Helping poor performing Helping poor performing nurses reach - - PowerPoint PPT Presentation

Competency Assessment & Competency Assessment & Performance Management Performance Management

Helping poor performing Helping poor performing nurses reach competence nurses reach competence

Regulatory Body Regulatory Body

The New Zealand Nursing Council (NZNC) is the

The New Zealand Nursing Council (NZNC) is the statutory body that regulates nursing in New Zealand statutory body that regulates nursing in New Zealand under the Health Practitioners Competence Assurance under the Health Practitioners Competence Assurance Act (HPCA) 2003. The role of the NZNC is to maintain Act (HPCA) 2003. The role of the NZNC is to maintain public safety and it does this primarily by ensuring public safety and it does this primarily by ensuring continuing competence of nurses ( continuing competence of nurses (New Zealand Nursing New Zealand Nursing Council, 2008) Council, 2008)

The assessment of competence is an

The assessment of competence is an evolving area for health care managers. evolving area for health care managers.

Competence is set out through a set of

Competence is set out through a set of four domains, with each domain outlining four domains, with each domain outlining practice expectations ( practice expectations (New Zealand New Zealand Nursing Council, 2008 Nursing Council, 2008). ).

Our organisation s obligations Our organisation s obligations

Fairly and transparently identify any

Fairly and transparently identify any competency issues competency issues

Employers must notify NC of any

Employers must notify NC of any regulated nurses that have identified regulated nurses that have identified competence to practice issues competence to practice issues

Growing unease about potential litigation if

Growing unease about potential litigation if the performance management process is the performance management process is poorly managed poorly managed

Thus documentation of the process is very

Thus documentation of the process is very important important

Supportive Improvement and Supportive Improvement and Performance Improvement Performance Improvement Management plans Management plans

SIP and PIP SIP and PIP

Southern DHB has developed a

Southern DHB has developed a framework to help identify competence framework to help identify competence issues issues

As a preceptor you might be asked to

As a preceptor you might be asked to participate participate

What's the problem What's the problem

Nurse J has been working in your area for

Nurse J has been working in your area for the last 11 months. Other staff are the last 11 months. Other staff are beginning to voice their frustration when beginning to voice their frustration when working with her on a shift or in the shift working with her on a shift or in the shift

• following. Some people look at the daily
• following. Some people look at the daily

allocation and sigh when she is on. allocation and sigh when she is on.

One RN has approached the CNM with her

One RN has approached the CNM with her

• concerns. She describes the situation as no one
• concerns. She describes the situation as no one

wants to work with Nurse J. They think wants to work with Nurse J. They think she is she is lazy and a bit useless lazy and a bit useless. When asked for more . When asked for more information the RN says she information the RN says she can t handle a can t handle a normal work load normal work load and staff have started giving and staff have started giving her less complex patients with a maximum of her less complex patients with a maximum of three patient workload. This has been getting three patient workload. This has been getting worse for the last 6 weeks and worse for the last 6 weeks and everyone has everyone has had enough! had enough!

What does the CNM do about this What does the CNM do about this

Option 1

Option 1 Nothing it will all blow over Nothing it will all blow over (wrong answer! wrong answer!)

Option 2

Option 2 Call in RN J and tell her to pull Call in RN J and tell her to pull her socks up ( her socks up (Wrong answer Wrong answer!) !)

Option 3

Option 3 Investigate the allegations and Investigate the allegations and try and define exactly what the issues with try and define exactly what the issues with RN J are and are they accurate and valid RN J are and are they accurate and valid

(yippee on the right track

yippee on the right track)

What tools/support does the CNM What tools/support does the CNM have? have?

Nursing Council competencies

Nursing Council competencies

Nurse Director

Nurse Director

Human Resource advisors

Human Resource advisors

NZNO advisor

NZNO advisor

What next? What next?

The CNM needs to establish if there is a

The CNM needs to establish if there is a problem by talking with staff that raised the problem by talking with staff that raised the issue issue

The CNM asks them to explain exactly

The CNM asks them to explain exactly what the issues are what the issues are

What the CNM found What the CNM found

The CNM found that:

The CNM found that:

RN J was often late for shift so didn

t get a full RN J was often late for shift so didn t get a full handover handover

She didn

t take her breaks She didn t take her breaks

Her patients missed care such as dressing

Her patients missed care such as dressing changes, IV antibiotic doses, patient changes, IV antibiotic doses, patient

• bservations not done
• bservations not done

Appears grumpy and moody at work particularly

Appears grumpy and moody at work particularly to students and the HCA to students and the HCA

Failed to do her daily bedside safety checks

Failed to do her daily bedside safety checks

Exercise Exercise

Look through the NC competency booklet

Look through the NC competency booklet and come up with any competencies that and come up with any competencies that is relevant that are not being met is relevant that are not being met

How does this relate to the NC How does this relate to the NC competences? competences?

