Utilizing the QSEN Framework to Redesign Nursing Orientation Competencies

Submitter Information

Author: Diana Alemar, MSN, AMB-BC, NPD-BC, NEA-BC, CNL
Title: Program Director
Institution: NewYork-Presbyterian Hospital
Email: dia9006@nyp.org
Coauthors: Diana Alemar, Monique Zayas, Lori Perlstein, Warly Remegio, Alycia Jarvis

Competency Category(s)
Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
New Graduates/Transition to Practice, Staff Development

Learner Setting(s)
Clinical Setting

Strategy Type
General Strategy

Learning Objectives

1-The Nurse Educator/Nursing Professional Development Practitioner will analyze the organization’s existing clinical orientation competency process for essential nursing content, inclusion of hospital policies, a structure and framework. (Evidenced Based Practice (EBP); Patient-Centered Care; Quality Improvement (QI); Safety)

2- The Nurse Educator/Nursing Professional Development Practitioner will describe an approach for restructuring the orientation competency to align with the QSEN competencies framework. (EBP; QI; Safety; Teamwork and Collaboration; Patient-Centered Care)

3- The Nurse Educator/Nursing Professional Development Practitioner will be able to change from an orientation checklist to a QSEN based competency assessment tool. (EBP; QI; Safety; Teamwork and Collaboration; Patient-Centered Care)

4-The professional nurse will describe the impact of quality and safety competencies on nursing care delivery. (EBP; Patient-Centered Care; QI; Safety)

Strategy Overview

The Department of Nursing Professional Development (NPD) embarked on the journey to revamp orientation competencies to ensure nurses are providing evidence-based care, rooted in promoting quality and safety. NPD needed to move away from a checklist-based approach to assess our nurses’ comprehension and implement a competency-based approach, which would give us insight into their knowledge and skills, as well as pinpoint any gaps. Our goal was to develop a single standard competency for all of our campuses. We wanted to ensure a consistent approach, as well as a systematic process for all of our orientation documentation that aligned with our departmental mission and vision.

We utilized both the SWOT (Strengths, Weakness, Opportunities, Threats) and SOAR (Strengths, Opportunities, Aspirations, Results) analysis to identify the strengths and opportunities for the organization’s orientation competencies. Based on the results of the analysis, NPD created a vision for QSEN-based orientation competencies for nurses.

Next, we formed general and specialty workgroups in order to develop the respective competencies. The workgroups formatted the new competencies to include measurable competency statements focusing on knowledge and skills. All competency statements were developed using Bloom’s taxonomy and supported by hospital policies and procedures. The intent for the inclusion of the policies and procedures within the competencies was to facilitate preceptor and orientee use. The competency statements were then categorized according to the QSEN framework.

Within the competency tool, we incorporated a self-assessment of the orientee’s existing competency utilizing Benner’s Novice to Expert Model. The orientee self-identifies as a Novice, Advanced Beginner, or Competent. The self-assessment enables the preceptor and NPD Practioner to establish a baseline understanding of the orientee’s existing competency in order to plan for an individualized orientation. Please note: the categories of “Proficient” and “Expert” were intentionally not included. An orientee may be proficient or an expert in their nursing specialty area; however, as a new hire they are learning how to be a nurse at our organization.

The orientee’s competencies were validated using measurable categories: Direct Observation -Actual, Direct Observation-Simulated, and Verbal Discussion. We also included a section where the orientee and/or NPD practitioner could select the patient population being cared for in their practice areas, such as Neonates/Newborns, Pediatrics, Adolescents, Adults, and Geriatrics. Lastly, we included a comment/feedback section for the preceptor to expand upon competency development and progression. Any competency not met while on orientation was documented under the “Action plan” for follow-up by the nurse manager post orientation.

Once the competencies were developed, we presented the new competency process to all NPD practitioners across the enterprise to elicit preliminary feedback, and then minor revisions were made accordingly. The general and specialty competencies were piloted on select units for one orientation cycle. We solicited feedback from key stakeholders which included nursing leadership, preceptors, and orientees. Additional revisions were made based on the feedback. Once the documents were updated, nursing leadership and preceptors were educated on the new competency document and process.

Submitted Materials

295-3-Orientation-Competency-Evaluation-QSEN-Model.pdf
295-2-original-FINAL-General-Orientation-Competency-Document-2.9.21.pdf

Additional Materials

Submitted a sample of a general orientation competency document and an orientation competency evaluation tool – attached.

Evaluation Description

NPD Practitioners, nursing leadership, preceptors, and orientees provided positive feedback and presented opportunities for improvement. Most of the feedback provided was anecdotal. Below are the overarching themes:

Positive:
-The self-assessment is now based on the foundation of Benner’s Novice to Expert Model
-The competencies are now measurable statements (not a checklist), making it easier for preceptors to assess and evaluate the orientee’s current state of practice

Negative:
-Concern about the length of the document now that each competency is a measurable statement.
As an opportunity for improvement, NPD developed a satisfaction survey for the orientee, preceptor, NPD Practioner, and nurse leader to evaluate the new competency (see attached). NPD also plans to evaluate the impact of the orientation competency on nurse-sensitive indicators and patient outcomes.