Download CCU Competency

RN Competency Form: Critical Care
Competence Verification & Learning Guide: Facility
Name (learner)
Date Initiated
Unit
☐RN  ☐LPN  ☐Recent Graduate  ☐Experienced Nurse  ☐New to Specialty  ☐Traveling Nurse 
Note: for LPN practice guidelines, see state nursing statutes & regulations
The preceptor will initial each competency when he/she, as preceptor and colleague, feels safe in allowing the learner to deliver this aspect of
care without direct supervision.
Self-Assessment: 1 – Identified Limitation (little or no experience); 2 – Capable (familiar but may need assistance); 3 – Independent - can
perform these tasks safely; 4 – Proficient - extensive experience *for further information, see instruction sheet at end of this form.
References
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
Initiate care for patient in respiratory distress or failure
set up for emergency airway
implement relevant protocols consistent with patient
status
Provide care for intubated patient (RN only)
monitor tolerance (volume, pressure, synchronicity
and oxygenation
maintain patent airway by positioning, suctioning,
checking and securing
check ventilator settings & that mode is appropriate
for condition
troubleshot alarms to correctly intervene
extubate a patient safely
Integrate ABG results into care (RN only)
interpret results correctly
act to correct abnormalities
Initiate care of patient with cardiac emergency per
protocols
Learning Guide #
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Preceptor initials
Verification method
& facility specific requirements
Learner initials
Required Competencies
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Date all met
Self-assessment
Learning Guide follows competency pages and contains items for each competency that need to be reviewed based on learner’s experience and unit
need, they include reminders of important teaching points that may otherwise be missed.
IA 1
IA 2
IA 3
IA 4
Identify ischemia, injury or infarct on a 12 lead ECG
IA 5
Provide care for client with transvenous or
transcutaneous pacemaker per policy (RN only)
demonstrate setting rate and sensitivity and
stimulation thresholds
identify complications
IA 6
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 1
References
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
RN Competency Form: Critical Care
Required Competencies
Provide care for patient with hemodynamic
monitoring(RN only)
check for safety (balloon, placement, etc.)
correctly performs monitoring/calculations
remove catheter safely
zero and calibrate lines
troubleshoot waveform changes
intervene as needed
IA 7
Use bedside and central monitors for all pertinent
functions
IA 8
Apply interventions for sepsis as indicated
IA 9
Provide initial burn treatment per protocols
IA 10
Apply interventions for brain hemorrhage or trauma per
protocols
IA 11
Manage patient with intracranial pressure (ICP) monitor
(RN only)
identify waveforms, cerebral perfusion pressure
(CPP), patient symptoms and their significance
implement measures to decrease/minimize
increases in ICP
IA 12
Monitor patient to identify complications of critical illness
IA 13
Integrate measures to ensure patient safety in the unit
setting
IA 14
Administer IV drips
calculate drip rate correctly
titrate drip per orders/need
wean drips per protocols
IA 15
Correlate clinical condition with drug indications, desired
effects, dosage and contraindications for commonly
given IV drips
IA 16
Optimize patient comfort with sedation, pain control and
paralytics
IA 17
Administer chemotherapy safely (RN only)
check dosing per policy
state hazardous waste precautions
IA 18
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 2
References
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
RN Competency Form: Critical Care
Required Competencies
Perform role during a high risk unit procedure
set up for procedure
provide nursing assistance during procedure
monitor patient during and after for complications
IA 19
Respond to hospital emergencies per policy
IA 20
Operate specialty equipment per manuals and policies
IA 21
Comments/alternative learning plans:
All preceptors are to sign & initial below. Ideally new graduates should have only one to two preceptors for the entire orientation.
Preceptor Signature
Initials
Preceptor Signature
Initials
Signatures at completion of preceptorship/orientation:
Preceptee/orientee
Date
Primary Preceptor
Date
Manager
Date
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 3
RN Competency Form: Critical Care
LEARNER GUIDE: Reference items in right-hand column that needs review.
