CorrectCare

Into the Future: Skill and Competency Testing in Corrections

by Jane Grametbaur, CCRN, CLNC, CCHP

Every new correctional health staff member soon learns that the chance of becoming involved in litigation is high during their employment. Questions that those involved in defending correctional institutions must address often relate to whether protocols and procedures for care of medical problems meet community standards.

Many institutions require that staff read and initial protocols and procedures as a way of documenting knowledge. When an incident occurs, staff may state they had no idea a particular protocol or procedure existed even when they clearly read and signed that they understood the protocol.

All institutions have some type of new employee orientation, with the length and depth of employee training varying from institution to institution. In some, a nurse may follow another nurse for a period of time to learn the routine; in others, the nurse may participate in a very structured and detailed orientation.

But once a staff member is oriented, how do you prove the nurse remains adequately trained and competent in practice? This question becomes extremely important when a facility is faced with litigation.

Myriad Questions
In a position statement relating to scope of practice, the International Council of Nurses says, “Nurses require appropriate initial and ongoing education and training as well as lifelong learning to practice competently within their scope of practice.”

There has been an ongoing dialogue among various organizations since the 1980s to answer the myriad questions this subject has raised. The major issues include how to measure competency, who should be involved in evaluations, who pays the bill, what are the legal ramifications and how measurements will be used in the workplace—especially when the results are substandard.

In 1998, the Joint Commission on Accreditation of Healthcare Organizations began requiring hospitals to assess the competency of employees when hired and then regularly throughout their employment. The competence assessment is defined as “the systematic collection of practitioner-specific data to determine an individual’s capability to perform up to defined expectations.” Testing of the skills and competency of employees has since become standard in acute care facilities.

This is important because the standards of both the American Nurses Association and the National Commission on Correctional Health Care state that correctional facilities should provide care on par with that given in the community. In addition, many states currently require health care providers to have a certain number of hours of continuing education.

Clearly, it is vital for correctional facilities to have a comprehensive program to provide ongoing training and to validate the skill and competency of their employees. Institutions interested in beginning a program of testing, or in evaluating a current program, must first establish the groundwork.

One model useful in nursing focuses on competency outcomes and performance assessment, or COPA. Published by Carrie Lenburg, EdD, RN, in 1999, the model outlines several essential steps. The program must identify the essential competencies relevant to the setting, identify the indicators that define those competencies, find the most effective ways to learn the competency and develop an effective way to document whether staff has successfully achieved the required competency.

Several other models are also available. Once an institution’s management makes a decision to start a program of staff evaluation, they must tailor whichever model they choose for the needs of the facility.

To develop a comprehensive program of training and testing, a facility also must evaluate its protocols and procedures to see whether they conform to the standard of care in the community. This can be determined by consulting resources such as medical textbooks, best practice guidelines in areas such as emergency medicine and family practice, and information from community providers.

Tips for Success
Where to begin? Because correctional health staff act as first responders when called to a medical emergency, evaluation of staff knowledge and implementation of emergency protocols can be a good starting place. Other areas to explore include changes in standard nursing protocols, introduction of medical protocols such as a new protocol for alcohol withdrawal, medical ethics or evaluation of staff ability to perform basic physical assessment. Staff responsible for developing training programs may opt to address issues that have been identified as opportunities for quality improvement, or line staff may suggest areas where additional training is needed.

Let’s say we will begin with emergency protocols. A good resource for assistance with updating protocols is the local county emergency medical system. EMS personnel must frequently respond to calls from jails and prisons, so they have an interest in seeing that facility emergency protocols meet community standards. They can be an invaluable help not only in drafting and updating protocols but also in helping to train staff.

Such a partnership will benefit both the EMS system and the correctional facility. Not only will staff learn the best practices for emergency response, but relations between staff and EMS personnel may improve when there is better understanding of common issues.

Testing of staff competency in carrying out emergency protocols can be done in several ways. A basic approach would be to incorporate it into mandated annual training in which staff review the different protocols and then take a written test, with the results documented and retained.

More interactive approaches to training and testing might be more memorable to the learner. An excellent method is to hold a skills fair where staff are evaluated on their hands-on performance of essential skills. This also provides a great opportunity for feedback and coaching. Similarly, emergency drills with joint participation by medical, security and EMS staff allow for hands-on practice and demonstration of skills, and they have the added benefit of facilitating the development of a coordinated and cohesive emergency response.

In-house resources should not be overlooked. Staff members with expertise in a particular specialty, such as HIV, can conduct in-service training, which should include both hands-on practice and written testing to verify successful completion.

As the population of incarcerated individuals continues to grow and budgets shrink, correctional administrators need to find ways to work with less money, fewer staff and fewer resources while still providing quality care. Training and testing competencies is a cost-effective way to promote professional practice and to document staff effectiveness.

— About the author: Jane Grametbaur, CCRN, CCHP, CLNC, is a senior comprehensive care nurse with the Orange County (CA) Health Care Agency as well as a legal nurse consultant.

[This article first appeared in the Spring 2008 issue of CorrectCare.]