Administrative Protocol Page 1 of 3

Nursing Practice Manual

John Dempsey Hospital Department of Nursing
The University of Connecticut Health Center

PROTOCOL FOR: Competency Checklist, Orientation and Annual: Completion for Department
of Nursing Staff

POLICY: 1. The compet ency of Depar t ment of Nur si ng empl oyees wi l l be val i dat ed
dur i ng or i ent at i on ( Gener al Nur si ng Or i ent at i on, and Uni t ,
Depar t ment and r ol e speci f i c or i ent at i on) and annual l y.

2. Annual uni t based compet ency t ool s ar e cr eat ed each r evi ew year
based on summat i ve dat a f r omannual per f or mance r evi ews, i dent i f i ed
needs and r egul at or y st andar ds. Once di st r i but ed t he uni t annual
checkl i st s ar e not r evi sed. Any addi t i onal l y i dent i f i ed
compet enci es ar e capt ur ed on Repor t of Educat i onal Of f er i ng sheet s
and t r anscr i bed ont o t he empl oyee s Educat i onal Act i vi t i es Recor d
whi ch i s at t ached t o t he annual per f or mance r evi ew.

3. Depar t ment of Nur si ng st af f wi l l compl et e t he Uni t - Based Or i ent at i on
Compet ency Checkl i st by t he end of t hei r uni t or i ent at i on and/ or
wor ki ng t est per i od.

4. Cont r act St af f ( Tr avel er ) Or i ent at i on usual l y i ncl udes up t o 24
hour s of gener al or i ent at i on and 24 hour s of uni t based or i ent at i on.
The St af f and Pat i ent Educat i on and Devel opment Speci al i st wi l l
i nsur e t hat cont r act nur si ng st af f compl et es t he sel f assessment
component of t hei r assi gned uni t ( s) based or i ent at i on compet ency
checkl i st pr i or t o ar r i val on t he uni t . Thi s sel f assessment wi l l
be compl et ed once a cont r act i s si gned or at l at est dur i ng t he
gener al nur si ng or i ent at i on of t he cont r act nur se. The sel f
assessment on t he or i ent at i on compet ency checkl i st i s r evi ewed by
t he pr ecept or f or pl anni ng and compl et i on of uni t based or i ent at i on.

5. Uni t - Based Annual Compet ency Checkl i st s ar e di st r i but ed on a uni t -
speci f i c basi s and cover t he eval uat i on year .

a. Cont r act cl i ni cal nur si ng st af f does not compl et e an Annual
Compet ency Checkl i st unl ess t hey have been cont r act ed f or mor e
t han 11 mont hs t o one year .

b. Non- cl i ni cal st af f does not compl et e an Annual Compet ency
Checkl i st .


ACTION/DECISION-
MAKING PROCESS:

1.Obtaining Checklists

a. St af f wi l l r ecei ve t he appr opr i at e Gener al Nur si ng Or i ent at i on
( GNO) Checkl i st as f ol l ows:

1) Depar t ment of Nur si ng St af f wi l l r ecei ve t he GNO
Checkl i st ( J DH Nur si ng Or i ent at i on Act i vi t y Checkl i st )
dur i ng cent r al or i ent at i on f or compl et i on by t he
Depar t ment of St af f and Pat i ent Educat i on.

2) Cont r act / agency nur si ng st af f wi l l compl et e Heal t h
Cent er / Cl i ni cal Oper at i ons Or i ent at i on and GNO t hr ough a
sel f - l ear ni ng and i nt er act i ve f or mat f aci l i t at ed t hr ough
St af f and Pat i ent Educat i on. They must pr esent evi dence
of a cur r ent BCLS cer t i f i cat i on car d and ot her r ol e
speci f i c r equi r ed mandat or y t r ai ni ng.
Administrative Protocol Page 2 of 3
Nursing Practice Manual
John Dempsey Hospital Department of Nursing
The University of Connecticut Health Center

PROTOCOL FOR: Competency Checklist, Orientation and Annual: Completion for Department
of Nursing Staff


b. Nur si ng St af f wi l l r ecei ve t hei r Uni t - Based Or i ent at i on
Compet ency Checkl i st s as f ol l ows:

1) Depar t ment of Nur si ng St af f wi l l obt ai n t he uni t - based
or i ent at i on compet ency checkl i st f r omSt af f and Pat i ent
Educat i on bef or e t he f i r st day of uni t - based or i ent at i on.

