Marian Grace A.

Gascon

 WHAT ARE THE MANAGEMENT AREAS IN NURSING?

CORE COMPETENCY STANDARDS: ITS APPLICATION TO NURSING PRACTICE

Significance of the Core Competency Standards

The core competency standards serve as a unifying framework for nursing education, regulation and practice.

Nursing Regulation

11 Nursing Core Competencies

Nursing Education Nursing Practice

NOVICE

EXPERT

SIGNIFICANCE OF THE CORE COMPETENCY STANDARDS guide in developing curriculum in nursing framework in developing test syllabus for entrants into the nursing profession tool for performance evaluation among nurses basis for advanced practice and specialization framework for developing a training curriculum for nurses protect the public from incompetent practitioners yardstick for unethical and unprofessional practice of nursing

The Core Competencies for the Entry-Level

There are eleven-(11) core competency areas for nursing practice that were identified which include the following:

The Core Competencies for the EntryLevel

1. 2. SAFE AND QUALITY NURSING CARE MANAGEMENT OF RESOURCES AND ENVIRONMENT 3. HEALTH EDUCATION 4. LEGAL RESPONSIBILITY 5. ETHICO-MORAL RESPONSIBILITY 6. PERSONAL AND PROFESSIONAL DEVELOPMENT 7. QUALITY IMPROVEMENT 8. RESEARCH 9. RECORD MANAGEMENT 10. COMMUNICATION 11. COLLABORATION AND TEAMWORK

Key Area of Responsibility

A. SAFE AND QUALITY NURSING CARE

Core Competency 1: Demonstrates knowledge base on the health/illness status of individual/groups Core Competency 2:

Indicators: Identifies the health needs of the patients / groups Explains the health status of the patients / groups Indicators: Identifies the problem Gathers data related to the problem Analyzes the data gathered Selects appropriate action Monitors the progress of the action taken

Provides sound decision making in the care of individuals/ groups

Core Competency 3: Indicators:

Performs age-specific safety Promotes safety measures in all aspects of and comfort of patient care patients Performs age-specific comfort measures in all aspects of patient care Core Competency 4: Indicators:
Sets priorities in nursing care based on patients needs
Identifies the priority needs of patients Analyzes the needs of patients Determines appropriate nursing care to be provided

Core Competency 5:

Indicators: Refers identified problem Ensures continuity of to appropriate care individuals/agencies Establishes means of providing continuous patient care Core Competency 6: Indicator:

Administers medications Conforms to the 10 golden and other health rules in medication therapeutics administration and health therapeutics

Core Competency 7: Indicators: Obtains consent Utilizes nursing Completes appropriate process framework assessment forms for nursing Performs effective assessment techniques Performs Obtains comprehensive Comprehensive and client information systematic nursing Maintains privacy and assessment confidentiality Identifies health needs

Core Competency 8:

Indicators: Includes patient and Formulates a plan of his family in care care in collaboration planning with patients and States expected other members of the outcomes of nursing health team intervention
Develops comprehensive patient care plan

Accomplishes patient centered discharge plan

Core Competency 9:

Implements planned nursing care to achieve identified outcomes

Indicators: Explains interventions to patients and his family before carrying them out Implements nursing intervention that is safe and comfortable
Acts according to clients health condition and needs Performs nursing activities effectively and in a timely manner

Core Competency 10: Indicators: Monitors effectiveness of Evaluates progress nursing interventions toward expected Revises care plan when outcomes necessary Core Competency 11: Indicators: Respond to the urgency of the patients condition
Identifies sudden changes in the patients health conditions Implements immediate and appropriate intervention

Key Area of Responsibility

B. MANAGEMENT OF RESOURCES AND ENVIRONMENT

Core Competency 1: Organizes work load to facilitate patient care

Indicators:
Identifies tasks or activities that need to be accomplished Plans the performance of tasks or activities based on priorities Finishes work assignment on time

Core Competency 2: Utilizes resources to support patient care

Indicators:
Determines the resources needed to deliver patient care Controls the use of supplies and equipment

Core Competency 3: Ensures functioning of resources

Indicators: Checks proper functioning of equipment Refers malfunctioning equipment to appropriate unit Indicators:
Determines tasks and procedures that can be safely assigned to other member of the team Verifies the competency of the staff prior to delegating tasks

Core Competency 4: Checks proper functioning of equipment

Core Competency 5:

Maintains a safe environment

Indicators: Observes proper disposal of wastes Adheres to policies, procedures and protocols on prevention and control of infection Defines steps to follow in case of fire, earthquake and other emergency situations

Key Area of Responsibility C. HEALTH EDUCATION

Core Competency 1: Assesses the learning needs of the patient and family

Core Competency 2: Develops health education plan based on assessed and anticipated needs

Indicators: Obtains learning information through interview, observation and validation Defines relevant information Completes assessment records appropriately Identifies priority needs Indicator:
Considers nature of learner in relation to: social, cultural, political, economic, educational and religious factors.

