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iThe Creation of a Competency-Based Tool for Nurse Educators

The Creation of a Competency-Based Evaluation Tool for Nurse Educators

Kelly Fitzpatrick DNPc, RN, BC, CMSRN

Simmons College

School of Nursing and Health Sciences

Doctor of Nursing Practice

March 2018

© 2018, Kelly A. Fitzpatrick

iiThe Creation of a Competency-Based Tool for Nurse Educators

Signature Page

Simmons College

Doctor of Nursing Practice

Capstone Manuscript Approval Form

Name: Kelly Fitzpatrick

Title of Project: The Creation of a Competency-Based Orientation Evaluation tool for those in

the Specialty of Nursing Professional Development.

Date: March 2018

This manuscript has been read and accepted for the Doctor of Nursing Practice degree at

Simmons College: School of Nursing and Health Sciences.

iiiThe Creation of a Competency-Based Tool for Nurse Educators

Abstract

Background: Focused specialties within nursing have their own set of competencies including

Nursing Professional Development (NPD). New healthcare regulations, reforms, accreditations

processes, professional standards, increased accountabilities, and financial priorities; all suggest

the need for a more fully developed nurse educator. Brunt (2014) validated 79 NPD

competencies which take into consideration the roles, responsibilities, knowledge, skills, and

attitudes for the nurse educator.

Problem: At a specific acute-care hospital project site, which employs 12 nurse educators, there

was no competency assessment upon joining the organization or at any time after that. Beyond

the documented initial assessment of competence completed at the end of orientation,

competency should be assessed on an on-going basis with documentation of such at least once

every two years or more frequently as defined by the organization’s policy (Joint Commission,

2017).

Aim: The aim of this Performance Improvement (PI) project was to create a measurement tool

that demonstrates the competency of newly onboarded nurse educators. This competency-based

tool incorporated the essential NPD competencies chosen by current nurse educators. This

competency-based tool in addition can be utilized as an annual self-assessment for current nurse

educators.

Method: Deming’s PDSA framework for improvement was utilized to create the competency-

based measurement tool for use with nurse educators (W. Edwards Deming Institute, 2016). A

survey was completed by current nurse educators at the specific project site to determine the

essential NPD competencies to be included in a competency-based orientation tool. A similar

ivThe Creation of a Competency-Based Tool for Nurse Educators

competency measurement tool incorporating all 79 NPD competencies then became a self-

assessment survey for the current educators to validate their own competency.

Findings: The nurse educators at the project site evaluated each of the 79 NPD competencies

and 67 were determined to be essential, meaning used and valued in their practice. These

essential competencies were incorporated into the new nurse educator’s orientation as well as

used by current nurse educators for their annual self-assessment. A knowledge gap was also

identified concerning 12 NPD competencies. This assisted in the development and

implementation of educational programs for the nurse educators specifically designed to address

knowledge gaps identified through the survey.

Implications: A gap in the literature exists regarding what is the acute care nurse educators

required competence and their continued evaluation of their skills, knowledge and abilities.

Without a set of standardized competencies, there may be a disparity in the development of acute

care hospital nurse educators, resulting in a variation in education of the bedside nurse which

could potentially create inconsistencies in nursing care at the bedside. This PI project assists in

advancing the knowledge to assure NPD competence for nurse educators in an acute care

hospital.

Keywords: clinical nurse educators, educator competencies, nursing professional development,

nursing staff development, nurse staff development core competencies, nursing skill acquisition,

competency-based orientation checklists

vThe Creation of a Competency-Based Tool for Nurse Educators

Acknowledgments

I would like to thank Dr. Eileen McGee my DNP program advisor and my 1st reader.

Thank you for all the time you granted me to discuss my progress (or lack thereof), and how to

make my project “Bueno”.

I must thank Dr. Sharon Perkins my 2nd reader, my colleague, and one of my partners in

crime for her tireless patience, unwavering support, and guidance, and relentless pestering to

keep me on track. Sharon, you made me understand what it means to think differently and

practice as a Doctoral prepared nurse leader. Thank you; I won’t ever forget the generosity of

your time with my questions, my whining, and my tears to complete this project.

I want to thank my fellow students for all the insight and advice which you have shared

with me over the past two years. In particular, I would like to thank my two immersion weekend

buddies Jen Deneault and Paula Lynch-Ritchie; we survived years of laughter, tears, and talks off

the ledge; I would NOT have made it without you! For me, online learning was difficult, so I

always looked forward to the F2F weekends for clarity and a little downtime. Never did I dream

the fun we would have in Boston twice a semester-The Best Memories!

I must recognize SSH for joining the Simmons DNP cohort and making this lofty idea of

obtaining a DNP someday, a reality. To my lunchtime CPDSs thanks for listening to me drone

on about Biostats, Economics, APA format, etc. You were always supportive.

Most importantly I must acknowledge my family. I cannot thank you for your love,

support and patience with me- I know it was not easy- I was fragile! Most importantly to my

Mumma who supports everything I do. You celebrated my successes, listened to my rants,

comforted me when I felt like giving up; thank you- I love you. I am aware that you can never

wear buttons because you are so proud-they would burst!

viThe Creation of a Competency-Based Tool for Nurse Educators

Dedication

I would like to dedicate this project, and the journey it took to reach completion to my

family, my friends, and my colleagues. I cannot put into words how to thank you for your

patience with me, your tolerance of my fragile states, and my absence at gatherings both big and

small. Opportunities for fulfilling a dream do not come along that often. Seize the chance if you

get yours-it is hard work but worth it!

This project is dedicated to all of you.

Thank you with all my heart.

.

viiThe Creation of a Competency-Based Tool for Nurse Educators

Table of ContentsSignature Page……………………………………………………………………………………..iAbstract..........................................................................................................................................iiiAcknowledgments...........................................................................................................................vDedication.......................................................................................................................................viList of Figures.................................................................................................................................ixList of Charts...................................................................................................................................xIntroduction......................................................................................................................................1Background......................................................................................................................................2Purpose Statement...........................................................................................................................4Aims.................................................................................................................................................5Practice Inquiry Questions...............................................................................................................5Significance.....................................................................................................................................5Review of Literature........................................................................................................................7

Nursing Professional Development.........................................................................................................8

Competencies........................................................................................................................................10

Roles......................................................................................................................................................12

Onboarding and Orientation.................................................................................................................15

Summary...............................................................................................................................................15

Theoretical Model..........................................................................................................................16Methods.........................................................................................................................................19

Design....................................................................................................................................................19

Setting....................................................................................................................................................23

Sample...................................................................................................................................................23

Data Analysis.................................................................................................................................24Ethical Considerations...................................................................................................................27Limitations.....................................................................................................................................28Discussion......................................................................................................................................28Plan for Dissemination..................................................................................................................30Implications for Practice................................................................................................................32Conclusion.....................................................................................................................................32References......................................................................................................................................35Appendix A: Nursing Professional Development Competency statements..................................42Appendix B: Nursing Professional Development Practice Model ©............................................45

viiiThe Creation of a Competency-Based Tool for Nurse Educators

Appendix C: The Dreyfus Model of Skill Acquisition’s five stages............................................46Appendix D: South Shore Hospital’s CPDS orientation checklist (est. 2014).............................47Appendix E: Survey Monkey self-assessment survey of the 79 NPD competencies....................53Appendix F: sample request for participation letter mailed to CPDS team at SSH.....................73Appendix G: IRB responses from Simmons College and South Shore Hospital........................74Appendix H: Competency-Based Orientation Evaluation for CPDSs at South Shore Hospital. .76Appendix I: 12 NPD competencies considered a knowledge gap for current nurse educators.....84Appendix J: Survey results Competency #9..................................................................................85Appendix K: Grant Writing Basics PowerPoint for nurse educators Feb’18................................86

ixThe Creation of a Competency-Based Tool for Nurse Educators

List of Figures

Figure 1. Benner’s Novice to Expert Theory…………………………………………………….18Figure 2. Deming PDSA Cycle…………………………………………………………………..20

xThe Creation of a Competency-Based Tool for Nurse Educators

List of Charts

Chart 1. Competencies in Role…………………………………………………………………25Chart 2. Competencies Valued in Role…………………………………………………………26Chart 3. Competencies Met vs. Not Met………………………………………………………..27

1The Creation of a Competency-Based Tool for Nurse Educators

Introduction

Competency is an expected and measurable level of performance that integrates

knowledge, skills, abilities, and judgment, based on established scientific knowledge

(Association for Nursing Professional Development [ANPD], 2016). Despite the similarities

in nurse educators’ credentials, there are variations in the competencies individual nurse

educators in the tertiary care setting bring to the job. In the hospital setting, nurse educators

must be prepared to meet the complex and rapidly evolving educational needs of the bedside

staff. Those responsible for hiring nurse educators must be able to assess the individual

competencies of the educators to better tailor orientation programs and mentorship. One

method currently utilized to address competence is the Nursing Professional Development

(NPD) competencies (ANPD, 2013; Brunt, 2014). The use of these competencies may better

assist healthcare organizations in preparing nurse educators while meeting the learning needs

of staff.

