1 copyright © 2011 by mosby, inc., an affiliate of elsevier inc. chapter 16 providing competent...
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1Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 16
Providing Competent Staff
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Benner’s Five Stages
Novice Advanced Beginner Competent Proficient The Expert
Benner (1984)
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Staff Competency
The Joint Commission requires hospitals to have an adequate number of competent staff to meet the needs of the patients (2007)
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Hospitals Are Required To Have Competent Staff
Traditional employer-employee arrangements or contractual arrangements can provide competent staff
Staff must be oriented, trained and educated Ongoing in-service education and training must be
provided Hospitals must assess, maintain and improve staff
competence Staff must have ongoing, periodic competence
assessments Staff should be encouraged to pursue ongoing
professional development
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New-Employee Orientation
Orientation provides initial job training and information Some elements of orientation need to occur before staff
provides care, treatment, and services Other elements of orientation can occur when staff is providing
care, treatment, and services All employees, regardless of level of competence, are required
to attend orientation New-employee orientation covers organization-specific
functions, policies and expectations, such as mission, vision, values, stakeholder expectations, performance improvement, basic skill evaluation, and a mandatory policy review
Hospital orientations can range from 3 weeks to 6 months depending on the organization and responsibilities of the nurse
For new graduates, the orientation is often expanded to allow for mentoring to the new role
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Preceptor Model
A preceptor is an experienced staff member who possesses excellent clinical skills and facilitates learning through caring, respect, compassion, understanding, nurturing, role modeling, and the excellent use of interpersonal communication (Speers, Strzyzewski, and Ziolkowski, 2004)
Experienced nurses are frequently required to serve as preceptors as part of their normal responsibilities
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The performance appraisal should include:
Strengths and weaknesses Accomplishment of last year’s goals Future goals Specific examples of performance should be
included There should be a correlation between the
evaluation, the job description and the goals of the institution
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At the time of the performance appraisal:
Discuss only the employee The first topic should be the accomplishments and
successes The interview should be positive and professional If improvement is needed in certain areas, these
specific areas must be addressed The employee should be granted a period of time to
improve their performance If disciplinary action is warranted, the nurse manager
should explain what is required to correct the performance
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Clinical Ladders
Clinical ladders were developed in organizations in reaction to Benner’s concept of Novice to Expert (1984)
They were developed as a means to promote an individual’s growth as a professional nurse on the path to expert status
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Clinician I
Entry-level professional nurse Focused primarily on developing knowledge
and skills Provides safe patient care at a basic level Shows the ability to care for increasingly
complex patients Requires consultation with more experienced
clinicians and benefits from feedback
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Why should a hospital encourage nurses to continue to develop their career?
Reduces employee attrition (turnover) Provides equal employment opportunities Improves use of personnel Improves quality of work life Improves organizational competitiveness Avoids obsolescence and builds new skills
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Clinician II
Capable clinician Focused on expanding knowledge and skills,
capable of daily charge role Consistently provides effective direct care as
part of interdisciplinary team to a variety of complex patients
Seeks as well as provides feedback for improved clinical practice
Assumes a novice leadership role but seeks mentoring in this process
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Clinician III
Experienced and highly skilled clinician who is recognized for knowledge and skills
Uses an interdisciplinary and evidence-based approach to patient care
Has an emerging leadership style and functions consistently and autonomously
Is learning to negotiate the health care system to maximize the delivery of quality care and to minimize cost of patient care
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Clinician IV
Minimum Baccalaureate of Science in Nursing Graduate level education preferred Well-developed clinical expertise within a defined specialty Recognized by peers as a leader within the institution Works predominantly with patients, families, and nursing staff Has aggregate responsibility at the regional level for nursing
care Incorporates current literature and research into practice Identifies the strengths within the service area and takes the
opportunity to develop and/or mentor others to promote professional growth and improve patient outcomes
Has demonstrated expertise in chosen scholarly activities focused toward the advancement or promotion of the profession