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Providing Registered Nurses with essential

Critical Care Skills

National Competency Framework for Adult Critical Care Nurses

SupportSupport Information

Critical Care Networks- National Nurse Leads


Produced by

Melanie Kynaston: Chair, Critical Care National

Competency Working Group on behalf of CC3N.

email contact can be made via:

http://www.cc3n.org.uk

Telephone: Andrea Berry 0161 746 2226

Acknowledgements

This document has been produced by CC3N,

with support from the British Association of

Critical Care Nurses, the Intensive Care Society

Nursing AHP Committee, the Royal College

of Nursing Critical Care Inflight Forum, the

Independent Healthcare Advisory Services,

ICU Steps and representatives from Higher

Educational Institutes.

Thanks to all for their time and commitment

in the production of this document.

Who this documented is intended for:

• Commissioners of adult critical care nurse

education programmes

• Local Education and Training Boards & Chairs

• Higher Education and other institutions who

deliver post registration critical care nurse

education programmes

• Acute Trust Directors of Nursing

• Acute Trust Education & Training Leads

• Critical Care Lead Nurses/Matrons and

Managers

• Critical Care Practice Based Educators/Mentors/

Assessors

Created for CC3N by Giraffics Ltd. [email protected]


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Introduction

This supporting document has been developed to provide background information

explaining the development of the National Competency Framework for Adult

Critical Care Nurses. It includes the anticipated benefits of the framework and how

it can be used to provide robust assessment of competence in practice alongside

exams, vivas and assignments as part of an academic programme of study.

The guidance should provide Directors of Nursing, Critical Care Nurse Leads

and Practice Based Educators (or equivalent) with a strategic view of how

the competency framework can be used. In particular how it assists in the

development of a critical care workforce that has the skills and knowledge

needed to deliver safe high quality bedside care to the critically ill. Explanation

is provided to demonstrate how the competencies should be used in association

with the National Standards for Critical Care Nurse Education1 and the agreed

core curriculum (fig.1). For commissioners and providers of post registration critical

care courses this document will describe the benefits associated with having a

standardised and transferable competency framework which supports academic

programmes of study.

Figure 1 - Critical Care Award

National Standards for Critical CareNurse Education 2011

National Competency Framework for Critical Care Nurses 2012

60 CreditsLevel 6 or 7

Step 2 & 3 CompetenciesDelivered by expert critical care

Core CurriculumExams, vivas & assignments

Work based standardised clinical assessment

Successful completion of academic programme

Validated and transferablecritical care award

Successful completion of academic competencies

Background

It was recognised that these variations had a direct impact on the quality of care being delivered within critical care units and indirectly on recruitment and retention of the critical care nursing workforce.

The outcome of the critical care educational review resulted in the development of the “National Standards for Critical Care Nurse Education” published in 20111. They were developed by a national working group representing key stakeholders, including critical care networks and those involved in the provision of critical care nurse education. The standards set out a nationally agreed service driven core curriculum to underpin critical care nurse education and made clear recommendations to support the development of a competent and academically educated nursing workforce (Table 1).

Table 1. National Standards for Critical Care Nurse Education – Recommendations

Recommendation 1 Post registration courses for critical care nurses should follow the set key standards and principles. They should be utilised to support other audit or review processes associated with academic standards. In applying these there will be the opportunity for equity in course delivery and outcomes

Recommendation 2 The identified core curriculum should form part of all critical care programmes

Recommendation 3 A nationally recognised transferrable “Award in Critical Care Nursing” should be at least a graduate level award at academic level 6 with a minimum of 60 credits, e.g. Graduate Certificate In Critical Care Nursing

Recommendation 4 Nurses may be required to meet future National Occupational Standards (NOS) and should work towards core critical care competencies as they emerge

Recommendation 5 Assessors supporting a nurse on a critical care programme of study need to be a competent critical care nurse and to have completed a programme of study that meets the requirements of mentorship (NMC, 2008)2. As a minimum all assessments should be made against the performance criteria in emerging critical care competencies and linked to NOS in order to ensure consistency and to make assessment more objective

Recommendation 6 Strategies to monitor the success of changing critical care educational programmes. Workforce knowledge and clinical competency must match the requirements of the service provider

Recommendation 7 Commissioners of education are advised to review the Standards and Principles for Critical Care Nurse Education and utilise the content to support the development of national standards for critical care education