The American Hospital Association (AHA) defines onboarding as “the process of

assimilating a new employee into the healthcare organization with structured engagement

while having access to employees, resources, and technology to perform the job effectively

and become contributors to the organization” (2013, p. 15). Orientation is the time to define

the essential functions of the job: determine what knowledge, skills, and abilities the novice

possesses which are required to be successful in the role. (Brunt, 2014; Kaiser Permanente,

2001-2017; Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009; Swihart, 2009;

Swihart, 2010). Onboarding of a nurse educator in the acute care setting requires a

coordinated plan to ensure the success of the candidate as well as assess the competency of

each nurse educator.


A competency-based orientation gives clear standards regarding expectations and

future development of the nurse educator. Without a set of standardized competencies, there

may be a disparity in the development of hospital-based nurse educators, resulting in a

variation in education of a bedside nurse which could potentially create inconsistencies in

nursing care at the bedside. The validated list of 79 Nursing Professional Development

competencies was created to support the numerous roles and responsibilities of the nurse

educator (ANPD, 2016; Brunt, 2014).

Background

A robust body of literature spanning more than a decade supports the need for a more

highly educated and competent workforce in nursing (Aiken, 2011; American Association of

College of Nursing [AACN], 2006; AHA, 2013; Institute of Medicine [IOM], 2010;

Patterson & Krause, 2015; Stanley & Dougherty, 2010; Tanner, 2010). The IOM’s Future

of Nursing report (2010) made a compelling case that advances in science and technology,

as well as increasing patient complexity, has hastened the nurses’ ability to manage a

challenging and increasingly diverse healthcare environment. Huston (2008) stated few

settings have been more unpredictable in the 21st century than healthcare, as the challenges

facing the United States have shifted dramatically. These challenges include healthcare

reform, compensation, reimbursement, the bachelors’ prepared nursing shortage, access and

cost of care, the focus on health maintenance and prevention, and the aging population

(Harper & Maloney, 2016a; IOM, 2010; Johnson & Smith, 2017).

Professional healthcare education has not kept pace with these challenges in

preparing nurses to effectively meet the current and future expectations of the healthcare

system. Stagnant fragmented curricula, lack of emphasis on pedagogy, and silo mentality are


all named as barriers that have hampered changes necessary to professional nursing

education (Frenk, 2010; Bullin, 2018). According to the IOM (2010) bedside registered

nurses in the hospital setting are expected to recognize and respond to a surge of new

demands arising from a dynamic and increasingly complex healthcare system (Aiken, Clarke,

Cheung, Sloane, & Silber, 2003). Registered nurses must be competent in capacities such as:

the use of evidence-based practice, trends in health policy and reimbursement mechanisms,

inter-professional communication and collaboration, systems leadership, disease prevention,

and population management (IOM, 2010; Stanley & Dougherty, 2010; Swihart, 2010).

Consequently, hospital-based nurse educators must provide education in ways which

address the complex learning needs of staff. Outdated teaching methodologies will not be

sufficient in meeting the rapidly-changing healthcare system within which nurses practice

(Pennbrant, 2016). According to Pennbrant (2016), “the nurse educator role requires a high

level of general and specific knowledge, an ability to identify needs in healthcare provision

and to implement theoretical knowledge in the practical learning” (p.430).

With the goal of providing quality, patient-centered, accessible, and affordable

healthcare, many nursing roles including that of the hospital-based nurse educator must be

further developed. To meet this objective, incorporating a developed set of competencies is

required. Competencies for bedside nurses have been updated to complement their practice,

however organizations fail to realize the competencies of the nurse educators should be

updated as well (ANA 2014; IOM, 2010: Harper & Maloney, 2016b; Swihart, 2009).

Nurse educators are experienced registered nurses who have earned a minimum of a

Master’s degree in Nursing or Nursing Education. The nurse educator is a prominent role in

acute care facilities, advancing skills of bedside nurses whose skill set ranges from novice to


expert. In the acute care setting the nurse educator’s job title might be a nurse educator, staff

development practitioner or continuing education specialist. Swihart (2009) and other authors

acknowledge that nurse educators play an integral in: project management, education,

program and portfolio development, competency management, continuing education,

leadership, and relationship building, research and evidence-based practice implementation,

technology advancements and nursing practice excellence (ANPD, 2016; Harper and

Maloney, 2016).

Nurse educators’ roles may vary in the hospital setting, bringing a variety of

experience and skill sets to their practice. The hospital-based nurse educator’s role is focused

on the education and professional development of the bedside nursing staff. The nurse

educator is assuming newly defined roles and responsibilities in the acute care setting to

support the unpredictable direction of healthcare; therefore, it is essential for the nurse

educator to have a predetermined set of knowledge, skills, and abilities validated by a

standardized set of competencies (ANPD, 2016).

Purpose Statement

The purpose of this Performance Improvement (PI) project was to assist the nurse

educator team at a 375-bed community based acute care hospital in Massachusetts, to

identify areas of competence that are deemed essential for the nurse educator role within the

facility.

After identifying a list of essential core competencies, the purpose became to create a

competency-based assessment tool for use within the nurse educator group. This tool will be

incorporated and utilized to guide ongoing orientation, mentorship, self-evaluation and

educational programs for nurse educators.


The project was developed under the guidance of the 2016 Association of Nursing

Professional Development (ANPD) scope and standards, a validated list of NPD

competencies, and Benner’s novice to expert skill acquisition theory.

Aims

The aim of this PI project was to have a measurement tool that demonstrates the

competency of newly onboarded nurse educators. An additional aim of the project was to

introduce the use of the competency measurement tool as a method of self-assessment for all

nurse educators (see Appendix H). The creation of this competency-based tool identified

gaps or variation in the knowledge, skills, and abilities of nurse educators. This project also

standardized the onboarding process for a newly hired nurse educator at the project site. This

project identified gaps in knowledge around 12 of the competencies, which were then used to

set-up a yearlong education series for the current nurse educators at the project site.

Practice Inquiry Questions

The questions guiding this PI project were:

1. Will incorporating a Nursing Professional Development (NPD) competency-

based assessment tool identify gaps in knowledge among new nurse

educators?

2. Will the use of the assessment tool as an annual self-assessment, identify

additional learning needs of nurse educators currently practicing as nurse

educators in the facility?

Significance

In the 21st century, the hospital-based nurse educators roles and responsibilities

include documenting educational progress, evaluating training programs, preparing


orientation for new bedside nurses, developing training courses including major curricula,

grant proposal writing, researching evidence-based practices, participating in various

associations, developing new procedures, and ensuring quality control. (ANPD, 2016,

Brundt, 2014). These nurse educators must possess effective communication skills, excel in

clinical practice, and be capable of assessing staff. Nurse educators must also be able to

develop programs and evaluate the efficacy of said programs. These essential nurse educator

roles and responsibilities are all encompassed within the NPD competencies (Brunt, 2014).

The nurse educators’ defined roles and responsibilities as they relate to supporting bedside

nurses amidst the challenges of healthcare in the 21st century have grown. With that growth,

the list of NPD competencies has grown to 79 statements, each with supporting performance

standards.

The American Hospital Association (AHA) has recommended and explained the

value of competence within a workforce, which includes the hospital-based nurse educator.

The AHA (2013) stated that gathering data regarding competencies is necessary and suggests

the completion of a planning process, including the determination of future needs and closing

gaps in existing knowledge. That planning process helps hospitals “identify the level of

competencies required to achieve their vision, goals, and mission” (AHA, 2013, p.9).

Compiling data of nurse educators’ practice has never been completed at this project site and

no competencies have been utilized in the onboarding process or beyond for the site’s nurse

educators.

Organizations should carefully examine the competencies that are required for every

position including the nurse educator role. These required competencies, or an organization’s

ability to acknowledge the lack of them, can easily determine the success or failure of an


organization (AHA, 2013). All healthcare professionals who are possess knowledge

pertaining to healthcare, communication skills, leadership, professionalism, and relationship

building are vital to an organization (AHA, 2013). Therefore, competent healthcare

professionals such as nurse educators who are aware of their competencies and utilize them

in their current role will add value to the organization. Nurse educators are often considered

nurse leaders who embody the characteristics of a role model and therefore add value to an

organization. A competency-based program has never been put into place to measure or

evaluate nurse educators at the project site.

The result of this PI project provided useful data to the nurse educators as well as

their administrator because it illuminated competencies that the nurse educators found most

valuable to utilize in their current role. The results provided a lucrative tool that can be used

for the recruitment and development of future nurse educators. The results of this project

identified knowledge gaps to improve upon within the nurse educator team.

Review of Literature

An extensive review of the literature on the importance of a competency-based

orientation for nurse educators was conducted. Databases that were used include CINAHL,

Medline, PubMed and Google Scholar. The initial search incorporated the keywords of

clinical nurse educator; nurse educator competencies; nursing staff development; nursing

professional development; nurse staff development core competencies; and competency-

based orientation. The literature restrictions were set for studies in English and those

published after 2005, which yielded few research articles, only peer-reviewed descriptive

articles. This literature review summarizes the current knowledge base surrounding

competency-based orientation as well as the role of the hospital-based nurse educator.


The literature search produced studies and articles used for the creation and

evaluation of the National League for Nursing nurse educator competencies (Halstead, 2007;

Patterson & Krause, 2015; Ramsburg & Childress, 2012). After review of this literature, it

was evident that these competencies were explicitly defined for faculty teaching nursing

students in higher learning organizations. A more precise return to the literature was

launched with a defined focus on acute-care hospital educators and the specialty of Nursing

Professional Development (NPD) and their latest competencies. A search for other

organizations that use the NPD competencies in orientation was also included. This new

search specifically omitted sources with a focus on academic faculty.

