Running head: COMPETENCY CHECKLIST
Resource Nurse Competency Checklist
Betty J. Sousley
Ferris State University
1
COMPETENCY CHECKLIST
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Abstract
Emergency Nurses Association [ENA] (2011) relies on the Standards for Practicing Nurses to
define the standardization of competent skill sets for nurses in the emergency department.
Emergency Nurses possess a specialized set of skills within their area of expertise. Benner’s
Theory (1984) from Novice to Expert, identifies categories in which a nurse is functioning, based
on skill level. Nurses that have the knowledge, experience, and skill to perform at the proficient
and expert level are suitable candidates as a resource nurse. The duties that the resource nurse is
responsible for are numerous, and performed at the proficient and expert level. Although there
has not been a standardization defined for the resource role, identifying the role’s responsibilities
and competencies are necessary. The development of a resource nurse competency checklist will
set the foundational standards for this vital and integral role.
Keywords: resource nurse competency checklist, proficient, expert
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Resource Nurse Competency Checklist
Accurate documentation of skills and competencies for the individual nurse should be
concise and standardized. Competency checklists can vary, depending on the responsibilities
and skill level of the nurse. A standardized competency checklist that identifies the roles and
responsibilities of the resource nurse was researched. Through the research conducted,
managerial responsibilities and extra duties assigned to the resource nurse were identified. These
tasks and duties are not identified in the current competency checklist at Allegan General
Hospital (AGH).
The current competency checklist used at AGH (see Appendix A) is utilized for initial
orientation, six-month evaluation, annual evaluation, and any progression that would indicate
advancement in skill level. This checklist became cumbersome with various dates and
signatures. Leading to difficulty in the differentiation of which skill was mastered, date and time
of the accomplished skill and the name of the preceptor signing the form, indicating that the
employee can perform at set of skills, and at which skill level. The competency checklist
included all the skill levels, from novice to expert, on the same checklist, leading to confusion.
In any setting, emergency nurses must integrate critical thinking skills and evidencebased knowledge into their practice (ENA, 2011). Small community hospitals, like AGH, have
fewer resources to rely on and therefore count on the skill and expertise of the nurses. With the
lack of immediate access to specialized care and limited diagnostic capabilities, it is imperative
that the nurse functions at the proficient and expert skill level.
The purpose of this paper is to: identify and incorporate the common threads of
responsibilities and tasks assigned to the resource nurse to the competency checklist, discuss the
development and presentation of the project, including the goals and objectives, and an analysis
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the outcome of the project. A PowerPoint presentation and evaluations from the stakeholders
and preceptor of the scholarly project are identified, along with a self-evaluation (see Appendix
D, E, F).
Overview of Scholarly Project
In a time when knowledge and technology is ever increasing and nursing is practiced in
various settings, it is essential that the new nurse be prepared to provide safe, accurate, and
compassionate care (Benner, Sutphen, Leonard, & Day, 2010). Nurses must be able to assess a
patient, understand their disease or illness, and be able to apply care based on the knowledge and
skills they have gained. The heightened levels of responsibility and duties that accompany the
resource role necessitates that the nurse possess a measureable competency in clinical experience
and skills.
According to Benner’s Theory (1984) from Novice to Expert, the skill level of a nurse
varies and can vacillate between levels, depending on environment. The advanced beginner
relies on textbook accounts of patient signs and symptoms related to disease, injuries, and
therapies but cannot recognize subtle variations or gauge the severity in relation to other
situations (Benner, 2004). The expert nurse integrates the grasp of the situation into the action
taken (Benner, 2004).
Eggenberger (2012) identifies the resource nurses as the ones that provide a unique
leadership perspective, supporting frontline care that improves quality of care, safety, and patient
satisfaction. The ENA (2011) defines the resource role as being that of the expert nurse that
possess excellent clinical experience and skill that supports evidence-based best practices for
safety. The use of a competency checklist documents the aptitude of these skills. However, not
all competency checklists are identical.
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Allegan General Hospital is a critical access hospital in Allegan, MI. The emergency
department continues to grow and the current competency checklist must reflect the changes that
have occurred within the environment. A research of the surrounding emergency departments
was conducted within a 50-mile radius, in hopes to obtain data as to their resource nurse
competencies. The objective was to compare the resource nurse competency checklist being
utilized by these facilities and incorporate the findings with the current competency checklist for
revision.
The research involved seven hospitals, starting with the four smaller organizations that
were comparable to the culture of AGH. It did not take long to identify lack of uniformity or
standardization of a competency checklist for the resource nurse within these smaller
organizations. The research began with interviewing emergency department representatives
from Lakeview, Borgess-Pipp, Three Rivers, and Pennock hospitals as to their competency
checklist for the resource roles and practices.
T. Johnson (personal communication, January 21, 2012) identified the emergency
department at Lakeview Hospital as one that did not have a designated resource nurse. The
hospital is not a trauma center and therefore utilizes the house supervisor as the resource
“charge” nurse. The only qualification is that the house supervisor has taken a Trauma Nursing
Core Curriculum (TNCC) course.
B. Chrisman (personal communication, January 22, 2012) describes the emergency
department at Borgess-Pipp Hospital similar to that of Lakeview Hospital. The house supervisor
serves as the resource nurse. There only specific qualification is that the house supervisor is an
experienced practicing nurse of five years.
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L. Kent (personal communication, January 23, 2012) serves as the clinical coordinator at
Three Rivers Hospital. The hospital utilizes the clinical coordinator as the resource “charge”
nurse. The only qualification is that the house supervisor has taken the TNCC course.
