Developing and Sustaining a Competent and Confident Clinical Workforce through
Essential Clinical Competencies for Non-Registered Practitioners
Competency Title: Observations and The Deteriorating patient [September 2013]
Competency Leads: Shane Moody, Lead Nurse and Vikki Crickmore, Sister. Critical Care Outreach service
Document Author
Authorised Signature
Written by:
Authorised by:
Signed:
Signed:
Date:
Date:
Job Title:
Job Title:
Effective Date:
Review Date
Approval at:
Date Approved:
Authors: Glenn Smith, Karen Barnett, Donna Baker - October 2013
1
CC/HCA/DP March 2014
How to use this Competency Framework
This Competency Framework has been developed to enable the assessment of clinical competence. In light of the Francis Report [and the move towards
Foundation Trust status], the Isle of Wight NHS Trust is required to demonstrate that clinical staff are competent to provide quality care for everyone, every time
and are all practicing to an agreed level.
Definition of Competence
A definition of competence was agreed by IOW NHS Trust clinical leaders in May 2013 and is detailed below.
“A set of specific and detailed outcomes that need to be achieved in order to a] prove immediate competence in essential skills or b] aid personal and
professional development in desirable skills. The competencies must incorporate knowledge, skill, behaviour and demonstration of how these all equate to
personal professional accountability for competent care of the patient” (Barnett 2013).
This definition focuses attention on the importance of recognising individual personal responsibility and accountability in the delivery of high quality care. This
means taking appropriate actions following the results of any clinical assessments to ensure the individual needs of the patient are met and this care is delivered
with care and compassion. Competency is not about performing the task in hand in a mechanistic way without patient involvement.
Responsibilities
It is the responsibility of the competency lead to develop the competency statements using the agreed framework, present the competency pack to the competency group for
approval, develop and co-ordinate the delivery of the master classes, prioritise staff groups requiring assessment, undertake competency assessments and ensure the outcome
is forwarded to Development and Training for recording on Pro4.
It is the responsibility of the clinical lead to ensure that they are competent and that their registered staff are competent within their scope of practice. The clinical lead may
undertake competence assessments themselves or delegate to Band 6s / Nurse Educators / Nurse Mentors / Clinical Educators who have been competency assessed and who
have also attended a recognised course on assessment. The clinical lead should also monitor compliance and escalate any concerns to their line manager and ensure that the
essential competencies are reviewed annually at appraisal. The clinical leads are professionally accountable to the Executive Director of Nursing and Workforce and their
relevant Professional Body.
It is the responsibility of the individual professional to ensure that they are competent within their scope of practice and that the essential competencies are reviewed annually
at appraisal. Individuals are professionally accountable to the Executive Director of Nursing and Workforce and their relevant Professional Body.
2
CC/HCA/DP March 2014
The Process of Competency Assessment - Clinical Leaders
A master class will be timetabled within the monthly clinical lead development day in addition to being accessible
electronically via the Intranet/Internet. This will provide all the relevant underpinning knowledge needed to inform
practice and prepare for the competency assessment.
The clinical lead feels prepared for the competency assessment.
Add wh
Yes
No
http://intranet/index.asp?record=4457
Contact the relevant competency
Contact the relevant competency lead to
lead to arrange further input.
organise a date for assessment. It is
recommended that the assessment takes
place within 4-6 weeks of accessing the
First Assessment
master class/gaining underpinning
 The assessor provides feedback to the
assessee, documents the outcome and
knowledge
completes PART 1 of the action plan.
 The assessor will refer the outcome to the
assessee‘s line manager.

The line manager will complete an
The outcome of the competency
No
individual learning plan in preparation for
assessment is a Pass.
the second re-assessment. A second
assessor will be identified for the second
assessment.

The line manager will consider invoking
Yes
informal capability.
The assessor provides feedback to the
assessee and completes the assessment
documentation.
The Pass outcome of the competency
assessment will be forwarded to
Development & Training within 48 hours of
the assessment.
The Clinical Lead is now competent to assess
their clinical staff.
