Leadership: Enhancing the Leadership: Enhancing the OR Nurse Competencies OR Nurse Competencies

towards Global Proficiencytowards Global Proficiency

Maria Linda G. Buhat, RN, Ed.D.PHC-Asst. Director for Nursing Service

4141stst Annual Convention and Scientific Meeting Annual Convention and Scientific MeetingJuly 5, 2015July 5, 2015

Disclosure

ReferencesReferences

Department of Health, Philippines (DOH) Patricia Benner. Retrieved from http://www. currentnursing.com/nursing_theory/Patricia • http://www.brainyquote.com/quotes/keywords/

competence.html#ubGCOLcIlDsKUceI.99

Definition of CompetenciesDefinition of Competencies

• The specification of knowledge and skills, and the application of such knowledge and skills, within an occupation or industry level, to the standard of performance required in employment

Definition of CompetenciesDefinition of Competencies

• The combination of skills, knowledge attitudes and attributes needed to carry out a task or job to a defined performance standard

• The critical characteristics that cause or predict outstanding job performance

• Include personal characteristics, motives, self-concept, knowledge, and behavioral skills

The competency-based approach to defining performance and development is

premised on the use of critical characteristics that predict outstanding job

performance – behaviors that are consistently demonstrated at the

workplace so that success is assured.

GloballyGlobally

• Competency certification is the trend to promote culture of safety

CertificationCertification

• Gain credibility and recognition from colleague, patient and physician

• Personally gain confidence in their skill

• Knowledgeable of the current standard

Asean Qualifications Reference Framework (AQRF)

8

1

2

34

5

6

7

123456

78

9

12

34

5

6

7

Qualifications(A)

Qualifications(B)

Country(A)

Country(B)

AQRF

8

LEVEL 6

KNOWLEDGE, SKILLS AND VALUES

Graduates at this level will have a broad and coherent knowledge and skills in their field of study for professional work and lifelong learning

APPLICATION Application in professional work in a broad range of discipline and/or for further study

DEGREE OF INDEPENDENCE

Independent and /or in teams of related field

QUALIFICATION TYPE Baccalaureate Degree

LEVEL 7

KNOWLEDGE, SKILLS AND VALUES

Graduates at this level will have advanced knowledge and skills in a specialized or multi-disciplinary field of study for professional practice, self-directed research and/or lifelong learning

APPLICATION Applied in professional work that requires leadership and management in a specialized or multi-disciplinary professional work and/or research and/or for further study

LEVEL 7

DEGREE OF INDEPENDENCE

Independent and or in teams of multidisciplinary

QUALIFICATION TYPE Post-Baccalaureate Program

TESDATESDA

HIGHER HIGHER EDUCATIONEDUCATION

POST BACCALAUREATE

DOCTORAL AND POST DOCTORAL

BACCALAUREATE

NC I

G12

10

The Philippine Qualifications The Philippine Qualifications FrameworkFramework

BASIC BASIC EDEDL 8

L 7

L 6

L 5

L 4

L 3

L 2

L 1

DIPLOMA

NC III

NC II

NC IV

(Approved by the NEDA SDC-Cabinet on May 18, 2012)(Approved by the NEDA SDC-Cabinet on May 18, 2012)

Legal Basis: DOH Mandate

EO No. 102 s. 1999: “Redirecting the Functions and Operations

of the Department of Health”

Section 3. Powers and Functions k) Ensure quality of training and health human resource development at all levels of the health care system

Rationale

•Improve the quality of delivery of health services through an upgrading of competencies of nurses in health facilities

•Standardize training programs in clinical and public health nursing areas through a system of competency-based development

•Increase employability and opportunities of certified nurses

The DOH Nurse Certification Program (DOH-NCP)

• Program was launched last November 23, 2012

Objectives:1.Standardize clinical competencies in various

specialty areas2.Address competency gaps3.Improve delivery of nursing care

Issuances

• Department Order No. 2012-0181 “Guidelines on the Department of Health Nurse Certification Program”, dated October 15, 2012

• Department Order No. 2013-0100 “Operational Guidelines on the Implementation of Department of Health Nurse Certification Program (DOH NCP) in Designated Hospitals”, dated July 23, 2013

What DOH-NCP is What DOH-NCP is NOT

A DOH- initiated and supervised system of developing and certifying nurses based on a set of standard competencies in specific specialty areas.