J. Wolf-Duis (personal communication, January 24, 2012) is a registered nurse in the
emergency department at Pennock Hospital. They have natural leaders within the department,
and they are the nurses designated and resume the resource role. Their qualifications are that
they have to have taken Advanced Cardiac Life Support (ACLS) and TNCC at some point in
their career. The TNCC certification is valid for four years after completion of the course and
they do not have to renew their certification. The lack of support from the research conducted
required an expansion, and three larger hospitals were then interviewed.
A. Freeze (personal communication, January 25, 2012) described the emergency
department at Metro Health Hospital as one that utilizes clinical coordinators as their resource
nurses. The qualifications for these resource nurses is that they must have a minimum of four
years emergency nursing experience and be certified in TNCC, Emergency Nursing for Pediatric
Course (ENPC), ACLS, and hold a Baccalaureate degree.
D. Dominguez (personal communication, January 28, 2012) describes the emergency
department at Bronson Methodist Hospital as one that requires the resource nurse to have two
years’ experience on the trauma team and one-year experience in triage. The resource nurse has
an extensive interview process with two resource nurses and one emergency physician. The
mandatory competencies are TNCC, ENPC, ACLS, and Pediatric Advanced Life Support
(PALS).
J. Beckman (personal communication, February 2, 2013) describes the emergency
department at Spectrum Health Hospital as one that has an extensive orientation and resource
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nurse responsibilities. The resource nurse is required to follow their patient to the Cardiac
Catherization Lab, shadow at the Burn Center, spend two hours with a physician, two hours with
a pharmacist, and four hours with a respiratory therapist. They have 20 classes to complete
which include their computer system, core classes, triage class, lab, culture safety, and
electrocardiographic interruption. The certifications and qualifications requirements include
TNCC, ENPC, and ACLS.
The research from the surrounding hospitals lacked support from governance committees,
evidence based practices, or standardization in regards to resource specific competency checklist.
Therefore, I turned to the ENA experts for guidance and support. The set standards and
measuring criteria set by the ENA (2011) mirrored that of the core competencies from the NLN
(2005). The research conducted provided a plethora of orientation information on the role of the
resource nurse, but not reflective solely to the competencies for the resource nurse. Additional
research will be required in identifying standardization for a resource nurse competency
checklist.
The common threads found during the research were that of leadership responsibilities,
counseling, precepting, throughput and workflow. These common threads reflect a compilation
of core practice competencies (see Appendix B) that served as the foundation for the revision of
the current competency checklist. The orientation information obtained from the research was
woven into the revised competency checklist. These competencies assisted in meeting the goal
of developing and implementing a resource competency checklist that was user friendly, easier to
follow, with clear timeframes, expectations, and performance at the proficient and expert level at
AGH (see Appendix C). Evidence supports that the proficient and expert skill level nurses
provide the best evidence-based practices and have better outcomes (ENA, 2011).
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Personal and Professional Accountabilities
A responsibility of nurse educators is to function as a change agent and improve the
quality of the care. Through the revision and implementation of the competency checklist, the
care delivered at Allegan General Hospital can be improved. Through the implementation of the
revised competency checklist, the resource nurse will have a better understanding and clearer
expectations of what the role entails and hold the resource nurse accountable, not only to the
organization, but to the professional standards in which they are governed.
The revised competency checklist may facilitate a domino effect within the organization.
Job titles reflecting of the competency checklist will be required. The job description will
require mirroring that of the competency checklist, and the orientation will require a makeover.
ENA (2007) identifies the orientation of emergency registered nurses requires a global
knowledge base established through the application of a specific body of evidenced-based
knowledge.
As an educator, there is a desire to bridge the gap between the manners in which we
currently practice and practice that is supported and governed through accrediting bodies (NLN,
2005). As practicing nurses, it continues to be our responsibility to search for opportunities to
bring the best evidence based practices to our work place and institute necessary changes.
Institute of Medicine (2010) identify that emergency registered nurses be encouraged to
participate in lifelong learning, pursue certifications, obtain advanced degrees, and hold active
membership in in their professional organizations.
The development of the resource nurse competency checklist aligns with the Core
Competencies V: Function as a change agent and leader and Core Competency VI: Pursue
continuous quality improvement in the nurse educator role (NLN, 2005). The nurse educator is
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responsible for implementing change and being the change agent. This allows educators the
opportunities to develop leadership skills to promote and implement change. Kirby and
DeCampi (2008) state nursing leadership is vital to the effectiveness and efficiency in the
emergency setting and provides the building blocks for safe practice and care.
Core Competency V: Function as a Change Agent and Leader
The goal was to revise the current resource nurse competency checklist. The revision
would identify and reflect the resource nurse as one who functions at the proficient and expert
level. Benner (2011) identified that the emergency nurse leader as one that is supported and
proactively engaged in their personal and professional growth as they advance form novice to
expert through lifelong learning, coaching, mentoring, and classroom experience. The personal
accountability was demonstrated by functioning as a change agent and leader through the
research conducted to support the necessary changes and identify the commonalities of the roles
and responsibilities of the resource nurse. A competency checklist should mirror that of the
proficient and expert nurse along with the core practice standards and additional responsibilities
assigned. The development of a PowerPoint presentation to the stakeholder at AGH based on the
research obtained and the integration of the common threads of standardized core practices was
