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Crit Care Nurse 2002 Feb; 22(1): 88-87
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In Our Unit

Surviving Clinical Competencies: Taking the Immunity Challenge

Elizabeth Hand, RN, MS, CCRN

Elizabeth Hand is the adult critical care clinical instructor at St John Medical Center, Tulsa, Okla. For more information about the competency fair approach described in this article, e-mail Elizabeth Hand at keajhand{at}olp.net.

"In Our Unit" highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming "In Our Unit," send it to CRITICAL CARE NURSE, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn{at}aacn.org.

Completing annual competency requirements can be a tiresome task for both staff nurses and nurse educators, especially in the busy intensive care unit (ICU) and emergency department (ED) practice settings. At St John Medical Center, Tulsa, Okla, new nurses hired in the ICUs and ED are closely precepted and monitored for initial competency completion. However, because of the high patient census and acuity in these areas, completing the high-risk, low-frequency, problem-prone competencies1 required of incumbent nursing staff as well as ancillary unit staff is difficult. Using Alspach’s competency suggestions,1 St John managers and educators created written forms to verify initial and annual competencies. Nevertheless, they often were frustrated by the numerous attempts to complete these annual requirements.

Now, cluster-specific ICU and ED clinical instructors who are responsible for tracking annual competency completions have devised a purposeful, creative way to address this need. The vehicle is a competency fair planned around the theme of the television series "Survivor." The goal was that more than 60% of the staff competencies would be completed at least 6 months before the next scheduled visit by the Joint Commission on the Accreditation of Healthcare Organizations.

Like the television series, nurses could earn immunity by completing a task—in this case the competencies. In fact, by successfully meeting the immunity challenge, they could earn a year of freedom from being "hassled" by a clinical instructor to complete the competencies. Those who completed the competencies during the fair received a T-shirt.

To prepare for the project, the instructors collaborated with the managers to develop a list of essential annual competencies to be completed at the fair. Part of this preparation entailed planning a variety of educational and competency completion strategies, based on the principles of adult learning.2 The educators also wanted to include aspects of critical thinking by designing competency completion stations that would engage each nurse’s experience, educational preparation, and skill level.3 The educational and competency booths included posters, one-on-one instruction, games, simulators, and manikins using ED and ICU equipment. In addition, "Survivor"-themed music, decorations, and food were used to set the mood.

The planning team had to obtain approval from all levels of nursing management, from purchasing and from the pharmacy. The St John Medical Center Community Relations Department assisted the team in locating low-cost T-shirts and props and provided general guidance in soliciting vendors for food and prizes. Following strict solicitation guidelines, the instructors were able to obtain donations sufficient to cover the cost of prizes, T-shirts, decorations, and miscellaneous other necessities. The unit with the highest percentage of staff completing the competencies received the grand prize of a dinner that was donated for its entire staff.

The clinical instructors became a close-knit team, at first meeting bimonthly but then weekly as the fair drew near. Total planning time, which was worked in and around other duties, was approximately 4 months. Each instructor collaborated with the manager to develop a list of essential annual competencies to be completed at the fair.

The average percentage of participation among the 4 units was approximately 85%. The managers reported increased staff morale and the written evaluations of the fair were predominantly positive. As a result, management has approved another competency fair in 2002.



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  		A tiki hut backdrop helped set a fun tone for the competency fair at St John Medical Center. Pictured are (from left) Anne Hoit, Cathy Cunningham, Elizabeth Hand, and Melissa Dimick.

 
Acknowledgments

Also contributing to this article were Cathy Cunningham, RN, BSN, Melissa Dimick, RN, BSN, CCRN, and Ann Hoit, RN, BSN, CEN, all unit-specific, clinical instructors who the author has mentored for more than a year.

References

  1. Alspach JG. Designing Competency Assessment Programs: A Handbook for Nursing and Health-Related Professions. Pensacola, Fla: National Nursing Staff Development Organization; 1996.
  2. Knowles M. Andragogy in Action. San Francisco, Calif: Jossey-Bass; 1984.
  3. Alfaro-LeFebre R. Critical Thinking in Nursing: A Practice Approach. 2nd ed. Philadelphia, Pa: WB Saunders; 1999.




This Article
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