Core competency 3: Develops learning materials for health education

Indicators: Involves the patient, family, significant others and other resources Formulates a comprehensive health education plan with the following components: objectives, content, time allotment, teachinglearning resources and evaluation parameters Providers for feedback to finalize the plan

Core Competency 4: Implements the health education plan

Indicators:
Provides for a conducive learning situation in terms of time and place Considers client and familys preparedness
Utilizes appropriate strategies Provides reassuring presence through active listening, touch, facial expression and gestures Monitors client and familys responses to health education

Core Competency 5: Evaluates the outcome of health education

Indicators:
Utilizes evaluation parameters Documents outcome Revises health education plan when necessary

Key Area of Responsibility

D. LEGAL RESPONSIBILITY

Core Competency 1: Adheres to practices in accordance with the nursing and other relevant legislation including contracts, informed consent.

Indicators:
Fulfills legal requirements in nursing practice Holds current professional license Acts in accordance with the terms of contract of employment and other rules and regulations Complies with required continuing professional education Confirms information given by the doctor for informed consent Secures waiver of responsibility for refusal to undergo treatment of procedure Checks the completeness of informed consent and other legal forms

Core Competency 2: Adheres to organizational policies and procedures, local and national

Indicators: Articulates the vision, mission of the institution where one belongs Behaves in accordance with the established norms of conduct of the institution/organization Shows membership of the accredited professional organization and a professional organization relevant Indicators: Utilizes appropriate patient care records and reports Accomplishes accurate documentation in all matters concerning patient care in accordance to the standards of nursing practice.

Core competency 3: Documents care rendered to patients

Key Area Responsibility

E. ETHICO-MORAL RESPONSIBILITY

Core Competency 1: Respects the rights of individual/groups

Core Competency 2:

Indicators: Renders nursing care consistent with the patients bill of rights: (1i.e.confidentiality of information, privacy, etc.)

Indicators:

Meets nursing accountability Accepts requirements as embodied in the job responsibility and description accountability for own Justifies basis for nursing actions and decision and actions judgments Projects a positive image of the profession

Core Competency 3: Adheres to the national and international code of ethics for nurses

Indicators: Recites the code of ethics for Nurses and abides by its provision Reports unethical and immoral incidents to proper authorities

Key Area of Responsibility

F. PERSONAL AND PROFESSIONAL DEVELOPMENT

Core Competency 1: Identifies own learning needs

Indicators: Verbalizes strengths, weaknesses, limitations Determines personal and professional goals and aspirations
Indicators: Attends formal and non-formal education Earns required continuing education units

Core Competency 2: Pursues continuing education

Core Competency 3: Gets involved in professional organizations and civic activities

Core Competency 4: Demonstrates a good manners and right Projects a conduct at all times professional image Dresses appropriately of the nurse Demonstrates congruence of words and action Behaves appropriately at all times

Indicators: Participates actively in professional, social, civic, and religious activities Maintains membership to professional organizations Support activities related to nursing and health issues Indicators:

Core Competency 5: Possesses positive attitude towards change and criticism

Core Competency 6: Performs function according to professional standards

Indicators Listens to suggestions and recommendations Tries new strategies or approaches Adapts to changes willingly Indicators:
Assesses own performance against standards of practice Sets attainable objectives to enhance nursing knowledge and skills Explains current nursing practices, when situations call for it

Key Area Responsibility G. QUALITY IMPROVEMENT

Core Competency 1:
Gathers data for quality improvement

Indicators: Demonstrate knowledge of method appropriate for the clinical problems identified Detects variation in the vital signs of the patient from day to day
Reports necessary elements at the bedside to improve patient stay at hospital Solicits feedback from patient and significant other regarding care rendered