An abundance of descriptive scholarly journal articles, books, white papers, and

position statements were found and utilized for guidance within this PI project. The current

literature surrounding hospital-based nurse educators and competency-based orientation was

characterized into themes of: the specialty of NPD, NPD educators, NPD competencies, NPD

scopes and standards, and onboarding.

Nursing Professional Development

Nursing Professional Development (NPD) dates back to 1969 when a meeting to discuss

national nursing education was scheduled. In 1972, the American Nurses Association (ANA)

created a Commission for Continuing Education and denoted the practice as staff

development. The first official recognition of staff development as a nursing specialty

emerged in 1990 with the first Standards for Nursing Staff Development from the American

Nurses Association (Harper & Maloney, 2016a). The ANA defines the standards of practice

for all professional nurses, and in 2010 they distinguished NPD as a nursing specialty group.

The Association of Nursing Professional Development (ANPD, 2016) shared the focus of


NPD as “a specialized nursing practice that facilitates the professional role development and

growth of nurses and other healthcare personnel along the continuum from novice to expert

as described by Benner” (p. 6). The ANA (2010) defined NPD as: encompassing the sciences

of nursing, technology, research and evidence-based practice, change, communication,

leadership, and education.

Historically, the original name for the specialty of NPD was “in-service education”,

making it one of the oldest nursing specialties preceding critical care and emergency nursing

(Harper & Maloney, 2017). Since 2010, the ANA has recognized those formally known as

staff development nurses or nurse educators as NPD practitioners. Swihart (2009) and others

acknowledged that the hospital-based nurse educator has many more roles including project

management, education, program and portfolio development, competency management,

continuing education, leadership, and relationship building, research and evidence-based

practice implementation, technology advancements and nursing practice excellence (ANPD,

2016; Harper and Maloney, 2016c). The literature illustrates that nurse educators work with a

broad range of direct care nurses who have varied competencies, learning needs, and tiered

academic preparations, across all practice settings and environments of care (Swihart, 2009).

Concurrently, now the focus on inter-professional continuing education and collaboration has

further transformed NPD practice, as the prior emphasis on nurses was expanded to

encompass the entire healthcare team (Harper & Maloney, 2016c). Irrespective of which

specialty the educators support, each one must be proficient in adult learning principles,

nursing career development, program development management, continuing education, and

leadership (ANA & NNSDO, 2010; Keith 2008; Swihart, 2009).


Competencies

The use of competencies and how to achieve competence is a widely discussed topic

within the nursing literature (Baldwin, Clark, Fulton, & Mayo, 2009; Benner, 2001; Billings

& Kowalski, 2008; Brundt & Aucoin, 2008; Brunt, 2014; Dreyfus, 2004; Lenburg et al.,

2009; Lenburg et al., 2011). A nurse in any specialty is individually responsible and

accountable for maintaining a certain level of competence which can be defined, measured,

and evaluated. Assurance of competence is the shared responsibility of the person doing the

profession, regulatory bodies, employers, individual nurses, and other key stakeholders.

According to the ANA (2004), the measurement criteria included with the standard of

nursing practice are clear indicators of competence for each standard. Therefore, the

measurement criteria are the competency statements for each standard of nursing practice and

professional performance. Competencies are statements which exemplify the expected and

measurable level of performance that integrates knowledge, skills, abilities, and judgment,

based on established evidenced-based knowledge (ANPD, 2016). In 2014, the ANPD Board

of Directors charged a workgroup to update the NPD scope and standards to reflect current

and future practice and transition from measurement criteria to competencies. Defining

competencies for a profession can sort out essential knowledge, skills, and personal

characteristics which are required for successful performance. Baldwin et al. (2009) worked

with Clinical Nurse Specialist competencies and stated that performance competencies

should be: vigorous, clear about technical knowledge and skills, and written in behavioral

terms. Aside from the ANPD work, very little literature on the use of NPD competencies or

effective methods to measure those competencies exists, exemplifying a gap in the literature

(Brundt & Aucoin, 2008; Brunt, 2014).


Considering that every role in nursing has a specific set of knowledge, skills, and

abilities, there is pressure to amend competencies to the ever-changing demands and

requirements of every nursing role, as nurses must guide their practice based on those

competencies and skill acquisitions. The NPD competencies outline the acceptable level of

quality for the nurse educator specialty (ANPD, 2016). Nurse educators must attain the

knowledge, skills, and abilities to support education and learning. Although competencies

and skill acquisition have been investigated in other disciplines within the literature, they

have not been explored for hospital-based nurse educators. It is imperative that the nursing

profession explore the current level of skill acquisition amongst these nurse educators to plan

for and support their professional development, both current and future.

Barbara Brunt (2014) published the culmination of her life’s work around

competencies for hospital-based nurse educators. In this study, which spanned over 19 years,

there were four stages identified. Stage one included Brunt sharing the 63 advanced practice

NPD competencies created in 1995 from a Delphi consensus reaching study. Next, she did a

subsequent review of the literature and added 46 more competencies, bringing the total to

109 competency statements. In stage three, she completed a pilot study to create a validated

comprehensive description of the NPD competencies. In the final phase of this study, Brunt

validated the results nationally and regionally using only 25 of the competencies with a group

of nurse educators including staff development nurses who functioned in the academic

setting. The result of that multi-phase study was a comprehensive, research-based tool to

measure the competence of hospital-based nurse educators (Brunt, 2005, Brunt 2007). In

2010 when the ANA deemed NPD a specialty practice and subsequently published a scope

and standards of practice, Brunt realized there were seven more competencies that needed to


be added. Then an additional research study was conducted to have nurse educators classify

the competencies and identify a level of expertise coinciding within Benner’s model. This

study subsequently yielded the final list of 79 validated NPD competencies (see Appendix A)

utilized in this PI project.

Brunt (2014) is transparent in stating that the complete list of 79 competencies will

not be applicable in every setting that utilizes nurse educators, and the list of competencies

can be tailored for organizations without permission. These 79 validated NPD competencies

represent all levels of practice from novice to expert (Benner, 2001; Brunt, 2014).

Roles

The most common theme in the literature related to NPD competencies identifies the

role of the nurse educator. The role of the nurse educators was to foster nurses to develop and

maintain competency, advance their professional nursing practice, and support achievements

of their academic or career goals (Brunt, 2014; Harper& Maloney, 2016b; Swihart, 2009).

The NPD literature focused on the changing roles of the nurse educator. Harper and

Maloney (2017) suggested that hospital-based nurse educators needed to move beyond

traditional roles of hosting orientation, in-services, and continuing education. These non-

traditional roles include serving as a: learning facilitator, change agent, advocate for the NPD

specialty, partner in transitions, champion for scientific inquiry and mentor, coordinator of

population health, and team leader informatics specialists, all of which are reflected in the list

of NPD competencies (ANA & NNSDO, 2010; ANPD, 2016; Billings & Kowalski, 2008;

Brunt, 2014; Burke, Richardson & Smith, 2017; Harper & Maloney, 2016b; Swihart, 2009;

Warren & Harper, 2017).


The NPD literature also presents a change around the ‘who’ nurse educators should

influence. The nurse educators’ functional responsibility cannot remain to purely educate and

develop the bedside nurse workforce. These hospital-based nurse educators now need to use

their expertise to create change and promote quality in the practice environment while

encompassing the entire healthcare team (ANPD, 2016). Those nurses who choose the nurse

educator path will utilize their knowledge, experience, and evidence-based practice to

“transform education” in all of healthcare (ANPD, 2016, p. 6).

A collection of literature has established the importance for the need of a highly-

educated and competent nursing workforce in the acute care setting to improve patient

outcomes (Aiken, 2003; IOM, 2010; Kaiser Permanente, 2001-2017). The Future of

Nursing: Leading Change, Advancing Health (IOM, 2010) explores how nurses'

roles, responsibilities, and education should change significantly to meet the increased

demand for care that will be created by healthcare reform and suggested recommendations to

further improvements in the United States’ increasingly complex healthcare system. Those

IOM recommendations elevate the former roles of the bedside nurse and in doing so; raise

the competencies needed by the nurse educator in support of those bedside nurses.

The ANPD, the professional organization that advocates for NPD practice, created

standards of practice which provided clarity around the roles and responsibilities of the NPD

practitioner (ANA & NNSDO, 2010; Brunt, 2014). At that time, their roles under that title

were that of an educator, change agent, researcher, servant leader, and mentor (ANA and

NNDSO, 2010; Swihart, 2009). The most recent revision of standards resulted in the

Nursing Professional Development: Scope and Standards of Practice 3rd

Edition (2016). The 2016 edition describes the essence of the NPD specialty by defining


and elaborating “the who, what, where, when, why, and how, of the NPD specialty” (ANPD,

2016, p. 7). This revision continues to focus on strengthening NPD as a specialty practice

area. The NPD Practice Model (see Appendix B) is nested within the NPD Scope and

Standards and provides a visual illustration of the relationships among fundamental concepts

of NPD practice (ANPD, 2016; Harper & Maloney, 2016a). This NPD Practice Model is a

systems model consisting of inputs, throughputs, outcomes, and feedback (ANPD, 2016;

Brunt, 2014). Contained within the NPD Practice Model are the most recently defined roles

and responsibilities of the nurse educator. “The roles of the nurse educator are the expected

behavior patterns, while the responsibilities are the required duties” (ANPD, 2016, p. 16).