Competency 2.1

Competency 2.1- Provides planned Provides planned nursing care to achieve identified nursing care to achieve identified

• utcomes.
• utcomes.

Administers interventions treatments and

Administers interventions treatments and medications within legislation, codes, medications within legislation, codes, scopes of practice and according to scopes of practice and according to authorised prescriptions and established authorised prescriptions and established policies policies

Competency 1.5

Competency 1.5 Promotes an Promotes an environment that enables client safety, environment that enables client safety, independence, quality of life and health independence, quality of life and health

Indicator:

Indicator: Accesses, maintains and uses Accesses, maintains and uses emergency equipment and supplies emergency equipment and supplies

Competency 4.1

Competency 4.1- Collaborates and Collaborates and participates with colleagues and members participates with colleagues and members

• f the health care team to facilitate and
• f the health care team to facilitate and

coordinate care coordinate care

Indicator: Provides guidance and support

Indicator: Provides guidance and support to those entering as students, beginning to those entering as students, beginning practitioners and those who are practitioners and those who are transferring into a new clinical area. transferring into a new clinical area.

Is there a reason for RN J s poor Is there a reason for RN J s poor performance? performance?

Must explore if there are any Must explore if there are any reasons for this? reasons for this?

That means that the CNM should call in RN J

That means that the CNM should call in RN J and raise the concerns with her and ask her if and raise the concerns with her and ask her if there are any reasons for the observed there are any reasons for the observed behaviours or practices? behaviours or practices?

Could be: Crisis at home, relationship issues,

Could be: Crisis at home, relationship issues, sick family member, financial issues, domestic sick family member, financial issues, domestic violence, problem with other family member violence, problem with other family member

Could be a problem with alcohol, drug use,

Could be a problem with alcohol, drug use, gambling gambling

A good employer offers support A good employer offers support

The CNM should offer Vitae (used to be

The CNM should offer Vitae (used to be SEED or EAP) free counselling sessions x SEED or EAP) free counselling sessions x 3 paid for by the employer 3 paid for by the employer

No one knows who goes or accesses it

No one knows who goes or accesses it HR get a bill with no detail unless a HR get a bill with no detail unless a request by the employee to apply for more request by the employee to apply for more sessions. sessions.

Stage one Stage one Supportive Supportive Improvement Plan (SIP) Improvement Plan (SIP)

Based on supporting the Nurse to reach a

Based on supporting the Nurse to reach a competent level competent level

Is an informal process with no long term

Is an informal process with no long term implications if the nurse returns to competence implications if the nurse returns to competence

However is time framed

However is time framed

If no improvement is seen with maximum

If no improvement is seen with maximum support then would move to a Performance support then would move to a Performance Management Plan (more formal with potential Management Plan (more formal with potential employment outcomes or reporting to regulating employment outcomes or reporting to regulating body possible) body possible)

The process SIP The process SIP

Letter

Letter

Meeting

Meeting

Formulate the plan

Formulate the plan

Choose a preceptor

Choose a preceptor

Decide level of supervision to work along side or

Decide level of supervision to work along side or supernumerary nurse supernumerary nurse

Establish timeframe

Establish timeframe

Daily feedback

Daily feedback

SIP SIP

In the SIP the CNM and ND must make

In the SIP the CNM and ND must make the plan simple so that RN J knows the plan simple so that RN J knows exactly what she needs to do to be exactly what she needs to do to be competent competent

How would she demonstrate this?

How would she demonstrate this?

Why daily meeting with Preceptor? Why daily meeting with Preceptor?

Daily feedback in real time helps to build

Daily feedback in real time helps to build the relationship between those involved in the relationship between those involved in the process. the process.

The use of feedback is not well

The use of feedback is not well understood as feedback is not merely a understood as feedback is not merely a stimulus but a complex intervention that is stimulus but a complex intervention that is dependant on the characteristics of the dependant on the characteristics of the individual recipients individual recipients

Research point Research point

At times of increased job stress managers

At times of increased job stress managers who showed supportive behaviours and who showed supportive behaviours and staff that received more positive staff that received more positive recognition through the use of feedback recognition through the use of feedback increased the likelihood of the nurse s increased the likelihood of the nurse s intention to stay at work. intention to stay at work.