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
IA 1
Initiate Care for patient in respiratory distress or failure
Review P & P and equipment for emergency respiratory management including
CPAP, BiPAP
Review emergency airways: ETT, cricothyrotomy, tracheostomy
IA 2
Provide Care for intubated patient
Review ventilator and intubation protocols, equipment, standing orders, and
troubleshooting
Review initiation and indications for jet vent if applicable
Review SVO2 monitoring, set up and data analysis if done in unit
Review extubation protocols
IA 3
Integrate ABG results into care
Review ABG norms and interpretation of changes
-complete checklist for drawing ABG’s if applicable
-correctly verbalize ways to correct abnormalities
IA 4
Initiate care of patient with cardiac emergency per
protocols
Review the following unit protocols
-initial chest pain management
-dysrhythmias
-significant BP change
-CHP or pulmonary edema
-cardiogenic shock
-cardiac arrest
-code cart management
IA 5
Identify ischemia, injury or infarct on a 12 lead ECG
Review ECG interpretation
IA 6
Provide care for client with transvenous or
transcutaneous pacemaker
Review equipment, manufacturers recommendations, safety considerations,
how to operate the pacer, pacing modes
Review complications: failure to pace, failure to sense, failure to capture,
dysrhythmias, burns & pain (with transcutaneous)
IA 7
Provide care for patient with hemodynamic monitoring
Review hemodynamic parameters
-correctly performs monitoring/calculations
-remove catheter safely
-zero and calibrate lines
-troubleshoot waveform changes
-intervene as needed
Review lines and monitoring equipment and practice with it
Review protocols for changes in patient status
IA 8
Use bedside and central monitors for all pertinent
functions
Review setting parameters, calculating functions, changing modules,
troubleshooting
IA 9
Apply interventions for sepsis as indicated
Review protocols, fever reduction methods, circulatory support including
vasoactive drips
IA 10
Provide initial burn treatment per protocols
Review procedures and initial burn management protocol
Review fluid replacement protocol, wound management and transfer
criteria/procedure
IA 11
Apply interventions for brain hemorrhage or trauma per
protocols
Review policy and pathophysiology and treatment of CVA, subarachnoid,
subdural/epidural hemorrhage, trauma related damage and swelling
Review radiology and neurology resources
Review coma scale and interventions
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 4
RN Competency Form: Critical Care
LEARNER GUIDE: Reference items in right-hand column that needs review.
IA 12 Manage patient with intracranial pressure (ICP) monitor
Review policies and manual for ICP monitor
-identify waveforms, cerebral perfusion pressure (CPP), patient symptoms and
their significance
-implement measures to decrease/minimize increases in ICP
IA 13
Monitor patient to identify complications of critical illness
Review protocols, labs and medications for the following: DIC, PE, DVT, stroke,
skin breakdown, delirium, line infection, medication & blood reactions, renal
insufficiency & failure
IA 14
Integrate measure to ensure patient safety in the unit
setting
Review the following:
-skin breakdown prevention
-ventilator acquired pneumonia prevention protocol
-visitor policy and teaching
-equipment safety
-spinal precautions, collar fit, alignment, turning &transferring
IA 15
Administer IV drips
Review all related policies, protocols and standing orders for commonly used
IV drips
-calculate drip rate correctly
-titrate drip per orders/need
-wean drips per protocols
IA 16
Correlate clinical condition with drug indications, desired
effects, dosage and contraindications for commonly
given IV drips
Review the following medications: dopamine, dobutamine, norephinephrine,
epinephrine, nitroglycerine, nitroprusside, diltiazem, lidocaine, amiodarone,
thrombolytics, procainamide, potassium, aminophylline, heparin, insulin,
octreotide and others used in unit
IA 17
Optimize patient comfort with sedation, pain control and
paralytics
Review sedation and pain scales and interventions
Review use of and interpretation of results from peripheral nerve stimulator
Review policy for procedural sedation and complete any facility required
training and or checklists
IA 18
Administer chemotherapy safely
Review policy and complete any facility required training and/or checklists
Review hazardous waste precautions and spill response
IA 19
Perform nursing role during a high risk unit procedure
Review procedure, equipment and risks of: thoracotomy, thoracentesis,
pericardiocentesis, lumbar puncture, central line insertions, arterial line
insertions and monitoring, hemodynamic pressure monitoring, SengstakenBlakemore tube, cardioversion, external pacing, endoscopy, chest tube
IA 20
Respond to hospital emergencies per policy
Review policy and role in emergency response throughout hospital
IA 21
Operate specialty equipment per manuals and policies
Review manuals and facility policy for operating fluid/blood warmer, rapid
transfuser, hypo/hyperthermia blanket, PCA pump, epidural
Other facility specific items to cover:
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 5
RN Competency Form: Critical Care
REQUIREMENTS: All nurses will complete these competencies upon hire. Some competencies may be reviewed annually. This form
follows the Competency Outcomes and Performance Assessment (COPA) model.