To meet the IOM’s demands and fulfill the ANPD scope and standards, the

importance of the nurse educator’s competence is repeated through the literature. Nurse

educator competence directly affects the skills and abilities of bedside nurses (Brunt, 2014;

Ramsburg & Childress, 2012). Common themes in the literature include: healthcare

regulations and reforms, accreditations processes, professional standards, increased

accountabilities, and financial priorities, all of which suggest the need for a more fully

developed bedside nurse, as well as those nurse leaders who are guiding them (IOM, 2010;

Swihart, 2009; Warren & Harper, 2017).

Often, those who work as nurse educators have diverse educational backgrounds,

years of experience, and role delineations within their specific areas of expertise. The

updated NPD standards assist in clarifying the nurse educator role and accountabilities. In

every practice setting, the nurse educator emphasizes safety, quality, efficiency, and efficacy

of practice while continuously aiding the transition of multiple generations of nurses from

novice to expert (ANPD, 2016; Brunt, 2014; Harper & Maloney, 2016b; Swihart, 2009).


Onboarding and Orientation

Orientation programs need to be continuously updated because of persistent changes

in healthcare (Kennedy, Nichols, Halamek, & Arafeh, 2012). Onboarding should include

current evidence-based practice changes, informatics upgrades, and new or modified policies

and procedures (Sims & Bodnar, 2012). A competency-based orientation is used to influence

both role orientation and development while guiding from novice to expert (Brunt, 2014;

Kaiser Permanente, 2001-2017). It is vital for an organization to have a formal orientation

program to retain and motivate employees, decrease turnover, increase productivity, improve

staff morale, facilitate learning, and reduce the anxiety of new hires (Ragsdale & Mueller,

2005). Competency-based orientations give clear guidelines regarding expectations and

progression. Without utilizing a set of standardized competencies during an onboarding

process, a disparity in the nurse educator’s development may exist. Variation in process

leads to variation in practice.

Summary

There is limited nursing workforce research about our nation’s hospital-based nurse

educators. The literature has examined the background of NPD and defined the role and

responsibility of those nurse educators functioning within the specialty of NPD. The

supporting literature was geared toward skill acquisition within nursing and the use of

Benner’s model of novice to expert. The literature demonstrated that competency validation

is recommended during onboarding and throughout the trajectory of an educator’s career.

While the role of the nurse educator is to use her expertise to create change and promote

quality in the practice environment, there are also necessary role changes the nurse educator


must consider in order to best assist in the progression of the bedside nurses and the

betterment of the healthcare team at large.

Theoretical Model

While nurse educators often have strong clinical backgrounds, their role is complex

and requires a commitment to skill acquisition (Halstead, 2007). Two brothers developed the

Dreyfus Model of Skill Acquisition; Stuart Dreyfus was a mathematician and systems

analyst, while his brother, Hubert Dreyfus, was a philosopher (Dreyfus & Dreyfus, 2004).

Dreyfus and Dreyfus (1980), created a model of how students acquire skills through formal

instruction and experience. The Dreyfus Model of Skill Acquisition was based on studying

practice situations and determining the level of practice that is evident in that given situation

(Benner, 1982). The Dreyfus brothers believed learning was experiential, as well as situation-

based, and that a student had to pass through five very distinct stages of learning, from

novice to expert. The brothers, observing chess masters, Air Force pilots, Army commanders

and tank drivers, theorized that in the acquisition and development of a skill, a student passes

through five levels of proficiency. These five stages of skill acquisition are: novice, advanced

beginner, competent, proficient and expert (see Appendix C). The Dreyfus Model of Skill

Acquisition has provided a template for studying skill acquisition in several fields including

nursing (Ramsburg & Childress, 2012).

Patricia Benner (1982) is a nursing theorist who first developed a model for the stages

of clinical competence in her classic work "From Novice to Expert: Excellence and Power in

Clinical Nursing Practice.” Benner’s’ theoretical framework was heavily influenced by the

Dreyfus Model. Benner’s model is one of the most cited theoretical frameworks for assessing

nurses' needs at different stages of professional growth. Benner’s classic theoretical


framework of novice to expert differentiated practical and theoretical knowledge while

building on the Dreyfus Model of Skill Acquisition. Benner related the Dreyfus model and its

application to clinical nursing in studies that spanned 20 years.

Benner based her model on the Dreyfus Model of Skill Acquisition by utilizing

observations in the clinical setting, discussing clinical situations outside of the patient case,

and through individual and group interviews with pairings of nurses (one nurse who was new

to the field and as one who was considered an expert). Benner distinguished five levels of

nursing practice: novice, advanced beginner, competent, proficient and expert (see Figure 1).

Benner’s model was based on studying clinical practice situations and determining the level

of practice evident in the clinical situation (Brunt, 2014: Ramsburg & Childress, 2012).

Benner’s research aimed at discovering whether or not there were discernible differences in

the descriptions of identical clinical incidents as told by the novice and the expert, and, if so,

how these differences are understood (Benner, 2001).

Figure 1: Benner’s Novice to Expert theory

http://nursingpedagogy.com/intro.html (not copyrighted)

Beginners, or novices, have no experience in the situations they are asked to perform.

They often are taught objectively about a given situation and instructed to follow the rules to


guide their actions due to their inability to predict what could happen (Benner, 2004). The

advanced beginner demonstrates marginally acceptable performance as they have had some

experiences that enable them to recognize recurrent, meaningful elements of a situation. They

have the knowledge but not enough experience (Benner, 2001). At the competent stage the

learner has some mastery and can rely on planning and organizational skills; they recognize

patterns (Benner, 2004). Those deemed in the proficient stage are capable of seeing situations

as "wholes" rather than parts. They learn from experience and can modify plans in response

to different happenings (Benner, 2001). Experts can recognize demands and resources in

situations and attain their goals. These nurses know what needs to be done. They no longer

rely exclusively on rules to guide their actions because they have an intuitive grasp of the

situation based on their in-depth knowledge and experience (Benner, 2004).

Benner’s classic theoretical framework of Novice to Expert (1982) has been utilized

extensively in a multitude of settings, “in particular, the novice to expert model is frequently

used in the development of mentorship programs” (Butts & Rich, 2015).

The nurse educator role has evolved to encompass a variety of competencies;

achieving them can be challenging for the expert educators and overwhelming for the novice

(Ramsburg & Childress, 2012). Competency assessment is outcome oriented; the goal is to

evaluate performance for the practical application of knowledge and skill in the practice

setting. Competency assessment techniques address psychomotor, cognitive, and affective

domains. Competencies can be generic to clinical practice in any setting or specific to a

clinical specialty, basic or advanced (Benner, 1982).

While Benner’s application of the Dreyfus Model conveys the skill acquisition for

direct care nurses, the model is also useful in assessing the skill acquisition of nurse


educators. The significance of Benner’s theory in building a competency-based orientation is

that these levels of novice to expert reflect growth from abstract concepts to concrete

experiences. Both Benner’s framework and the Dreyfus Model are applicable to any nurse

gaining skill acquisition in any specialty including the nurse educator.

Methods

Design

This PI project utilized the Plan, Do, Study, Act (PDSA) cycle, a four-step framework

for improvement. The PDSA framework (see figure 2) is a systematic process for acquiring

valuable learning and knowledge for the continual improvement of a process. The PDSA

cycle “promotes a trial-and-learning approach to improvement efforts with encouragement to

test an idea rather than do extensive analysis” (Langley et al., 2009, p.454). These four steps

can be repeated over and over as part of a never-ending cycle of continual learning and

improvement. For this PI project, the process in need of improvement was the onboarding

process for nurse educators at SSH.

Figure 2: Deming’s PDSA Framework

Image Retrieved from: https://deming.org/explore/p-d-s-a


The PDSA cycle begins with the Plan step. The cycle involves identifying the

problem and a goal. In this project, the goal was to create a competency-based measurement

tool for use during the onboarding period of a nurse educator at the project site. For the past

15 years at the project site, the onboarding process included the newly hired nurse educator

shadowing with an experienced educator for a matter of weeks. The onboarding

documentation was an orientation checklist which included dates to meet the organizations

leaders and a list of equipment the new hire must become familiar with (see Appendix D). At

no time were the competencies of a nurse educator assessed or discussed.

To create an onboarding competency-based assessment tool, the first step was to

determine which of the 79 NPD competencies the current nurse educators felt were essential

to their role/practice. To obtain those essentials, questions about the use and value of the

NPD competencies must be posed to those who do the job (Lenburg et al., 2009). The next

phase involved the creation and administration of a survey which aimed to determine (1) the

extent to which the 79 NPD competencies were used by the nurse educators; as well as to

determine (2) the importance of each competency from the nurse educators.

The survey itemized the 79 validated NPD competencies by Brunt (2014) and their

performance criteria statements and asked two questions about each competency using a 3-

point Likert scale (see Appendix E). This self-assessment was meant to ask those who are

currently in the educator role to determine the essential NPD competencies.

