1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 16 Providing Competent Staff

2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Benner’s Five Stages  Novice  Advanced Beginner  Competent  Proficient  The Expert Benner (1984)

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4 Staff Competency  The Joint Commission requires hospitals to have an adequate number of competent staff to meet the needs of the patients (2007)

5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Hospitals Are Required To Have Competent Staff  Traditional employer-employee arrangements or contractual arrangements can provide competent staff  Staff must be oriented, trained and educated  Ongoing in-service education and training must be provided  Hospitals must assess, maintain and improve staff competence  Staff must have ongoing, periodic competence assessments  Staff should be encouraged to pursue ongoing professional development

6 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. New-Employee Orientation  Orientation provides initial job training and information  Some elements of orientation need to occur before staff provides care, treatment, and services  Other elements of orientation can occur when staff is providing care, treatment, and services  All employees, regardless of level of competence, are required to attend orientation  New-employee orientation covers organization-specific functions, policies and expectations, such as mission, vision, values, stakeholder expectations, performance improvement, basic skill evaluation, and a mandatory policy review  Hospital orientations can range from 3 weeks to 6 months depending on the organization and responsibilities of the nurse  For new graduates, the orientation is often expanded to allow for mentoring to the new role

7 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

8 Preceptor Model  A preceptor is an experienced staff member who possesses excellent clinical skills and facilitates learning through caring, respect, compassion, understanding, nurturing, role modeling, and the excellent use of interpersonal communication (Speers, Strzyzewski, and Ziolkowski, 2004)  Experienced nurses are frequently required to serve as preceptors as part of their normal responsibilities

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10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The performance appraisal should include:  Strengths and weaknesses  Accomplishment of last year’s goals  Future goals  Specific examples of performance should be included  There should be a correlation between the evaluation, the job description and the goals of the institution

12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. At the time of the performance appraisal:  Discuss only the employee  The first topic should be the accomplishments and successes  The interview should be positive and professional  If improvement is needed in certain areas, these specific areas must be addressed  The employee should be granted a period of time to improve their performance  If disciplinary action is warranted, the nurse manager should explain what is required to correct the performance

13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Clinical Ladders  Clinical ladders were developed in organizations in reaction to Benner’s concept of Novice to Expert (1984)  They were developed as a means to promote an individual’s growth as a professional nurse on the path to expert status

16 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Clinician I  Entry-level professional nurse  Focused primarily on developing knowledge and skills  Provides safe patient care at a basic level  Shows the ability to care for increasingly complex patients  Requires consultation with more experienced clinicians and benefits from feedback

17 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Why should a hospital encourage nurses to continue to develop their career?  Reduces employee attrition (turnover)  Provides equal employment opportunities  Improves use of personnel  Improves quality of work life  Improves organizational competitiveness  Avoids obsolescence and builds new skills

18 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Clinician II  Capable clinician  Focused on expanding knowledge and skills, capable of daily charge role  Consistently provides effective direct care as part of interdisciplinary team to a variety of complex patients  Seeks as well as provides feedback for improved clinical practice  Assumes a novice leadership role but seeks mentoring in this process

19 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Clinician III  Experienced and highly skilled clinician who is recognized for knowledge and skills  Uses an interdisciplinary and evidence-based approach to patient care  Has an emerging leadership style and functions consistently and autonomously  Is learning to negotiate the health care system to maximize the delivery of quality care and to minimize cost of patient care

20 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Clinician IV  Minimum Baccalaureate of Science in Nursing  Graduate level education preferred  Well-developed clinical expertise within a defined specialty  Recognized by peers as a leader within the institution  Works predominantly with patients, families, and nursing staff  Has aggregate responsibility at the regional level for nursing care  Incorporates current literature and research into practice  Identifies the strengths within the service area and takes the opportunity to develop and/or mentor others to promote professional growth and improve patient outcomes  Has demonstrated expertise in chosen scholarly activities focused toward the advancement or promotion of the profession