A competency-based development program that will address the ‘skills gap’ of nurses

•Employment •A solution to unemployment

•A training program•A Volunteer program•A program for nurse specialist training

•A guarantee for local or international employment

•An ICN equivalent to nurse specialization

DOH Nurse Certification DOH Nurse Certification Program TheoryProgram Theory

CAUSAL INTERVENTION OUTCOME

• 'Competency gaps' of nurses entering the workforce

•Lack of standard competencies as basis for training nurses at the workplace

• Competency based assessment, development and certification of nurses in standard workplace competencies

• Improve competencies of nurses in the health facilities

•Improve quality of health services delivery

•Increase employment opportunities for certified nurses

DOH Nurse Certification Program Competency Framework

Level 5

Level 4

Level 3Level 3 Certified (through an assessment process of Level 3 competencies)

Level 4 Certified (through an assessment process of Level 4 competencies)

Entry-level Competencies (Level 2), with DOH-identified qualifications

Stage 1 of Development, to produce a Nurse with the necessary Core (Level 3) Competencies for a particular Specialty AreaOn entry: Pre-Specialty Training and Assessment

Stage 2 of Development, to produce a Nurse with Level 4 Competencies for chosen Specialty and Sub-Specialty Area

Stage 3 of Development, to produce a Nurse with the highest possible level of Competencies in a Specialty Area and in Management

DOH Nurse Certification Program Competency Framework

12mos 21mos18mos6mos 24mos0yrs

• Competency-based development that will be standardized across all DOH hospitals • With level progression: Levels 1-2 – General Nursing; Levels 3-5 – Specialty Nursing • Assessment of competencies is a major part of the implementation • Certification will be based on the competencies demonstrated and applied in the workplace • Creates a pool of DOH-certified nurses

• Provides nurses options for different career paths

Ward & OR nursing I Ward & OR nursing II

Renal I Renal II Renal III

Cardio I Cardio II Cardio III

Pedia I Pedia II Pedia III

Level 1 Level 2 Level 3 Level 4 Level 5

PHN III PHN IV PHN VPublic Health Nursing I Public Health Nursing II

DOH Nurse Certification Program

Competencies are both cumulative and incremental. A higher level of proficiency assumes an individual has gone through

and been declared competent in the lower level competencies.

“With higher levels of competence, a nurse is expected to be able to synthesize theory with

practice, and apply past experiences to actual nursing situations in a holistic

manner.”

- Benner, Patricia

Basic Core Competencies Basic Core Competencies

• Safe Quality Nursing Care

• Management of Resources and Environment

• Health Education

• Legal Responsibility

• Ethico-Moral Responsibility

• Personal and Professional Development

Basic Core Competencies Basic Core Competencies

• Research

• Records Management

• Communication

• Collaboration and Teamwork

• Quality Improvement

DOH Additional Basic Core DOH Additional Basic Core Competencies Competencies

• Professional/Personal Development

• Personal Mastery

Sample Competency Profile Competency Area Level 3

(Competent)Level 4

(Proficient)Level 5(Expert)

ER, PICU, CCU, MICU, SICU, Telemetry Unit, OR, CV Lab, Cardio-Renal

ER, PICU, CCU, MICU, SICU, Telemetry Unit, OR, CV Lab, Cardio-Renal

Level 4 areas + Management responsibilities

• Safe and Quality Nursing Care

• Assessment: History-taking NCCVNL3A01

Obtains a complete and accurate patient history to identify risks, predisposition to and/or actual cardiovascular problems

Underpinning NCCVNL3A01 Obtains a complete and accurate patient history to identify risks, predisposition to and/or actual cardiovascular problems

NCCVNL5A01 Develops nurses’ ability in obtaining complete and accurate cardiovascular patient history

NCCVNL4A01 Obtains a complete and accurate patient history to identify impending cardiovascular complications

NC CVN – Nurse Certification Cardiovascular Nursing

Self-Assessment Tool

Assessment Plan

Sample Assessment Guide

Checklist for Assessors

Competency-based Assessment and Certification

1. Application and self assessment

2. Validation (by immediate supervisor)

3. Assessment

Certification

FeedbackCompetency - based learning interventions

Reassessment

“not yet competent” “competent”

1. Choose a specialty area 2. Go to: www.hhrdb.doh.gov.ph/ncp and

download the self-assessment tool 3. Do a self-assessment and determine if

you have the competencies or not

If you are confident that you have all the competencies on a particular Level, prepare the following: 1) accomplished Application Form- downloaded from the website, 2) Portfolio of evidence of your competencies. Then contact the designated hospital to get a schedule for Assessment.

If you feel that you still have “gaps” in your competencies, contact the designated hospital and get advise on the available modules that you can take and the schedule of enrolment.

