Today’s health care system and nursing workforce issues demand that nurses are capable of functioning optimally and assuming increasing responsibilities across a broad continuum of care.
1 Therefore, nursing competencies are important to facilitate nurses to adapt to new environments and perform superior professional practices
2 that are safe and cost-effective.
In September 2004, the Institute of Mental Health (IMH) in Singapore began its journey to prepare for the Joint Commission International (JCI) accreditation. In tandem, IMH’s Nursing Department decided to critically appraise its existing nursing competencies against JCI’s Staff Qualifications and Education (SQE) standards. Nursing leaders from the education, clinical, and management areas formed a workgroup to plan and design an organized, systematic, and comprehensive framework to ensure the delivery of competent to superior nursing care to the patients within the nurses’ various psychiatric disciplines. The result is the Nursing Competency Assessment Checklists for two grades of staffs—registered nurses and enrolled nurses.
Nursing Competency Assessment Checklist Development
The workgroup’s ultimate challenge was to develop competencies that support IMH nurses in achieving safe, quality, patient-centered care. Various resources were used, including JCI’s standards, existing IMH practices, and extensive literature review. The following competency checklists were the fruition of those efforts:
- Induction and Nursing Competencies for Newly Recruited Registered Nurses
- Induction and Nursing Competencies for Newly Recruited Enrolled Nurses
- Nursing Competency Assessment Checklists for Specialty Areas
- Adult General Psychiatric
- Child and Adolescent Psychiatric
- Psycho-Geriatric
- Psychiatric Rehabilitation
- Psychiatric Isolation Ward
- Psychiatric Medical Ward
- Forensic Psychiatric
- Addiction
- Community Psychiatric
- Behavioral Medicine Clinic Psychiatric
- Psychiatric Emergency Department
- Electro-Convulsive Therapy Room
Portions of the checklists are shown below (
see Figures 1–4).
Figure 1. Sample Checklist Cover Sheet
Figure 2. A Sample Induction Checklist for Registered Nurses
Figure 3. A Sample Generic Competency Checklist for Registered Nurses
Figure 4. A Sample Psychiatric-Specific Competency Checklist for Registered Nurses
The developmental process of the competency checklist took about 14 weeks. The Gantt chart below (see Figure 5) reflects IMH’s planned process:
Figure 5: Competency Checklist Development Timeline (Gantt Chart)
Competency Familiarization
There were numerous collaborative discussions, modifications, and validations of the competencies with the clinical experts and ground staff to facilitate the development of a tool that is comprehensive, user-friendly, and that can best support the nurses’ achieving higher standards of performance.
Next was the large task of identifying and providing training to bridge practice gaps for all the clinical staff. To ensure buy-in from the nurses, several workshops were conducted to introduce and familiarize nurses with the new Nursing Competency Assessment Checklists. Continuous training and “road shows” were conducted to disseminate to the nurses this new assessment paradigm. This quickly led to mass acceptance and mindset change and corresponding boosts in the nurses’ confidence level.
The Nursing Competency Assessment Checklists became “the tool” to induct all new nursing staff to the practice setting and ensured that nursing standards are consistent across all clinical areas. This is particularly useful when staff members are transferred from one specialty area to another.
The Nursing Department also drew up a Managing Nurses’ Competencies policy and instituted the document with immediate effect. The document outlines the following objectives:
- Familiarize the new nurse to the organization, services, policies, and job expectations
- Facilitate the staff’s acquisition of knowledge and skills
- Assimilate the nurse into the new clinical area
- Maintain the competencies of current nurses.
Competency Implementation
IMH Nursing Competency Assessment Checklists were implemented hospitalwide on 1 January 2005. To date, 128 nurses—both new hires and those transferred to another clinical area for professional development—were assessed using the checklists. Many preceptors, nurse managers, and nurse clinicians appreciated the competency-based assessment approach for its thoroughness, structure, and systematic process that extends beyond the initial entry of nurses to include ongoing evaluation of their professional skills.
IMH became Asia’s first JCI-accredited mental health institution in September 2005. Final modifications were made to the Nursing Competency Assessment Checklists after JCI auditors’ recommendations in July 2005, resulting in the checklists being cited by JCI as a “best practice.”
IMH Nursing Competency Assessment Checklists developed professionalism and advanced training opportunities for the nurses to achieve evidenced-based, standardized, patient-centered care. However, the development of appropriate evaluation tools to measure competence remains the challenge now. It therefore behooves the nursing leadership to continue to challenge paradigms, review existing processes, and devise innovative approaches to foster a climate of continual growth and learning to develop credible nurses who are always operating on the cutting edge.
References
- Utley-Smith, Q: 5 Competencies Needed by New Baccalaureate Graduates. Nursing Education Perspectives 25(4), 166–170, July/Aug. 2004.
- Zhang, Z, Luk, W, Arthur, D, Wong, T: Issues and Innovations in Nursing Practice. Nursing Competencies: personal characteristics continuing to effective nursing performance. Journal of Advanced Nursing 33(4), 467–473, 2001.