conducted. After the presentation, analysis of the evaluations, and making any potential revision
based on feedback, I would then present the scholarly project to the Medical Director and the
forms committee for implementation. Having the ability to bridge the gap between the research
and knowledge allows the opportunity to become a change agent and channel the evidence back
into practice.
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Core Competency VI: Pursue continuous quality improvement in the nurse educator role
The goal was to pursue continuous quality improvement in the nurse educator role. The
objective was to identify the role of the resource nurse as being at the proficient and expert level,
provide clarity of the checklist, and be user friendly. The nurse educator is responsible for
continuous quality improvements. The personal accountability was demonstrated through the
initiation of improving the current competency checklist to reflect best practices and the changes
within the environment of the emergency department. The emergency department has acquired
additional rooms, equipment, and implementation of electronic medical record (EMR) system.
The current competency checklist lacked the identification of the new space, equipment, and
EMR. It also lacked ease of identifying timeframes of completion of skills and tasks. The
revisions clearly identify specific periods and timeframes in which skills and tasks are
accomplished. By identifying the resource nurse at the proficient and expert level, the
competencies are identified for that specific role and responsibilities.
As nurses orientate, they are given a competency checklist. Due to the complex
checklist and the lack of ease with the current competency checklist (see Appendix A) at AGH is
utilized for orientation, six-month evaluation, annual evaluation, and during the nurses’
advancement in their skills. This checklist is cumbersome and difficult to differentiate between
achieved skills and not completed skills. By the end of one year, the individual’s competency
checklist had various dates, checkmarks, and signatures leaving the checklist indiscernible. The
revisions made to the competency checklist will improve the processes in which novice though
expert nurses can be differentiated along with the skills, and tasks assigned (see Appendix C).
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Analysis of Outcomes
Implications of the outcomes of this scholarly project will hold the nurses accountable for
the role in which they practice. Historically, if a nurse has been practicing within a specialty
area for greater than a year, that nurse would qualify as a resource nurse. Organizations are
placing inexperienced nurses in positions that require additional education and training. Without
proper training and education, nurses would not be meeting or practicing within their scope and
standards for practice. This could potentially set the stage of noncompliance to the ENA (2011)
and NLN (2005). Nurse educators are challenged as the experienced nurses are leaving the
workforce and inexperienced nurses are replacing them. Valdez (2009) identified that with the
increasing number of nurses leaving the workforce, due to burnout, complacency, or the aging
population this leaves the inexperienced nurses practicing. This positions the nurse educators to
develop educational opportunities for those left to fill the shoes of those experienced nurses
departing the emergency department (Valdez, 2009). With budget cuts and downsizing, utilizing
experienced nurses to educate those requiring experience and skill in the development of critical
thinking, clinical judgment, and reasoning would be the best manner in which to alleviate
additional financial burden to an existing problem. Providing the opportunity to capitalize on the
experienced nurses mentoring and sharing their experiences remains a focus for the educators.
ENA position statement (2011) states that nurse leaders in the emergency department possess
licensure as a registered nurse with experience in the specialty of emergency nursing. Leaders of
organizations are to ensure that the registered nurses are qualified and competent to practice.
Legal and Ethical Concerns
Emergency nurse leaders consistently apply ethical principles that demonstrate honesty,
integrity, and respect (ENA, 2011). There are legal and ethical ramifications for holding nurses
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accountable for the job they perform. They must be practicing within their scope of practice and
be able to delegate to others. Legally, the job description and education of the individual
performing in that role can be called to question. The ethical question may come in to play when
the job description and title are not disclosed in its entirety and changed for the organizations
benefit. As a case in point, the staffing ratio is typically 2:1, staff is on vacation, and it is a
holiday weekend so the ratio increases to 3:1. The staff that was on orientation suddenly is off
orientation because staffing is short and now there is a need. Vacancies in staffing and safety
ratios are not for the benefit of the organization or manager convenience. Charge nurses cannot
just be placed in that position because there is a need, training and competencies are required. A
safe environment for the patients, staff, and organization are to be the frontline priority. The
educational background, training, and qualifications may also be explored. Without standards
that are outlined and evidence demonstrating the competency of the nurse functioning in that
role, it can prove to be a danger. Humphries Lynch (1997) state that child and/or adult abuse and
neglect, sexual assault victims, and other forms of violence are reportable mandates. The
presence of the registered nurse in these situations is also required.
Reportable mandates of these circumstances can and may go unreported when nurses are
placed in situations they are not competent or have knowledge of these mandates. Nurses can be
held civilly and criminally liable if he or she fails to make a report of suspected abuse (Lewin,
1994). If they contravene such obligations, they face penalties. In addition to the penalties, and
when the nurse is functioning outside the scope and standard of practice, that individual can
jeopardize their license. When certain situations are presented in the court of law, you are
subjecting your licensure to a potential disciplinary action and the organization to financial
retribution and settlements.
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Nursing Concerns
The Standards of Emergency Nursing Practice (ENA, 2011) states that nurses’ practice is
guided by the Code for Nurses (ENA, 2011) and identify that “the emergency nurse functions
autonomously to the extent that knowledge, skills, and role permit” (p. 44). Utilizing unqualified
nurses and placing them in roles that they are not equipped to perform in, whether it is through
knowledge or skill level is concerning, unethical, and may have legal ramifications. Without
accountability, the threshold for patient advocacy can atrophy. Nursing can improve upon the
