You have a recently accepted position at a home health agency that provides 24-h

Question

You have a recently accepted position at a home health agency that provides 24-hour care to a qualified patient. You

are assigned a patient who has care provided by an RN during the day, and LPN in the evening, and a nursing assistant at night. You are the day RN. You are concerned that the patient is not progressing well, and you suspect the evening and night shift personnel are not reporting changes in the patient's status. What specific assessments should you make to validate your concerns? How would you justify any change in staffing? What recommendations would you make to the nurse manager, and why?

Explanation / Answer

The assessment strategy should recognise the knowledge, expertise and previous experience of the concerned nursing staff. It acknowledges that the nurse is registered on a professional register of nurses maintained by a nursing regulatory body in another country. In addition it also takes into account the individualised instructions set out in each nurse’s NMBI decision letter which states the length of the required period of adaptation.

The Competence Assessment Tool is designed to allow for a transparent assessment process that is user-friendly. The focus is on facilitating learning opportunities that allow the Candidate Nurse to further develop independent learning skills and the performance criteria of competence associated with life long learning and continuing professional development.

Evidence of competence may be gathered by a number of methods including:

• By direct observation of the Candidate Nurse’s performance throughout the period of adaptation

• By question and answer sessions to assess underpinning knowledge

• By reflective discussions between the Candidate Nurse and the Preceptor/Assessor regarding professional progress

• By testimony from other key qualified nursing staff

• By product evidence, e.g. documented nursing care

• By learning log evidence

There is no identified cohesive mechanism for ensuring continuing competence for nurses. According to the American Nurses Association statements about continuing competence, individual nurses and employers play a significant role in ensuring and measuring continuing competence:

1. The purpose of ensuring continuing competence is the protection of the public and advancement of the profession through the professional development of nurses.

2. The public has a right to expect competence throughout nurses’ careers.

3. Any process of competency assurance must be shaped and guided by the profession of nursing.

4. Assurance of continuing competence is the shared responsibility of the profession, regulatory bodies, organizations/workplaces and individual nurses.

5. Nurses are individually responsible for maintaining continuing competence.

6. The employer’s responsibility is to provide an environment conducive to competent practice.

7. Continuing competence is definable, measurable and can be evaluated.

8. Competence is considered in the context of level of expertise, responsibility, and domains of practice.

There are four levels of competence: Level an individual “knows” measured by his or her general knowledge Level two = what an individual “knows how” to act measured by his her competence Level three = what an individual “shows how” to act as measured by his or her performance Level four = what an individual “does” as measured by his or her action

Recommendations: The RN should advise the nursing manager on the outcome of the period of adaptation and assessment by furnishing a report on the concerned nurse. The report states whether, in the opinion of the Director of Nursing, the Candidate Nurse has or has not demonstrated competence and recommends or does not recommend registration accordingly.

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