1. Maloy, Lisa R. MSN, RN
  2. Mattas, Cheryl MS, RN, CNS, CCRN

Article Content

Statement of the Project

Several methodologies and approaches to evaluate staff for annual competencies are often lacking in methods to evaluate critical thinking skills, care delivery performance, and patient-focused decision making. These processes can be difficult and tedious work for the educator and for the staff involved in the process. Often, the programs are set up more like a workshop or all-day testing stations and fail to capture the essence of certain performance criteria necessary to ensure competent performance.


Description of the Project and Resultant Change

In early November 2003, the CNS team identified a need to redesign an annual competency program to better validate nurses critical thinking skills, care delivery options, and collaborative communication among the healthcare team. The goal was to engage the nursing staff in an active learning project that stimulated patient-focused care while at the same time support organizational goals. With limited resources, including time constraints, the CNSs in the critical care department designed and developed a case study program that addressed competency validation issues. A review of competency validation programs in place at different facilities was conducted. Most programs were considered adequate to validate required technical skill performance but few addressed critical thinking and decision-making performance competencies. The majority of programs were focused on technical skill performance and included lecture presentations with return demonstration. Return demonstration of equipment operation was considered tedious and time-consuming. The method/instrument to validate competency was a skills checklist that lacked evaluation of performance criteria that was nurse sensitive and patient focused. Incorporating regulatory requirements, clinical competency, low-volume/high-risk performance standards were critical components for our program. Specific to the needs of the units, the CNSs designed and developed a series of case-based scenarios incorporating critical thinking, collaborative practice principles, patient safety goals, as well as policy and procedure components. A study guide was provided to the staff for their review prior to attending the program. Two hours were allocated to each nurse to complete the "stations" that were set up in poster format containing a variety of resources for staff to utilize. To complete the case studies, specific directions were provided on how to return demo a set of specific skills and fill in the blanks on the case studies. Staff were allowed to proceed through the stations at their own pace, in groups, or individually, as they preferred, thus creating a positive, stress-free experience.



The nurses came to the experience with a very task-oriented mind-set. Feedback from the staff after the competency program was completed was positive. Although anecdotal evaluation of the new program is the only data to date, it has been significant. Nearly every staff member reported a reduction in their stress and reported a renewed appreciation for each other and their contributions to patient care delivery. Additionally, they reported an increase in self-confidence, more opportunity to collaborate with one another and others of the healthcare team, thus providing a teaching/learning environment that is professionally focused and patient centered.



A hands-on approach to competency validation and utilization of adult learning principles created an environment where individual goals and institution goals were met and costs of programming kept to a minimum.


Recommendations for Future

Continue with the successes gained in design of the case-based study approach for future programming of competency program and work to (1) offer the program format as template for other specialties to adopt in the acute care setting, (2) make necessary changes to the structure of the program as evidence-based practices changes occur, (3) improve the program's effectiveness by adding active learning participation such as game playing and interactive group participation, (4) collect data on program strengths and areas for improvement, and (5) utilize evaluation tools that address the goals of program and measure program success such as PBDS (Performance-based Development System), and/or Professional Judgment Rating form.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.