manner in which they practice. By remaining diligent and researching, the best practices they
improve upon the care they delivery and can implement change. It is only through lifelong
learning that we remain on the cutting edge of technology and improving outcomes. Bringing
the best practices to the profession for better outcomes is in turn being the best advocate for the
patients. Change is inevitable and constant; we must become part of that change.
Organizational Concerns
Nurses must have knowledge and understanding to protect the organization (ENA, 2011).
Interfacility transfer guidelines as mandated by Consolidation Omnibus Budget Reconciliation
Act of 1986 (COBRA)/Emergency Medical Treatment and Active Labor Act (EMTALA)
legislation require compliance. There are fines attached to violations for these serious
infractions. It is the obligation of the nurse to have knowledge of guidelines and mandates.
Bond (2008) identified implications of EMTALA during the triage process. When nurses are
assigned duties and they lack knowledge of regulatory mandates the organization could suffer
the ramifications of improper processes related to EMTALA and COBRA. Allowing
inexperience nurses to function in a resource nurse role for which they have not been properly
prepared sets the stage for unnecessary potential limitations. Inexperienced nurses may find
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themselves in situations that require adherence to guidelines and mandate requirements they
were for which they are unaware.
General Concerns
The issues, concerns, and challenges encountered during this scholarly project largely
centered on the fact that there was no standardization specific to the resource role and
responsibilities identified on the competency checklist. The research conducted identified
similar orientation standards and core practice competencies that were included in the revised
competency checklist (see Appendix B). These core practice competencies address and align
with the Standards of Emergency Nursing Practice according to the ENA (2011). These
competencies align with that of the expert nurse as well, and have been adopted into the revised
resource nurse competency checklist (see Appendix C) for Allegan General Hospital. The
emergency department manager and reflection in the job description of the resource nurses can
also utilize this core practice competencies during annual evaluations. The ease of adapting this
within the organization and flowing through to other department would be practicable.
The greatest concern was the lack of identifying the resources role into the proficient and
expert level of nurse and the skills required to maintain that position. Without standardization,
care of the clients and communities can be compromised. ENA (2011) state evaluation of
specialized knowledge and clinical judgment by a credentialing agency contributes to quality of
care. Nurses who function at capacities in which they are not educated to practice should be
informed of the legal and ethical concerns that may be encountered. The implementation for
change was addressed to the stakeholders at Allegan General Hospital through the awareness of a
presentation of the revisions to the competency checklist. Even though change is constant, it
continues to be met with resistance. By pointing out the difficulties within the current
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competency checklist, the presentation would reflect the ease of use, clarity, improve outcomes
and the care delivered, motivating buy-in.
Evaluation of Scholarly Project
An evaluation is a tool that measures objects, events, or people into categories (Wood &
Ross-Kerr, 2011). Once the data is collected and analyzed, the evaluator can identify areas that
require improvements and areas that were positive. Polit and Beck (2012) state a Likert Scale
indicates the degree in which a respondent agrees or disagrees with a statement. Open-ended
questions are geared towards the identification of perception or opinion of the evaluator, not
limiting the answers to pre-established alternatives (Polit & Beck, 2012). The open-ended
comments will provide feedback for further growth and areas of improvement, serving as a
valuable tool. One of the most valuable tools for the growth of individuals is that of the
feedback from the evaluations.
The completed evaluations from the stakeholders (see Appendix D) and preceptor for
this scholarly project (see Appendix E) were reviewed and analyzed. Areas of strength were
consistent in the fact that the presenter had a great deal of knowledge of the topic, workflow, and
challenges in the emergency department at AGH. Knowing the audiences skill level and
knowledge base provided the presenter insight to determine the depth that explanations would
need to be to make a point or relay information. Specific meaning and theorist did not require
additional defining as this was a familiar topic to the stakeholders. Knowing the audience and
their knowledge base provided the presenter with an ease as to the word usage and set the pace in
which to articulate. Brouse (2007) states the importance of connecting and knowing your
audience is relevant, the audience wants to know what information they can learn for themselves
and are interested in what the speaker has to say. Key factors during a presentation or public
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speaker is commonality and the culture of the audience. The feedback provides areas of
strengths, weaknesses, and comments for the presenter to reflect and grow for future scholarly
work.
A self-evaluation (see Appendix F) completes the scholarly project. The feedback from
the stakeholders and preceptor provided an opportunity to self-reflect and accept considerations
for areas of growth. The feedback and comments provide insight into areas of improvements.
Knowing that the topic was intertwined with the role, confusion occurred for brief periods.
Having this pointed out in an evaluation confirmed the need for the presenter to clarify and be
mindful of being concise and clear as to the topic. This experience has provided the presenter
the opportunity to meet the core competencies according to the NLN (2005) Scope of Practice
for Academic nurse Educators. Having the opportunity to develop and present this resource
nurse competency checklist was an experience every student should embrace.
Recommendations
It has been clearly identified that competency checklists differ from organizations and are
based on the culture of the organization. The separation of nurse skill levels, from the original
competency checklist, would ease the use of the competency checklist, along with decreasing the
confusion as to what skill a nurse is competent. The resource nurse competency checklist
defines the specific role and responsibilities to which the nurse is held accountable. By
identifying the dates and preceptor’s signature, on the competency checklist the individual nurse,
preceptor, and manger will be able to identify the progress of the nurse.