Organizational email was chosen as the preferred method for data collection via a

Survey Monkey® link. The survey consisted of a list of the 79 NPD competencies and their

performance criteria statements asking two questions using a 3-point Likert scale and eight

demographic questions. Included with the electronic survey link was a personal request


inviting the nurse educators to participate, an explanation of the purpose of the survey,

assurance of confidentiality, the deadline for the survey’s response, the declaration that the

survey is voluntary, and the certainty of the dissemination of the survey results to all

participants as well as the Executive Director of Clinical Professional Development and other

stakeholders (see Appendix F).

The survey was left open for 33 days, with the closure date being coincidently the

start of Nursing Professional Development (NPD) Week per the Association of Nursing

Professional Development (ANPD). Every question in the survey was required, and each

question had the ability for the participant to leave a comment in addition to a rating. This

self-assessment survey mimicked the 3-point Likert’s scale questions used to validate the

Clinical Nurse Specialist Competencies published in 2009 (Baldwin et al., 2009). For each of

the 79 competencies, the survey questions asked the participants (1) Do you use this

competency in your current role? and (2) How important is this competency to your practice?

A 3-point Likert scale ranging from ‘very much’ to ‘not at all’ was used for rating responses.

After studying the data and identifying the gaps, a competency-based assessment tool was

created using the 67 chosen essential competencies for a nurse educator at the project site.

Due to unanticipated cost-containing strategies at the project site, the completed tool was

unable to be implemented on a newly hired nurse educator.

A second PDSA cycle was initiated with the second goal of the project being to

utilize a competency-based measurement tool as a self-assessment for the current nurse

educators. A second survey was created including the original 79 NPD competencies, with

the goal of knowing how the current educators assessed their own practice. For this self-

assessment, a Survey Monkey® link was again chosen as the preferred method for data


collection and sent out through the organizations email to the 11 nurse educators. This

second survey identified if the nurse educator had “met” or “not met” each competency,

meaning the nurse educator utilized the competency in their role as defined in the

performance criteria. The educators were allowed two weeks for their self-assessment. Every

question in the survey was required, and each question had the ability for the participant to

leave a comment along with either response.

Deming’s Study step is the time to evaluate what was learned from the previous two

steps. The result of this survey illustrated 12 of the 79 NPD competencies the nurse educators

assessed as “not met”. These 12 competencies were considered a knowledge gap. These 12

competencies comprising a knowledge gap portrayed four themes: new tasks, educational

efforts, research related and financial endeavors. The next step was to address the knowledge

gap for each of the competencies which were “not met”. For calendar year 2018 (CY’18),

quarterly sessions were created by grouping competencies that relate to the overarching

theme. These educational sessions were created to address the knowledge gaps surrounding

the competencies which the nurse educators felt were “not met” (see Appendix I).

In February of 2018 the first quarterly education session was completed. This session

focused on the NPD competency of: writes grant proposals and participates in grant writing

process (see Appendix J). This competency falls within the domain of a novice nurse

educator yet was unanimously considered “not met” by the nurse educators at the project site

and determined 100% not used by the educators. A PowerPoint bringing basic knowledge

surrounding the topic of grant writing was created and delivered (see Appendix K).


The Act step concludes the PDSA cycle and integrates the learning generated by the

entire process. It is here in the PDSA cycle that the goal is adopted, adjustments are made, or

augmentation from a small-scale experiment to a larger implementation plan occurs.

In this PDSA cycle the newly created competency-based measurement tool was

adopted for newly hired nurse educators at the project site for onboarding in the future. An

expansion of this PI project occurred when the competency-based self-assessment tool was

completed by each nurse educator assessing their own practice using the aforementioned

NPD competencies.

Setting

The project site is a subsidiary of the not-for-profit South Shore Health System which

provides acute, outpatient, home health, and hospice care. South Shore Hospital (SSH) is a

375-bed acute care hospital with immediate plans to expand the acute care platform, as well

as the leading regional provider of acute-care to the approximately 725,000 residents of

Southeastern Massachusetts. The measure of SSH’s success is reflected in excellent medical

outcomes, increasing clinical performance initiatives, ongoing research and programs, and

state and national recognition (http://www.southshorehospital.org/aboutus).

Sample

The nurse educator team at SSH consists of twelve members. Of the twelve, ten have

been onboarded to the nurse educator role within the past 15 years. The onboarding of those

ten nurse educators included only a task-driven skills checklist (see Appendix D) and no

competency evaluation process. The nurse educator team at SSH varied in their educational

degrees, certifications, and work experience; however, they all lacked of exposure to and

knowledge of the NPD competencies associated with their role.


This project created a standard competency-based orientation evaluation tool, to be

used in conjunction with the skills checklist for the onboarding of new nurse educators.

Data Analysis

The survey data collected was analyzed and pertinent information regarding the usage

and the value of the competency were obtained. That data determined the essential required

competencies for a nurse educator at SSH. These essential competencies were used to create

the new nurse educator onboarding competency-based assessment. Each of these

competencies were ranked as 82% or higher as “sometimes” or “not at all” used in the initial

survey (see Chart 1). These 12 competencies, while not currently used, also were ranked as

having “sometimes” or “not at all” value ranking more than 81% (see Chart 2). Those 12

competencies ranked as not used and not valued were omitted in the creation of competency-

based orientation tool.

Chart 1: nurse educators ranking of NPD competencies use in their current role shown in a

clustered column chart


Chart 2: nurse educators ranking of NPD competencies value in their current role shown in a

clustered column chart

A second survey was conducted after the educators completed a self-assessment using

the competency-based tool. That survey was given to better understand which of these 79

NPD competencies the current nurse educators felt they had “not met”. These results exposed

the “not met” competencies and were the exact same 12 NPD competencies earlier ranked as

not used but valued (see Chart 3). Those surveys illustrated a consistent knowledge gap for

12 of the 79 NPD competencies.


Chart 3: nurse educators’ self-assessment of NPD competencies shown in a clustered

column chart

Reviewing skill acquisition and Benner’s novice to expert framework, these 12

competencies were spread across all five domains. Competency #9: writes grant proposals

and participates in grant writing process, falls within the domain of a novice nurse educator.

At SSH most grant writing is done through the Nurse Scientist or the SSH Foundation

department not the nurse educators. Competency #14: Develops or provides input into annual

budget, falls within the advanced beginner domain. At SSH the budget is prepared and

refined by the Executive Director with very little input from the nurse educators.

The competencies which fell into the domain of expert were all used in current nurse

educator practice as well as being valued as important. In that domain this was the only


omitted competency. This competency was ranked as 100% “not at all” when asked about its

use in the current role.

Within Benner’s domain of competence was one skill seen as non-essential and

removed from the new tool. That competency was #30: Develops sponsor relationships with

business and industry. To apply this competency at SSH conflicts with the Compliance

Departments strict policies that business and industry personnel interactions must be limited.

Within the proficient domain, Competency #56: Evaluates effectiveness and

outcomes of educational endeavors was not used. This competency was valued but not

incorporated in the educator’s practice consistently.

Competency #24: Develops and consults research was not used because South Shore

Hospital has a small research team on staff. One of their roles is to guide the Shared

Governance evidence-based practice council. Nurse educators are not represented on this

council at present. As the literature exhibited the NPD practitioner’s role is to utilize

evidence-based practice (ANA, 2010; ANPD, 2016; Harper & Maloney, 2017), it was

reassuring to see the nurse educators did consider this competency as essential to the role.

After the survey results were examined, 67 of the 79 NPD competencies were included in the

competency-based evaluation tool.

Ethical Considerations

This project involved human subjects voluntarily and anonymously answering a

survey and completing an evaluation of the final competency-based orientation tool. The

purpose of the IRB was to assure that appropriate steps would have been taken to protect the

rights and welfare of humans participating in research, but this project was deemed a

performance improvement project and needed no such approval.


The intent of this project was to improve an internal process and not to contribute to

generalizable knowledge; therefore, the application was deemed a Performance Improvement

project and did not require IRB approval (see Appendix G).

Limitations

There are several limitations to this PI project. The initial limitation is that the

findings of this PI project are only relevant to the 12 acute care educators at SSH. A small

team of nurse educators were utilized to assist in the creation of a competency-based

onboarding measurement tool.

A second limitation is the timing of this PI project. Upon initial planning, there were

no anticipated roadblocks to the completion of the aim of the project. The timing and amount

of competing priorities for the nurse educators surrounding the initial data collection window

was arduous at South Shore Hospital. The organization implemented a new electronic health

record within the time frame of this project. The available time for an educator to

meaningfully complete this survey was minimal. The initial survey contained 87 questions

therefore could be considered time-consuming. Per Survey Monkey® three educators took

over an hour to complete the survey while eight took 50 minutes or less which equates to less

than one minute on each question. An unforeseen hiring freeze within the organization

prevented the implementation of the competency-based tool with a new educator.

Discussion

This PI project met its aims and served several functions. It created a competency-

based measurement tool for the onboarding of nurse educators at SSH where a tool was

currently devoid. This finished project closed that void. The existing nurse educators had

verbalized discontent with the orientation checklist that had been used in the past to onboard


novice nurse educators. The “competency” tool of the past was a skills checkoff list with no

evidence or competency recognition. The topic of nurse educator competency was rarely

broached after onboarding within this organization. This completed project will now provide

support for nurse educators’ skill acquisition using the newly developed competency-based

measurement tool during onboarding. This project also created a competency-based self-

assessment tool for the nurse educators which can be used to guide ongoing orientation,

mentorship, and educational programs for nurse educators. Finally, this project identified

gaps in the nurse educators’ knowledge around 12 of the NPD competencies, which are in the

process of being taught over calendar year 2018.

