Nursing Practice: Demonstrating Continuing Competency - Protecting the Public

Continuing Competency Overview Chuck Cumiskey, BSN, MBA RN Nursing Practice Advisor, Nursing Care Quality Assurance Commission February 1, 2011

On completion, you will be able to: Identify the purpose of continuing competency requirements for all registered and licensed practical nurses in Washington State. Define the requirements for active practice and continuing education to maintain an active registered and licensed practical nursing license in Washington State. Explain active practice and acceptable documentation of active practice requirements. List and describe options available to nurses not meeting active practice requirements: inactive license, expired license, and approved refresher courses. Describe the audit process and how to meet audit requirements. Describe technical assistance available to nurses not meeting continuing competency requirements. Describe the timeline of events implementing the continuing competency requirements and how this timeline will impacts licensure renewal. Explain continuing competency requirements to coworkers, supervisors, human resource personnel, and colleagues. Refer coworker, supervisors, human resource personnel, and colleagues to the Nursing Care Quality Assurance Commission’s Website with resources and frequently asked questions on continuing competency.

Continuing competency requirements for all RNs and LPNs in Washington State. It is the purpose of the NCQAC to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline. (RCW 18.79.010)

Continuing Competency Competency is the ongoing ability of a nurse to maintain, update, and demonstrate sufficient knowledge, skills, judgment, and qualifications necessary to practice safely and ethically in a designed role and setting in accordance with the scope of nursing practice. WAC 246-840-202(3)

Continuing Competency Continuing competency is achieved: Self-directed program that includes: active practice, self assessment and reflection, and continuing nursing education WAC 246-840-202(3)

Active Practice Requirement 531 hours over a three-year review period (paid or unpaid) starting in 2011 on your birthday Wide interpretation of nursing practice Nursing license is required or Nursing knowledge is necessary to do the job Examples CEO of Sisters of Providence SW Washington Service Area Regulatory Nurse or Patient Safety Officer Staff Nurse, Nurse Manager, or Nurse Executive Faculty member Consultant

Options available to nurses not meeting active practice requirements: Inactive license Personal choice to move from active practice Expired license Let your license expire and reactivate within three years; you will be audited and must provide documentation of 177 active practice hours and 15 hours of CE upon renewal. Approved refresher courses required for expired licenses of 3 yr or more: http://www.doh.wa.gov/hsqa/professions/Nursing/document s/refresher.pdf

Refresher Course Requirements Philosophy, purpose, and objectives: Philosophy, purpose, and objectives of the course shall be clearly stated and available in written form. They shall be consistent with the definition of nursing as outlined in chapter 18.79 RCW. Objectives reflecting the philosophy shall be stated in behavioral terms, and describe the capabilities and competencies of the graduate. Faculty: Must hold a current license to practice as a RN in Washington State. Must be qualified academically & professionally for their respective areas of responsibility. Must be qualified to develop and implement the program of study. Must be sufficient in number to achieve the stated program objectives. The maximum faculty to student ratio in the clinical area shall be 1 to 12. Exceptions shall be justified to and approved by the Commission.

Acceptable documentation of active practice requirements W-2 or pay-stub Log book signed by employer Attestation signed by manager WAC 246-840-203 (2) Failure to complete the attestation every 3 years may be grounds to deny the license or place the license on expired status according to WAC 246-12-010 (11)(b) and Chapter 34.05 RCW.

Continuing Education Requirement 45 CE contact hours in 3 years Continuing education hours should relate to the nurse's area of professional practice, or areas identified through self- assessment and reflection for professional growth and development. WAC 246-840-203 (ii) (B)

Audit Process & Audit Requirements The 3-year review period starts on your birthday month in 2011 and you become qualified for audit on your birthday month in 2014 (up to 5% of RNs and LPNs will be audited) Have an accounting system to track, log, & store practice hours worked (paid and unpaid) Have an accounting system to track, log, & store CE hours

The Audit Process Pay fee You will go through the annual renewal process Pay fee Sign attestation stating that you are in compliance with continuing competency rules Starting in 2014, in your birth month after your license has been renewed, the audited nurse will receive a letter from the Commission stating that he/she has been chosen for random audit