A recommendation for the original competency checklist is to separate the skill levels
into the identifying roles of the nurses, using Benner’s Theory from Novice to Expert skill level.
The resource nurse needs to function at the proficient and expert level. According to the
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definition of roles at AGH, the resource nurse is considered first-person. Once the revised
competency checklist is implemented, the secondary and tertiary roles will need to be revised
and have a checklist to reflect specific skill level and responsibilities.
Utilizing ENA (2011) Standards of Emergency Nursing Practice as a starting point for
competencies, provided a solid foundation for the checklist and provides unity across the
profession. Providing a competency checklist that mirrors NLN (2005) Scope and Standards for
Practice will assist in guiding the nurses toward providing the best evidence-based practices for
better outcomes. Evidence suggests that the expert nurse is proficient and processes expert
clinical experience and skills (Benner, 2011). Research has indicated that a nurse practicing at
the proficient and expert level provides the environment in which best outcomes can be
achieved.
Conclusion
Retaining records of competencies that reflect an individual’s accomplishment of skills
and tasks is imperative. These skills and tasks are recorded on a competency checklist. Clarity
and ease of identifying competencies is crucial. The original competency checklist utilized at
AGH had identifiable areas requiring revision. During the project for standardizing a
competency checklist at AGH, research was conducted within a fifty-mile radius. Seven
hospitals were interviewed in regards to practices they currently use for the resource nurse.
Unfortunately, there was not a standardized checklist. Common threads of core practices were
identified from the research and utilized as a foundation for the revision of the original checklist.
Commonalities for the resource nurse were managerial tasks and additional duties.
Research has identified that nurses practicing at the proficient and expert level have
additional responsibilities, and are held accountable to various other duties. The competency
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checklist should reflect the additional responsibilities assigned. Nurses should be aware of the
legal and ethical ramifications, to themselves and the organization, if they are practicing outside
of their scope and standards for practice. Research also suggests that the proficient and expert
nurses have a more global view of their environment, organization, and profession (ENA, 2011).
A resource nurse competency checklist that identifies the nurse at the proficient and
expert level was developed. A Power Point presentation of the revised checklist that includes the
roles and responsibilities of the resource nurse was presented to the stakeholders at AGH.
Through the implementation of the scholarly project, change and continuous quality
improvements can benefit patients, the nursing profession, and organization collectively.
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References
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing
practice. Reading, MA: Addison-Wesley.
Benner, P. (2004). Using the Dreyfus model of skill acquisition to describe
and interpret skill acquisition and clinical judgment in nursing
practice and education. Bulletin of Science Technology & Society, 24,
188-199. doi: 10.1177/0270467604265061.
Benner, P. (2011). From novice to expert. Retrieved from
http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html
Benner, P. B., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical
transformation. San Francisco, CA: Jossey-Bass.
Bond, P. G. (2008). Implications of EMTALA on nursing triage and ED staff education. Journal of
Emergency Nursing, 34, 205-206.
Brouse, C. (2007). Promoting discussions about cultural competence in an undergraduate health
course. Health Education Journal, 66(2), 179-187.
Eggenberger, T. (2012). Exploring the charge nurse role holding the frontline. Journal of
Nursing Administration, 42(11), 502-506. doi:http://0dx.doi.org.libcat.ferris.edu/10.1097/NNA.0b013e3182714495
Emergency Nurses Association. (2007). Emergency nursing orientation online. Des Plaines, IL:
Author
Emergency Nurses Association. (2007). Trauma nursing core course (6th ed.). Des Plaines, IL:
Author.
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Emergency Nurses Association. (2011). Emergency nursing scope and standards of practice (1st ed.).
Des Plaines, IL: Author.
Humphries Lynch, S. (1997). Elder abuse: What to look for, how to intervene. American Journal
on Nursing, 97,27-32.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.
Washington, DC: National Academies Press.
Kirby, K. K., & DeCampli, P. (2008). Nurse manager development beyond the classroom. Nurse
Leader, 6(2), 44–47.
Lewin, L. (1994). Child abuse: Ethical and legal concerns for the nurses. Journal of Psychosocial
Nursing and Mental Health Services, 32(12), 15-8.
National League for Nursing. (2005). The scope and practice for academic nurse educators.
New York, NY: National League for Nursing.
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Valdez, A. (2009). So much to learn, so little time: Educational priorities for the future of
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Appendix A
Name:______________________________________________ Unit/Department:_______________________
COMPETENCY SUMMARY FOR E.D. REGISTERED NURSES
This document may be used for:
o Orientation
o Performance Updates
o Annual Review
It is required for Resource qualified personnel to achieve all P and/or E ratings
COMPETENCY LEVEL
N-Novice
Needs assistance of
other user or manual to
perform function.
Follow rules/guidelines
AB-Advanced
Beginner
Performs function
with minimal
assistance, can
describe function.
Simple decision
making.
C-Competent
P-Proficient
E-Expert
(Expected level one year post-hire)
Comfortable, familiar with function.
Consistently accurate in performing
function. More complex decision
making.
Similar to competent can
perform with increased
speed. Can demonstrate
function to another.
Comfortable with
complex decisions.
Able to teach another
how to perform function.
Understands how
function impacts other
users of system. Able to
mentor others.
Preceptors to evaluate competence level, check appropriate boxes, initial, date and sign form.
Return to manager or________________ when complete. This document will be stored in Unit Personnel file and
COMPETENCY CHECKLIST
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reviewed annually.
Signatures:
Preceptor: ___________________
Preceptor: _____________________
Preceptor:
Date: ____/______/______
Date: _____/_____/______
_________________________
Date: ____/_____/____
Unit Specific-Emergency Department
Environment
Work with preceptor
Order entry
Work with preceptor
Computer classes
Care of the patient with a
burn
Work with preceptor
Emergency Nursing
Core Curriculum 5th
Edition (pg 184-191)
Care of the patient who is
having a pelvic exam
Work with preceptor

