By Rebecca R. Hastings, MS, SPHR, PHRca
Leading organizations in the medical-surgical nursing community have developed a competency-based tool to help institutions redeploy nursing personnel needed to care for patients with COVID-19.
Widespread news reports have alerted the general public to many of the challenges faced by hospitals suddenly overrun with COVID-19 patients, including a lack of personal protective equipment and ventilators. Yet another key issue hospitals are facing is how to make sure they have enough health care providers with the right competencies in place at the right time, to meet the needs of their community when cases begin to spike.
A Unique Staffing Challenge
Many hospitals created COVID-19-specific units contained from other areas of the hospital in order to provide specialized care, according to Terri Hinkley EdD, MBA, BScN, RN, CAE, CEO of the Medical-Surgical Nursing Certification Board (MSNCB) and the Academy of Medical-Surgical Nurses (AMSN) in Sewell, New Jersey. AMSN represents approximately 600,000 medical-surgical nurses, who are the individuals providing most of the general acute care adult nursing that most sick people need. This includes individuals who have had heart attacks or strokes, as well as those needing post-operative care.
“We knew staff would be needed in New York City to deal with a crush of patients who were critically ill,” Hinkley explained. This presented a unique staffing challenge: “Hospitals needed to bring in people they didn’t know; as many hands as they could possibly find,” she said. For example, in order to staff COVID-19 units, hospitals have options such as:
- Redeploying existing nurses from other units that have excess capacity due to the cancellation of routine or non-emergency procedures;
- Recruiting nursing students and medical students with sufficient medical knowledge; and
- Attracting experienced former nurses, such as educators or administrators, and retired registered nurses back into direct patient care.
Finding a way to identify enough individuals with the right competencies needed to help out with a health care crisis is difficult enough when the impact is localized or short-term, such as following a natural disaster or an act of terrorism. But with a crisis of this magnitude affecting everyone, including large and small facilities in cities and rural areas, MSNCB and AMSN “felt it was a great opportunity to help out,” Hinkley said.
Sharing a Solution
How can institutions be sure candidates have the skills needed to provide efficient and quality care? How can hospitals feel confident placing someone who hasn’t worked at the bedside for a couple of years, back in a patient setting?
“The easiest thing to do is to put them on medical-surgical units because they aren’t providing critical care,” said Hinkley. “That allows the hospital to free up some medical-surgical nurses and move them into their critical care and ICU units. There’s a lot of movement to make it all work.”
Fortunately, AMSN was already working on developing a new competency model for medical-surgical nurses. Although some institutions and nursing schools have their own models, “there was no one consolidated competency model,” according to Hinkley.
Their work began in August 2019 and included a literature review. Subject matter experts from around the U.S. representing different regions, types of organizations and medical-surgical practice settings worked together to map the knowledge and task statements from job descriptions to build the competency model. When the pandemic hit and staffing became an immediate issue, AMSN recognized that the existing work for the competency model could be repurposed as a solution.
However, in order to repurpose the draft model for COVID-19 purposes, the organization first identified the domains of practice which were most relevant. They then focused on emerging and established competencies only, rather than worrying about expert-level competencies. From this work they were able to develop a self-assessment that takes 15-20 minutes to complete. “The tool was pilot-tested by a large health care system, who felt it was quite comprehensive and assisted in their decision-making,” said Hinkley.
The self-assessment has a four point scale, from “cannot perform” to “requires no guidance to complete,” and asks the individual to identify their level of knowledge and experience with COVID-19-specific tasks such as patient safety: “recognize the occurrence of an adverse event.”
The instrument can be distributed by institutions or accessed directly by individuals, such as nursing students who were released early from their programs due to social distancing restrictions. Individuals can take the results to job interviews or email them to existing employers to help determine where to place people.
“The domains of practice being evaluated include patient and practice management and professional concepts, with sub-domains including the nursing process, patient safety, infection prevention, medication management, education of patients and families, leadership and critical thinking, to name a few,” explained Hinkley.
The self-assessment is primarily intended for use by hospitals, because that is where most COVID-19 patients are being treated, Hinkley explained. They’ve had well over 2,000 visits to the website (https://www.amsnstaffingtoolkit.org/) to download the instrument, which is being provided free of charge. “We really felt that we had a professional obligation to make sure that we got this out there as widely as we could. We only asked for people to provide us with feedback on the tool.”
They also launched a staffing model to help hospitals, and created some flashcards to help nurses who were being moved to work with different patient populations or practice areas.
Although the full competency model has not yet been finalized with data from a validation survey, Hinkley said the psychometrician who worked on the project felt the subject matter experts’ work provided sufficient validity support — as long as results were used as a self-assessment only, and not for employment decisions.
When asked what advice she would give other credentialing organizations, Hinkley said “Consider how you might leverage what you already have. [Addressing staffing issues amid a global pandemic] was never the intention of the competency model.” Although the model is meant to have a number of uses in practice and education, as well as certification, “we never had the vision that it could apply to this,” she said. She suggested credentialing organizations tap into the wealth of data derived from a job task analysis, “instead of just putting it on a shelf.”
Building and maintaining relationships with non-certified professionals, such as those who are members of a professional association, is key, according to Hinkley, in order to continue to listen and watch for signs and signals that there may be an unmet need.
Having great relationships with consultants, vendors and volunteers is also critical. Hinkley praised the volunteers on the competency task force for contributing their “incredibly valuable time in the midst of a health care crisis.” She also noted that Jennifer Naughton, MEd, CAE, SPHR, of Naughton Consulting, who helped develop the assessment, was the one who questioned whether the work they were doing on the competency model could be used in a way to help during the pandemic. Both Naughton and team members from Assessment, Education and Research Experts (AERE) donated their time to make the self-assessment available quickly.
“We know some hospitals, depending on their size, have the ability to do this on their own,” Hinkley added. “But we felt those community or small, rural hospitals would not have the resources to manage this process.”