Clinically Competent Peers and Support for Education: Structures and Practices That Work

Abstract

Structures that foster clinical competency include annual reviews, educational support, recognition, review sessions, and best-practice teams.“By your actions they will know you.”“My goal is to provide the best care possible to each of my patients, based on knowledge that flows from my brain to my fingertips with compassion.”“The signs were subtle, but I knew this patient was going to get into more trouble, so I bugged them [physicians] until they did something.”“We take pride in being superbly competent; it’s “in the water” here—part of our culture. And the hospital backs up this expectation by providing resources, educational programs, tuition and fees, and time so that you can go. The physicians in PACU [postanesthesia care unit] provided review courses for our national specialty certification exams.”“I wish there was some way that I could learn and could help others meet all our responsibilities at once.The preceding excerpts from interviews with staff nurses in magnet hospitals reflect the key messages reported in this article. (Unless otherwise stated, all excerpts are from staff nurses who were interviewed for this study. The professional role of the speaker is cited for physicians [MDs] and nurse managers [NMs].) Competency is multifaceted and evident through actions. Clinically competent peers is all about competent performance, not the potential for performance. Both performance and potential are important for quality patient care, but here we focus solely on what others see or hear that leads to the judgment or conclusion that nurses on the front line in acute care hospitals are clinically competent.We describe what clinical nurses have to say about 2 elements that staff nurses identify as essential to a healthy work environment: clinically competent peers and support for education. This article is based on the last of the 3 structure-identification studies (Table 1) in which we interviewed 244 staff nurses, 105 managers, and 97 physicians on 101 clinical units in 8 magnet hospitals selected because staff nurses on these units had previously reported satisfying, productive work environments. In other words, we interviewed experts to find out what works. What are the structures and best practices that foster competent performance? That support education?Working with other nurses who are clinically competent has long been cited by staff nurses as a key feature of a satisfying and productive unit work environment, that is, an environment in which personal needs can be met and in which clinical nurses at the front line can give quality patient care. The AACN Standards for Establishing and Sustaining Healthy Work Environments1 define such an environment as one that is healthy. Since 1984, when the characteristics of an excellent work environment were first measured using the 65-item Nursing Work Index constructed from the original magnet hospital criteria,2 thousands of staff nurses in magnet, community, county, Veterans Affairs, and academic hospitals have consistently cited clinically competent peers as the No. 1 attribute of a satisfying unit work environment in which nurses can give high-quality patient care.3 In 2001, when the criteria of a magnetic work environment were shortened to those 37 attributes most often selected by thousands of staff nurses who completed the Nursing Work Index, staff nurses in 14 magnet hospitals cited clinically competent peers as the most important of the 8 attributes essential to a healthy work environment.4 We labeled these 8 attributes the Essentials of Magnetism (EOM) and designed the EOM tool to measure them.5 Each of the 8 essentials has a subscale and a score; the aggregate score of the 8 essentials is a measure of a healthy work environment. Using the same instrument, home health nurses in 9 states selected clinically competent peers as the fourth highest essential attribute.6 Competency is also one of the Baldrige criteria for performance excellence.7Support for education, anot