this topic highlights the competencies and implementation of competencies system for nurses in clinical services

1. Competencies in Nursing
Practices
By
Rehmat Ullah
Nursing Director MTI Khyber Teaching
Hospital, Peshawar

2. Definition
• The word competency is derived from the
Middle French and Latin word competens.
– To be competent is to be proper or rightly pertinent,
to have requisite or adequate ability or qualities,
– to be legally qualified or adequate, or to have the
capacity to function or develop in a particular way
(Merriam-Webster Online, n.d.).

3. Competencies
• “The skills & abilities to practice safely &
effectively without the need for direct
supervision” Rutowski (2007).
• “The combination of skills, knowledge, attitudes,
values and abilities that underpin effective
performance as a nurse” Nursing Council of New Zealand,
(2008a).
• “The ability to perform the task with desirable
outcomes under the varied circumstances of the
real world” Benner (1984)

4. Competency Management
• A systematic approach that an organisation
takes to ensure its collective competence
covering the assessment and training of
current employees as well as in recruitment
and succession planning.

5. Competency Management
• Should be supported by a Competency Framework
which typically consists of three levels;
1. Competency categories
2. Competency groupings within each category
3. Specific competencies & is where the performance
criteria are identified

6. Competency Framework
• Should reflect institutional & departmental objectives
• Where the two tier competency categories include;
– Human Factors then
– The second tier groups are likely to include:
1. Communication skills
2. People management
3. Customer service skills
4. Team skills
5. Leadership/ decision making skills
6. Problem solving
7. Performance management
8. Technical skills

7. ENTRY-TO-PRACTICE COMPETENCY
• The conceptual framework organizes the
competencies in five categories:
– Professional responsibility and accountability
– Knowledge-based practice
– Ethical practice
– Service to the public
– Self-regulation

8. Models of Competencies
• Dreyfus and Dreyfus (1979, 1980) Model,
– five stages of competence include,
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

9. Factors that influence competence
• Critical thinking…. to think about a subject,
situation, or project accurately and clearly, as well as
deeply and broadly, in order to learn about the care
requirements of that person
• Reflective practices

10. 10
Competence
Involves Responsibility:
Responsible to self, patient, employer,
profession (for example, following
policies and procedures)
and Accountability:
Accountable to the Council, employer,
profession (i.e. adhering to the regulations)

11. 11
Demonstration of Competency
• Experience
• On the job training
• On-going education
• Attendance at educational session
• Formal course work

12. Exceptions
• All the nurses must;
– Practice with confidence according to The PNC code of
ethics, practice in a holistic, non-judgmental, caring and
sensitive manner that avoids assumptions, supports social
inclusion; recognises and respects individual choice; and
acknowledges diversity.
– Use up-to-date knowledge and evidence to assess, plan,
deliver and evaluate care, communicate findings, influence
change and promote health and best practice.
– Work effectively across professional and agency
boundaries, actively involving and respecting others’
contributions to integrated person-centered care.
– Build partnerships and therapeutic relationships through
safe, effective and non- discriminatory communication.

13. Areas of Assessment
• Knowledge…..workshop attendance & Results
• Skills….Assessment of Skills at patient bed
side…. Procedure assessment
• Attitude…. Communication and Empathetic
approach

14. Assessors
• Nurse Manager ---- Block Nursing Manager/ Supervisors/ ICN,
NRM, ISC and other specialized roles
• Head Nurse…..
• AHN/Acting Supervisor….

15. LISTING COMPETENCIES (BOOKLET)
• Enable the skills & knowledge needed to
perform certain roles and tasks to be
identified
• This should follow a three step process
covering:
1. The identification of the competencies needed
for a role or task
2. A performance standard for each competency
3. Assessment of the role holder (Nurse)

16. COMPETENCIES BOOKLET
Nurse’s Name: _____________________________ Employee Code #: ____________ Department: ________________
Competencies Date Assessed Standard Grade Assessor Remarks
To be able to provide education to patient’s and
attendants regarding: Health, Safety, Treatment & Side
– Effects
 Pre-op & post-op education
 Post-up Exercises / Ambulation
 Pre & post- Blood Transfusion
 Moving & Handling Techniques
To ensure that patient’s & attendants are provided with
a safe environment:
 Fire Regulation
 Basic Cardiac Life Support
 Awareness
 Handling & Sharps Disposal
 Bed Making
 Hygiene

17. Competency Scoring System
Level of Achievement Standard Grade
Cannot perform the activities satisfactorily to
participate in the clinical environment
Unsatisfactory 1
Can perform the activities satisfactorily without
assistance and / or supervision
Competent 2
Can perform the activities to a more acceptable level
with initiative and adaptability, and can lead others in
performing the task
Proficient 3
All nurses in the probation period must achieve Level 2 (Competent)
Thereafter all nurses must achieve Level 3 (Proficient)

18. Criteria for Assessment Evaluation
SR # Critical Steps Standard Grade Assessor Remarks
1
To be able to provide education to patient’s and attendants regarding: Health, Safety, Treatment and Side
effects.
a. Ability to provide correct information and
education regarding pre and post surgical
procedure using the Operating Theatre
pre & post operative checklist
Competent 2 AP
Good knowledge &
communication
a. Ability to provide and demonstrate the
correct method of post surgical exercises.
Evidence based
knowledge
a. Ability to provide post-op respiratory
exercises
a. Ability to mobilize and ambulate the
patient as appropriate or as prescribed by
the Physician
a. Ability to provide information to patient
regarding pre-chemotherapy side effects,
care and when to report any untoward
symptoms such as: redness in cannula
site, pain in cannula site, feeling of
coldness or vertigo during or after IV
Hydration, Antibiotic and Blood
Transfusion
a. Ability to know the correct technique of
moving and handling of patients following
the RMH Manual of Clinical Nursing
Procedure 7th Ed. 2008

19. Areas of Competency- Initial
• Education to patient’s and attendants
• safe environment (Safe Patient Care)
• Comprehensive Nursing Assessment
• vital sings, its significance & documentation
• Nursing Care Plans & Its Implementation
• Work in a team with the Multidisciplinary
Team Members
• Routine Nursing Care of Patient

20. Areas of Competency- Renewal
• Education to patient’s and attendants
• safe environment (Safe Patient Care)
• Comprehensive Nursing Assessment
• vital sings, its significance & documentation
• Nursing Care Plans & Its Implementation
• Work in a team with the Multidisciplinary
Team Members
• Routine Nursing Care of Patient

21. Other Relevant areas
• Workshop Attended During The Year
– Workshop related competency must need
workshop attendance, then skills & Attitude
assessment at bed side.
• Sedation Management
– Special session/workshop for OT, critical care, &
Casualty staff and Inpatient staff who meet the
criteria
• Sedation Training / Competency /
Credentialing Guidelines

22. Sedation Training / Competency /
Credentialing Guidelines
• 1st Step
– All Nurse Managers and Head nurse/Acting NS.
– Pass the Assessments (Theory and Practice)
• 2nd Step
– All Registered Nurses must complete as above
– The Sedation Module will be within the Basic Pharmacology
Workshop A
• *3rd Step
– Registered Nurses in the below areas must meet the following
criteria to be Credentialed to monitor patients receiving
Moderate or Deep Sedation;
– Minimum 3 years’ experience as a Staff Nurse
– Competency in BCLS and ACLS