In 2008 the Critical Care National Network Nurse Leads Forum (CC3N) undertook a review of critical care nurse education programmes. This followed concerns raised by critical care nursing leads nationally and related specifically to the inequity and differing quality of critical care education provision, including:

• Variation in academic courses offered (including curriculum covered and skills attained)• Variation in academic awards attached to programmes• Variation in cost and value for money• Variation in the competence of nurses at the bedside (despite achieving formal courses)• Lack of transferability of critical care awards across geographical boundaries

1 National Standards for Critical Care Nurse Education; A framework to improve educational outcomes and quality (2011) Critical Care Nurse Education Review Forum on behalf of the Critical Care National Network Lead Nurse Forum (CC3N)

2 NMC Mentorship (2008) Standards to support learning and assessment in practice. NMC standards for mentors practice teachers and teachers.


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Development of the Competency FrameworkIt has been recognised that over the past decade, higher education post registration courses have developed essential analytical and critical thinking skills for nurses. However, it is also recognised that there has been a move away from the equally important assessment of clinical competence. It became increasingly apparent during the development of the National Standards for Critical Care Nurse Education1 that post registration critical care programmes should include both theoretical and competency assessment to prepare critical care nurses with both the relevant knowledge and skills needed to practice high quality safe and effective care with confidence.


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The process for developing the competency framework for nurses in critical care included:

• Establishing an expert group to guide and inform competency development, including:• Local Critical Care Nurse Leads • Critical Care Practice Based Educators• Critical Care Network Lead Nurses• Higher Education Institute-Critical Care Programme Leads• Royal College of Nursing• Intensive Care Society - (Nurses/AHP Forum)• British Association of Critical Care Nurses• Independent Healthcare Advisory Service - Critical Care Educators• Reviewing existing frameworks and documentation• Developing core/essential system based competencies to mirror the core curriculum outlined in the National Standards for Critical Care Nurse Education1 (Table 2)• Agreeing standardised language and terminology • Discussing critical care specific national occupational standards with Skills for Health• Widely consulting with key critical care stakeholders regularly including those from practice and academia • Agreeing and signing off of competencies following the final consultation process

The objective of the national competency working group was therefore to identify and agree the essential competencies required for an adult general critical care nurse working in a level 3 area, to develop them through their preceptorship period (starting as a novice) in the critical care environment, through to obtaining a post registration academic award in critical care studies.

Table 2. Critical Care Competency Framework Content

System Additional Areas

Respiratory Medicines Management

Cardiovascular Admission & Discharge

Renal End of Life Care

Gastrointestinal (including liver & biliary) Rehabilitation

Neurological Psychosocial Wellbeing

Integumentary Communication & Teamwork

Infection Prevention & Control

Inter & Intra Hospital Transfer

Evidenced based practice

Professionalism

Defensible Documentation

Leadership

Competence based education and evaluation consists of two components: identification in clear, measurable terms, with indicators for the level of performance required for specific skills; and the evaluation of skill acquisition through measurable criteria3.

The National Standards for Critical Care Education1 describes competence as:“The combination of skills, knowledge and attitudes, values and technical abilities that underpin safe and effective critical care nursing care and interventions”. (p.14)

The competencies are set out to provide a pathway of progress, starting with a novice in critical care to becoming a competent and safe practitioner. The competencies have been divided into 3 steps to support this progressive development (fig. 2).

Figure 2 - Steps of Competence

Step 1 Competencies should be commenced when a nurse begins in critical care where he/she has no previous experience of the speciality. These competencies can aid staff development during preceptorship4.

It would generally be expected that staff will have completed Step 1 Competencies before accessing an academic critical care programme

It is recommended that all Step 1 Competencies should be completed within 12 months

Step 1 competencies are suitable for use in Level 2 facilities

Local Organisations and HEI’s/Providers of acute care courses may use their discretion as to whether Step 1 competencies are relevant and transferable to Level 1 enhanced care areas and/or Critical Care Outreach teams

Steps 2 & 3 Competencies should be completed during the period of an academic critical care programme where ‘the learner’ will gain the necessary depth of related theory and knowledge.