Two separate surveys showing the very same 12 competencies were: not used, not

valued, and not met, illustrating a knowledge gap for the current nurse educators. These 12

competencies need further defining education. Without these surveys this knowledge gap

would have gone unrecognized. The educators indicated the gap through a self-assessment,

and the focused learning sessions to close that knowledge gap have now begun.

Harper and Maloney (2017) stated those who specialize as nurse educators must

position themselves to provide value to healthcare, their organizations and own their practice;

the nurse educator team at South Shore Hospital has taken a step in that direction by assisting

in this project to improve their onboarding process. Huston (2008) articulates healthcare team

members in 2020 will be characterized by highly educated, multidisciplinary experts. South

Shore Hospital has those experts amidst their team. A competency-based tool shows

evidence of that expertise. There are other opportunities for this project’s results. The

competency-based tool will be utilized at three levels within the organization:


1. Self-evaluation – the nurse educator uses these competencies to assess their

performance and professional growth.

2. Peer reviews – the nurse educators use these competencies peer to peer to

address strengths and competencies with opportunities for growth.

3. Organizational performance evaluations– to ensure and document the

consistent and competent performance of nurse educators.

Although competency assessments and performance evaluations are two unique

Joint Commission requirements, they are certainly symbiotic. The competency assessment

measures whether or not staffs have the skills, knowledge, and abilities to perform their

assigned duties. An annual performance evaluation reveals how well staff performed the

assigned job responsibilities over the past year. Beyond the documented initial assessment of

competence completed at the end of orientation, competency should be assessed on an on-

going basis with documentation of such at least once every two years or more frequently as

defined by the organization’s policy (Joint Commission, 2017). Including this competency-

based evaluation tool into the annual performance evaluation of a nurse educator would:

build on initial documented competence, assist in the creation of the educator’s annual goals

or opportunities for growth, and keep the performance evaluation assessor in touch with the

progress of their nurse educator team.

Plan for Dissemination

Dissemination of the results of a project is the culmination of a DNP project; it is

critical to disseminate findings of evidence-based practice and research to improve healthcare

outcomes (AACN, 2006). At SSH, nurse educators focus on assessing and validating

bedside nurses’ competencies while never having knowledge of their own NPD


competencies, until this project. Ongoing use of the results of this project will include

continually embracing the original data surrounding the competencies. This data is valuable

because it was obtained from those currently in the nurse educator role.

The next phase at the project site has begun. Efforts are ongoing for developing and

implementing educational sessions to address the 12 knowledge gaps identified in the data.

These sessions will inform the nurse educators and enhance their understanding of their

required knowledge, skills and abilities for their role.

This newly created competency-based tool also has the potential to be altered and

utilized as a self- assessment of the nurse educator’s competence for annual performance

appraisals to guide from novice to expert. Both the Executive Director of Clinical

Professional Development and the nurse educator should utilize this tool to identify goals for

professional growth between annual appraisals.

Discussions across disciplines have already occurred since this project was begun. At

the project site, the director and a manager from the Therapies Department reached out for

assistance in incorporating their specialty competencies in an onboarding process. The

meeting attendees heard the purpose, aim, and methods of this project and saw the final

competency-based orientation tool. Subsequent working meeting sessions have occurred and

a similar onboarding tool incorporating their specialty’s competencies was drafted.

The results of this DNP PI project have been reported to the survey participants, the

project site’s nursing leaders and stakeholders, and a portion of the academic community at

Simmons College. Dissemination of information at a state or national nursing conference

through a podium or poster presentation would be an effective method of sharing this


competency-based tool. After implementation and subsequent evaluation of the new tool on a

novice nurse educator, another venue for dissemination could be to submit for publication.

Implications for Practice

Information from this PI project may be of interest to researchers interested in NPD

skill acquisition or role development. To keep the NPD competencies relevant there need to

be research as well as PI projects done to show continued support of so many competencies.

Johnson (2017) reminds nurse educators and nurse leaders that as healthcare changes

continue over the next decade, nurse educators must establish themselves as essential to their

organizations. Nursing leaders such as nurse educators must: know the key players involved

in change, become politically savvy, be at the table for decision-making, focus on the

strategic initiatives of the organization, communicate, collaborate and measure results

(Johnson, 2017). Each of these recommendations falls within one or more of the NPD

competencies, therefore being conscious and utilizing the competencies in practice keep

nurse educators relevant, and indispensable.

Conclusion

Every role in nursing requires an onboarding process involving competency

evaluation and the role of a newly hired nurse educator is no different. The questions to be

answered through the implementation of this PI project were: (1) did the nurse educator team

at South Shore Hospital utilize the Nursing Professional Development competencies in their

role? and (2) which of the Nursing Professional Development competencies did the team

members say they “not met” using a self-evaluation?


The team expressed that of the 79 NPD competencies there were 67 which they used

and valued in their current practice. When each nurse educator then completed a self-

assessment using the competency-based tool, 12 competencies they ranked as “not met” were

now viewed as gaps in knowledge. These gaps in knowledge have become a year-long

educational series for the nurse educators at South Shore Hospital.

The nurse educator role is multifaceted, and success requires a commitment to

developing a variety of skill acquisition beginning with orientation. Cultivating and

sustaining the competencies of nurse educators requires keeping pace with shifting healthcare

expectations, evolving practice requirements, modern technologies, and rapidly changing

evidence-based practice.

This project’s deliverable was the development of a competency-based orientation

process for use in the onboarding of a new nurse educator. Additional opportunities for the

inclusion of the NPD competencies will be presented to nursing leadership at South Shore

Hospital and further use and development of the tool will take place.

The American Association of Colleges of Nursing (AACN) is the driving force for

innovation and excellence in academic nursing and incorporates The Essentials which are

necessary curriculum and expected competencies of graduates from Doctor of Nursing

Practice (DNP) program (AACN, 2006). A DNP graduate who practices at the

system/organizational level is asked to “define actual and emerging problems and design

comprehensive level interventions. These interventions require that the DNP graduate is

competent in systems, and advanced organizational or community assessment techniques, in

combination with a skilled level of understanding of nursing and sciences” (AACN, 2006,

p.18).


This DNP final project examined the role of the hospital-based nurse educator and

uncovered competency discrepancies in that specialized discipline. A competency-based tool

was then created that can be utilized in several ways to encompass competency validation for

the nurse educator. This project supports the DNP Essential of a DNP graduate being

proficient in quality improvement strategies and in creating changes at the organizational

level.


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Appendix A: Nursing Professional Development Competency statements

1. Uses a variety of teaching strategies and audiovisuals.

2. Promotes a safe and heathy work environment.

3. Maintains confidentiality.

4. Demonstrates expertise in use of computers.

5. Maintains required documentation and record keeping system.

6. Provides technical assistance to clients.

7. Maintain educational standards.

8. Demonstrates proficiency in use of technology

9. Writes grant proposals participates in grant writing process.

10. Integrates ethical principles in all aspects of practice.

11. Maintains educational or clinical competencies appropriate for role.

12. Promotes concept of lifelong learning.

13. Participates in committees, task forces, projects etc.

14. Develops or provides input into annual budget.

15. Assists with excellence initiatives (i.e. Magnet Recognition).

16. Involves the client in defining problems and selecting solutions.

17. Establishes credibility with other professionals.

18. Demonstrates emotional intelligence.

19. Participates in activities external to practice settings.

20. Networks within and outside nursing.

21. Conducts focus groups.

22. Accesses information external to organization.

23. Assesses resources needed to facilitate research.

24. Develops and consults research.

25. Facilitates the adult learning process, creating a climate conducive to learning and

fostering a good relationship with learners.

26. Identifies internal and external resources available for staff.

27. Uses appropriate measurement tools and methods in quality improvement activities.

28. Markets the NPD and continuing education programs.


29. Publishes information that can be used by other educators.

30. Develops sponsor relationships with business and industry.

31. Uses principles from theories of adult learning, organizational development, system

change, and quality improvement.

32. Serves as a change agent.

33. Uses appropriate measurement methods to assess and document competence of

personnel.

34. Communicates effectively with all levels of organization.

35. Facilitates peer review.

36. Facilitates change.

37. Facilitates teambuilding.

38. Functions within the political climate of the organization.

39. Coaches and provides feedback to improve performance.

40. Uses and evaluates material resources and facilities.

41. Conducts needs assessments using a variety of strategies.

42. Critically processes information and problem-solves.

43. Seeks opportunities to develop the various NPD intertwined elements of practice.

44. Involves learners in assessment of needs an identification of outcomes.

45. Demonstrates awareness of historical and emerging trends.

46. Designs and revises educational activities.

47. Serves as a role model for education.

48. Supports integration of research into practice.

49. Collaborates with and across organizations.

50. Develops links with academia and service.

51. Ensures educational programs are congruous with organizational mission and goals.

52. Communicates impact of new educational strategies to others.

53. Produces desired outcomes relevant to organizations.

54. Interprets and communicates across boundaries.

55. Selects appropriate teaching strategies to facilitate behavioral change.

56. Evaluates effectiveness and outcomes of educational endeavors.

57. Incorporates research findings from a variety of disciplines into programs.


58. Calculates risks and benefits of educational innovations.

59. Creates and applies newer educational methodologies.

60. Oversees evidence-based practice (EBP) and practice-based evidence (PBE).

61. Develops curricula (classes or courses around a common theme).

62. Evaluates overall program effectiveness.

63. Consults and performance problems.

64. Applies skill in strategic planning.

65. Promotes career development and role transition.

66. Maintains flexibility when managing multiple roles and responsibilities.

67. Measures and communicates return on investment (ROI).

68. Develops proactive educational policies and procedures for organization.

69. Fosters systematic analysis of issues.

70. Differentiates educational problems from system problems.

71. Develops standard for educational practice in own setting.

72. Sees beyond role-established boundaries.

73. Determines and revises priorities for scheduled and unscheduled educational

activities.

