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How often do we need to repeat the competency?
Frequency of competency assessment will be decided by the relevant nursing or midwifery network, based upon clinical practice and exposure to the relevant care to evidence the competency.
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Do we still need to get related evidences such as Lippincott checklists?
Lippincott is an excellent evidence-based e-resource which nurses and midwives can use to acquire or refresh their knowledge and practice. Lippincott or other checklists cannot be used for assessing competence. This is because competence is evidenced holistically, through overall output and performance, rather than fragmented aspects of care.
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Who will be responsible to assess the assessors to make sure they are competent?
• All staff who are licensed with QCHP and are working to their scope of practice are deemed to be competent.
• Nurses and midwives have a professional responsibility and accountability to recognize and work within the limitations of their knowledge.
• Professional development needs are managed through the APR process.
• Competence must be evidenced holistically, through overall performance in practice and learners should work with a range of inter-professional team members to acquire and confirm competence. This is coordinated by the preceptor.
• Preceptors must also demonstrate their competence through their overall performance within their scope of practice, thus confirming they are competent to make judgements about learners under their supervision.
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Whose idea is this?
Development and implementation of a nursing and midwifery competency framework was an objective of HMC’s 2015-2018 Nursing and Midwifery Strategy. This has been incorporated in current nursing strategy 2019-22.
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What shall we do if a staff is deemed "not competent"?
• Head nurses, Directors of Nursing and Unit Managers are responsible assuring that nurses/midwives under their supervision are competent and fit to practice.
• If a practitioner identifies a gap in their own practice, they are professionally accountable and must not practice beyond the limitations of their knowledge.
• The practitioner must liaise with their head nurse/line manager to ensure they access the appropriate resources to develop their knowledge, skills, behaviors and attitudes to evidence their competence to practice.
• If a team member believes a colleague is not competent to practice, they are professionally accountable and must bring this to the attention of the head nurse/line manager
• The education team will work with the unit staff to develop an appropriate learning plan to ensure the practitioner achieves the levels of knowledge, skills, behaviors and attitudes to evidence their competence to practice.
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What if the staff are unable to demonstrate the competencies in a specified period?
• The normal HR processes and policies for performance management should be followed.
• The education team will work with the unit staff to develop an appropriate learning plan to ensure the practitioner achieves the levels of knowledge, skills, behaviors and attitudes to evidence their competence to practice.
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Who will assess the competence of charge nurses and head nurses?
• All staff who are licensed with QCHP and are working to their scope of practice and have successfully completed their orientation are deemed to be competent.
• Nurses and midwives have a professional responsibility and accountability to recognize and work within the limitations of their knowledge.
• Head Nurses and Charge Nurses must demonstrate clinical and HMC leadership competencies through their overall performance within their scope of practice, thus confirming they are competent to make judgements about staff under their supervision.
• Head nurse and charge nurse competence will be managed through the normal line management processes.
• Head nurse and charge nurse professional development needs are managed through the APR process.
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Why are there so many more skills checklist now than before?
• There are no skills checklists in the new competency framework. There are generic competence statements (see slide 11 from the educator’s workshop ppt for examples of competence statements).
• Competence to practice is evidenced through knowledge, skills, behaviors and attitudes which are agreed by nursing/midwifery clinical networks.
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How does the new framework support standardized practice?
• Competence to practice is evidenced through knowledge, skills, behaviors and attitudes which are agreed by nursing/midwifery clinical networks, relevant to the specialty and scope of service.
• This means a critical care nurse in Hamad Hospital must demonstrate the same competence as a critical care nurse in Al Wakra Hospital for example.
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Compassionate and holistic are very broad terms. How do we know what they mean?
• Definitions of compassionate and holistic care are included in the HMC nursing administrative protocol for competency assessment.
• These definitions are based on feedback from HMC nurses working in clinical practice and international research evidence.
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What is the plan for roll-out of the competency framework?
• The competency framework will be rolled out across specialties, not by facility.
• The first 4 areas (Critical Care, Mental Health Services, Child Health/Pediatrics and Midwifery) will launch in December 2019.
• Medicine, Surgery and ED will launch by the end of Q1 2020.
• The aim is to complete the implementation of roll out Q4 2020.
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How are decisions disseminated to the staff?
• There will an awareness campaign with regular updates in Start the Week and the Nurse Advocate. Awareness sessions for staff will be delivered for all HMC facilities.