PRECEPTEE/LEARNER INSTRUCTIONS:
Complete self-assessment: Rate your skill in each area to identify the areas where you need additional experience, access to
teaching resources, and/or lab practice. Discuss your results with your preceptor to help establish a plan and goals for your learning
experience and to aid in choosing patient assignments. Scoring per instructions at the top of page 1.
PRECEPTOR INSTRUCTIONS:
A. Review self-assessment with preceptee/learner to establish plan.
B. Required Competencies: The specialty area competency forms are required for independent practice on this unit. This column
represents the Alaska Statewide required competencies per ACE-HC and should not be altered. The preceptor will sign each one off
when he/she, as preceptor and colleague, feels safe in allowing the preceptee/learner to deliver this aspect of care without
direct supervision.
C. Verification Method & Agency Specific. Document comments/check marks for the competency and any agency specific
requirements. Verification methods include:
1. Demonstration – Preceptor watches learner perform task/procedure in safe, capable manner in a simulated lab or computer
setting or as part of direct care performance. The expectation for new graduates is that they demonstrate as many of the
competencies as possible.
2. Test – Learner passes a test provided by the facility to measure competence for this skill. (Minimum passing grade indicated.
Initial only after test passed.)
3. Module –Learner has completed a training tool (computerized or written module, class, video, etc.) provided by the facility to
measure competence for this skill.
4. Verbalization - Learner explains to the preceptor the process and/or planning that evidences safe, reliable knowledge base.
This may include case scenarios, discussion, and/or description of plan.
NOTE: some competencies may have the verification method specified per facility guidelines (e.g. “test only”)
Record N/A and initials only for items that never apply to this learner’s role or performance.
D. Sign-off: Sign and date when all elements of the competency are met. If unable to sign off an area due to patient population issues
or learner needs more time, document a plan in the comments section at the end of the form. Discuss alternative ways of meeting
the requirement(s) as well as any additional time needed with the nurse manager and/or nurse educator. All preceptors assisting in
orientation of a new staff member/intern must sign and initial in the signature chart at the end of this document.
E. References: Competencies should be met in accordance with these. Add your facility approved references here.
F. Learning Guide: These are memory ticklers. The amount of time spent on each of them depends on the learner’s experience. New
graduates will likely need time on almost all of the areas listed.
REFERENCES COLUMN: List foundational documents to support the learning experience and to use as the official measure by which
the competencies are assessed. The ACE-HC group recognizes the following as sources for evidence based practice that can be
included in the reference list along with local policies, procedures and forms: Perry & Potter, Elsevier/Mosby, Lippincott, Kozier & Erb,
ANA, nationally recognized hospital related regulatory organizations (CLIA, CDC, CMS, JC, etc.), and specialty nursing organizations’
scope, standards and core curricula. This column’s content may be changed to be facility specific.
NOTE: ACE-HC competency forms are intended to be used between facilities within Alaska.
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 6