Competency Days Help Ensure Nursing Knowledge

Planning
It took a full year of planning before Saint Francis piloted the fair. It was extremely well received by staff members, says Morris, giving them a full eight-hour day away from patients to focus on education.

The first question, of course, was how to get nurses away from the bedside and still maintain patient safety.

"Initially, we had to get permission to get staff in off their scheduled hours," says Morris.

They looked at the number of employees, how many employees they could manage in a given day's fair, and how many fairs they could manage in a year. Staff was responsible for signing up.

They also figured out how to make sure employees showed up to the competency day.

"I think one of the drivers of our success is that in the last couple of years, attendance has become an enforced expectation," says Siddell.

Prior opportunities for education were offered and staff members were supposed to attend, but there really were no repercussions if they skipped out. Starting in 2008, however, if staff did not attend the mandatory session, it affected their ability to get their annual raises on time. The impetus behind this was tied to The Joint Commission's requirement for annual competency testing of staff, says Siddell.

Who's involved
As previously discussed, over the past few years, there has been an evolution in the nursing shared governance structure at Saint Francis. When the competency day program began, the education department was a more collaborative practice of clinical nurse specialists, says Siddell. They had direct care consultants as advanced practice RNs (APRN), but they were also responsible for unit-based education.

When a new CNO arrived in 2006, she mandated structural changes—one of these being a requirement that nursing education become a collaborative process with nurse educators and clinical nurse specialists to support the new shared governance structure.

"We were looking at the way the nursing council worked," says Siddell. "This new approach had to be vetted by our nursing management council, and some discussions were had with human resources and also at the director level to drive down accountability and make sure staff were attending. It was a cultural shift for us."

Structure
All nurses come through the competency day at some point during the year. They are scheduled away from their work area.

"We house it all in the educational department," says Kathy Urban, RN, MSN, nurse educator at Saint Francis. "The educators are responsible for different stations."

Aside from a pacemaker company that Saint Francis requested send a representative for competency education, all other stations are managed in-house, says Urban.

"One of the things Kathy did that was very successful was create a steering committee of nurse educators," says Siddell. "We've had to go back to Joint Commission requirements looking at high-risk/high-frequency, high-risk/low-frequency types of activities. We've worked with colleagues to come up with standard templates for each [education] area."

They have also looked at key skill areas and knowledge bases for various groups—critical care, for example, has competency requirements that look different from behavioral health, which are different from women and children, and so on.