Validating competency

From the educator's point of view, more orientation is always better. Unit managers, on the other hand, are concerned about time constraints and how quickly competent staff can be placed at the bedside. This dilemma has faced nurse administrators in acute care settings for ages. One system, SETON Healthcare Network, based in central Texas, has met the challenge, and since its pilot program was initiated last winter, has succeeded in what many may feel is the impossible—cutting orientation time for supplemental staff across multiple settings and saving thousands of dollars, while maintaining high quality standards.

In 2002, Mary Ann Whicker, RN, CCRN, began her new role as critical care specialty education coordinator (SEC) at SETON Healthcare Network in Austin. Drawing on past experiences during her 15-year career at SETON as an ICU nurse, staff educator, charge nurse, and coordinator, she realized orientation for travelers varied widely from institution to institution and specialty to specialty. "It could be extremely short or as detailed as the same weeklong program for permanent staff. My first task was to evaluate the orientation process for the four hospitals in our system that had critical care areas, determining how we could maximize resources. At the time, SETON ICUs alone were utilizing the services of 10 to 12 mobile nurses from multiple staffing agencies to assist us with increased census during the winter. Other units in my facility and across the network were also contracting with healthcare travel companies."

When assessing the current processes, she soon discovered that the policies for critical care and other units needed standardization. Plus, initial research showed that agency nurses had to have the same competencies as regular staff to meet the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) standards. "Within a month, I had developed a centralized process for critical care that involved three ICUs, four intermediate care units (IMCs), two telemetry units, and two cath labs and imaging units. With the support of our chief nursing officer and other managers and educators at the facilities, we reached consensus and implemented a standardized, 40-hour orientation for supplemental staff across the four organizations, three of which are magnet hospitals."

After eight months, administrators realized that the program, while ensuring quality, expended too many human and financial resources. "It was back to square one," admits Ms. Whicker. "This time, my research delved deeper into nursing practice. I went to our accreditation people and determined the minimum acceptable competency requirements to meet JCAHO standards while achieving our goals. In essence, I took an outcome and worked backwards, asking nurse managers and educators about the competencies travelers needed to possess to provide quality care to a basic patient on their units, and then determined the best approach. The program had to be efficient and effective; promote patient safety; meet the needs of patients, hospital, supplemental staff, and agency; and validate competence of contractual personnel."

The first step in the redesign was a needs assessment for all units in the critical care specialty. Regulatory requirements had to be defined, as well as network policies and procedures. Secondly, a method had to be determined to validate travelers' clinical experience, knowledge, and practice.

It was then that Ms. Whicker was invited to begin discussions with a supplemental staffing firm, which would eventually become SETON's single source provider, to design a comprehensive orientation program for temporary healthcare professionals. "The timing was perfect. This company, which had performed its own assessment of our unit needs, not only could provide all of our supplemental staffing requirements, but it was able to offer pre-contract educational tools and assessment tests that were on par with ours, verifying certain competencies ahead of time and reducing orientation length."

The next phase of the collaborative process involved gaining a clear understanding of each partner's expectations. Through enhanced communication between representatives of the staffing company and the healthcare network, participants—in the span of four short months—were able to approve pre-contract testing modules, develop online exam packets that would reduce orientation time by up to four hours, agree on responsibilities of contractual nurses, define the orientation process, and establish a method for timely follow up on concerns.