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The future of quality care is competency-based staffing

Home | Science | S.I.S 5th January, 2023

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Current staffing models are typically not informed by workforce competency and patient variables, but this approach is changing. With high levels of nurse shortages across acute, post-acute, and ambulatory settings, health systems and nurse leaders are using technology to assess and ensure their departments are staffed with an adequate number of competent professionals with the knowledge and skills to provide quality patient care.

For a safe work environment, it is critical that nurses have an awareness of their staff’s competencies and ensure they have the right skill mix in the unit for each shift.

In a recent webinar, “Managing Nurse Competency to Ensure a Safe Work Environment,” experts from Intermountain Health, Wolters Kluwer, and Kahuna Workforce Solutions explored how technology can be used to manage nurse competencies that inform staffing decisions.

Joyce A. Gamble, MS, BSN, RN, Learning Network Clinical Education Director, Consultation Services, Intermountain Healthcare, shared the health system’s experiences in leveraging technology to increase consistency and transparency in nurse orientation, support role development, and improve staff engagement. Lisa Bonsall, MSN, RN, CRNP, Senior Clinical Editor for Lippincott NursingCenter, moderated the panel. She was joined by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Wolters Kluwer, Health Learning, Research, & Practice; and Margaret Vaughan, MBA, BSN, RN, Solutions Engineer, Kahuna Workforce Solutions.

The challenges of managing staff competencies

For Intermountain Health, "the pandemic magnified staffing challenges to a level we were not prepared for,” said Gamble. In fact, this reality rang true for the majority of health systems. Even before COVID-19, the U.S. faces a shortage of 1.1 million nurses by 2030, exacerbated by the fact that the largest group of nurses leaving the profession is in the 25 to 35 age range. Hospitals are often left to make do with less staff or let available nurses fill in without adequate transparency into their current skill sets.

Traditional staffing models — ratio-based, volume-based, and situational-based — are generally not informed by competency and patient variables. At Intermountain Healthcare, there was a need to share staff and inform other nurse leaders of their current competencies and level of expertise. However, float pools of nurses often moved between hospitals and departments without this clarity.

To create real-time visibility into nurses’ proficiencies and to improve patient safety, Intermountain transitioned to a new model — competency-informed staffing — with the help of Kahuna Workforce Solutions and Lippincott® Solutions.

Four takeaways on competency-based staffing 

1. Standardized competencies help increase safety

“Technology helped us tremendously because it gave us a single solution to be able to have standardized competencies across our enterprise,” Gamble said. Intermountain Health is now able to see all its staff and their competency levels within a centralized dashboard, creating greater skill visibility and enhancing nurse mobility across the health system. Charge nurses, unit managers, and nurse administrators now have clear insight into nurses’ competencies when they arrive. This flexibility also means that nurse leaders can zero in on skill gaps that might be associated with changes in patient acuity, which makes training more intentional and improves patient safety.

2. Competency-based staffing supports career advancement

Nurse attrition is more likely without continuing education and a clear career trajectory. Healthcare is constantly changing, and with integrated technology, Intermountain Healthcare is able to keep its staff up to date on the latest advances and competencies. By making it easy for both preceptors and learners to access the assigned and validated skill sets, there can be a collective acknowledgment of how much each nurse has advanced in their role — and they can take these validated skills with them across the organization. Nurses can have pride, explained Gamble, “because they know they have a certain degree of expertise that they’re already coming to the table with.”

3. Centralization ensures readiness for Joint Commission and other audits

With a system-wide platform that centralizes relevant data and materials, nurse leaders at Intermountain are fully prepared for Joint Commission and other audits, explained Gamble. “It's been a great win because no longer are you worried about the documentation not being completed,” she emphasized. Intermountain can show regulatory bodies all material and referential information they provide their caregivers — from procedures to any e-learning management courses. Auditors have a complete picture of what nurses are validated on and the resources made available to them during the process.

4. Digitization of the competency process brings substantial ROI

Paper documents that track competency progress are often left where no one can review or validate them. This manual approach is inherently less efficient. Instead, with the support of technology, “You can look there quickly to see what’s left to complete in [nurses’] orientation process,” said Gamble. At Intermountain, nurse leaders and caregivers can access the platform at any time and location to ensure competencies and reduce care variabilities in real time. Moreover, the digitization of the competency process takes clerical work away from educators and creates marked time savings for leaders who already have enough on their plates.

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