74. Uses consultation skills internally and externally.

75. Mentors other professionals.

76. Incorporates transformational leadership principles into practice.

77. Adjusts content and teaching strategies during presentation based on learner’s

reaction.

78. Coordinates complex educational offerings.

79. Possesses expert knowledge of how to teach within organizational culture.

(Brunt, 2014)


Appendix B: Nursing Professional Development Practice Model ©

(Association for Nursing Professional Development [ANPD], 2016, p. 10)

January-March 2018, used without permission (await email response for permission authorization from ANPD)

Appendix C: The Dreyfus Model of Skill Acquisition’s five stages


(Dreyfus, 2004, p.181)


Appendix D: South Shore Hospital’s CPDS orientation checklist (est. 2014)

SOUTH SHORE HOSPITAL, INC.NURSING DEPARTMENT

CLINICAL PROFESSIONAL DEVELOPMENT SPECIALISTORIENTATION OBJECTIVES

Name Preceptor Date of Orientation

For the purpose of documenting the orientee's progress, the preceptor's/supervisor's/manager's signature and date shall mean that the employee has accomplished the designated skill/task in a competent manner. Competence is defined as the ability to demonstrate or perform the task or skill following the policies, procedures, and standards of care, and/or practice of South Shore Hospital. It is the responsibility of the orientee to actively seek opportunities to complete all items on the checklist during the orientation period. Any items, for which there is no opportunity, or skills are not at a competence level, should be circled. The orientee's responsibility will be to continue to seek those opportunities following orientation. It will be the responsibility of the manager/employee to develop a learning contract to address unmet competences. Upon completion, it will be added to the employee's personnel file.

The following should be completed within eight weeks of employment. After eight weeks, any competencies which could not be achieved during the orientation period will be identified by the Mentor. In collaboration with the orientee’s director, a plan for meeting these competencies will be developed. The learning objectives worksheet/plan will be the responsibility of the orientee. The learning objectives on the worksheet should be completed within 6 months.

Orientee Initial/Date

Department mission, philosophy and objectives ____ __________ __________

Department specific policies, procedures, protocols __________ __________

Review of Job Description/Performance Standards __________ __________

Department specific safety policies/procedures andthe employee's role __________

__________

Department specific infection control policies/procedures, and the employee's role __________ __________

Department specific quality assessment and improvement activities, and the employee's role/responsibilities __________

__________

____________________________ _________Preceptor/Supervisor/ Date

Manager Signature/Title

1. Participates/attends in General Hospital Orientation


2. Participates/attends Nursing Orientation

Completed Initials

3. Meets and establishes rapport with the following Department/Management Directors.

Informal meetings with the following…

Director of Clinical Professional Development (name)________________________ (date) ______________

Director of Parent Child Services/Nursing (name)__________________________ (date) ____________

Director of Emergency Services/Nursing (name)__________________________ (date) ___________

Director of Medical-Surgical Nursing (name)__________________________ (date) ___________

Director of Critical Care Nursing (name)__________________________ (date) ____________

Director of Surgical Services/Nursing (name)__________________________ (date) ____________

Vice President for Nursing Services (name)__________________________ (date) ____________

Administrative Clinical Coordinators (name)__________________________ (date) ____________

Others pertinent to area of specialty:

Date Name

Date Name

Date Name

Under the guidance of mentor:

4. Attends Manager Meetings for orientee’s division and begins to establish relationship with Nurse Manager(s), Operations Supervisors and Staff in assigned areas

Completed__________________________Initials___________________

5. Attends/conducts meetings with staff to establish work relationships



6. Reviews specialty specific PI projects being conducted in various departments across the continuum


7. Serves as a liaison and resource for clinical staff as needed

Completed Initials

8. Assist in monitoring professional standards of care(specialty)

Completed Initials

9. Can locate the following information/databases:

Nursing Policy and Procedure for area Patient Care Services Learning Management Education & Training registration Meditech/Employee skills Patient & Family Education SSH Conference Rooms Medication Formulary Lotus Notes Database Directory

Completed Initials

10. Miscellaneous Locates education calendar

Knows how to have programs added to the education calendar Knows how to register for programs Knows how to access the Clinical Professional Development Department during day time Locates Education Resource Book on unit-what it should contain Knows how to get/set up programs

CompletedInitials

Can locate and states understanding of use:

Printing Requisitions Attendance Sheets Evaluation Forms CEU Forms (BORN/ANCC)

Completed Initials

11. EQUIPMENT:


Demonstrates understanding/operation of:

Equipment room and contents Plasma Screens Laptop/power beam Telephone/voicemail/greetings Video camera TV/VCR/DVD Floor based copy machines with appropriate codes Review of training manikins and carts


12. PROGRAM DEVELOPMENT A. Assessment

1. Conducts an educational needs assessment for areas assigned in collaboration with Shared Leadership Professional Development Council

2. Identifies other sources for identifying needs 3. Collaborates on the development plan for meeting identified needs

B. Development Designs and/or coordinates program for clinical staff following ANCC guidelines

1. Select date, time 2. Book room a. knows resources to check rooms availability

b. chooses room appropriate for size of audience 3. Book Speaker a. speaker agreement/disclosure b. speaker fee/check received 4. Is able to arrange publicity as necessary in a flyer/brochure format 5. Develops or obtains objectives and content outline 6. Obtains a program/computer name 7. Calculates number of contact hours to be awarded 8. Creates contact hour certificates9. Obtains C.V. from speaker

10. Obtains/creates handouts 11. Attendance Roster C. Evaluation

1. Utilizes evaluation tool 2. Complete summary evaluations of program 3. Files documentation with Clinical Professional Development Department 4. Completes or assures data entry of attendance

D. In-service1. Understands procedure for company reps to come into SSH

2. Set up/document/advertise in-service programming.3. Attendance Rosters 4. Records attendance in computer

Completed Initials

13. NURSING ORIENTATION

Participates in conducting nursing orientation classes as required


Functions with orientees as a clinical preceptor Collaborates with Nurse Managers, SG council reps and unit-based preceptors

to assess progress and/or identify learning needs of the orientee

Completed Initials

14. COMPUTER SYSTEM for Education records

Single source of truth=MEDITECH Enters/updates employees’ skills files Obtains reports of either individual or departmental attendance

Completed Initials 15. COMPUTER TRAINING

Meditech (specifics to areas cover) Lotus Notes

-Knows how to set up orientees with Lotus Notes tutorial E-mail

-Knows how to use “out of office” function-Knows how to accept invitations

Equipment booking Personal calendar

-Knows how to open personal calendar to specific colleagues Educational calendars (CME, Education & Training) Meditech (order entry, PCS, employee skills files) Excel, Word, PowerPoint, Adobe, Publisher

Completed Initials

16. If new to the organization, spends time with mentor(s) to develop an understanding of daily operations in various in-patient care settings (e.g. CC, M/S, OB, Pedi)

Completed Initials

COMPLETION:

_________________________has completed an orientation to the Department of Nursing can utilize (Orientee)his/her peers as resources as needed.

__________________________________ORIENTEE

__________________________________MENTOR

__________________________________DIRECTOR OF Nursing (Pertinent to Orientee)


________________________________has completed an orientation to the hospital and the role of (orientee) Clinical Professional Development Specialist. (specialty)I____________________will continue to function in the role of mentor to assist (mentor) in the development of The Clinical Professional Development Specialist.

Orientee/date _______________________________ Mentor/date__________________________________

3/2014

KAF

Appendix E: Survey Monkey self-assessment survey of the 79 NPD competencies


Appendix F: sample request for participation letter mailed to CPDS team at SSH

September 15, 2017

My fellow Clinical Professional Development Specialist,

I am requesting your assistance in data collection related to my DNP project. Let me give you some background. I have worked at South Shore Hospital as an educator for 16 years, but under many role titles. Our most recent self-created title of Clinical Professional Development Specialists is our title, but our roles fall under the umbrella of the nursing specialty of Nursing Professional Development (NPD).

Within that NPD specialty, there are 79 validated competencies that encompass our roles. I have done much research on this and wish to get feedback in the form of a survey from you about these competencies. I am asking you to review each of the 79 competencies and rate if you (1) utilize this competency in your current role at SSH, and then rate (2) how important you perceive the competency to your current practice at SSH. The model for this survey was taken from the landmark Baldwin et al. (2009) study validating the core competencies of the Clinical Nurse Specialist.

My goal with this survey is of course to make you aware of these competencies for our specialty, but I would like to improve out CPDS onboarding at SSH. I would like to create a SSH CPDS orientation checklist that encompasses the competencies that you feel are important and pertinent to our roles. The initial step is getting data from those who currently do the role.