Core Competency 2: Participates in nursing adults and rounds

Indicators: Contributes relevant information about patient condition as well as unit condition and patient current reactions Shares with the team current information regarding particular patients condition Speaks for the patient what is relevant to his condition Documents and records all nursing care and actions Performs daily check of patients records / condition Completes patients records Actively contributes relevant information of patients during rounds thru readings and sharing with others

Core Competency 3: Identifies and reports variances

Indicators:
Documents observed variance regarding patient care and submits to appropriate group within 24 hours Identifies actual and potential variance to patient care Reports actual and potential variance to patient care Submits reports to appropriate groups within 24 hours

Core Competency 4: Recommends solutions to identified problems

Indicators:
Gives appropriate suggestions on corrective and preventive measures Communicates and discusses with appropriate groups Gives an objective and accurate report on what was observed rather than an interpretation of the event.

Key Area of Responsibility

H. RESEARCH

Core Competency 1: Gather data using different methodologies

Indicators: Able to identify researchable problems regarding patient care and community health
Identify appropriate methods of research for a particular patient/community problem Combines quantitative and qualitative nursing design thru simple explanation on the phenomena observed Analyzes data gathered

Core Competency 2: Recommends actions for implementation

Core Competency 3: Disseminates results of research findings

Indicator: Based on the analysis of data gathered, recommends practical solutions appropriate for the problem.
Indicators: Able to talk about the results of findings to colleagues/patients/family and to others Endeavors to publish research Submits research findings to own agencies and others as appropriate

Core Competency 4: Applies research findings in nursing practice

Indicators: Incorporates findings in research in the provision of nursing care to individuals/groups/communiti es Able to make meta-analysis of research findings to ameliorate nursing practice.

Key Area of Responsibility I. RECORDS MANAGEMENT

Core Competency 1: Maintains accurate and updated documentation of patient care Core Competency 2: Records outcome of patient care

Indicators: Completes updated documentation of patient care.

Indicators: Utilizes a records system ex. Kardex or Hospital Information System (HIS)

Core Competency 3: Observes legal imperatives in record keeping

Indicators: Observes confidentially and privacy of the patients records Maintains an organized system of filing and keeping patients records in a designated area. Refrains from releasing records and other information without proper authority

Key Area of Responsibility

J. COMMUNICATION

Core Competency 1: Establishes rapport with patients

Indicators: Creates TRUST and CONFIDENCE G reets client in an open and respectful manner A sks client about themselves T ells client about choices depending on clients needs H elps client make an informed choice E xplains fully how to choose options R eturns visits for future consultation Indicators: Spends time with the client to facilitate conversation that allows client to express concerns

Core Competency 2: Listens attentively to clients queries and requests

Core Competency 3: Indicators: Identifies verbal and Interprets and validates non-verbal cues clients body language and
facial expression (IEC materials)

Core Competency 4: Indicators: Utilizes formal and Interprets and validates informal channels clients body language and
facial expression (IEC materials)

Core Competency 5: Responds to needs of individuals, family, group and community Core Competency 6: Uses appropriate information technology to facilitate communication

Indicators: Provides reassurance through therapeutic, touch, warmth and comforting words of encouragement Readily smiles Indicators: Utilizes telephone, cell phone, email and internet for disease information
Identifies a significant other so that follow up care can be obtained Provides Holding or emergency numbers for services

Key Area of Responsibility

K. COLLABORATION AND TEAMWORK

Core Competency 1: Establishes collaborative relationship with colleagues and other members of the health team

Indicators: Contributes to decision making regarding clients needs and concerns

Participates actively in patient care management including audit Recommends appropriate intervention to improve patient care Respect the role of other members of the health team Maintains good interpersonal relationship with clients, colleagues and other members of the health team

Core Competency 2: Collaborates plan of care with other members of the health team

Indicators: Refers clients to allied health team partners Acts as liaison / advocate of the client Prepares accurate documentation for efficient communication of services

APPLICATION OF CORE COMPETENCY IN NURSING PRACTICE

FUNCTIONS / ACTIVITIES A. ASSESSM ENT OF INDIVIDUA L PAT IENT NEEDS FOR NURSING (15%) 1. Establishes rapport and trust with the patient, family and significant others.

QUALITY INDICATORS

Welcomes the patient, fa mily and significant others on admission. Greets patient by name; introduces self and co-staff Co mmunicates in a friendly, polite and tactful manner. Encourages verbalization of needs and feelings through attentive listening. Conveys availability and willingness to help by attending to needs at the soonest time possible.

2.