Feedback is dependent on: Feedback is dependent on:

The message

The message

what s said what s said

The provider of the feedback

The provider of the feedback - Who provides

Who provides feedback feedback

The addressee

The addressee

the nurse involved the nurse involved

The timeliness of feedback

The timeliness of feedback

close to event close to event

The vehicle used to provide feedback

The vehicle used to provide feedback

verbal or written verbal or written

Research supports: Research supports:

Giving balanced feedback with both

Giving balanced feedback with both positive feedback and an indication of positive feedback and an indication of where improvements could be made is where improvements could be made is more beneficial. more beneficial.

Verbal feedback is seen as powerful if

Verbal feedback is seen as powerful if immediate, positive feedback is a potent immediate, positive feedback is a potent motivator and peer feedback is positive if motivator and peer feedback is positive if given consistently. given consistently.

Visual graph form about an individuals

Visual graph form about an individuals performance did have a positive performance did have a positive reinforcing effect. reinforcing effect.

This supports that different styles of giving

This supports that different styles of giving feedback are important and visual feedback are important and visual feedback may have a synergistic effect feedback may have a synergistic effect when coupled with timely verbal feedback. when coupled with timely verbal feedback.

Gut feeling

• Gut feeling
• may be right BUT you need

may be right BUT you need to be specific to be fair and give the best to be specific to be fair and give the best chance for the individual to gain insight chance for the individual to gain insight into the improvement they need to make into the improvement they need to make

Daily Evaluation Scale Daily Evaluation Scale

Scale Standard procedure Quality of Performance Assistance

Accomplished 4

Safe and accurate Proficient, coordinated, confident, ethical and clinical role model for others. Anticipates consistently and assists others

Independent 3

Safe and accurate Competently performs tasks within an acceptable timeframe Works independently without supportive cues

Assisted 2

Safe and accurate Most of the time requires prompts from preceptor Can perform tasks but needs support and guidance, takes longer than expected to complete tasks Occasional verbal and physical directive required to complete the task

Marginal 1

Safe with direct supervision Unskilled, inefficient requiring a prolonged time period to achieve nursing outcomes Requires direct supervision frequent verbal and physical directives in most areas

Date Grade Sign Comments Uses a daily planning sheet to note drug/treatment/care times for patients Is aware of scope of practice and seeks assistance when needed Accurately assesses patients needs related to their condition Uses resources to update knowledge by referring to ODHB policies and Midas system Has knowledge of medication uses, doses, routes and side effects Reassesses, plans and implements changes in response to changes in patient status Practices procedures and skills competently and safely, for example carries out neurovascular observations, interprets results and updates care

Goal A

0.5 1 1.5 2 2.5 3 3.5 D a t e 2 4 6 Date Score Goals A

Goal C

0.5 1 1.5 2 2.5 1 2 3 4 5 6 7 8 9 Date Score C

Progress on Daily Assessment of Goals Over time

A A A A A A A A A B B B B B B B B B C C C C C C C C C D D D D D D D D D E E E E E E E E E F F F F F F F F F G G G G G G G G G H H H H H H H H H I I I I I I I I I 0.5 1 1.5 2 2.5 3 3.5 1 2 3 4 5 6 7 8 9 Days Competence Scores A B C D E F G H I

PIP PIP

Similar to SIP but the process is more formal

Similar to SIP but the process is more formal with more HR involvement and the with more HR involvement and the consequences stronger consequences stronger- possible termination, possible termination, reporting to NC reporting to NC

The process is not something that is quick but

The process is not something that is quick but understand that it is labour intensive and costs understand that it is labour intensive and costs $$$$ $$$$

Costs come from supernumerary time, CNM and

Costs come from supernumerary time, CNM and ND, HR time, legal opinions, meetings, ND, HR time, legal opinions, meetings, documentation documentation

Reporting to Nursing Council Reporting to Nursing Council

Nurse must be informed that this is occurring

Nurse must be informed that this is occurring and are encouraged to self report and are encouraged to self report

This occurs even if the nurse resigns

This occurs even if the nurse resigns

It is the organisations obligation to report the

It is the organisations obligation to report the nurse but it is the council who undertakes their nurse but it is the council who undertakes their

• wn investigation
• wn investigation

NC can direct the individual to undertake a

NC can direct the individual to undertake a Competency Assessment Programme or further Competency Assessment Programme or further education. education.

NC process takes time NC process takes time

The New Zealand Nursing Council annual report

The New Zealand Nursing Council annual report 2010, shows the total number of nurses 2010, shows the total number of nurses practicing as at March 31, 2010 was practicing as at March 31, 2010 was 47,129. 47,129.

