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1 NCAPHNA Conference 2015 Public Health Nursing Skills Competency & Nursing Certification Presenters: Deborah Herring, RN, BSN, MHA Validation DON, Pitt County Health Department NC Board of Nursing Member Evelyn Coley, RN, BSN, MSA - Implementation DON, Wayne County Health Department Presenters Continuation: Susan Little, MSN, RN, APHN-BC, CPHQ Certification NC Department of Health and Human Services Nurse Consultant, Division of Public Health Local Technical Assistance and Training Branch Public Health Nursing and Professional Development Unit 1

2 NC Board of Nursing Perspectives Purpose Mission Statement of the North Carolina Board of Nursing is to protect the public by regulating the practice of nursing. NCBON Consultants for Competency Validation BON Staff assigned to Public Health for consultation: Joyce Winstead, MSN, RN, FRE Practice Consultant Crystal L. Tillman, DNP, RN, CPNP Manager Education & Practice Deborah Herring, Board Member - will serve as the liaison to NCAPHNA & Local Health Director s Association 2

3 Foundation for Today s Presentation Credit Given to Eileen C. Kugler, RN, MSN, MPH, FNP Kugler, E. C. (2010, Fall). Validation of nursing competence: What does it mean for you? Nursing Bulletin: Official Publication of the North Carolina Board of Nursing. Retrieved from Validation of Nursing Competence: What Does It Mean for You? Purpose is to ensure the individual has the right knowledge, skills, and behaviors to do the work that is required to fulfill the mission of the organization and the nursing plan of care. 3

4 The National Council of State Boards of Nursing (NCSBN) Defines competence as the application of knowledge, and the interpersonal, decisionmaking and psychomotor skills expected for the nurse s practice role within the context of public health, welfare and safety (NCSBON, 2009) Defines competence assessment as the evaluation of the nurse s knowledge, skills and abilities. Assessment Mechanisms: Demonstration and Observation Self-reflection Examination Peer Review Professional Port-folio Professional Certification 4

5 How to Meet the Challenge: Being Competent NCBON Perspective Remember or Consider: Just Culture Right Touch Regulation Novice to Expert Nursing s Historical Stereotype eating their young The Four Cornerstones of a Just Culture As Leaders we must establish a fair and Just Culture Focus on using unanticipated outcomes to be used as a learning process where learning can occur rather than focus on grounds for punishment. 5

6 The Four Cornerstones of a Just Culture 1. Create a Learning Culture recognizing risk at both the individual and organizational level. Be accountable for your practice choices. 2. Create an Open and Fair Culture move away from an overly punitive culture and strike a middle ground between punitive and blame free. The Four Cornerstones of a Just Culture 3. Design Safe Systems by reducing opportunities for human error. Try to capture errors before they become critical. 4. Manage Behavioral Choices by coaching each other around reliable behaviors. 6

7 Right Touch Regulation Should be. 1. Proportionate 2. Consistent 3. Targeted 4. Transparent 5. Accountable Novice to Expert Competence does not mean expert. According to > Novice to Expert: Excellence and Power in Clinical Nursing Practice (1984), Patricia Benner applied the Dreyfus Model of Skill Acquisition to nursing. 7

8 Novice to Expert - continued Five levels of proficiency: 1. Novice no actual experience in area 2. Advanced Beginner perform methodically 3. Competent - Novice to Expert - continued 4. Proficient comes with experience 5. Expert integrate theory & experience to function at higher level. Analyze data, adapt/modify plans, problem solve, utilize resource to achieve desired outcomes. 8

9 How to Meet the Challenge: Being Competent NCBON Perspective 1. Nurses are accountable for attaining knowledge and competency that reflect current nursing practice. 2. NC Nursing Law and Rules hold all nurses accountable for accepting only the assignments for which they are competent. How To Meet The Challenge Continued: 3. Registered Nurses (RN) are accountable for supervising, teaching and evaluating those who perform or are preparing to perform nursing functions and for providing for the maintenance of safe and effective nursing care whether rendered directly or indirectly. (NC Pursing Practice Act 2009) 9

10 How To Meet The Challenge Continued: 4. Nursing managers are held responsible for assessing the capability and competence of personnel in relationship to client status, plan of nursing care and for delegation responsibility or assigning nursing care functions to qualified personnel. How To Meet The Challenge Continued: 5. Nursing administrators are further held accountable for ensuring a mechanism is in place to validate the qualifications, knowledge and skills of nursing personnel. 10

11 How To Meet The Challenge Continued: 6. The administrator must provide educational opportunities related to expected nursing performance; and ensure the implementation of a system for periodic performance of staff. Responsibility For Competence Individual Nurse Managers Supervisors Director of Nursing 11