Obtains a nursing history and does an initia l physical e xa mination. Recognizes norma l and abnorma l findings fro m co mmon laboratory and diagnostic e xa mination results. Defines health needs and problems fro m data gathered.

Applies the general princip les of and follows a logica l sequence in history taking and physical e xa mination.

3.

Co mpares results fro m a standard listing of norma l values / results of common laboratory and diagnostic exa minations.

4.

Identifies the significant findings fro m the nursing history, physical e xa mination and laboratory / diagnostic test results.

E. DOCUM ENTATION OF CARE GIVEN (15%) 1. Documents all relevant informat ion pertinent to patient care. Records, where appropriate (kardex, flow sheets and/or nurses notes) assessments results, treatments and medicat ions, nursing and other health care interventions, the patients responses and reactions to such interventions, and other pertinent information. Writes simp ly, co mprehensively and legibly. 2. Reports / endorses as appropriate. Files reports relevant to patient care, where appropriate (report book / communicat ion book / others). Submits summary of endorsements of assigned patients to charge nurse or Nurse IV for inclusion in the endorsement report. Records in the disposition sheet the name of the patient, ward and bed number, amount given, date and time ad min istered, name and dangerous drugs license number (S-2) of the prescribing physician, name and signature of ad min istering nurse.

3.

Records the disposition of dangerous drugs / narcotics.

DELEGATION IN THE CLINICAL SETTING

 Delegation
is entrusting the performance of selected nursing tasks to competent persons in selected situations. The nurse retains the accountability for the total nursing care of the individuals

Supervision
Provision of guidance by a qualified nurse for the accomplishment of a nursing task or activity with initial direction of the task or activity and periodic inspection of the actual act of accomplishing the task or activity.

Accountability
Being answerable for what one has done, and standing behind that decision and/or action.

The delegate is accountable for accepting the delegation and for his or her own actions in carrying out the task.

Delegator is accountable for:

Making the decision to delegate in the first place Assessing the patients needs Planning the desired outcome Assessing the competency of the delegate Giving clear directions and obtaining acceptance from the delegate Following up on the completion of the task, providing feedback to the delegate

What if the delegate makes a mistake?

Its 7 am on your busy MS unit. You scan your assignment quickly, reviewing the high points with your nursing assistant before going into report. With trays coming at 7:30, you remind your assistant that your patient in room 210 will be going to surgery this morning and is NPO. Coming out of report, you make brief rounds, only to find that your patient in room 210 is happily drinking her morning coffee.
What are you accountable for? Did you delegate correctly? What do you do now?

Principles of Delegation
Select the right person to whom the job is to be delegated Delegate both interesting and uninteresting tasks Provide subordinates with enough time to learn Delegate gradually Delegate in advance Consult before delegating Avoid gaps and overlaps

Purpose of Delegation
Promote internalized motivation and job enrichment Cost savings Time savings Professional growth for employees Professional growth of the manager

Four Rights of Clinical Delegation

Right Task
What can I delegate? What cant I not delegate?

Right Person
Right task for a competent person in a selected situation

Right Communication
Clear, concise, correct, complete

Right Feedback
Giving and receiving feedbacks

Right Task: Do Not Delegate

Jobs that are too technical and those that involve trust and confidence Authority to sign ones name Responsibility for maintaining morale Evaluating the staff or taking necessary corrective or disciplinary action Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit

RIGHT PERSON
FOCUS ON OUTCOMES Patient: Mr. Y Outcome: Patient will be clean Task/Process: Bath Who will Perform It: Nursing assistant or other care associate

Performance Weaknesses
In this scenario, you are an RN working night shift on an oncology unit, and an agency nursing assistant, May, comes to work with you this shift. May is excited about possibilities of interviewing for a regular night shift position and would love to work extra on holidays and weekends. As you begin to discuss her assignment for the night, she states, Oh, I forgot to tell you, I dont ever take patients that are HIV positive! Ever!

Sources of Performance Weakness

Unclear Expectations Lack of Performance Feedback Educational Needs Need for Additional Supervision and Direction Individual Characteristics: Past experiences, motivational or personal issues

RIGHT COMMUNICATION
Clear: Does the team member understand what I am saying? Concise: Have I confused the direction by giving too much unnecessary information? Correct: Is the direction according to policy, procedure, job description, and the law? Complete: Does the delegate have all the information necessary to complete the task?

