elements of the specific unitStandardized to a degree; each unit will have specific requirementsvery different caregiving opportunities and expectationsStandardize things such as required documentation, bedside handoff, shift change report, change RN procedures such as assigning patient assignments, admissions etc. Each unit or specialty will have different expectations of new staff related to competence at the end of orientation, many times related to the level of support available to the new staff person upon completion of orientation realizing that onboarding doesn't end at the end of orientation. Less support after orientation= higher expectations at the end of orientation. Unit specific competencies differences between pediatric & adult patients; between critical care versus medsurg floor units or even between units neuro specific versus transplant or GUnot sure what this meansYes, but may need further competencies for each specialty area....ED, Critical Care, OB, etc.Standardized but allow for unit/specialty specific needs. Foundational core yes-but then needs to be individualized to specific unit. For instance, orientation for new nurse to OR is ideally 6-9 months; for med surg it may be much shorter. As appropriate. All units are not the same. Have addendum for unit specificity Specialty units will need additional competency which may not be standardized across the organization (i.e.: transplant unit, neuro unit)Specialty areas tend to suffer when competency programs are so standardized to med/surg. Different areas require longer orientations such as; L&D.The main framework and concepts could be, but skills/procedures, case studies, specifics would need to be individualized.Some basic foundational principles, yes; additional requirements based on unit of hiresome specialties will be different ICU, OB, NICU, MedicalYou would need to add additional job specific elements This should happen as much as possible while being mindful of areas such as the ED and OR.Yes, but obviously some nurses will require different skills for different departments such as Birth Center.Certain areas may need some modification as the work flow is different i.e. acute care vs post-acute careNeeds to be flexible to allow for adaptation for OR, Ambulatory, and Home Health settingsMight have additional topics for specialty areasAs much as possible. In small facilities consistency may not always be possibleQuestion 30 - 3. Adapt to changes in environment, regulations, or agency practice issues?Recommendationsshould be part of the standardized plan as a "what if" section with input from frontline staff and managers to openly discuss required regulations and how they can be integrated into bedside care without overloading the bedside nurses How?Need to be careful not to include too many regulations or agency practice issues. General national regulations and agency practices need to be shared.Question 31 - 4. Be customizable to various disciplines/educational levels/ individuals/ agenciesRecommendationsAble to integrate & collaborate with various....Gear towards new nurses or nurses new to the certain area of practice.Again, identify what everyone should be able to know/do. Scope of practice will need to be taken into account. The greatest issue I have with current residency programs is that they are not customizable. I think it should be nursing specific and based on the ANA scope & standards of care/code of ethics, BUT customizable to various educational levels (new grad vs experienced nurse) and settings (inpatient vs outpatient, etc.)It should be mildly customizable to an area of practice or disciplines. I disagree with it being customizable to an individual or agency - everyone is held to the same standard within a discipline.It cannot be too specific but should be focused on RNs. Educational Level of RN is really not important here. With the exception of NPs, all RNs in our organization go through the same type of orientation process.Question 32 - 5. Outline knowledge content for all new hires that is standardized within each specialty?RecommendationsHave realistic expectations about timelines for getting online projects completed. MAKE SURE to check on these and incorporate the content into daily practice when appropriate.How would you measure knowledge?This would make it non-generalizable to different areas. Either the goal should be generalizability (it could have a space that says "knowledge content" that is specified by each specialty) or it is specific to a specialty. I would prefer a "fill in the blank" with evidence-based guidance for setting standards for each specialty area.The statement is unclear. I'm not entirely sure what is meant by this. This is going to get very complicated. This would be a great option to work on after the larger project. Question 33 - 6. Provide comprehensive goal statements where individual subtasks are inherent to achieving the stated goal.? Example: Determine lethal vs non-lethal cardiac rhythms on patient presenting with chest pain.?? In this case, applying the monitor leads, attaching the correct wires, turning on the monitor, running a strip and accurate reading of the ECG are all inherent to determining the critical nature of the cardiac rhythmRecommendationsI believe the preceptor needs a prompt related to what all they need to look for even though it would be implied - some take it for granted when it isn't spelled outMay need to spell out the components e.g. the performing of the test versus the interpretation of the resultReading a strip can take a while to learn could add that it must be read by person competent to read lethal vs non-lethal rhythmsActually, they aren’t in the example. And this approach seems overly complicated. Use measurable outcomes instead of goals (per latest information from Association for Nurse Professional Development (ANPD) Program Documents and Process Question 34 - 1. Present performance criteria in the manner in which care is provided?RecommendationsIf this is what is being used as evidence of capability as referenced in a previous questionNot quite sure what you mean by this statement.Again, not sure what this means.Not sure what this meansUnclear of intentNot sure what this statement means/ example please?Please provide an example.Question 35 - 2. Focus on clear, concrete, and concise performance statements? Example: Provides templates for policies and procedures involved in model?RecommendationsMay have to be customized to the military treatment facility environmentwith positive focus of what should be improved and how that will be accomplishedInclude professional guidelines, recommendations, regulatory/accrediting requirements, and EBP as rationale for actionsInstitutions will likely already have