I recently responded to a rapid response team (RRT) call for a patient in acute respiratory distress. Despite interventions, the patient was transferred to the critical care unit, intubated, and placed on a ventilator. The nurses on the floor had done an excellent job recognizing the patient was in trouble and called for help. The team worked like a well-oiled machine, no drama, no chaos; everyone in attendance knew exactly what to do. That’s what competency looks like – a team knowing how to assess a situation, use their critical thinking and judgement skills, intervene, reassure the patient, get the job done and, in this case, have a good patient outcome. 

Competency is defined by the American Nurses Association as an expected level of performance that integrates knowledge, skills, abilities, and judgments (ANA, 2014). Competency is a key component of the new American Association of Colleges of Nursing Essentials and it’s how undergraduate and graduate nursing students are taught – with the goal of producing competent, practice-ready nurses after they complete an orientation or nurse residency program. Novice nurses are not the only ones who need additional education and training to be competent. Nurses who are expert in some areas of practice may be novice and not competent in others. Competency needs to be routinely measured and documented and this information needs to be readily available for surveyors and nursing leadership.

The pandemic has revealed the disconnect with staffing based on hours per patient day, beds alone, or average census without considering the acuity of the patient and the competency of workforce. A nurse is not a nurse. You can’t take a nurse who is competent in med/surg and expect them to care for critically ill, high acuity patients in the critical care unit. Staffing must take into consideration the acuity of the patients and the competency of the nurses caring for the patients. The reason the RRT went well in the case illustrated above is because there was an adequate number of staff who were competent to care for the patient.

Competency-based staffing that considers patient acuity/severity of illness is not a new concept; nurses have been advocating for it for years. In a recent nurse leader survey by UKG and Wolters Kluwer (2022), up to 81% of respondents indicated that having competency inform their nurse staffing/scheduling patterns during the next 18 months will be important/very important and up to 79% believe they will need to implement competency-informed shift coverage.

What does competency-informed staffing mean for nurses?

For staff on the front lines, it means having adequate numbers of staff working with you who are competent to care for the type of patients on your unit. We talk about the concept of our colleagues having our back when we work; it means others pitch in and cover your patient while you are dealing with an emergency. You can feel it right away when you walk onto your unit; the culture and who you are working with for that shift set the tone for how your shift is going to be no matter how busy you are. Working beside someone who you know has the knowledge, critical thinking, and skills to step up and handle any situation using clinical judgement makes all the difference.

What does competency-informed staffing mean for healthcare organizations?

For nurse leaders who are responsible for insuring quality patient care, competency-informed staffing will help ensure quality outcomes and greater staff satisfaction because this change supports a safe work environment. Inevitably, changing how we staff will need investment. Healthcare organizations need to collaborate with workforce management industry partners to create the business case that illustrates the return on investment.

Here’s the bottom line, healthcare organizations, nurses and other members of the healthcare workforce want to deliver high quality patient care. Innovative staffing based on patient acuity and care-giver competency has the potential to be the catalyst for optimum quality care and a safer work environment.  

References
American Nurses Association (ANA). (2014, November 12). Professional Role Competence: ANA Position Statement. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/professional-role-competence/

UKG and Wolters Kluwer. (2022). Nursing Workforce Survey; Nursing’s Wake-up Call: Change is Now Non-negotiable.

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