Shift Your Competency Mindset

“The perioperative environment has so many technical skills and equipment that turn over constantly—if leaders have a competency for every technology, they are not going to make it,” stresses Donna Wright, BSN, MN, RN, a consultant with Creative Health Care Management, author and lecturer who helps health care organizations redesign their competency assessment process. “We have to look at defining competencies beyond return demonstration.”

She notes two other big mistakes perioperative nurse leaders make with competencies.

One is when leaders develop a highly specific competency to solve a grievance such as a surgeon who is unhappy with actions in the OR. The other is when a leader “sprays” a blanket competency such as hand hygiene compliance across the entire department and then “prays” that it sticks. “On so many levels, there is no evidence-base that says any of this works,” she says.

Reevaluate Your Competency Priorities

Wright suggests a good approach to developing and assessing a competency should be to meet these three goals:

1. Ownership—Staff should have a say in shaping the competency to feel ownership in their practice.
2. Empowerment—Staff should feel empowered in the choices they have within a specific competency to stay engaged.
3. Accountability—Staff must be accountable to their own practice. In some work places, a failed competency is not a fire-able offense but more of a gray area. Remember, what you accept is what you teach.

With these goals in mind, a nurse leader should then approach competency development by zeroing in on the source of the problem, and also constantly asking why a competency is needed to clean house in evaluating outdated competencies. “This decade in health care is really about shifting our mindset and competencies are a huge area for implementing this shift.”

Implement Smarter Competency Strategies

Looking beyond return demonstration to more far-reaching and usable competencies, Wright suggests nurse leaders consider these two key strategies.

• Leverage attitude—There is such thing as an attidudinal competency and it will carry anyone far, especially in perioperative services where nurses are known for having confidence, tenacity and focus, Wright assures.

  “Nurses don’t often think about attitude as a competency because we have gotten into such a rut thinking competency is about a checklist,” she acknowledges, noting an example of attitudinal competency she worked on with a team of float nurses. “In observing the work of a highly competent float nurse, I observed that none of his skills were technical, instead they were tied to social interaction, including how to learn on the fly, how to market yourself in a positive way, and crisis management.



• Empower—Too often a leader will come in acting like they know everything and ignoring the wisdom of their team. When a leader can understand how to empower and develop ownership in others, they are relying on their team members to own their practice and share their knowledge with each other, with other disciplines and with outside visitors including patients, families and even surveyors.

In fact, some of the best situations for competency development I have observed have been when a leader didn’t have the clinical background and had to rely on the team for solutions, Wright notes. “This is an important way a leader can emphasize that competency goes beyond a checklist.”

She says it also helps a nurse leader to work smart by considering competency-related activities already underway.

For example, quality improvement data are often demonstrate competency. Say there is a set role in which an individual sets up the procedural room. Then, once the room is set up, their work is evaluated to ensure the room is ready. This evaluation is a competency assessment.

Wright’s advice to leaders approaching a competency overhaul is “don’t do it alone,” she recommends. “Everyone in your organization is struggling with competency development so seek out those in MedSurg and the ER and ask them how they are handling their competency process.”

Free Resources for Members

Guideline Essentials: Develop and verify competencies to meet facility requirements with ready-to-use and customizable templates & tools for over 20 Guidelines.