Competencies and evidence-based practice have changed nursing. The evolution over my 30 years has been enlightening and challenging. Competency or being knowledgeable is no longer just having a skill set. It is the ability to integrate the technical aspect of a skill with critical thinking and then being accountable for our actions or inactions (Wright, n.d.).
It is not a check-off list to be completed in a flurry of daily activities.
Wright (n.d.) states factors to be considered when developing a competency include organizational mission and goals, new policies and procedures, changes in practice, high risk/low incident practices, and recurrent problematic areas (incidents, quality improvement indicators). Using Bloom?s Taxonomy, the competency should be stated and the employee have options on how to verify their competence (Wright, n.d.). Verification can be done through testing, peer/customer reviews, self-assessment, discussions, presentations and observation to name a few (Wright, n.d.).
Coronary Artery Anatomy and the Global Implications of Disease on these Vessels is a class presented to all new hires, regardless of experience. Having all nurses on the same playing field and understanding the content in the same way eliminates errors, improves quality of care and promotes team functionality. It eliminates discrepancies in presumed care practices. The objectives of the class include:
1. Name the three major coronary arteries, locate on a heart model and state which artery(s) supply which side of the heart by labeling on the coloring sheet.
2. Explain coronary artery perfusion and discuss the global implications of diseased arteries on heart function and the rest of the body.
The objectives will provide knowledge and skills to become competent in providing care to the cardiac patient. It will allow the nurse to anticipate and prepare for potential complications, to provide education to the patient and family on disease process and behavior modification to affect health care changes.
The National League for Nursing (2016) lists eight competencies for the nurse educator to promote. The Coronary Artery Anatomy class facilitates learning through both didactic and hands-on learning emphasizing the importance of vessel disease and the impact it has on patient well-being. A pre- and post- quiz can evaluate effectiveness of teaching and could be incorporated into the class (NLN, 2016). For the learner, writing an exemplar of how they recognized and averted a patient complication is a way to verify this if it was a competency included in floor orientation. Two other competencies for the nurse educator that would impact the class include leadership/acting as a change agent and engaging the learner in scholarship (NLN, 2016). It is so important for the educator to be not only knowledgeable about the topic, but to know how the topic impacts the patients and organization.
Cardiac disease is a top three diagnosis in our area. Cardiac anatomy is seemingly easy and may negatively affect attitudes of new hires, especially ones with experience. Changing those attitudes, by having facts, figures, quality initiatives, and morbidity and mortality rates to supplement the material will make the learning meaningful?even to an experienced nurse. A good sense of humor, passion and a couple of great stories will connect coronary arteries and disease and how it negatively affects the rest of the heart. It will show the correlation of poor blood supply on other cardiac structures and promote critical thinking.
Competencies are changing nursing. They are more global and have multiple ways to prove excellence. They look at gaps in knowledge, skill and practice and focus on new, changed or problematic areas. It is no longer a check-off sheet, haphazardly completed by a tired, end-of-shift preceptor and tucked away in a file. It is a well thought out, individualized set of proficiencies to make the patient experience a positive one.
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