Transcription

Guidelines for Competence AssessmentUpdated August 2019

ContentsIntroduction . . . . .3Purpose of the guidelines. . . . 3Nursing Council documents which support competence assessment .3Continuing competence requirements .4Types of assessment. .4Preparing to be assessed. . .5Self-assessment. .5Assessing another nurse. 6Assessments for nurses practising in management, education, policy, research andexpanded practice7Guidelines for nurses working in isolation. . . .8Nursing Council-approved assessors 8Principles for assessing the practice of other nurses . .9References . . . . 11Glossary of terms. . . . .12

3IntroductionThe Health Practitioners Competence Assurance Act (2003) requires the NursingCouncil of New Zealand as the body that regulates the practice of nursing, to ensure thecontinuing competence of practitioners to protect the health and safety of the public.Competence assessment is one of the tools used by the Nursing Council to ensure initialand continuing competence to practise. Competence assessment is used to assess thefollowing: students at the completion of New Zealand nursing programmesoverseas-educated nurses who undertake competence assessment programmesbefore registration to practise in New Zealandnurses who wish to return to the workforce after five or more years away frompractice at the completion of a return to nursing programmenurses who hold annual practising certificates but do not meet the continuingcompetence requirementsnurses who are selected for the recertification audit of their continuingcompetencenurses required to demonstrate competence under a competence review processPlease note that the assessment processes used by Nursing Council-approved PDRPs(Professional Development and Recognition Programmes) may differ from the processoutlined in this document. PDRPs may use other methods or a combination of methodsof assessment to ensure validity and reliability of assessment, e.g. portfolio review by atrained assessor.Purpose of the guidelinesThe purpose of the guidelines is to guide nurses assessing the competence of nurses.The guidelines are also intended to guide the nurse being assessed and makesuggestions for preparing for self-assessment as part of the competence assessment.Nursing Council documents which support competence assessmentThe Nursing Council has a number of other documents which support and informcompetence assessment that can be downloaded from our website: Code of conduct for nursesCompetencies for the registered nurse scope of practiceCompetencies for the enrolled nurse scope of practiceCompetencies for the nurse practitioner scope of practiceGuidelines for cultural safety, the Treaty of Waitangi and Maori health in nursingeducation and practiceGuideline: Direction and delegation.Updated August 2019

4Continuing competence requirementsIn the interests of public safety, nurses must be competent to practise. Competence isthe combination of skills, knowledge, attitudes, values and abilities that underpineffective performance as a nurse. All practising nurses must maintain their competenceto practise by: completing 60 days or 450 hours of practice in the last three years completing 60 hours of professional development in the last three years being able to meet the Nursing Council's competencies for their scope ofpractice.Individual nurses are expected to retain evidence of their continuing competence.Applicants applying for practising certificates are asked to declare whether they havemet these requirements each time they renew their annual practising certificate. Five percent of nurses renewing their practising certificates each year are randomly selected toprovide evidence of their competence to practise as part of the individual recertificationaudit. (For further information please refer to the Nursing Council websitewww.nursingcouncil.org.nz.)Types of assessmentAll assessments for the Nursing Council’s purposes are to be completed using thecompetencies for the registered nurse, enrolled nurse or nurse practitioner scopes ofpractice. The competencies and assessment forms for each scope of practice can befound on the Nursing Council website www.nursingcouncil.org.nz.For continuing competence or audit purposes the following three types ofassessment are accepted:A senior nurse assessment is completed by a nurse in a designated position, e.g. acharge nurse, a nurse educator, team leader, coordinator, nurse manager or director ofnursing.A self-assessment is completed by a nurse after reflecting on the competencies forhis/her scope of practice. More information on self assessment is included later in thisdocument.A peer assessment is completed by another nurse. A peer assessor must be anexperienced registered nurse who has recognised clinical skills in the area of practice.This nurse will either work with the nurse or will have observed his/her practice for thepurpose of making an assessment. Information for nurses working in isolation (i.e.without a nursing colleague in the same workplace) is included on page 8.The Nursing Council has specified the assessment skills required of the assessorfor the following assessments:An assessment of a student at the completion of a nursing programme. This includesregistered nurses completing competence assessment programmes. The student isassessed against the Nursing Council’s competencies for their scope of practice by aregistered nurse from the education provider and/or a registered nurse from the clinicalpractice environment who is responsible for signing off competency. This nurse must havecompleted an appropriate course in adult education/assessment.Updated August 2019