DOH Nurse Certification Program Offerings

Ward & OR

Nursing

Renal Nursing

Cardiovascular Nursing

Pediatric Nursing

Level 1 and 2Level 1 and 2 Level 3 to Level 5Level 3 to Level 5

Mental Health Nursing

Public Health

Nursing

Orthopedic and Rehabilitation Nursing

Infectious Disease Nursing

Maternal and Child Nursing

Emergency and Trauma Nursing

Operating Room Nursing

Public Health Nursing

Standard Learning Modules under DOH-NCP CARDIOVASCULAR

NURSING CVN Level 3 CVN Level 4CVN Level 5

INFECTIOUS DISEAS NURSING INF Level 3INF Level 4INF Level 5

MATERNAL AND CHILD NURSING

MCN Level 3

MCN Level 4

MCN Level 5

MENTAL HEALTH NURSING MHN Level 3MHN Level 4MHN Level 5

PEDIATRIC NURSINGPED Level 3 PED Level 4PED Level 5

PULMONARY NURSING PUL Level 3PUL Level 4PUL Level 5

ORTHOPEDIC AND REHABILITATION NURSING

ORB Level 3ORB Level 4ORB Level 5

RENAL NURSING

REN Level 3

REN Level 4

REN Level 5

TRAUMA NURSING

TRA Level 3TRA Level 4TRA Level 5

OPERATING ROOM NURSINGLevels 1-5

WARD NURSINGLevels 1-2

PUBLIC HEALTH NURSINGLevels 1-5

*each level of specialty area is composed of several modules

DOH-NCP Providers (as of Nov 2012)

HOSPITAL LEARNING INTERVENTIONS

1. Philippine Heart Center Cardiovascular Nursing Level III-V, all modules

2. National Kidney and Transplant Institute Renal Nursing Level III-V, all modules

3. Lung Center of the Philippines Pulmonary Nursing Level III-V, all modules

4. National Children’s Hospital Pediatric Nursing Level III-V, all modules

5. Philippine Children’s Medical Center Pediatric Nursing Level III-V, all modules

6. National Center for Mental Health Mental Health Nursing Level III-V, all modules

7. Philippine Orthopedic Center Orthopedic and Rehabilitation Nursing Level III-V, all modules

8. Dr. Jose Fabella Memorial Hospital Maternal and Child Nursing Level III-V, all modules

9. San Lazaro Hospital Infectious Disease Nursing Level III-V, all modules

10. East Avenue Medical Center ER/Trauma Nursing Level III-V, all modules

Operating Room Nursing

National Kidney and Transplant Institute Philippine Heart Center

Level Course Title/Learning Intervention

Modules Duration

Level III Competency Development in Perioperative Nursing

5 640 hours

Anesthesia Care Nursing

East Avenue Medical CenterJose Reyes Memorial Medical Center

Lung Center of the PhilppinesPhilippine Heart Center

Quirino Memorial Medical Center

Level Course Title/Learning Intervention

Modules Duration

Level III Competency Development in Anesthesia Care Nursing

5 640 hours

DOH HHRDB

DOH Nurse Certification Program Committee

Assessment and Certification

Learning and Development

Accreditation

Over-all program mgt and supervision Formulates policies & guidelines

Supervises activities of 3 sub-committees and program implementation

Maintains pool of assessors

Processes applications for assessment

Supervises assessments Safeguards integrity of

certifying body

Sets standards for LD interventions in accredited facilities

Develops, implements and regularly reviews modules per level

Monitors conduct of LD interventions by level and specialty

Sets standards for accreditation of facilities as providers

Reviews policies and quality standards for accreditation

Monitors facilities

SUBCOMMITTEES

Implementing Structure

SAFETY INDEX 2013 2014 PERCENTAGE DIFFERENCE

Medication Error 6 2 -66.67%Fall 3 0 -100.00%Procedural Error 6 10 66.67%Communication 8 4 50.00%

PERFORMANCE RATING 2013 2014 %Outstanding 0 62 38.51%Very Satisfactory 154 99 61.49%Satisfactory 0 0 0*Unsatisfactory 154 161

Note: An increase in the procedural error was contributed by some factors from other discipline.

(*Note: Non certified or probitionary)

Who can apply?

• PRC- licensed nurses

• Foreign nurses with Special Temporary Permit from PRC

ChallengesChallenges

• Global proficiency – Leadership

• Transformational Leadership

• Create a comprehensive and effective plan

“No human being will work hard at anything unless they believe that they are working for

competence.”

-William Glasser