Locate supplies

Document correct information

Determine what physician is on call from the call schedule list
Preceptor will confirm ability to:
 Accurately enter lab and x-ray orders [ ]
 Perform lab inquiry [ ]
 Cancel lab or x-ray orders [ ]
 Order blood [ ]
 Microbiology orders [ ]
Preceptor will confirm ability to care for a patient with a burn:
 Fluid replacement (Parkland formula)

Assessment of airway

Burn dressing
–
Verbalize special considerations for facial burns
–
Splinting burns for maximum function after healing

Recheck of a burn patient
Preceptor will confirm ability to:

Assist with routine pelvic exam

Select the correct culture media

Assist with vaginal bleeding patient
I
C
A
A
D
G
Evaluation Date
Age Specific
I–Infant (Birth-1) C-Child
(2-12)
A-Adolescent (13-18)
AD-Adult (19-65)
G-Geriatric (>65)
Blank – N/A
Month/Day/Year
Place competence code in appropriate Age Specific level.
N-Novice AB-Advanced Beginner C-Competent
P-Proficient E-Expert
Verification
Method
V-Verbal
D-Demo
L-Lab
C-Computer
Initials
Evaluation Mechanism
Hands
On
Learning
Options
Review
Performance
Criteria
Evaluator’s/Preceptor’s
Employee: _______________________________________ Date: ______/______/_
COMPETENCY CHECKLIST
Care of the alleged sexual
assault victim
Work with preceptor
Care of a patient of
alleged domestic abuse
Care of the patient with
an eye injury/complaint
Work with preceptor
Domestic Abuse booklet
Work with preceptor
Emergency Nursing
Core Curriculum 5th
Edition (pg. 467-486)
Eye Injury/Complaint
(cont.)
Care of the patient with
epistaxis
Work with preceptor
Emergency Nursing
Core Curriculum 5th
Edition (pg. 158-160)
Care of the patient with a
laceration
Work with preceptor
Emergency Nursing
Core Curriculum 5th
Edition (pg 661-677)
Care for a patient
requiring intubation
Work with preceptor
Work with RT
ACLS
Intubation (cont.)
23

Assist with spontaneous abortion: complete vs. incomplete
Preceptor will confirm ability to:
Accurately assist with a sexual assault case as outlined in NMH
administrative policy.
Preceptor will confirm ability to:
Care for the patient as outlined in the NMH policy.
Preceptor will confirm ability to:
 Anticipate and provide appropriate assessment/meds for eyes.

Perform visual acuity exam

Select the appropriate exam equipment

Irrigate an eye

Apply an eye patch

Position patient at the slit lamp
Recognize urgent vs. non-urgent eye conditions (welder burn,
rupture vitreous, Foreign Body, Chemical Burns acid/alkaline.)
Preceptor will confirm the ability to:

Apply nose plug

Verbalize difference between ant/post bleed, care and potential
complications.
 Meds/medical condition affecting nosebleed. How to treat.
 Anticipate physician needs:
- Select appropriate exam equipment
- Set up prior to physician seeing patient

Assist physician
Preceptor will confirm ability to:

Set up suture tray, sterile fields

Assist physician: e.g. cut suture, maintain blood free field

Ability to Control Bleeding

Apply appropriate dressing
Simple
Complex: tube gauze, splint
Support/distract etc. pediatric patients to facilitate a positive
experience for the child and parent
Appropriate restraints
 Suture removal/staple removal:
- Identify healed vs healing
- Identify infectious process
Preceptor will confirm ability to:
 Locate intubation equipment
 Identify and know use of intubation equipment, including:
- Magill forceps
- Differentiate between straight and curved blades

CO2 detector

Confirm bilateral breath sounds

Assist physician

Correctly utilize bag-valve-mask devise

Anticipate medications required, including RSI
-
COMPETENCY CHECKLIST
24
Appendix B
Competencies for Resource Nurse in the Emergency Department
Core Practice Competency #1 Assessment and Intervention Skills



Assist with nursing tasks such as assessments, IV starts, discharges, admissions, and transfers
Maintains a safe patient care environment using National Patient Safety Goals and
Emergency Nurses Association (ENA) recommended practices.
Has successfully completed the annual competency checklist at the proficient or expert level
Core Practice Competency #2 Communication Skills







Demonstrates excellent communication skills and teamwork behaviors
Maintains customer service in accordance with the Behavioral Standards set by Allegan
General Hospital
Demonstrates effective conflict resolution skills
Appropriately handles complaints and requests from waiting room patients and families
Communicates with management, and physicians if necessary, when the department is at
capacity
Maintain confidentiality
Assists with multiple agency coordination
Core Practice Competency #3 Critical Thinking Skills











Demonstrates the ability to work through complex situations
Assists staff members in problem solving situations
Assists in the management of patients requiring constant cardiac monitoring
Assists in the management of trauma patients
Demonstrates the ability to work with the different age populations
Identifies urgent/emergent situations
Implements protocol orders
Identifies situations which require incident/occurrence reporting
Reprioritizes patient care when unexpected events occur
Manages acute changes in patients condition
Demonstrates knowledge of interqual criteria for admissions
Core Practice Competency #4 Human Caring and Relationship Skills



Demonstrates effective interpersonal relationship skills
Acts as a patient advocate
Acts as a staff advocate
COMPETENCY CHECKLIST






25
Utilizes feedback from peers in order to improve practice
Provides emotional, psychosocial and spiritual support
Provides culturally sensitive care
Involves patient/significant other in developing plan of care
Provides hourly rounding on active and waiting room patients
Communicates with physician/designee regarding patient status using Situation-BackgroundAssessment-Recommendation (SBAR) communication
Core Practice Competency #5 Management Skills




Assists in setting goals and objectives for the team in a positive and respectful manner
Manages overall function and through put of the department
Rounds in each area of the emergency department
Answers the Hospital Emergency Radio Network (HERN) radio and assigns Emergency
Medical Service (EMS) beds pre-arrival based on acuity level
Core Practice Competency #6 Leadership Skills








Demonstrates leadership by helping to facilitate and implement change
Demonstrates involvement in process improvement for the department and organization
Demonstrates appropriate and efficient delegation
Demonstrates and enforces regulatory compliance
Acts as a role model and clinical resource
Demonstrates appropriate use of chain of command
Participates in quality initiatives
Collaborates interdepartmentally
Core Practice Competency #7 Teaching Skills