5A competence assessment by a Nursing Council-approved assessor means that anurse with skills in assessment is approved to undertake an assessment by the NursingCouncil before the assessment takes place. For example, following a competencereview process. Information on the criteria for approved assessors is on pages 8 and 9.Preparing to be assessedIf you are a nurse preparing to be assessed it is important to understand thecriteria you will be assessed against. For the Nursing Council’s purposes thesewill be the Nursing Council competencies for your scope of practice. We suggestthat you do the following to prepare yourself. Review the competencies and indicators; think of specific examples from yourpractice where you met each competency. You do not have to include everyindicator.Think about what you do well and what you could improve.Gather any documentation relevant to your practice e.g. professionaldevelopment records/certificates, your job description, letters of attestation,samples of care plans/progress notes, reflections/exemplars/case studies,evidence of membership of organisations, a portfolio if you have one1.Complete a self-assessment of the competencies (see below).When you have completed this preparation you will need to identify a senior nurseor a suitable peer who can complete your assessment2. Identify an appropriate assessor and arrange appropriate times for theassessment. This may include time for the assessor to complete a documentreview, observe your practice and interview you about your practice, getfeedback from your colleagues and then give you feedback on the assessment.We advise you to: clarify the assessor’s expectations of the assessment process practise receiving feedback about your professional practice assume the best intentions see feedback as an opportunity to learn.We encourage you to reflect on the feedback given to you by an assessor as thisprocess may reveal your strengths as a nurse and areas in your practice where furtherprofessional development is required.Self-AssessmentHow to self-assess? Carefully read each competency and think of and documentexamples of how you demonstrate this in practice. If you are unclear, look at theindicators. It may be helpful to discuss with colleagues from the same setting as1The requirements of patient confidentiality should be met.Nurses practising in isolation or those who must have a Nursing Council-approved assessorrefer to these sections of the document. Students enrolled in nursing programmes will be guidedby their clinical lecturer.2Updated August 2019

6yourself. The Nursing Council competencies are generic and every competency appliesto all settings. If you need to learn more about a competency or believe you do notapply it in practice, consider if there are any specific standards or other documents toinform your assessment. For example, a nurse working in maternity may have access tothe baby-friendly hospital standards; mental health nurses may have national standardsrelating to recovery principles.You may also need to review some literature or a policy, or consult a mentor. In this waythe competency assessment contributes to ongoing quality improvement.If you intend to submit your self-assessment to the Nursing Council for the recertificationaudit complete a comment including an example against each competency andcomplete the ‘met/not met’ column. The assessment must be signed and dated by youand the verifier (another nurse with a practising certificate who has knowledge of yourpractice and verifies that you have completed the assessment).Assessing another nurse(Please read this in conjunction with pages 9 and 10.)If you have been asked to complete an assessment for another nurse first of all clarifywhat the assessment is for and whether it is appropriate for you to complete theassessment. It is not appropriate to complete assessments for close friends andfamily members. You may also need to clarify whether the assessment is to becompleted by a senior nurse, peer assessor or Nursing Council-approved assessor. Werecommend that you do the following to prepare for the assessment. Identify that you have the appropriate tool (i.e. assessment form for the nurse’sscope of practice).Make sure you understand the competencies and indicators.Prepare an assessment plan (consider time for document review, observation ofpractice, discussion and giving feedback-what order and when- timing, resourcesand any special needs of the nurse being assessed or the environment).Have a pre-assessment discussion with the nurse to clarify expectations.Make sure the environment/context is preparedGather evidence – you need enough evidence to be sure the competency is met.Discuss the assessment with the nurse’s line manager.If assessors are uncertain as to requirements the Nursing Council suggests seekingadvice from others with knowledge and experience. Such expertise may be sourcedfrom PDRP assessors and coordinators, trained preceptors and professionalorganisations such as the New Zealand Nurses Organisation (NZNO), College of NursesAotearoa, and Te Ao Maramatanga New Zealand College of Mental Health Nurses.Please see section Principles for assessing the practice of other nurses (page 9) formore information on assessor preparation before undertaking assessment.The type of evidence you will need may include the following: direct observation of practicean interview with him/her to ascertain nursing care in different scenariosevidence provided by him/her including self-assessments, exemplars orexamples of practiceUpdated August 2019