CC/HCA/DP March 2014
 Second Assessment
 The assessor provides feedback to the
assessee, documents the outcome and
completes PART 2 of the action plan.
 The assessor will refer the outcome to the
assessee‘s line manager.
 The line manager will complete an individual
learning plan and arrange an individual
tutorial led by the competency lead in
preparation for the final re-assessment.
 The line manager will consider invoking
formal capability.
Final Assessment
Referral at the final attempt may lead to further performance
management in line with Trust policy. This will be discussed in
confidence with the clinical lead and their line manager.
3
Process of Competency Assessment – Non-Registered Practitioners
A master class will be accessible either face to face or electronically via the Intranet /Internet. This
will provide all the relevant underpinning knowledge needed to inform practice and prepare for the
competency assessment.
The non-registered practitioner
feels prepared for the competency assessment.
http://intranet/index.asp?record=4457
Yes
No
Contact the relevant competency
lead to arrange further input.
Contact their clinical lead to organise a date
for assessment. It is recommended that
the assessment takes place within 4-6
weeks of accessing the master class.
The outcome of the competency
assessment is a Pass.
No
Yes
First Assessment
 The first assessor provides feedback to the
assessee, documents the outcome and
completes PART 1 of the action plan.
 The assessor will refer the outcome to the
assessee‘s line manager.
 The line manager will complete an individual
learning plan in preparation for the second reassessment. A different assessor will be
identified for the second assessment.
 The line manager will consider invoking
informal capability.
The assessor provides feedback to the
assessee and completes the assessment
documentation.
The outcome of the competency assessment
will be forwarded to Development & Training
by the competency assessor within 48 hours
of the assessment being undertaken for
input onto Pro 4
 Second Assessment
 The second assessor provides feedback to the
assessee, documents the outcome and completes
PART 2 of the action plan.
 The assessor will refer the outcome to the assessee‘s
line manager.
 The line manager will complete an individual
learning plan and arrange an individual tutorial led
by the competency lead in preparation for the final
re-assessment.
 The line manager will consider invoking formal
capability.
Final Assessment
Referral at the final attempt may lead to further performance
management in line with Trust policy. This will be discussed in
confidence with the non-registered Practitioner and their line manager. 4
CC/HCA/DP March 2014
Name:
Role:
Band:
Work Base:
First Assessor Name and Role:
Second Assessor Name and Role:
Competency Statement
(Core Competencies to be included in all
Competency Assessments)
Expected Level of Competency
Non-Registered Practitioner delivers person
centred care with sensitivity and compassion
respecting the dignity and diversity of patients,
relatives, carers, visitors and colleagues.
During this assessment the NRP is observed
acting with respect, kindness, compassion
and sensitivity. Demonstrates consistent
person centred care with very good
professional conduct/behaviour in line with
trust expectations. Eg Lets Show We Care.
During this assessment the NRP consistently
uses helpful strategies to enable people to
understand the interventions in order to give
informed consent. During this assessment
the HCA is able to consistently communicate
safely, sensitively and effectively using
appropriate methods according to the
situation.
Non-Registered Practitioner gains consent for
all interventions and maintain confidentiality
as per trust policy while providing accurate and
meaningful verbal information in a polite and
respectful manner to patients, relatives,
visitors and colleagues.
Non-Registered Practitioner completes
documentation in accordance with
Organisational standards.
Non-Registered Practitioner demonstrates a
awareness of limitations and the need to
maintain an open and honest approach.
Non-Registered Practitioners demonstrates
how to safeguard vulnerable adults and
children, and when to raise identified concerns
through the appropriate channels.
Level of Competency Evidenced
Signature of Assessor
During the assessment the NRP is observed
practicing or is able to explain the standards
for documentation applicable to the Trust
E.g. Accurately and contemporaneously with
dates, times and signatures.
During the assessment the NRP consistently
recognises and works within the limitations of
their knowledge, skills and understanding
their responsibility and accountability for
their own actions and omissions.
During the assessment the NRP is observed or
is able to recognise and respond correctly
when people are in vulnerable situations, at
risk or in need of support and protection.
