We are at the height of the summer, and I hope that many of you have had the chance to take some time to enjoy your family and friends. This is beach weather (don't forget the sunscreen!), and many people also enjoy camping and hiking in our beautiful national parks and touring famous cities all over the world. It is often the highlight of a family's year, and the anticipation leading up to vacation is almost as exciting as the actual vacation. Barbeques, fireworks, and family gatherings are all part of the rhythm of summer.
You expect the lifeguard at the beach to know how to swim, the park ranger capable of rescuing you from a mountain, and your tour guide to know the city you are touring inside and out. Obviously, the firefighter must know how to put out fires. These people have positions where competency is a given and built into the job description, and consumers expect that competency.
There is another group of people who have expectations of competency and that group is our patients. Our consumers of healthcare, the orthopaedic patients we care for every day, expect competency. We know that our consumers are people who have choices about their healthcare needs and patient satisfaction with their experiences in the hospital are now components of the bundled reimbursement system. Because nurses are the providers with whom patients have the most contact during their hospitalization, it is essential that orthopaedic nurses possess the knowledge and skills required to deliver competent care.
Along with barbeques and fireworks, there is another summer tradition that most of us have participated in. In fact, we all have, and it is called new nurse orientation. There is a wave of new graduates who are taking jobs and joining the ranks of registered nurses. Some of these new graduates may end up on your orthopaedic units, and most will have no idea of how to care for an orthopaedic patient.
Remember how scared you were when you started your first job as a nurse? I can clearly recall the waves of nausea, the wet armpits, and the utter fear I felt on my first day as the "orientee" on the orthopaedic unit at Albany Medical Center in Albany, NY. Back then, orientation consisted of learning about different forms that needed filling out, how to pass meds, and how to figure out what service the patient was on. There was very little teaching on how to take care of the patient because it was expected that you already knew how to take care of patients.
So, how do we, as orthopaedic nursing leaders, blend these two concepts-patient expectation of competence and orienting new nurses to orthopaedic nursing? How robust is your unit's orientation for new nurses? Who does the orientation? What qualifications are required for nurses who precept new nurses? How long is your orientation? What skills are included in your orientation? Do you have a formal mentoring program? How about a nursing residency program?
In 2010, The Institute of Medicine called for a transformation in nursing and recommended that nurses should have the benefit of a residency program at the start of their careers and during career transitions. Residencies have been shown to increase job satisfaction and decrease turnover, therefore are actually cost-efficient (Trepanier, Early, Ulrich, & Cherry, 2012).
It is so important for preceptors to embrace the role and not just teach the new nurse the "mechanics" of the unit. The preceptor must also demonstrate the culture of the unit, and it must be evident during orientation, so the new nurse can experience it and assimilate it. The preceptor's demeanor and commitment to orthopaedic nursing should serve as the model for the new nurse to emulate.
Attaining and maintaining continuing competency in orthopaedic nursing are critical components of nursing practice. Many hospitals use general nursing procedure manuals for their nurses to refer to when implementing care, but there usually are few orthopaedic procedures listed. Does your unit use the NAON Core Competencies: Across the Lifespan textbook (3rd ed.; NAON, 2012) for orientation? If you haven't looked, it is worthwhile to do so, as there is information about orthopaedic procedures as well as competency checklists that are not copyrighted and you can tear the lists out and reproduce them for your employee files for documentation.
Documentation of competencies is a great way for you and your employees to start and maintain a professional portfolio. The professional portfolio is a collection of materials that document the nurse's competencies and highlights the nurse's expertise in a given area (Oermann, 2002). This portfolio is useful when an individual nurse is applying for a clinical ladder promotion, institutional documentation of skills when applying for Magnet status, or preparing for The Joint Connection site visits.
How often does your hospital require you to reassess the nurses' competencies? Most hospitals follow The Joint Commission's regulations on frequency of assessing competency. Currently, hospitals make a decision as to the frequency of education that will be provided to staff on the various topics. There are only a few topics that require annual education and/or training: multidrug-resistant organisms (MDROs), central line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and waived testing. Education and training on the use of restraint and MDROs, CLABSIs, and SSIs must also be provided at the time of hire (Strader & Di Giacomo-Geffers, 2016).
Currently, 22 states do not have any form of continuing education requirement for relicensure, and several other states require some forms of worked hours, college classes, or a combination of these to be eligible for relicensure. It is important for you to know what requirements your state has with regard to relicensure. Do you find it troubling that nearly half of the states in our country do not require documentation of continuing competency?
Our patients deserve the highest quality of orthopaedic nursing care, and we as an organization are fortunate to have so many opportunities to acquire nursing CEUs (continuing education units). Please attend our webinars that are free to members and provide CEUs. Our journal offers CEUs in every edition. Of course, attending NAON's Congress is a wonderful opportunity to obtain CEUs while networking with other like-minded orthopaedic nurses.
Continuing competency is a theme that is threaded throughout nursing units, hospitals, and, of course, NAON. Provide a culture of competence in your working environment that demonstrates your commitment to our orthopaedic patients. They deserve nothing less than excellence.
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