This is a Survey Monkey® assessment which includes 79 NPD competency questions as well as several demographic questions. For each competency statement, I have listed (in purple) the performance criteria, or an example, to assist you in answering the Likert scale rating of each competency.

I would like to assure you of the confidentiality I will maintain with the survey results. Only I will be analyzing the data through Survey Monkey®. The demographic questions are only to aid me in the description of the SSH CPDS team for the project. I will disseminate the results of this survey and the orientation checklist with all of you as well as our leaders. I will share with you first as the subjects.

I have included below the link to the survey. I do need to give a deadline on this survey, and I have made that date October 18th at NOON, which coincidently is the start of Nursing Professional Development Week.

I would like to thank you in advance. I am keenly aware that 79 questions is NOT a small quick survey, and I appreciate that time is a limited commodity for the CPDS team. I will of course be sending reminders to complete the survey. I will be sending them in a blanket email as I will be unable to tell who has taken the survey. I appreciate your tolerance.

Survey link >>>>>>>>>Thank you again, and please contact me for any questions or concerns.Kelly

Kelly Fitzpatrick MS, RN BC, MSRN, DNP(c) (781) 624-8405(work) or (781) 254-2965 (cell)[email protected] (work) or [email protected] (home


Appendix G: IRB responses from Simmons College and South Shore Hospital


Emails re: IRB process at South Shore Hospital Outcome: not necessary to submit to SSH IRB, SSH does not have a process for reviewing performance improvement at this time. The intent of project is not to contribute to generalizable knowledge but is to improve internal processes.

From: Maureen M Demenna Sent: Monday, May 08, 2017 10:46 AMTo: Kelly Fitzpatrick; [email protected] Cc: Susan Duty

Hi KellyPlease see the response below from my director and our IRB administrator. You should be all set since your project doesn't really involve research. SSH does not have a process for reviewing performance improvement at this time. Thanks for reaching out to me.Best, Maureen

From: Andrea Collins (formerly Landers) Sent: Monday, May 08, 2017 10:19 AMTo: Maureen M Demenna <[email protected]>Subject: RE: IRB process-Simmons DNP student

I agree this does not sound like research as the intent is not to contribute to generalizable knowledge but is to improve internal processes. When the invitation is sent to employees, the project should not be referred to as a research study.

Thank You,Andrea Collins, MHA, CIPDirector, Office of ResearchIRB AdministratorSouth Shore Hospital 55 Fogg Road, Mailbox 26South Weymouth, MA 02190Phone: 781-624-4369 [email protected]://www.southshorehospital.org/clinicalresearch

From: Maureen M Demenna Sent: Monday, May 08, 2017 9:25 AMTo: Andrea Collins (formerly Landers) <[email protected]>Subject: FW: IRB process-Simmons DNP student

Hi Andrea - This does not sound like research to me. I imagine we will be getting several such requests in the next few weeks as the DNP students plan their capstone projects. Let me know how you would like me to respond to Kelly.Thanks, Maureen

From: [email protected] [mailto:[email protected]] Sent: Saturday, May 06, 2017 2:20 PMTo: Maureen M Demenna <[email protected]>Subject: IRB Simmons DNP student request

mailto:[email protected]




http://www.southshorehospital.org/clinicalresearch



Appendix H: Competency-Based Orientation Evaluation for CPDSs at SSH

Competency-Based Evaluation for the Clinical Professional Development Specialist Name/Credentials _____________________________ Date of Hire __________________________

Area(s) of Responsibility __________________________Title _______________________________

Assigned Preceptor(s)________________________________________________________________________

The purpose of this Competency-Based Orientation (CBO) Evaluation is to establish an orientation program for the newly hired South Shore Hospital Clinical Nurse Development Specialist colleague. This CBO Evaluation tool is set up in phases to advance the CPDS from: Novice-Advanced Beginner-Competent-Proficient-Expert encompassing the Nursing Professional Development (NPD) competencies. This CBO Evaluation is to be completed by the new CPDS and their assigned CPDS preceptor. Please include dates competency met and examples when possible. If competency is unable to be met, please list a comment.

The CBO Evaluation tool incorporates the six responsibilities of a CPDS which include: onboarding and orientation; competency management; education; professional role development; academic and interprofessional collaborative partnerships; and research/evidence-based practice/quality improvement (ANPD, 2016; Warren & Harper, 2017). Within those responsibilities, these attached 75 competencies were endorsed as valuable and required for the current CPDS role at South Shore Hospital by the CPDS team (2017).

Upon attainment of the Phase 1/NOVICE CPDS competencies, please complete the accompanying CPDS Skills Orientation checklist within one month and bring to Human Resources to receive WHITE badge. Continue to complete this CBO Evaluation for the remaining 11 months.

References:

Association for Nursing Professional Development. (2016). Nursing Professional Development: Scope & Standards of Practice (3rd Ed.). Chicago, IL: Association for Nursing Professional Development (ANPD).

Brunt, B. (2014). Nursing Professional Development Competencies: Tools to Evaluate and Enhance Educational Practice. Danvers, MA: HcPro.

Warren, J. I., & Harper, M. G. (2017). Transforming Roles of Nursing Professional Development Practitioners. Journal for Nurses in Professional Development, 33(1), 2-12.


Phase 1 (first month) of orientation, the SSH CPDS will:

Competency and Performance Criteria

met Date/example not met

Comments

Use a variety of teaching strategies and audiovisuals.Promote a safe and heathy work environment.Maintain confidentiality.Demonstrate expertise in use of computers.Maintain required documentation and record keeping system.Provide technical assistance to clients (ie. RN/NA/Providers.)Maintain educational standards.Demonstrate proficiency in use of technology.Integrate ethical principles in all aspects of practice.Maintain educational or clinical competencies appropriate for role.Promote concept of lifelong learning.

Also completed the CPDS Skills Orientation checklist

Comments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________

Signatures: orientee/date ___________________

preceptor/date _________________

At the completion of this phase 1, the CPDS is a NOVICE CPDS.


Phase 2 (at 3 months) of orientation, the SSH CPDS will:



Comments

Participate in committees, task forces, projects etc.Assist with excellence initiatives (ie. Magnet/Beacon Recognition).Involve the client (RN, NA, and Provider) in defining problems and selecting solutions.Establish credibility with other professionals.Demonstrate emotional intelligence.Participates in activities external to assigned practice settings.Network within and outside nursing. Access information external to organization.Assess resources needed to facilitate research.Facilitate the adult learning process, creating a climate conducive to learning and fostering a good relationship with learners.Identify internal and external resources available for staff.Use appropriate measurement tools and methods in quality improvement activities.Market the NPD and continuing education programs.





At the completion of this phase 2, the CPDS is an ADVANCED BEGINNER CPDS.




Comments

Use principles from theories of adult learning, organizational development, system change, and quality improvement.Serve as a change agent.Use appropriate measurement methods to assess and document competence of personnel.Communicate effectively with all levels of organization.Facilitate peer review.Facilitate change.Facilitate teambuilding.Function within the political climate of the organization.Coach and provide feedback to improve performance.Use and evaluate material resources and facilities.Conducts needs


assessments using a variety of strategies.Critically process information and problem-solves. Seek opportunities to develop the various NPD intertwined elements of practice.Involve learners in assessment of needs an identification of outcomes.Design and revise educational activities.Serve as a role model for education.Support integration of research into practice.Collaborate within and across organizations.Develop links with academia and service.Ensure educational programs are congruous with organizational mission and goals.Interpret and communicate across boundaries.


Signatures: orientee/date _________________

preceptor/date __________________

At the completion of this phase 3, the CPDS is a COMPETENT CPDS.





Comments

Select appropriate teaching strategies to facilitate behavioral change.Create and apply newer educational methodologies.Oversee evidence-based practice (EBP) and practice-based evidence (PBE).Develop curricula (classes or courses around a common theme).Evaluate overall program effectiveness.Consult on performance problems.Apply skill in strategic planning.Promote career development and role transition.Maintain flexibility when managing multiple roles and responsibilities.Measure and communicate return on investment (ROI).Develop proactive educational policies and procedures for organization.Foster systematic analysis of issues.Differentiate educational problems from system problems.Develop standard for educational practice in own setting.


See beyond role-established boundaries.Determine and revise priorities for scheduled and unscheduled educational activitiesComments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________

Signatures: orientee/date ________________

preceptor/date ___________________

At the completion of this phase 4, the CPDS is a PROFICIENT CPDS.




Comments

Use consultation skills internally and externallyMentor other professionals.Incorporate transformational leadership principles into practice.Adjust content and teaching strategies during presentation based on learner’s reaction.Coordinate complex educational offerings.Possess expert knowledge of how to teach within organizational culture.

Comments from preceptor(s): ________________________________________________________________


________________________________________________________________________________________________________________________________



At the completion of this final phase 5, the CPDS is an EXPERT CPDS

Upon completion of this year-long CBO Evaluation bring a copy to Human Resources and to the Executive Director

Appendix I: 12 NPD competencies considered a knowledge gap for current nurse educators

1/2017 kaf


Appendix J: Survey results Competency #9


Appendix K: Grant Writing Basics PowerPoint for nurse educators Feb’18

Survey #1nurse educators

do not use competency 54% value competency

Survey #2nurse educators

unanimous gap in knowledge

The Creation of a Competency-Based Orientation€¦ · Web viewThese 12 competencies need further...

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