The total number of nurses practicing in the DHB

The total number of nurses practicing in the DHB setting was setting was 23,575 23,575

The current Nursing Council statistics show

The current Nursing Council statistics show 90 90 nurses had concerns about their competence nurses had concerns about their competence notified to Council in 2010. Following the initial notified to Council in 2010. Following the initial inquiry, no further action was required in relation inquiry, no further action was required in relation to 38 nurses, to 38 nurses, 42 42 nurses were assessed as nurses were assessed as requiring a competence review and requiring a competence review and 10 10 were still were still at the inquiry phase at the end of the year. at the inquiry phase at the end of the year.

End result. After a lot of input End result. After a lot of input and opportunity to improve and opportunity to improve

• Nurse deregistered for professional misconduct

Nurse deregistered for professional misconduct

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• Thu, 31 Mar 2011

Thu, 31 Mar 2011 News: Dunedin News: Dunedin

• The Health Practitioners Disciplinary Tribunal has recommended a former Dunedin Hospital nurse be struck off the

The Health Practitioners Disciplinary Tribunal has recommended a former Dunedin Hospital nurse be struck off the register for falsifying patient records, failing to recheck abnormal test results and asking another nurse to register for falsifying patient records, failing to recheck abnormal test results and asking another nurse to "accumulate" medication for his wife. "accumulate" medication for his wife.

• Rabindranath Joyram was fired from the hospital's neurosurgical ward in April 2009 after he admitted forging a

Rabindranath Joyram was fired from the hospital's neurosurgical ward in April 2009 after he admitted forging a patient's respiration rate. patient's respiration rate.

• Several days earlier he administered insulin to a patient based on a "significantly out of line" blood sugar test

Several days earlier he administered insulin to a patient based on a "significantly out of line" blood sugar test result. result.

• "Rather than rechecking the result, making sure the client had washed their hands or checking the calibration of

"Rather than rechecking the result, making sure the client had washed their hands or checking the calibration of the machine, Mr Joyram increased the insulin rate...and then failed to advise his supervisor that her (the patient's) the machine, Mr Joyram increased the insulin rate...and then failed to advise his supervisor that her (the patient's) blood sugar had increased or the actions he'd taken," the tribunal said. blood sugar had increased or the actions he'd taken," the tribunal said.

• The patient was later found drowsy and sweating.

The patient was later found drowsy and sweating.

• In a disciplinary meeting with management, Mr Joyram said he had a "germ of dishonesty".

In a disciplinary meeting with management, Mr Joyram said he had a "germ of dishonesty".

• Just days after he was fired, Mr Joyram emailed a former colleague asking her to steal medication from the ward.

Just days after he was fired, Mr Joyram emailed a former colleague asking her to steal medication from the ward.

• "My wife needs some Tramadol capsules...all you need to do is accumulate as many as you can and, if you are

"My wife needs some Tramadol capsules...all you need to do is accumulate as many as you can and, if you are agreeable, to give them to me before I leave (the country)," he said. agreeable, to give them to me before I leave (the country)," he said.

• Hospital staff later discovered the ward used three times more Tramadol than normal while Mr Joyram's wife was

Hospital staff later discovered the ward used three times more Tramadol than normal while Mr Joyram's wife was in the country for a holiday. in the country for a holiday.

• The tribunal found Mr Joyram guilty of professional misconduct and recommended his nursing registration be

The tribunal found Mr Joyram guilty of professional misconduct and recommended his nursing registration be cancelled. cancelled.

• It also recommended he be formally censured and pay 40 percent of the costs associated with the investigation

It also recommended he be formally censured and pay 40 percent of the costs associated with the investigation and prosecution. and prosecution.

• Mr Joyram, who trained as a nurse in Mauritius, is thought to have left the country.

Mr Joyram, who trained as a nurse in Mauritius, is thought to have left the country.

Research Project Research Project

Research paper completed a research proposal

Research paper completed a research proposal for investigating how the NC competency for investigating how the NC competency assessment process is undertaken for regulated assessment process is undertaken for regulated nurses nurses

Is the use of daily feedback useful for those

Is the use of daily feedback useful for those involved in the process, CNM, Preceptor, nurse? involved in the process, CNM, Preceptor, nurse?

Survey all DHB

s to assess current situation Survey all DHB s to assess current situation

6 CNM, 6 Preceptors, 6 nurses for their

6 CNM, 6 Preceptors, 6 nurses for their experience how to improve the process experience how to improve the process