Licensed Nursing Competency Document

Non-Licensed Nursing Competency Document

Unit Specific – 7N Cardiac Step Down 2012

DUE 12/31/2012

Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self, peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.

Name : ______

Unit Specific Competencies
Competency: Phlebotomy
Key topics:
·  Patient identification
·  Patient safety
·  Technique
Required: / Date Completed / Evaluator
Completion of module: VUH Phlebotomy for Care Partners
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
Completion of module: Blood Cultures – Collection and Contamination
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
Phlebotomy Skills Verification: Click here for checklist and have Nurse Educator or RN observe and verify your skills on the provided checklist on 3 successful venipunctures. Include checklist in your packet.
Competency: Telemetry
Key topics:
·  Purpose
·  Lead placement
·  Patient education
Required: / Date Completed / Evaluator
Successfully completes Lead Placement Test. Click here for test: Lead Placement
Include test in your packet.
Competency: Ventricular Assist Device (VAD)
Key topics:
·  Patient Monitoring
·  Equipment
Required: / Date Completed / Evaluator
Completion of module: HMII VAD Aware
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
Competency: Pre and Post Procedure Care
Key topics:
·  Patient Monitoring
·  Patient Safety
Complete ONE of the following: / Date Completed / Evaluator
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Groin Prep. Include checklist in your packet. Click here for checklist: Groin Prep
Complete Exemplar Statement regarding the care of a patient post procedure (i.e. post pacemaker/ICD insertion or post cath). Click here for form: Exemplar. Include Exemplar in your packet.
Competency: Heart Failure
Key topics:
·  Daily Weight Monitoring
·  Strict I/O Measurement
Complete ONE of the following: / Date Completed / Evaluator
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Daily Weight Monitoring. Include checklist in your packet. Click here for checklist: Daily Weights
Complete exemplar statement regarding the care of a heart failure patient you cared for and specifically describe your interventions related to intake and output measurements for this patient. Click here for exemplar statement: Heart Failure
Competency: Technical Skills
Key topics:
·  VS
·  Clean Catch
·  Surgical Scrub
·  Assisting RN with Trach Care
Complete ONE of the following: / Date Completed / Evaluator
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Obtaining VS. Include checklist in your packet. Click here for checklist: VS
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Obtaining a Clean Catch Urine Specimen. Include checklist in your packet. Click here for checklist: Clean Catch
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Performing a Surgical Scrub. Include checklist in your packet. Click here for checklist: Surgical Scrub
Skills Demonstration – use provided checklist and have peer/nurse educator verify your skills related to Foley Care. Include checklist in your packet. Click here for checklist: Foley Care
Competency: Quality Improvement Initiatives
Key prevention topics:
·  Pressure Ulcers
·  Falls
·  Hand Hygiene
Required - Complete 1 of the following: / Date Completed / Evaluator
Pressure Ulcer Prevention: Complete a Pressure Ulcer Prevention Review on a patient you are assigned to using the tool provided. Include tool in packet. Click here for tool: Pressure Ulcers Prevention Review
OR
Falls Prevention: Complete a Falls Prevention Review on a patient you are assigned to. Include tool in packet. Click here for tool: Falls Prevention Review
OR
Hand Hygiene: Complete 10 hand hygiene observations AND Infection Prevention Tracer Survey. Record on tools provided. Include tools in packet. Click here for tools:
·  Hand Hygiene Audit Tool
·  Infection Prevention Tracer Survey
Resources in Preparation: Vanderbilt Policies
·  Pressure Ulcer Prevention and Treatment
·  Falls Prevention - Adult
·  Hand Hygiene
Hospital Wide Competencies
Competency: Safety: Demonstrates ability to respond to emergency situations
Key topics:
·  Emergency response (NPSG 15)
Required: / Date Completed / Evaluator
Current BLS (Healthcare provider) or Heartsaver/AED completed
(Current certification expires ______)
Mock Code experience in new employee orientation, Safety Fair or Department Based activity (Done every 2 years)
Last Date Completed ______)
Completion of Learning Module: Acute Coronary Syndrome in the Learning Exchange
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
·  This course is part of the VUH 2012 Non -Licensed Nursing Competency Program in The Learning Exchange.
Competency: Prevention of Harm to Staff: Takes measures to prevent injury to self and co-workers
Required: / Date Completed / Evaluator
Completes annual safety modules in Vandysafe prior to annual evaluation; provide date of completion.
·  Universal Safety Training
·  Patient or Blood and Body Fluid Contact Training
Click here to access: VandySafe
TB Mask Fitting (Date completed) ______
Click Here for Fit Testing Schedule
Competency: Prevention of Harm to Patients: Takes measures to prevent injury to patients and families
Key prevention topics:
·  Restraint use (NPSG 2, 8, 9, 15)
·  Foley cath- related UTI’s (NPSG 7)
·  Blood Stream infections (NPSG,7)
·  Falls (NPSG 2, 9)
·  VAP (NPSG 7)
·  Pressure Ulcers (NPSG 7, 14)
Required: / Date Completed / Evaluator initials*
Completion of module: Patient Restraint Review – Current Employees in the Learning Exchange.
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
·  This course is part of the VUH 2012 Licensed Nursing Competency Program in The Learning Exchange.
Demonstration of Restraint Application/Discontinuation – required every other year.
List date of completion: ______
Demonstrate Competency at:
·  Hands on Clinical Safety OR
·  Unit Based Competency Demonstration
Provide date and include checklist in your packet. Click here for checklist: Restraints
Completion of module: VUH - National Patient Safety Goals Review 2012 in the Learning Exchange.
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
·  This course is part of the VUH 2012 Non Licensed Nursing Competency Program in The Learning Exchange
Compliance Tracking: Provide Date of Completion
Required: / Date Completed / Evaluator initials*
Standards of Conduct in the Learning Exchange.
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
HIPAA in the Learning Exchange.
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
Conflict of Interest: click here to create
conflict of interest disclosure
·  Log into the system using your vunetid and password
·  Under My Disclosures click on Create Disclosure to the right of the box
Signed Job Description: click here to access, print, and sign:
CP Job Description
Hemoccult Testing Certification
(Expires annually; list date completed)
·  Proficiency Testing for recertification is offered on the 1st Tuesday of every month in TVC Room 4801 from
7:30 AM – 2:00 PM.
·  The written tests can be taken prior to arrival for the proficiency testing. Tests can be found in The Learning Exchange Search the title above and assign yourself the module.
VUMC Policy Review in the Learning Exchange:
Click here to access: The Learning Exchange
·  Click on My Current Course Schedule to complete or
·  Click on Completed Courses and Events to retrieve the date you completed it.
Equal Employment Opportunity & Affirmative Action (HR – 001)
Anti-Harrassment (HR – 002)
Hours of Work (HR – 003)
Attendance & Punctuality (HR – 026)
Smoking & Tobacco (HR – 031)
Substance Abuse (HR – 035)
Solicitation (HR – 039)
False Claims/Whistleblower (HR – 040)
Dress Code (OP 10-10.16)

I certify that the information and competency data I submitted are true and accurately reflects my work and abilities to function as a nurse on my unit or area. I understand that my ongoing professional growth is my responsibility and that I will notify my educator or assistant manager if I have further training needs. I agree to submit additional competency assessment data if requested by the Management Team.

Employee: ______Date: ______

(print last name, first) (signature)

By signing and dating below, I acknowledge that I have read and understand the policies listed above and that I agree to comply with them as I manage patient care.

Employee: ______Date: ______

(print last name, first) (signature)

Verified by: ______Date: ______

Please complete this form as documentation of annual competency completion and place in unit-designated area.