Step 2 competencies will allow the nurse to:• Demonstrate skilled performance in the activity with enhanced theoretical knowledge and understanding giving rationale for practice • Demonstrate application of knowledge and understanding in relation to relevant policies, procedures and guidelines• Participate in problem solving through critical analysis and evaluation of more complex situations• Develop more varied critical care experience with minimum supervision and guidance, attaining competence in related knowledge and skills

Step 3 competencies will allow the nurse to:• Demonstrate competent performance in all the activities specified without direct supervision based upon relevant evidenced based knowledge, intuition and established practice• Independently problem solve complex situations and offer solutions through critical analysis and evaluation • Supervise and instruct others in a range of activities related to their role and responsibilities • Apply knowledge, understanding and research to relevant policies, procedures and guidelines to critically analyse and improve practice

3 Manley K, Garbutt R. (2000) Paying Peter and Paul; reconciling concepts of expertise with competency for a clinical career structure. Journal of clinical Nursing 9: 347 – 359

4 Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. DH, London

continued on next page


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Measuring Competence


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For the competency document to remain valid and transferable between organisations and geographical areas, all core/essential competencies need to be achieved. If competencies are not achievable within the normal working environment, systems should be put in place that allow staff to gain exposure and experience in the outstanding core competencies within other departments and/or critical care units. For example, staff who generally work in a unit that does not provide renal replacement therapy will need to spend time working in a department/unit that is able to provide this experience. A lack of learning opportunities locally should not prevent an individual learner from progressing through the competencies.

Although competencies cannot be removed from the framework local organisations may add additional competencies to cover more specialist care pertinent to their own area, for example, cardiac surgery, major trauma, ECMO, burns and neurology.

How should the competencies be used?The competencies are designed to be a multi-purpose tool that will underpin the provision of high quality, individualised patient care. The competencies will support and inform strategic planning, workforce development and management at strategic and unit level. They provide guidance for educational commissioning and structure the content of critical care education and training programmes. The competencies will enhance local accountability and support the role and development of current and aspiring critical care nurses and future leaders.

Figure 3 - Competence for Critical Care Services

Using the competencies at differing levels:

Service and strategic level• Service reviews• Workforce/role design and profiling• Education commissioning, planning and provision

Unit and managerial level• Recruitment and selection• Staff appraisal• Education, training and development planning and delivery• Career development and advice• Design of professional and vocational qualifications

Individual and team level• Career progression• Self assessment and personal development planning• Coaching• Clinical supervision• Professional revalidation/registration


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Links to other key frameworksModernising Nursing Careers The National Critical Care Nurse Competencies have been developed to underpin the aims described in Modernising Nursing Careers5, where competence is seen as the currency that allows for greater movement and flexibility of the nursing workforce. Providing verified evidence of skills and competence makes it easier for nurses to demonstrate suitability for new posts, and also allows staff to plan and manage their careers more effectively.

Knowledge & Skills Framework The competencies support the generic Knowledge and Skills Framework6 (KSF) within the NHS, and can be used by organisations to develop the detailed content of KSF post outlines for nurses working in the critical care environment.

Liberating the NHS Liberating the NHS: Developing the Healthcare Workforce: From Design to Delivery (2012)7 sets out the opportunity for healthcare providers being ‘at the heart of the decision-making process, with the opportunity to design the shape of their workforce and the way in which they develop the people they employ’. These competencies aim to do just that by supporting nurses to attain the right professional and clinical skills in practice and strengthen partnerships between all academic providers, by utilising these competencies as part of developing theoretical knowledge.

NHS Leadership Framework The competencies are linked to the NHS Leadership framework, with particular focus on Demonstrating Personal Qualities and Working with Others8. The leadership competencies require individuals to draw upon their values, strengths and abilities to deliver high standards of service (fig.4) and are key in the professional growth that underpins high quality nursing.

Figure 4 - Demonstrating Personal Qualities, NHS Leadership Framework

5 Modernising Nursing Careers; setting the direction (2006) Department of Health, London6 Department of Health (2004) The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_40908437 Department of Health (2010) Equity and Excellence; Liberating the NHS. London8 NHS Leadership Framework. NHS Leadership Academy available at http://www.leadershipacademy.nhs.uk


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Recommended Best Practice Principles

Assessment and Accountability

Healthcare Organisations will need to consider putting in place the following infrastructure to support the use of the competency framework where it underpins an academic programme of study:

Learning Contract A learning contract is required between the individual learner, lead assessor and unit manager before undertaking the competency programme

Designated Practice Educator A designated critical care Practice Educator (or equivalent) is required to support the implementation of the competencies in practice and lead in the development and implementation of the adopted critical care education strategy

Supernumerary Study Time Provide a minimum supernumerary period of 4-6 weeks for newly appointed registered nurses and support protected study leave for formal educational programmes as and when required

Learner and Mentor Clinical Time Facilitate a minimum of 40% of learners’ clinical practice hours with their mentor/assessor/Practice Educator and/or delegated appropriate other