RIGHT COMMUNICATION
Tony has a heart condition and high blood pressure that requires medication and constant monitoring. One of our goals is to help Tony have a stable BP, within a range that is normal for him. On the days that you are visiting and giving the bath for him, I would also like you to take his BP. If it is outside the range of 120 to 170 systolic and 50-90 diastolic, I would like you to let me know. We may need to adjust his medication, or change his diet, or call his physician for different orders. Using the 4 Cs, evaluate your communication.

RIGHT COMMUNICATION
CLEAR
Does the home health aide understand what is being asked of her? This direction is fairly straightforward: an easily understood instruction of taking the blood pressure.

RIGHT COMMUNICATION
CONCISE
Have you confused the assistant by giving too much information? Or is it enough for her to complete the task? Only the assistant can help you with this determination. You will need to ask directly, Am I confusing you, or do you have enough information to do the job?

RIGHT COMMUNICATION
CONCISE
Every individual has different needs. However, you may want to make certain to check this out; some people will not be honest or accurate in their assessments of their understanding or abilities, leading to trouble later. Many of us are reluctant to ask questions, being afraid to admit our need for additional information. (We dont want to look like we dont know what were doing) This reluctance can ultimately result in harm to the patient, as assumptions are made that the direction was understood when, in fact, it was not.

RIGHT COMMUNICATION
CONCISE
Every individual has different needs. However, you may want to make certain to check this out; some people will not be honest or accurate in their assessments of their understanding or abilities, leading to trouble later. Many of us are reluctant to ask questions, being afraid to admit our need for additional information. (We dont want to look like we dont know what were doing) This reluctance can ultimately result in harm to the patient, as assumptions are made that the direction was understood when, in fact, it was not.

RIGHT COMMUNICATION
COMPLETE
Does the assistant have enough information to fulfill your expectations? Once again, you will need to ask the delegate for clarifications of his or her understanding of what you are asking.

RIGHT COMMUNICATION
COMPLETE

If you expect this assistant to also note the respirations and alert you to increased effort of breathing, have you shared that in your initial direction? Or did you assume she would naturally observe all vital signs, since you alerted her to the patients condition (and besides, shes a good assistant)? In our attempts not to appear condescending (I dont want to insult this assistant by reminding her to note the respirations-shed think I didnt trust her to think!), we may often choose not to be as complete as we should be in giving initial direction.

RIGHT COMMUNICATION
You are working on a surgical unit in a partnership with Sam, a NA you have been working with the past year. Your easy going style has led to a comfortable reliance on each other and the feeling that you know what each other expects. On this particular evening shift , you are traveling down the hall, intent on medicating one of your patients. You also see an OR nurse bring one of your patients back from surgery. Seeing Sam coming your way, you state: Sam, the postop is back in room 103. Evaluate your initial direction.

RIGHT COMMUNICATION
Thirty minutes later, you are standing at the nurses station, noting an order Sam is charting. You ask him, Sam, hows the patient doing in room 103? Expecting a brief report, you are surprised when Sam says, I dont know, I thought you were going to take him. What went wrong?

RIGHT FEEDBACK
An RN (Pat) is working with a float RN (Julia) for the first time. Julia is new in the pool but is an experienced nurse. Pat is so pleased with Julias experience and performance that shes gone off to have a nice long break and lunch with an old friend from third floor. Shes also taken time to meet with a colleague from the evening shift regarding a unit problem. Unfortunately, she hasnt been present on the unit much today. When Pat is having lunch with her friend, she exclaims That new float Julia is just excellent! If it werent for her, I couldnt be here having lunch with you. I hope that she knows how organized and valuable she is! Her friend, Alex, states, Well, you know you should tell her, not just me, about this. When Pat returns to the floor, flushed with a good intentions of making Julias day with effusive praise, she tells Julia about how lucky she has been to work with her today.

RIGHT FEEDBACK
Youve just noted that the night shift Mario didnt chart the I and O on three patients on your coronary care unit. Youve called him and are thinking about how to discuss this with him in a positive manner, yet you know that he isnt going to want to chat since it is about for him to rest.

RIGHT FEEDBACK
Youve just noted that the night shift Mario didnt chart the I and O on three patients on your coronary care unit. Youve called him and are thinking about how to discuss this with him in a positive manner, yet you know that he isnt going to want to chat since it is about for him to rest.

ASSESSING YOUR DELEGATION SKILLS

Assemble these documents: Your state nurse practice act Your job description and those of coworkers and delegates Skills checklists The patient list or assignment form from your shift