Technical assistance available to nurses not meeting continuing competency requirements. Technical assistance will be provided to the audited nurses who do not meet compliance standards Technical assistance includes: mentoring and guidance so that the nurse can comply with the standard

What do I submit if audited? Proof of 531 hours of active practice (paid or unpaid) Proof of 45 CE contact hours You do not submit your self assessment and reflection

Nursing Care Quality Assurance Commission’s Websites: resources and frequently asked questions on continuing competency. http://www.doh.wa.gov/hsqa/professions/Nursing/conti nuecomp.htm http://listserv.wa.gov/cgi-bin/wa?SUBED1=nursing- qac&A=1 Continuing Competency Web-link Tools for tracking hours and CEs Examples of self assessment and reflection tools Links to continuing education offerings Checklist of program essentials as audit preparation

Sample Active Practice Log List: Location of active practice Category of active practice Dates and hours of active practice

CE Log to attest to practice hours List: Continuing Education Topic or Title Category of Continuing Education (class, courses, publications, independent study, mentorship, presentations, specialty certification) Dates and Hours of Continuing Education

Reflection Based on Professional Responsibility Be familiar with current laws and rules relating to the nursing profession. Take responsibility for gaining new knowledge and skills to advance your nursing practice. Participate in professional activities that contribute to your nursing knowledge and skills. Incorporate new knowledge into your practice and evaluate its impact on your nursing practice. Support and help to create an environment in which learning, professional growth, cooperation, and mutual respect can occur. Make patient safety a priority for patients and patient populations. Incorporate patient-specific risk-factors and standardized approaches to reduce the risk of adverse outcomes: fall-reduction programs, “hand-off” communication, and infection control techniques.

Reflection Based on Knowledge-Based Practice Use evidence such as research findings & current standards of practice to base decisions relevant to practice. Encourage active involvement of patients in their own care as a patient safety strategy. Promote effective communication among caregivers; use data gathered from all members of the team to optimize patient outcomes. Promote the assessment of education needs of patients & families; make sure appropriate education is incorporated into plans of care. Use techniques to reduce the risk of health care-associated infections; ensure good hand-washing techniques for all. Identify alternate approaches to overcome obstacles & maximize health outcomes for patients.

Reflection Based on Legal & Ethical Practice Understand your duty to report unsafe or substandard nursing practices to the Nursing Commission; know mandatory reporting includes unprofessional conduct, boundary violations, and criminal convictions. Promote a patient’s right to privacy by protecting confidential information; use patient information only for legitimate healthcare purposes. Review the Uniform Disciplinary Act (UDA) and nursing law related to boundary violations and sexual misconduct; your relationships with patients and clients should be therapeutic and professional. Understand your responsibility to restrict your practice if you are not able to perform essential functions safely, including physical, emotional, or mental conditions, or other stressors. Seek advice when you are unsure if actions expected exceed your legally recognized scope of practice. Be familiar and know how to use the Nursing Commission’s Scope of Practice Decision Tree.

Test Yourself Why is the Commission doing this? What is the 3-year practice requirement? What is the 3-year CE requirement? When does the 3-year timeframe begin? When is the earliest an RN or LPN will be audited? If audited what must be submitted? What happens if you do not comply with the audit? How many nurses will be audited annually? If you let your license expire, when must you take a refresher course?

Questions? Chuck Cumiskey BSN, MBA, RN Nursing Practice Advisor Washington State Department of Health Nursing Care Quality Assurance Commission 310 Israel Road SE, Tumwater, WA 98501 Chuck.Cumiskey@doh.wa.gov 360-236-4725 Fax 360-236-4738 For more “Practice Information” please see our website at: http://www.doh.wa.gov/hsqa/professions/Nursing/default.htm Please sign-up for the Nursing Commission list-serve: http://listserv.wa.gov/cgi- bin/wa?SUBED1=nursing-qac&A=1 "Public Health - Always Working for a Safer and Healthier Washington”