A creative environment for learning Provide a range of learning experiences, involving patients, clients and professional team members to meet the defined learning needs of the workforce

Clinical Placement Provide and/or support clinical placements to facilitate learner development and achievement of clinical outcomes and core/essential competency requirements

Mentor and Assessor Quality Assurance Regulation and quality assurance of mentors and assessors should be undertaken by local organisations, HEI’s and critical care Practice Educators (and/or equivalent), to ensure validity and transferability of the assessment process and nurses’ competence

Through the application of effective mentorship and assessor strategies consistency in the attainment of nursing competence can be assured. The following standards should be achieved and practiced by all nurses with assessment responsibilities and mentorship accountability:

• Demonstration of a breadth of understanding in assessment strategies and the ability to contribute to the total assessment process as part of the teaching team

• Provide constructive feedback to learners and assist them in identifying future learning needs and actions

• Manage failing learners so that they may enhance their performance and capabilities for safe and effective practice or be able to understand and manage their failure and the implications of this for their future

• Be accountable for confirming that learners have met, or not met, the critical care competency statements and are capable of safe and effective practice at the relevant level

• Demonstration of a working knowledge of current educational programmes, practice assessment strategies and relevant changes in education and practice for the learner they are assessing

• Demonstration of an in depth understanding of their accountability for the decision they make to pass or fail a learner when assessing competence


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Assessment DocumentationTo assist the mentor, lead assessor and individual learner records of achievement and competency review documentation have been provided. The following assessment and development plan records should be completed by lead assessors at varying progress review points to identify learner needs:

• Assessment Record Summary• Initial Assessment & Development plan• Ongoing Assessment & Development plan • Step 1 Competencies tracker sheet• Step 2 Competencies tracker sheet• Step 3 Competencies tracker sheet• Final Competency Assessment • Annual Competency Review

Assessment Record Summary This is a live document that should be completed by the lead assessor at the end of each progress meeting. Once all competency development is complete it can be used as an annual review sheet in conjunction with any existing local appraisal process

Initial Assessment & Development Plan This document should be completed by the lead assessor in conjunction with the individual learner before embarking on Step 1 Competencies and should outline the learners’ current critical care knowledge, understanding and skills and list those competencies that need to be achieved within the first 3 months

Ongoing Assessment & Development Plan This document should be completed by the lead assessor in conjunction with the individual learner throughout their competency development. The ‘Initial’ or previous Assessment & Development plan should be used as a baseline for any ongoing assessment. It is expected that individuals should meet with their lead assessor to review and set development plans and learning opportunities at least 3 monthly

Step 1, 2, & 3 Competency Tracker Sheet There is a tracker sheet for each of the 3 sections and the respective document should be completed by mentors or assessors as the individual achieves each competency statement. This provides an easy and clear system to review and/or audit progress at a glance

Final Competency Assessment A final competency assessment sheet should be completed by the lead assessor at the end of each step and will provide the individual and the unit with clear evidence of achievement of competence

Annual Competency Review Once all ‘Steps of Competence’ have been achieved this document should be completed as part of a local annual appraisal system and will outline any learning requirements that need to be revisited or further enhanced to maintain competence


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Mentors/Assessors must meet the following requirements:

Complete an NMC approved mentor preparation programme.

Comply with the NMC Mentorship Standards2.

Performs all clinical skills in a professional, safe and consistent manner

Demonstrates evidence of developing their knowledge skills and competence beyond their nursing registration

Have completed a post registration qualification in critical care nursing

Demonstrates that their practice is evidenced based and in line with current critical care recommendations and guidelines

Is able to make recommendations in relation to competence and provide rationale

Is approved by the Critical Care Service Manager/Lead Nurse

To establish effective working relationship by:

Demonstrating an understanding of factors that influence how individuals integrate into practice setting

Providing ongoing constructive support to facilitate transition from one learning environment to another

Demonstrating effective professional and inter professional working relationships to support learning

To provide leadership by:

Planning a series of learning experiences that will meet learners defined learning needs

Acting as an advocate for learners to support them accessing learning opportunities that meet their individual needs

Prioritise work to accommodate support of learners within their practice roles

Provide feedback about the effectiveness of learning and assessment in practice

Specific responsibilities of mentors/assessors include:

Promotion of a positive learning environment

Support of the individual to expand their knowledge and understanding

Highlighting learning opportunities

Set realist and achievable action plans

Complete assessments within the recommended timeframe

Bring to the attention of the HEI, Education Lead and/or Manager concerns related to the individual nurses learning and development

