by Coleen de Leon, RNFA, BSN, MBA
Back in the 70s, when I received notification I had passed my State Board exam, I was ecstatic! As the reality of my accomplishment sank in, I realized, I’m a nurse. I’m really a nurse! I was now considered one of the “elite” team of health care professionals.
I had been educated, trained, and now would be expected to function on my own. Instantly nervous, I certainly did not feel well prepared for the career I had chosen. I initially accepted a position on the night shift on surgical floor. As I admitted patient after patient immediately following their surgeries, I found myself yearning to work in the operating room. It took a little over a year but, finally, I was able to persuade the OR manager to hire me as an operating room nurse. It was during my first week in the operating room that I realized my education and training had not prepared me for a job like this. (And, yes, the first surgery I observed I nearly passed out.)
The philosophy in the operating room at this time was “see one, do one, teach one.” The very next day after I had scrubbed my first cholecystectomy, a patient with a ruptured aorta aneurysm arrived in the emergency room and the OR charge nurse said with conviction, “You did a cholecystectomy yesterday, you are ready for an aorta today.” Without a second thought (there was no time for a second thought a life was at stake!), I scrubbed that aortic aneurysm procedure. I had never even seen a cardiovascular clamp until that day! It was with sheer terror that I survived the day and the many more to follow.
Times have certainly changed.
Today’s health care professionals are no longer expected to “see one, do one, teach one.” They must be thoroughly and competently trained. Fortunately, patients these days benefit across their whole continuum of care, from the due diligence of educators, preceptors, experienced nurses, and physicians, who assist in validating the competency of the health care team providing their care.
In the AAAHC Accreditation Handbook, Chapter 4, which focuses on “Quality of Care Provided,” I would like to draw attention specifically to Standard A:
All health care professionals have the necessary and appropriate training and skills to deliver the services provided by the organization.
By dissecting this further, I hope to give you a better understanding of the intent of this Standard. The following list is for reference and does not necessarily provide all options available to meet or exceed this particular Standard:
1. “All heath care professionals” includes all nursing staff (RN, LVN, MA, etc.), surgical and endoscopy technologists and instrument/ scope processing technicians.
2. “Training” includes education, certification, orientation, staff in-services, continuing education courses, on-line courses, ACLS, BLS, PALS etc.
3. “Skills” (competence) includes previous employment verification, reference checks, evaluation of competency by preceptor, self-assessment of skills inventory, performance appraisal, peer review, incident/occurrence reports, quality improvement indicators etc.
4. “Services provided by the organization” includes a list of all procedures approved by the Governing Board.
During the AAAHC survey process, various employee files will be reviewed by the surveyor. The surveyor will review the employee’s job description since this identifies training and skills necessary to perform their particular job. The organization’s general information gathered by the surveyor also allows him or her to understand the type of procedures considered high risk/low volume. This knowledge is also important when reviewing employee files. An example of how this information is used would be if a laser were used for a particular procedure (high risk, possible low volume), the surveyor would review the employee file for laser training. A laser incident/ occurrence would also prompt the surveyor to review that employee’s file for the appropriate training.
The intent of this particular Standard is to ascertain whether or not the health care professional possesses the knowledge and skills to perform their assigned duties. The health care professional’s knowledge is easily documented through education, training, and testing verification. Documentation of exactly how much this knowledge has been put into practice (skill/competency) tends to be an area of challenge.
By reviewing and following the list of suggestions noted in #3 previously, the organization should be able to thoroughly document a health care professional’s skill/ competency level. Of note, peer review currently used in the physician credentialing process is an ideal way to document a health care professional’s skills/competencies. Who knows better than your peers the quality of your work?
As we look to the future, growth in health care technologies will surely continue to place demands on health care professionals to obtain further knowledge and to acquire new skills. Organizations need to develop an effective way to verify and document health care professionals’ skills/competencies to be confident the services the professionals provide are within their capabilities.
About the author:
Coleen de Leon is the Nurse Administrator of River Surgical Institute in Modesto, California. She is a surveyor for AAAHC and has been involved in healthcare for over 35 years.