7 reports from other nurses and other health professionals.Assessments should be comprehensive and not solely based on the observation ofclinical procedures or on the nurse’s communication with health consumers and/or theirfamilies. Observation of practice can be of everyday practice, a specially createdpractice situation, or your knowledge of his/her prior performance. Consideration ofinformation gathered from at least three sources, i.e. triangulation or alignment ofevidence from different sources, can enhance the reliability of the conclusions reached.Assessors should reflect on what is a ‘competent nurse’ and how he/she practises in theparticular setting. Each competency has a number of indicators which are notexhaustive and are for guidance only. Some organisations have performance criteriawhich describe the intent of each competency. Nursing Council staff are also availablefor advice.The assessor may comment on any of the following attributes in relation to the NursingCouncil competencies: knowledge, skill, behaviour, attitudes and values.Eachcompetency must be assessed.Each comment made by the assessor against a competency needs to provide a specificexample as to how the nurse meets (or does not meet) each competency. Rephrasingof the competency or indicators is not acceptable.The assessment must be signed and dated by the nurse and assessor, and provide atleast one example or action of the nurse’s practice in support of each competency. Thiscan range from usual practice to role modelling how to handle unusual events to peers.At the end of the assessment: give feedback (commend, recommend, commend) – explain achievement/identifyand discuss areas where competencies are not met; discuss how to achievecompetencies; develop a plan for improvementit may be appropriate to discuss areas for development or overall career directiona comment that supports the assessment, indicating the evidence on which theassessment is based, is required for each competency.An important note to the nurse being assessed: it is your responsibility to ensure theassessor makes a different comment on every competency, does not repeat thecompetency itself, and writes in the Met/Not Met column.Assessments for nurses practising in management, education, policyresearch, and expanded practice.Registered nurses who are not practising in direct client care are exempt fromcompetencies in domains 2 and 3 that apply only to clinical practice. Other specificcompetencies for nurses working in management, education, policy and/or researchshould be assessed. Those practising in direct client care and in management,education, policy and/or research must also meet the clinical competencies.Nurses in expanded practice roles, e.g. first surgical assistants, nurse colposcopists, arerequired to meet additional competencies. More information on these requirements canbe found on our website www.nursingcouncil.org.nz.Updated August 2019

8Guidelines for nurses working in isolationNurses who do not work alongside other registered nurses may use different processesto demonstrate competence.All of the principles of assessment apply to allassessments. The following activities are not prescriptive or exhaustive and areintended as suggestions only. Use professional groups or corporate networks to identify suitable assessors. More than one assessor can be used in a single assessment for nurses workingin isolation. Each assessor should identify which domains/competencies they areassessing against and clearly provide examples or actions as well as signing,dating and giving their designation and position. Each competency must bedeclared ‘met’ or ‘not met’, and each page initialled by the assessor/s completingthe assessment on that page.A statement by the nurse being assessed should be provided to the NursingCouncil explaining why more than one assessor is being used. If payment has occurred to enable an assessment, this must be disclosed. Peer assessment in ongoing group settings can occur. These groups must havedocumented minutes and may, for example, review one domain of practice ateach group meeting. Electronic platforms such as video and teleconferencingcan be used. Nurses may provide presentations, copies of audits of notes, case reviews, careplans and other samples of evidence such as a company performance appraisal,to the assessor provided the usual requirements for client confidentiality are met.It is not necessary to send these documents to the Nursing Council. Nurses who are contractors may find an assessor who is a registered nurse inthe contracting organisation or, alternatively, a peer who undertake similar work.Practice hours may be verified by an estimation of hours from an appropriateverifier in the contracting organisation, and verification of completion of thecontract.Nursing Council-approved assessors:In some circumstances the Nursing Council requires the assessor to be Nursing Councilapproved in advance of the assessment. This means the nurse must nominate aspecific person to complete the assessment who must then be approved by the NursingCouncil even if they are already a Nursing Council-approved assessor. A NursingCouncil-approved assessor must: be a registered nurse in good standing with the Nursing Council who has acurrent practising certificate have at least three years’ post-registration clinical experience in the area theassessment is to take placeUpdated August 2019

9and have at least one of the following; an adult teaching certificate or diploma experience as a nurse lecturer in an approved undergraduate nursingprogramme evidence of undertaking a preceptor programme or clinical teaching programme,which includes learning on assessment unit standards from the New Zealand Qualifications Authority workplace assessortraining demonstrated equivalency of any of the above.Principles for assessing the practice of other nurses(Adapted from Australian Nursing Council (2002) Principles for the Assessmentof National Competency Standards for Registered and Enrolled Nurses.)As with all activities in practice, assessments should be undertaken only by those whounderstand the requirements of the activity. Each competency requires an example orevidence of an action or knowledge by the nurse being assessed which illustrates one ormore of the indicators. Throughout New Zealand training is available in assessment fornurses who need to develop their understanding of the nature of workplace assessment.Although the principles of assessment are the same, the complexity and nature ofevidence and the professional assessment judgement required may be expresseddifferently in different clinical settings and with nurses with different career trajectories.For example, a nurse who regularly assesses students at the end of the same degreeprogramme will become very familiar with the competency outcomes in the same setting.However, when assessing an experienced new employee with a background unfamiliarto the assessor, development of the assessor’s skills and processes may also berequired.Nurses involved in assessment (both the assessor and the nurse being assessed) arealways governed by the ethical standards of their profession.The following self-review questions are designed to assist an assessor in understandingthe ethical principles involved and how they may be assured they have undertaken anethical, rigorous and fair competence assessment of a colleague or employee.1. Contextual assessment What is the setting (e.g. the name and nature of the ward or clinic)?What does the competency mean in relation to the nurse’s practice setting?Does the assessor have sufficient knowledge and understanding of thesetting, the Nursing Council competencies and indicators to make ajudgement about another’s practice?Updated August 2019