• Ahead of the launch for each specialty, the education team will deliver a targeted awareness and briefing sessions for preceptors, head nurses and other relevant staff within that specialty.
• The Corporate Competence Framework Steering Committee provides a progress report to the Education and Practice Development Committee when it meets every other month.
• EPDC members cascade this information within their clinical areas.
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Before implementation how do you ensure assessors can assess using the holistic approach?
• Ahead of the launch for each specialty, the education team delivers a targeted awareness and briefing session for preceptors, head nurses and other relevant staff within that specialty. This session covers holistic assessment of competence.
• The newly launched preceptor program embraces the concept of holistic assessment.
• Student preceptors are taught the theory of holistic assessment in the classroom.
• Student preceptors must then demonstrate their own ability to be a preceptor in the practice are through their overall performance to achieve the learning outcomes of the preceptor program.
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What if the network is not active?
The Corporate Nursing Quality and patient safety team is working with clinical staff to ensure every specialty has an active clinical network or competency committee who will manage the development and revision of competencies.
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What type of evidence can be used to support my competence?
• A range of evidence can be provided, and includes observed clinical practice, knowledge, technical skills, ethics, professional behaviors, verbal feedback;
• Completion of formal and in-house education, reflective practice accounts and application of new knowledge into existing practice;
• Documentary evidence such as patient records, the APR process, professional portfolio, personal development plans, etc.
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Do existing staff need to repeat confirmation of competence following introduction of the new competency framework?
• No;
• However, all staff who are licensed with QCHP and are working to their scope of practice and have successfully completed their orientation are deemed to be competent;
• Nurses and midwives have a professional responsibility and accountability to recognize and work within the limitations of their knowledge.
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Does the new framework replace the appraisal?
• No;
• However, evidence used to demonstrate competence should be discussed during the APR and recorded in the professional portfolio.
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How will you train preceptors?
• A new preceptor program was launched in Q4 2020 to ensure learners understand, acquire, develop and apply the necessary knowledge, skills and behaviors to function effectively as a preceptor.
• Classroom sessions focus on the theory of teaching and learning in practice inform and underpin the development of the confidence and competence necessary to perform safely and confidently as a preceptor in the clinical setting.
• Staff evidence their competence to practice as a nurse/midwife preceptor in their clinical area through the achievement of the program outcomes, including demonstration of competence in the clinical setting.
• Successful completion of the preceptor program will ensure preceptors are competent to support new staff through role modeling, demonstration, feedback and dialogue during the orientation period and beyond preceptors will be invited to attend competency awareness sessions during NMCF rollout.
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What if preceptors are not willing to assume the new role?
Preceptors should discuss and negotiate their role with their line manager.
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What if there is a suspicion of malpractice or bias in competence assessment?
• Misuse of power should be reported, investigated and managed through the appropriate HMC policy (HR 3002 Bully and Harassment in the Workplace).
• In line with the HMC Code of Professional Behavior and Ethics for Nurses and Midwives, staff are accountable for the decisions they make regarding the competence of those under their supervision or guidance.
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What if nurses and midwives are unable to demonstrate their competencies in a specified period?
• As mentioned in NAP (draft) “Assessment of Nursing and Midwifery Clinical Competence in Practice, this is managed through the APR and/or HMC Policy 3049 (Performance Management and Evaluation).
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If staff are promoted or relocated to another unit, do they have to demonstrate the new competencies?
• Yes.
• It is every nurse or midwife’s professional responsibility and accountability to identify the elements of competence required in line with the new scope of service.
• Nurse and midwives are accountable for their practice and must acknowledge the limitations of their competence.
• Nurses and midwives must ensure they are safe, confident and compassionate to practice within the limits of their competence.
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What if there is an element of complex practice within my specialty (such as ECMO, therapeutic warming, stoma site marking, compression bandaging)? Am I expected to evidence this to be assessed as competent?
• If there is an element of complex practice within your specialty that is beyond the limitations of your scope of practice, you are not expected to evidence it.
• That element of practice will be marked as N/A in the template used for assessing your specialty practice competence.
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How will Competency Steering Committee members for specialties where it is not appropriate to have a network (e.g. services delivered on a single site) be appointed?
• Executive Directors of Nursing or their delegates will be responsible for identifying Competency Steering Committee members for specialties where it is not feasible to establish a network.