To facilitate learning by:

Using knowledge of the learners’ stage of development to select appropriate learning opportunities to meet the individuals’ needs

Facilitating the selection of appropriate learning strategies to integrate learning from practice and academic experiences

Supporting learners in critically reflecting on their learning experiences in order to enhance future learning

Identifying and applying research and evidence – based practice to their area of practice

Supporting learners in applying an evidence base to their own practice

Role and Responsibility of Mentors /Assessors


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To ConcludeThe competency framework should be used in conjunction the National Standards for Critical Care Nurse Education1 and aims to:

• Provide clarity for organisations and describes what they can expect a competent critical care nurses to do within their role

• Reduce variations in assessment of nurse competence across the critical care community

• Provide a standardised approach to the competency assessment of critical care nurses undergoing post registration academic programmes of study

• Provide a currency that allows recognition of competence between health care organisations


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This framework has been developed in partnership with a wide range of stakeholders from practice and academia within the critical care community across England, Wales and Northern Ireland. Thanks are extended to all contributors specifically the following:

Chair Critical Care National Competency Working Group:

Melanie Kynaston Cheshire & Mersey Critical Care Network, Mid Cheshire NHS foundation Trust

Members of the Critical Care National Competency Working Group:

Alison East on behalf of Herts and Beds Critical Care Network

Alison Eddleston University of Central Lancashire

Amelda Blignaut Independent Health Sector

Andrea Berry Lead Nurse Greater Manchester Critical Care Network, Chair CC3N

Andrea Baldwin Director & Lead Nurse Lancaster & South Cumbria Critical Care Network

Angela Himsworth Lead Nurse The Midlands Critical Care Networks

Ann Price BACCN Representative & Senior Lecturer Canterbury Christ Church University

Anne Miles Critical Care Unit Manager Wye Valley NHS Trust, Herefordshire

Caroline Wood on behalf of Mid Trent Critical Care Network, United Lincolnshire Hospital NHS Trust

Chris Hill Royal Free Hospital King’s College London

Debora Cheetham Practitioner/Lecturer North of England Critical Care Network, City Hospitals Sunderland NHS Trust

Diane Eady on behalf of Mid Trent Critical Care Network, United Lincolnshire Hospitals NHS Trust

Gemma Ellis Wales

Helen Jones The Walton Neuroscience Centre

Julie Platten Nurse Educator North of England Critical Care Network, Queen Elizabeth Gateshead

Karen Donnelly Nurse Educator North of England Critical Care Network, James Cook University Hospital

Kerry Pennington-Haigh Critical Care Sister St Helens & Knowsley NHS Trust

Linda Bower Kent & Medway Critical Care Network

Lesley Durham NOrF Representative, Director & Lead Nurse North of England Critical Care Network

Lisa Billington Senior Critical Care Sister, Mid Cheshire NHS Foundation Trust

Lorna Johnson NOrF Representative & West Yorkshire Critical Care Network

Lorraine Burgess ICS Representative & Senior Lecturer John Moores University

Lorraine Marsons Birmingham City University

Maria Kisiel Birmingham City University

Mary Jordan Workforce Development Lead Cheshire & Mersey Critical Care Network

Mary McQuillan Clinical Nurse Educator Tunbridge Wells Hospital

Neville Rumsby Practice Educator Liverpool Heart & Chest Hospital

Christie Peggy South Devon Healthcare NHS Foundation Trust

Sarah Clarke Director & Lead Nurse Cheshire & Mersey Critical Care Network

Sheila Kinoulty Northern Ireland

Stella Evison Education & Development Practitioner Central Manchester Foundation Trust

Acknowledgements


Critical Care Networks-National Nurse Leads (CC3N) 2013

All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and patents Act 1988.

Neither the Critical Care Networks-National Nurse Leads (CC3N) nor the authors accept any responsibility for any loss or damage arising from actions or decisions based on the information contained in this publication. Ultimate responsibility for the treatment of patients and interpretation of the published materials lies with the Registered Nurse.

This document has been produced with support from these organisations and is available through their websites.

www.baccn.org.ukwww.cc3n.org.uk

www.icusteps.org.uk

www.ics.ac.uk www.rcn.org.uk

www.independenthealthcare.org.uk

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Critical Care Networks- National Nurse Leads Support for ... · National Competency Framework for Adult Critical Care Nurses Page 7 For the competency document to remain valid and