2) For Cont r act St af f , t he uni t manager or desi gnee wi l l
over see t hat each cont r act nur se s uni t based or i ent at i on
compet ency checkl i st ( s) i s i ndi vi dual i zed t o t he per f or mance
expect at i ons of t he uni t based on t he i ndi vi dual sel f
assessment and agency pr ovi ded compet ency checkl i st .


2. Checklist Completion

a. The J DH Nur si ng Or i ent at i on Act i vi t y Checkl i st wi l l be compl et ed
i n GNO t o i dent i f y t opi cs and cl ass dat es at t ended by t he
or i ent ee.

b. The Uni t - Based Or i ent at i on Compet ency Checkl i st wi l l be compl et ed
as f ol l ows:

1) The pr ecept or and t he or i ent ee wi l l r evi ew t he or i ent ee s
per cei ved l evel of exper t i se as a basi s f or i dent i f i cat i on
of l ear ni ng needs. Thi s wi l l be used i n pl anni ng t he uni t -
based or i ent at i on.

2) The pr ecept or wi l l dat e and i ni t i al t he i ndi vi dual
t opi cs/ ski l l s when compet ency i n t hat t opi c/ ski l l has been
demonst r at ed accor di ng t o an i dent i f i ed st andar d. The
pr ecept or i dent i f i es t he met hod by whi ch val i dat i on of t he
compet ency was achi eved, usi ng t he code descr i bed on t he
compet ency checkl i st .

c. The Uni t - Based Annual Compet ency Checkl i st wi l l be compl et ed as
f ol l ows:

1) Val i dat i on of cl i ni cal compet ence i s det er mi ned at t he uni t
l evel by t he CNS or desi gnat ed cl i ni cal exper t nur se on t he
uni t .

2) These i dent i f i ed cl i ni cal exper t ( s) t hen val i dat e( s)
compet ence i n ot her st af f member s by obser vat i on i n cl i ni cal
pr act i ce, r et ur n demonst r at i on/ si mul at i on, ver bal or wr i t t en
t est .

3) The compl et ed checkl i st i s submi t t ed t o t he Nur si ng Manager
as par t of t he empl oyee s annual eval uat i on.





Administrative Protocol Page 3 of 3
Nursing Practice Manual
John Dempsey Hospital Department of Nursing
The University of Connecticut Health Center

PROTOCOL FOR: Competency Checklist, Orientation and Annual: Completion for Department
of Nursing Staff

3. Filing of Completed Checklists

a. For per manent Depar t ment of Nur si ng st af f , or i ent at i on and annual
compet ency checkl i st s wi l l be sent t o Human Resour ces f or f i l i ng
i n each empl oyee s f i l e. Manager s wi l l keep a copy of t he
checkl i st s i n t hei r f i l es.

b. For cont r act nur si ng st af f , cent r al or i ent at i on checkl i st s
( Cl i ni cal Oper at i ons Or i ent at i on, Gener al Nur si ng Or i ent at i on and
Medi cal - Sur gi cal Nur si ng Or i ent at i on) , uni t - based or i ent at i on
compet ency checkl i st s and appl i cabl e annual uni t based compet ency
check l i st s wi l l be sent by t he Uni t Manager t o t he Manager of
St af f i ng/ Payr ol l f or f i l i ng i n each empl oyee s per sonnel f i l e i f
appl i cabl e.

REFERENCES: Nur si ng Admi ni st r at i ve Counci l

EFFECTIVE DATE: 12/ 90

REVISION DATES: 1/ 92, 12/ 97, 10/ 00, 10/ 03, 10/ 07, 7/ 09, 11/ 09, 3/ 12