PEDIATRIC HEMATOLOGY ONCOLOGY UNIT
NON-LICENSED STAFF
EMPLOYEE NAME:
2015-2016
Competency and Compliance Plan
When complete (with included dates), please submit to your unit’s designated repository.
Employees are also accountable for completing any additional Learning Exchange Modules
assigned throughout the year.
This must be completed and submitted no later than April 30, 2016
The information and competency data I submit are complete (with dates), true, and accurately reflects my work and abilities to function as a non-licensed staff member in my department. If I completed an “Observation of Daily Work” or
“Case Study,” I submitted these items through the designated online submission site. I understand that my ongoing professional growth is my responsibility and that I will notify my educator or designated department leader if I have further
training needs.
Employee’s Signature
Date
CSL/Manager’s Signature
Date
Competency Transition Year: January 1, 2015-April 30, 2016
ORGANIZATIONAL COMPETENCIES
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Validation Criteria/Methods of
Verification
Competency
Completion
(Dates must be included)
JC HR.01.05.03 EP 3 & VUMC CL 30-08.21 & CL 30-19.22
Clinical Emergency
Response
(RR/Mock Code)
Demonstrates and communicates role in
activating or participating in the Tiered Response Team, STAT Team, and/or Code.

2015-2016 CAVE Event
Date_________
OR

Observation of Daily Work
OR

The ACLS, PALS, PEARS, or NRP training in 2015:
VUMC CL 30-06.30 & OP 30-10.04; HR-035
Medication Diversion
Demonstrate knowledge of Safe Medication
Administration and how to act in a situation
where Medication Diversion is suspected.

Learning Exchange Modules:
“Medication Diversion Accountability—Non
Licensed Staff 2015”
Date_________
Date_________
“The Impaired Caregiver—Non Licensed
Staff 2015”
Trouble finding the online submission site for “Observation of Daily Work” and “Case Study”?
Visit Vanderbilt’s Nursing site and type in “Competency.” Children’s competency site can be found under “Ongoing Competencies and Skills.”
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Compliance Requirements
Note: Compliance items require completion on an annual basis and may need to be completed
twice during this competency transition year (1/1/15-4/30/16) to remain compliant.

TB Skin Test

Point of Care Training
 Glucose
 Hemoccult
 Gastroccult
 Urine Dip
 Urine Pregnancy

N95 Fit Testing

MRI Training
________________
(Staff can only re-cert within
3 months of expiration.)
________________
_________
_________
_________
_________
 “Magnetic Resonance Imaging
(MRI) Safety”
 MRI Safety Survey
https://www4.vanderbilt.edu/
wellness/OHC/mri.php

Human Resources Annual Modules
(Staff can only re-cert w/Glucose
when meter prompts.)
________________
________________
________________
________________
 2015 Standards of Conduct and
Confidentiality Training
________________
 2015 Privacy and Information
Security (HIPAA)
________________
 2015 Annual Policy Review
VandySafe Modules:
As VandySafe Modules do not get released to staff until the fall, a separate document will be published at that time outlining
the unit specific requirements for completion.
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Questions about this document may be directed to
your unit educator or you can email
vcheducation@vanderbilt.edu
VandySafe Modules:
As VandySafe Modules do not get released to staff until the fall, a separate document will be published at that time outlining
the unit specific requirements for completion.