5
CC/HCA/DP March 2014
Competency Statement
Subject Specific Competencies
Non-Registered Practitioners can
demonstrate an understanding of
common causes of deterioration and
identify patient groups at potential
risk of deterioration.
Expected Level of Competency
Level of Competency Evidenced
Signature of Assessor
Causes – sepsis, chronic disease process,
co-morbidities, end of life / palliative,
failure to recognise, iatrogenic,
unavoidable complications.
Risks – co-existing disease, elderly,
emergency admissions, specific acute
illnesses, altered GCS, haemorrhage.
Non-Registered Practitioners can
BP: systolic 101-170
demonstrate knowledge of normal
HR: 51-100
values of vital signs and give examples RR: 11-20
of when differences should be
Saturations: >96%
considered ie: chronic conditions,
Temperature: 36 – 38 degrees
enhanced recovery.
Urine Output: 0.5ml/kg/hr
Non-Registered Practitioners can
Documentation date/time, Clear
demonstrate obtaining a complete set recording of observations, Frequency,
of observations using both observation Initials, calculating score.
machine and manual methods and
Manual BP, Pulse, Respirations
demonstrates competence in
Obtaining observations with machine.
documenting findings using trust
Use of fluid balance charts.
documents.
Non-Registered Practitioners can
Acute illness
explain rationale for using
Reduction in saturations
supplementary oxygen and the
Emergency situation
importance of target saturations for
Titrating to patients condition and target
individual patients.
saturations in COPD.
Non-Registered Practitioners can
Rationale for adult emergency
demonstrate knowledge of when to
(unresponsive, life threatening situation)
utilise 2222 trigger in the form of adult and cardiac arrest (actual cardiac arrest
emergency or cardiac arrest.
occurred) and how to initiate call.
6
CC/HCA/DP March 2014
Assessment Outcome – Please sign in relevant box
Rating
Outcome
Actions
Green
Pass - All essential
competencies evidenced.
Red
Refer - One or more
competencies not evidenced.
No action required. Review
annually at appraisal. Revisit
any development learning
points listed below as
recommended by assessor.
Clinical practice in relation to
the specific competency not
evidenced is to be supervised
and reassessed within 2
weeks.
Assessor Signature and
date
Initial Assessment
Assessor Signature and
date
2nd Assessment
Assessor Signature and
date
3rd Assessment
Learning points to revisit following successful competency assessment:
First Assessors Signature:
Non-Registered Practitioners Signature:
Date:
7
CC/HCA/DP March 2014
Action Plan following referral at FIRST assessment. To be completed following this assessment in preparation for second assessment.
PART 1
First assessor to tick, initial and date once completed
 Outcome of assessment and feedback given to non-registered practitioner
Initial:
Date:
 Line manager informed of referral at first assessment
Initial:
Date:
 Registered Practitioner signposted to further underpinning knowledge/ Competency Lead
Initial:
Date:
First Assessors Signature:
Non-Registered Practitioners Signature:
ACTION PLAN
PART 2
Individual Learning Plan between line manager and Non-Registered Practitioner.
assessment.
To be completed following this assessment in preparation for second
Date for re-assessment:
Line Managers Signature:
Non-Registered Practitioners Signature:
8
CC/HCA/DP March 2014
Action Plan following referral at SECOND assessment. To be completed following this assessment in preparation for final assessment.
PART 1
Second Assessor to tick, initial and date once completed
 Outcome of assessment and feedback given to non-registered practitioner
Initial:
Date:
 Line manager informed of referral at first assessment
Initial:
Date:
 Non-Registered Practitioner signposted to further underpinning knowledge / competency Lead
Initial:
Date:
Second Assessors Signature:
Non-Registered Practitioners Signature:
ACTION PLAN
PART 2
Individual Learning Plan between line manager and Non-Registered Practitioner.
assessment
To be completed following this assessment in preparation for final
Date for Reassessment:
Line Managers Signature:
Non-Registered Practitioners Signature:
9
CC/HCA/DP March 2014