1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 16 Providing Competent Staff

1Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 16

Providing Competent Staff


Benner’s Five Stages

Novice Advanced Beginner Competent Proficient The Expert

Benner (1984)



Staff Competency

The Joint Commission requires hospitals to have an adequate number of competent staff to meet the needs of the patients (2007)


Hospitals Are Required To Have Competent Staff

Traditional employer-employee arrangements or contractual arrangements can provide competent staff

Staff must be oriented, trained and educated Ongoing in-service education and training must be

provided Hospitals must assess, maintain and improve staff

competence Staff must have ongoing, periodic competence

assessments Staff should be encouraged to pursue ongoing

professional development


New-Employee Orientation

Orientation provides initial job training and information Some elements of orientation need to occur before staff

provides care, treatment, and services Other elements of orientation can occur when staff is providing

care, treatment, and services All employees, regardless of level of competence, are required

to attend orientation New-employee orientation covers organization-specific

functions, policies and expectations, such as mission, vision, values, stakeholder expectations, performance improvement, basic skill evaluation, and a mandatory policy review

Hospital orientations can range from 3 weeks to 6 months depending on the organization and responsibilities of the nurse

For new graduates, the orientation is often expanded to allow for mentoring to the new role



Preceptor Model

A preceptor is an experienced staff member who possesses excellent clinical skills and facilitates learning through caring, respect, compassion, understanding, nurturing, role modeling, and the excellent use of interpersonal communication (Speers, Strzyzewski, and Ziolkowski, 2004)

Experienced nurses are frequently required to serve as preceptors as part of their normal responsibilities




The performance appraisal should include:

Strengths and weaknesses Accomplishment of last year’s goals Future goals Specific examples of performance should be

included There should be a correlation between the

evaluation, the job description and the goals of the institution


At the time of the performance appraisal:

Discuss only the employee The first topic should be the accomplishments and

successes The interview should be positive and professional If improvement is needed in certain areas, these

specific areas must be addressed The employee should be granted a period of time to

improve their performance If disciplinary action is warranted, the nurse manager

should explain what is required to correct the performance




Clinical Ladders

Clinical ladders were developed in organizations in reaction to Benner’s concept of Novice to Expert (1984)

They were developed as a means to promote an individual’s growth as a professional nurse on the path to expert status


Clinician I

Entry-level professional nurse Focused primarily on developing knowledge

and skills Provides safe patient care at a basic level Shows the ability to care for increasingly

complex patients Requires consultation with more experienced

clinicians and benefits from feedback


Why should a hospital encourage nurses to continue to develop their career?

Reduces employee attrition (turnover) Provides equal employment opportunities Improves use of personnel Improves quality of work life Improves organizational competitiveness Avoids obsolescence and builds new skills


Clinician II

Capable clinician Focused on expanding knowledge and skills,

capable of daily charge role Consistently provides effective direct care as

part of interdisciplinary team to a variety of complex patients

Seeks as well as provides feedback for improved clinical practice

Assumes a novice leadership role but seeks mentoring in this process


Clinician III

Experienced and highly skilled clinician who is recognized for knowledge and skills

Uses an interdisciplinary and evidence-based approach to patient care

Has an emerging leadership style and functions consistently and autonomously

Is learning to negotiate the health care system to maximize the delivery of quality care and to minimize cost of patient care


Clinician IV

Minimum Baccalaureate of Science in Nursing Graduate level education preferred Well-developed clinical expertise within a defined specialty Recognized by peers as a leader within the institution Works predominantly with patients, families, and nursing staff Has aggregate responsibility at the regional level for nursing

care Incorporates current literature and research into practice Identifies the strengths within the service area and takes the

opportunity to develop and/or mentor others to promote professional growth and improve patient outcomes

Has demonstrated expertise in chosen scholarly activities focused toward the advancement or promotion of the profession

Documents

1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 16 Providing Competent Staff