Assesses individuals need for help
Assists with Electronic Medical Record (EMR)
Educates the patients in regards to specific discharge instructions
Orients students from different disciplines to the environment
Core Practice Competency #8 Knowledge Integration Skills



Demonstrates clinical expertise and skills
Stays abreast of best evidence based practices through continual research and lifelong
learning
Demonstrates appropriate use of American Nurses Association (ANA) principles for nursing
staff according to the Scope and Standards for Practice
COMPETENCY CHECKLIST
26
Appendix C
Revised Resource Nurse Competency Checklist
This document may be used for:
o Orientation
o Performance Updates
o Annual Review
FIRST PERSON (Resource) COMPETENCY LEVEL
N-Novice
Needs assistance of other
user or manual to perform
function. Follow
rules/guidelines.
AB-Advanced
Beginner
Performs function with
minimal assistance, can
describe function. Simple
decision-making.
C-Competent
P-Proficient
E-Expert
(Expected level one year posthire)
Comfortable, familiar with function.
Consistently accurate in performing
function. More complex decisionmaking.
Similar to competent can
perform with increased
speed. Can demonstrate
function to another.
Comfortable with complex
decisions.
Able to teach another how to
perform function.
Understands how function
affects other users of system.
Able to mentor others.
Preceptors to evaluate competence level, check appropriate boxes, initial, date and sign form.
Return to manager or________________ when complete. This document will be stored in Unit Personnel file and
reviewed annually.
Signatures:
Preceptor: _________________ Preceptor: _____________________
Preceptor: _____________________
Date: ____/_____/____
Date: _____/_____/______
Date: ____/______/______
Employee: _______________________________________ Date: ______/______/_
COMPETENCY CHECKLIST
Performance
Criteria
Environment
Order entry
Care of the patient
with a burn
Care of the patient
having a pelvic exam
Care of the alleged
sexual assault victim
Learning Options
27
Evaluation Mechanism
Through Observation and/or Demonstration





Locate and correctly charge for supplies
Locate Fire Extinguisher and exits
Locate Eye wash station
Locate Hazmat showers and decontamination trailer
Determine what physician and ultrasound technician is on call from the
call schedule list or SharePoint
Preceptor will confirm ability to:
 Process and acknowledge CPOE orders electronically
 Enter verbal orders through CPOE
 Cancel orders through CPOE
 Completes Patient Supply charging and processing electronically
Preceptor will confirm ability to care for a patient with a burn:
 Assessment of airway
 Fluid replacement
 Burn dressing(s)
 Verbalize special considerations for facial burns
 Splinting burns for maximum function after healing
 Recheck of a burn patient
 Consult the Burn Clinic for referrals
Preceptor will confirm ability to:
 Assist with routine pelvic exam
 Select the correct culture media
 Assist with vaginal bleeding patient
 Assist with spontaneous abortion:
- complete versus incomplete
 Obtain proper containers from lab for expulsion of the product of
conception
Preceptor will confirm ability to:
 Accurately assist with a sexual assault case as outlined in NMH
administrative policy
0-120
Days
Preceptor
Name
Date
121-240
Days
Preceptor
Name Date
241-365
Days
Preceptor
Name Date
COMPETENCY CHECKLIST
Performance
Criteria
Learning Options
Care of the patient
with epistaxis
Evaluation Mechanism
Through Observation and/or Demonstration