102. Ethical assessment Does the assessor have sufficient understanding to use a range ofprofessional assessment practices?Is there mutual respect, honesty, rigour and trust in the assessment anddocumented feedback process?Does the assessor reflect on the ethical implications of the assessment?What organisational support is available to assist those nursesundertaking assessments?3. Accountability. Does the assessor: maintain confidentiality and disclose only through appropriate channels?declare any conflict of interest?report in a timely fashion and maintain standards of documentation?engage in quality improvement of their own performance as an assessor?provide feedback according to best professional practice?4. Validity and reliability of assessment Does the assessment actually measure what is intended? Does theassessment process measure the nurse against the Nursing Councilcompetencies?Does the assessor have an understanding of the intended outcomes of thecompetencies and the indicators in the context(s) in which the nurse ispractising?Is the assessment consistently applied across the whole process?Would another assessor predict the same results for the same behaviours,knowledge, skills and attitudes/attributes?5. Evidence-based assessment Does the assessor have sufficient evidence?Is there a variety of data sources? For example, observation of actions ordocumentation, interviewing, attestation by reliable informants, and/or testing,either paper-based or in simulation.Are any inferences checked to validate the assessment judgement?Is there enough evidence over a sufficient timeframe to predict that theperson being assessed will perform the same way in similar situations andcontext(s)?Updated August 2019

11ReferencesAustralian Nursing Council (2002). Principles for the Assessment of NationalCompetency Standards for Registered and Enrolled Nurses. ANC.College of Nurses of Ontario (2001). Competency Review Tool for Nurses in DirectPractice. College of Nurses of Ontario.Health Practitioners Competence Assurance Act (2003).Taranaki District Health Board (2010). Professional Development and RecognitionProgramme. TDHB.Nursing Council of New Zealand (2005). Guidelines for Cultural Safety, the Treaty ofWaitangi and Maori Health in Nursing Education and Practice. NCNZ.Nursing Council of New Zealand (2007). Competencies for registered nurses. NCNZ.Nursing Council of New Zealand (2008). Guideline: Direction and delegation. NCNZNursing Council of New Zealand. Code of Conduct for nurses. NCNZ.Nursing Council of New Zealand (2010). Evaluation of the continuing competenceframework. NCNZ.Nursing Council of New Zealand (2012). Competencies for the enrolled nurse scope ofpractice. NCNZ.Updated August 2019

12Glossary of termsAccountabilityBeing answerable for your decisions and actions.AppropriateMatching the circumstances of a situation ormeeting the needs of the individual or group.AssessmentA systematic procedure for collecting qualitativeand quantitative data to describe progress andascertain deviations from expected outcomes andachievements.CollaborateWork together, co-operate with each other.CompetenceThe combination of skills, knowledge, attitudes,values and abilities that underpin effectiveperformance as a nurse.CompetentThe person has competence across all domains ofcompetencies applicable to the nurse at a standardthat is judged to be appropriate for the level ofnurse being assessed.CompetencyA defined area of skilled performance.DomainAn organised cluster of competencies in nursingpractice.EffectiveHaving the intended outcome.Enrolled nurseA nurse registered under the enrolled nurse scopeof practice.Expanded practiceExpanding the boundaries of nursing practiceoccurs as a professional strategy in response to achanging health care need with increased range ofautonomy, accountability and responsibility. Thereis a formal pathway to role expansion that entailsfurther education and credentialing.IndicatorKey generic examples of competent performance.They are neither comprehensive nor exhaustive.They assist the assessor when using theirprofessional judgement in assessing ment.NurseA registered nurse, nurse practitioner or enrollednurse.Updated August 2019

13Nursing Council of New ZealandThe responsible authority for nurses in NewZealand with legislated functions under the HealthPractitioners Competence Assurance Act (2003).The Nursing Council of New Zealand governs thepractice of nurses by setting and monitoringstandards of registration, which ensures safe andcompetent care for the public of New Zealand.As the statutory authority, the Nursing Council iscommitted to enhancing professional excellence innursing.Performance criteriaDescriptive statements that can be assessed andwhich reflect the intent of a competency in terms ofperformance, behaviour and circumstance.Registered nurseA nurse registered under the registered nursescope of practice.ReliabilityThe extent to which a tool will function consistentlyin the same way with repeated use.ValidityThe extent to which a measurement tool measureswhat it is supposed to measure.Updated August 2019

assessment are accepted: A senior nurse assessment is completed by a nurse in a designated position, e.g. a charge nurse, a nurse educator, team leader, coordinator, nurse manager or director of nursing. A self-assessment is completed by a nurse after reflecting on the competencies for his/her scope of practice.