12 Why Do We Need to Check Skills? ASSURE COMPETENCY (Knowledge, Skills, Behaviors) BON Practice Requirement Assess New Hires Skills Validate Ongoing Competency Identify Performance Deficits Provide Performance Improvement Feedback and Training Conduct an Accurate Performance Appraisal Methods of Assessment Observation Record Review/Audits Demonstration Peer Review Examination Certification Self Assessment 12

13 Frequency Upon Employment Annually or According to Agency Policy More Frequently when Needed New Procedure/Intervention New Assignment Policy Change Tools Job Descriptions Evaluation Tools Record Audit Tools Program Performance Plan 13

14 Skills Communication History Collection Documentation Counseling/Education Physical Assessment Case Management HIPAA Compliance Can Use Technical Components of Job Description Provide Employee Feedback Within 1 day of Assessment Discuss Assessment Acknowledge Good Performance Identify Areas that Need Improvement Develop an Improvement Plan: What Needs Improvement Date Needs Improvement Date of Follow-up Assessment Use Skill Checks to Validate Performance Ratings 14

15 Toolbox for PHN Competencies org/publications.htm Toolbox for PHN Competencies 15

16 Toolbox for PHN Competencies 16

17 Toolbox for PHN Competencies Toolbox for PHN Competencies 17

18 Toolbox for PHN Competencies Toolbox for PHN Competencies 18

19 Public Health Nursing Skills Competency Validation CALL TO ACTION 19

20 Professional Certification Certifications r/t PH & PHN ANCC APHN BC NBPHE CPH Professional PHN Organizations NCAPHNA NCPHA Nursing Section APHN Exemplar Professional Certification Increased access to job related power High perceptions of empowerment Nurse managers expressed a preference for hiring certified nurses Niebuhr B; Biel M; Nursing Outlook, Jul2007; 55(4): (6p) (Journal Article - research, tables/charts) ISSN: PMID: AN: p Stromberg MF, Niebuhr B, Prevost S, Fabrey L, Muenzen P, Spence C, et al. Specialty certification more than a title. Nursing Management 2005;36:

21 Professional Certification Certification enabled me to... "experience personal growth," "feel more satisfied as a professional nurse," "feel more competent in my skills as a professional nurse," "be seen as a credible provider," "feel more accountable as a professional nurse," and "experience more confidence in my practice." Cary, Ann H. PhD, MPH, RN, A-CCC, Certified Registered Nurses: Results of the Study of the Certified Workforce. American Journal of Nursing, Issue: Volume 101(1), January 2001, pp Why Certify? Stay current Meet and maintain a national, professional standard Increase recognition Commitment to public health 21

22 Why Certify? Show public health expertise Protect the public Distinguish yourself visibility of public health

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25 PHN Professional Organization Trifecta 25

26 NCPHA Nursing Section Association of Public Health Nurses 26

27 Congratulations to Carol Lynn Rose, RN, MSN, APHN BC Achieving Advanced Public Health Nurse Certification A journey through the ANCC s portfolio process for certification as an Advanced Public Health Nurse Carol Lynn Rose, RN, MSN, APHN BC 27

28 Get Prepared Know the requirements: Eligibility Graduate degree in nursing OR in public health (with BSN) 2000 practice hours in advanced PHN over last 3 years At least 30 continuing education hours related to advanced PHN Assess your readiness Do you have evidence? Is this the best time? Do you know your Advanced PHN competencies? Get Organized Have ANCC guidelines printed Make a REALISTIC timeline Decide who should complete the peer/supervisor evaluation ANA PHN Scope and Standards Gather evidence 28

29 Get Reflective The portfolio process requires self reflection Look back at those nursing theories and frameworks and figure out which one(s) guide your practice This will help you think systematically about your practice and be able to articulate this in your exemplar Start journaling Keep notes about your practice Write down stories that exemplify being a PHN Practice writing in an exemplar or narrative format Get Reflective List your accomplishments programs you implemented teams you ve led or been a part of measurable impacts on population health policies you initiated or revised for better practice board or organization membership research or scholarly publication community presentations effective community partnerships/collaborations evidence based practice quality improvement projects 29

30 Get it Together Set up your portfolio account on the ANCC website Start entering information Review, review, review Take it one section at a time Write your exemplar in Word They are serious about the word limits, so pay CLOSE attention to this. If you copy and paste your exemplar from Word into the website, it will cut off anything over the word limit. Send your peer/supervisor evaluation via the ANCC website make sure the peer/supervisor knows to look out for the Request your transcripts before your submit Get Over It You may feel pretentious. GET OVER IT. As we let our light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence actually liberates others. Marianne Williamson You ARE a really awesome public health nurse and sharing that will help other people embrace their awesomeness! 30

31 Get Certified Have someone you trust review your portfolio, especially your exemplar Do a final check for all portfolio sections Sleep on it or take a few days away from it Give it one last look Submit Keep a check on your in case ANCC contacts you about any missing portfolio information (they are very helpful) Give it at least two weeks, but it may take longer for the review to be completed (mine took exactly 2 weeks) 31