Care of a patient of
alleged domestic
abuse
Care of the patient
with an eye
injury/complaint
28
Consult appropriate agency(s)
Preceptor will confirm ability to:
 Care for the patient as outlined in the NMH administrative policy
 Consult appropriate agency(s)
Preceptor will confirm ability to:
 Anticipate and provide appropriate assessment/meds for eyes
 Perform visual acuity exam pre and post treatment
 Select the appropriate exam equipment
 Irrigate an eye
- Saline irrigation
- Morgan Lens irrigation
- Eye wash station
 Apply an eye patch
 Position patient at the slit lamp
 Recognize urgent vs. non-urgent eye conditions (welder burn, rupture
vitreous, foreign body, chemical burns acid/alkaline)
Preceptor will confirm the ability to:
 Apply nose clamp
 Verbalize difference between ant/post bleed, care and potential
complications
 Meds/medical condition affecting nosebleed. How to treat.
- Use of Afrin spray to stop bleeding
- Silver nitrate
- Set up Rhino rocket
 Anticipate physician needs:
- Select appropriate exam equipment
- Set up prior to physician seeing patient
 Assist physician
 Monitor patient pre and post procedures for patent airway and
hypotension crisis
0-120
Days
Preceptor
Name
Date
121-240
Days
Preceptor
Name Date
241-365
Days
Preceptor
Name Date
COMPETENCY CHECKLIST
29
Appendix D
Student Evaluation of Resource Competency Checklist for Betty Sousley, MSN student
Name ____9 Stakeholders___
Date _04/22/2013___
Please check the appropriate box for evaluating the questions. The numeric value is below the
degree of comment. Comment section is available. Thank you for your time.
Strongly
disagree
Goal 1:
Continuous
Quality
Improvement
1
Disagree Agree
2
3
Goals for
scholarly project
were identified
Objectives for
scholarly project
were identified
Lack of clarity in
the current
resource
competency
checklist were
identified
Strongly
agree
Comments
4
9
No comments noted
1
8
No comments noted
3
6
No comments noted
2
7
No comments noted
Goal 2:
Function as a
change agent
and leader
Resource
competency
checklist clearly
identifies the
COMPETENCY CHECKLIST
30
proficient and
expert levels
required
The core
competencies
were clearly
outlined
2
7
No comments noted
The presenter
had a good
knowledge base
of the topic
1
8
No comments noted
The presenter
was succinct in
teaching the
information
1
8
No comments noted
The presenter
has good
communication
skills
2
7
No comments noted
Additional comments: Nice job, Betty!
It was eye opening to see the differences in ER resource roles or lack of roles. The new checklist
looks easy to modify for other departments. Thank you for your hard work.
Great information!
Excellent work Betty!
Very nicely done! Well organized plan.
A lot of information presented in a small amount of time.
Enthusiastic! Strong knowledge of nursing in the E.D. and process flow along with challenges in
providing care to the community. Excellent presentation, thought provoking and Betty offered
strong workable solutions to difficult process changes.
Appreciate the pertinent data and the wide range of resources utilized.
Strengths: Betty had a good understanding of the entire subject matter. Teaching handouts were
excellent. She showed minimal signs of nervousness while presenting. She gave good examples.
Your goals to help strength the work environment with more defined roles, allowing for better
pt/staff flow.
Great List/competency/research.
Obviously knew her topic well. Seemed very confident with what she was presenting.
Betty is a confident public speaker. Good words, no word whispers, fluent, had your attention.
COMPETENCY CHECKLIST
31
In depth understanding of the E.D. environment.
Very organized. Aware of audience.
Weaknesses:
Having access to other Critical Access Hospitals to compare their process/workflow with current
practices @ AGH or larger institutions.
None, good job, good analysis of materials!
For me, there was a slight confusion between a project identified as “resource competency
checklist” and the broader subject of resource nursing roles in the department during the
presentation. For example, if a recommendation is being made that the resource nurse not take
assignments in order to accomplish the important resource tasks, this would be outside of the
“checklist”. That being said, all of the information presented was well done and helpful.
COMPETENCY CHECKLIST
32
Appendix E
Preceptor Evaluation of Scholarly Project for Betty Sousley, MSN student
Name: ___Phyllis Wilson____________ Date _____04/22/2013_______
Please check the most appropriate box for the evaluation. Thank you for your time.
Strongly
disagree
Goal 1: Continuous
Quality
Improvements
Met with the
preceptor throughout
the semester
Goals and objectives
for scholarly project
were identified and
established
Identification of the
lack of clarity in the
current resource
competency checklist
was established
Provided evidence of
the progression of the
scholarly project
Supporting literature
for scholarly project
was identified
Overall Core
Competency VI:
Continuous quality
improvements in the
nurse educator role
were met.
1
Disagree Agree Strongly
agree
2
3
Comments
4
X
Met frequently in person, via
telephone, and via e-mail
X
Shared very early on in the
process
X
X
Kept me up to date throughout
the process
X
Clear presentation of all
references
X
COMPETENCY CHECKLIST
Goal 2: Functioned
as a Change Agent
and Leader
Developed a resource
competency checklist
that clearly identifies
the expert clinical
experience and skills
Met with Preceptor
and CCO for final
approval
Resource competency
checklist was sent to
forms committee
Presented resource
competency checklist
to stakeholders
The information was
presented in a
succinct manner
The presenter
demonstrated
leadership abilities
The presenter
demonstrated herself
in a professional
manner
Overall the Core
Competency V:
Function as a Change
Agent and Leader
was met
33
X
Very clear, easy to read and
understand.
X
Shared information in a
thorough presentation prior to
group presentation
X
X
X
X
X
X
Additional comments: Betty also made suggestions of how this new format could be applied,
with modifications, to other areas of nursing. Very nice work.
Strengths: It has been a pleasure watching Betty develop and mature into here educator role.
Weaknesses:
COMPETENCY CHECKLIST
34
Appendix F
Self-Evaluation of Scholarly Project for Betty Sousley, MSN student
Name: ___Betty Sousley, BSN, RN_________ Date ___04/22/2013______________
Please check the appropriate box for evaluating the questions. Comment section is available. The
numeric value is below the degree of comment. Thank you for your time.
Strongly
disagree
Goal 1: Integrate
Core Competency
V: Function as a
Change Agent
and Leader (NLN,
2005)
1
Disagree Agree
2
Strongly
agree
3
Comments
4
Compose resource
nurse competency
checklist
X
The checklist
Meet with
Preceptor and
manager for
feedback and
approval
X
Had frequent meetings and
conversations with
preceptor, manager, and
CCO
Present final
proposed resource
competency
checklist to
preceptor and
CCO prior to
presentation for
feedback
X
See comments on preceptor
evaluation form.
Present resource
competency
checklist to
stakeholders
X
This went better than I had
anticipated.
COMPETENCY CHECKLIST
35
Goal 2: Integrate
Core
Competency VI:
Pursue continuous
Quality
Improvements
(NLN, 2005)
Define lack of
clarity in the
current resource
competency
checklist.
Provide evidence
of support
through research
for a standardized
competency
checklist.
Implement and
institute changes
to the resource
nurse competency
checklist
X
X
I think I could have done a
better job in this area. I
continued to vacillate
between the role of the
resource nurse and the
competency checklist. I did
not stay focused on the
competency checklist until I
received my feedback from
my draft and the stakeholder
evaluations.
X
X
This has to be presented to
the medical executive
committee for approval and
then the forms committee.
Additional Comments: The feedback was helpful in identifying areas of improvement and
changes that will require adjustments. .
Strengths: I knew what I was looking for during the research project, therefore I was able to
identify the common threads and integrate those into the core practice competencies and expand
on the way in which we practice at AGH. I know the workflow and responsibilities assigned to
the resource role and was facilitated me with meeting my objectives.
Weaknesses: Staying focused on the topic. The topic was not the responsibilities of the
resource role; it was the competency checklist for the resource nurse.