templates for policies and procedures. I would have agreed with the statement, but the example does not seem to relate. It seems that the orientee needs to know where the resources are and how to access them rather than have them provided.Question 36 - 3. Establishes systems for?clear communication among new hires, preceptors, facilitators and leadership?RecommendationsProvide information on chain of command, sentinel events, risk mitigation, and developing a culture of safetyCommunication needs to be flexible, and frequently the systems developed are not actually attainable. Some kind of weekly report will help with assignments, ill calls when preceptors are out, etc.Include timeline in communication planand co-workers (both licensed and unlicensed)Question 37 - 4. Include clear directions and scoring key at the start of every set of pages?RecommendationsThis is not the clearest statement.Scoring key?Does this mean scoring key on every page? In the footnote or header?Provide a place for signatures and comments by both orientee and preceptorNot sure what this means...Again, accountability of the new RN to ask questions if they don't understand. Sometimes, the baby birds need to fly. We can't lead them completely. Developing critical thinking skills also includes orientation competency. May not need to be on every set of pages; depends on how complex the scoring/directions are.Clear directions are needed; hard for me to provide feedback on this one as an example was not provided.Question 385. ?Require minimal administrative work burden to complete documentationExample: easy to read and navigate for all users?Recommendationsprovide time during preceptorship to complete the administrative work without being hurried or rushed through itDefine furtherYES!!!Please!Provide secure place, whether documentation is electronic or paper, to store this informationIdentify process, tracking, storage of filesElectronic!!!Question 39 - 6. Provide systems and tools for program and outcomes evaluation?RecommendationsWhat's the system/process for evaluation failure? This should be in the overall process/procedure and not necessarily individual competency Comments and suggestions: Please list any items you would like to add for consideration?Core competency is critical to successful nursing performance. What the competencies are and how they are best measured is where things get tricky. It’s important to be able to test a nurse's knowledge of a given subject and/or procedure etc., but it’s also very important to develop the "art" of nursing. When you break things down to little sections/elements it’s easy to lose sight of the whole. Great nursing care requires the ability to link the bio-psycho-social elements together. Provide a checklist for discussion and/or small competency tool for floating to other units in the hospital - to ensure new hires know realistic expectations and what to expect when performing care on a different unit that may have different practices than our own.Nothing at the momentbuy-in from all staff nurses as well as management is neededWould like to see some online modules for preceptor preparation to make this a hybrid programclear expectations from organizations on how often competency is to be validated with the same toolSTRONGLY suggest a program such as PBDS to help identify orientee needs and strong points from the start. Make sure there is leadership buy-in for all areas of Ed program. Charge nurses should not be preceptors, at least not on the same day that she is precepting. I highly encourage development and rewarding of preceptors, most especially those who are effective in their efforts. Having an orientee who does not do well in a particular unit should not be viewed as a failure of either orientee or preceptor. The orientee might be a better fit on another unit. On the other hand "just one more month/week/whatever" of orientations for a newly hired RN is probably not going to change anything in her performance. Orientation length should be flexible, but have a minimum required number of days/hours/whatever. Just because a unit is busy is not a valid reason to move an orientee off orientation. Management support of education timelines, goals, and methods is absolutely necessary.I believe I have covered everything in the previous pages that I would want considered. Thank you for the opportunity to participate in this survey. Structure also needs to include appropriate assignments for the new hire/preceptor. Environmental considerations need to address incivility in the workplace that may be directed toward new hire. Nursing leadership also needs to be educated on the expectations of a competency program and their role responsibilities in attaining positive outcomes. Opportunity for new staff to vent and share trials and joys of starting a new job.More information on transition shock and overcoming nurse burnoutInclude projected expected timeline for attaining competency to perform job based on previous experience. Additional components may be required to accommodate health systems that have a number of facilities in a specified region(s) and have various level of care; i.e. stroke certification at one hospital, major cardiovascular surgery at other hospital, etc. System for promoting professional growth (resources, professional organizations, conference attendances)Provide guidance for remediation of skills, competency or critical thinking. Everything was covered except staffing considerations/adjustments. The competency would either provide for formal "staff exchange" while competencies are being performed, OR (I believe) a better way would be to encourage staff to act on opportunities to demonstrate competency to preceptor as they arise, on an ongoing basis. Then, staff member and preceptor would ensure clarity of the process before demonstrating and thereby being validated, with patients.Maybe question about providing time for teaching, outside of clinical time. As an example, if the schedule is for three 12-hour shifts, there is four hours available before OT is reached. This could a time to meet out of staffing in order to have time to teach.Consider adding an item on assertive communication/lateral violence. Consider adding a component about clarifying role of manager vs role of preceptor vs role of educator/NPD. Consider adding something about a standardized orientation calendar with desired milestones to be met each week.Due to low staffing, the preceptor does not have the time to devote to the orientation program.Nurse Residency Programs enhance components of a competency program and I did not see questions related to ongoing transition management for the first year. ................
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