VALIDATING COMPETENCY-CAN IT REALLY BE DONE?

One huge growth area in the business of staff development involves assessing and validating staff competencies. Competency validation is required by the Joint Commission, the state department of health services, and just about any other accrediting or certifying body you can mention. The tasks of validating staff competencies and documenting those validations usually fall on staff development departments.

Whether instructors validate competencies for orientees, hold annual "skills days," observe employees in the workplace, or all of the above, competencies probably occupy large chunks of department time and effort. However, are we really ensuring competency?

I believe this question needs to be asked. If your experience is similar to mine, skills observation often turns into reteaching the skill, sometimes to the point of hand carrying the staff member through the procedure step by step. I still shudder when I recall a code blue station at skills day. The registered nurses had to find the patient (a manikin) pulseless, go through the steps of cardiopulmonary resuscitation, call for help, attach three leads, turn on the defibrillator, recognize the rhythm (ventricular fibrillation), and defibrillate the patient. Not one person who came through the station could perform all of the steps without coaching. By the time my staff development colleague and I finished the day, we were exhausted and depressed. We had experienced many good "teaching moments" but questioned whether it really was competency validation.

I am not saying that the above incident was a waste of time-it was not. The coaching we did was of value to the learners, and we hoped ultimately for the patients. However, when I take a look at other skills validation stations, the same pattern emerges. Not many people can complete skills steps without help. This raises several issues:

1. If the expectation is that staff members demonstrate skills without any coaching, what happens when they cannot? If coaching is okay, does that mean the person is competent in that procedure?

2. What is the impact on staff morale and confidence when employees are not able to meet expectations without help?

3. Is there anything organizations can do to make this a more positive experience for everyone involved?

Observing versus coaching. I would venture to guess that not many educators would be comfortable standing silent while learners struggle to demonstrate their competence. The question is more about when does assistance cross the line from "Let me give you some guidance" to "Let me teach you how to do this procedure." If it does cross that line, is that all right? If I talk someone through a procedure so that the person successfully completes the steps, am I doing the right thing by marking that person as competent to perform the procedure?

Staff morale and confidence. If staff members are unable to complete expected competencies without extensive coaching, how does that make them feel? Does the whole setup of competency validation set the staff up for failure? Or are they just suffering through it with their teeth gritted, relieved just to be signed off and set free? (I am willing to put a fairly large bet on the latter.)

Making competency validation a more positive experience. Some suggestions based on my experience with competency validation include the following:

1. Many organizations provide a "resource packet" with the steps of each competency so that staff members know the expectations ahead of time and can review what they need to do. Providing some study time before each station could help with this process.

2. Although it takes more time, demonstrating the procedure for each group going through a station before having each person return the demonstration can be very helpful to the learners. (The instructors will probably lose their sanity after the 20th or 30th demonstration, but then most of us are certifiable by the end of skills day anyway.)

3. Rather than an annual skills day, some hospitals have traveling skills laboratories that rotate through all nursing areas, reviewing and testing very small groups or individuals all through the year. Others use simulation laboratories that are open to all shifts all year long. Employees can review and practice competencies and then schedule skills validation with an instructor when they feel ready.

4. Finally, I believe that observing staff members in their actual work environment with real patients is the truest test of competence. Scheduling time to do this is extremely difficult, but the payoff might be worth it. Working side by side with learners takes away some of the pressure of being observed, and keeping employees on the unit rather than in an all-day session obviously will lower labor costs. When it comes to unit testing, I believe that supervisors should not be allowed to validate competencies. I have seen too many managers rush through a check-off sheet without observing actual performance. They either ask if the employee can do the procedure (who would say "no?") or just assume the person can do it ("after all, she's worked here for years").

However we can manage it, I think every staff development educator wants to make competency validation a positive experience for the participants. If you can schedule time for educators to be with employees in the workplace, it will make for a less stressful and more cost-effective encounter for learners and staff development educators alike. If that is not possible, anything you can do to make the skills testing a more beneficial learner experience will be worth the investment of time, thought, and effort. Good luck!