Failure to Validate and Document Nurse Competencies
Penalty
Summary
The facility failed to ensure a working system to evaluate and validate the competencies of nurses in skills, facility procedures, and knowledge, as evidenced by the lack of completed competency checklists and inadequate orientation for newly hired nurses. Three nurses were reviewed for competency validation, and it was found that two of them did not have completed competency checklists on file. The Staff Development Coordinator (SDC) reported that the process relied heavily on self-evaluation and verbal confirmation of skills, rather than direct observation or demonstration, and there was confusion about who was responsible for validating competencies when the SDC was working part-time. One resident was admitted with multiple complex medical conditions, including a history of stroke, congestive heart failure, diabetes, and a gastrostomy tube. The nurse assigned to this resident reported difficulty accessing the resident's electronic medical record, was unaware of the resident's orders, and had not received adequate training on facility procedures or the location of necessary supplies. The nurse also communicated protected health information via personal text message to a nurse practitioner, stating he had not been trained on secure communication protocols. Another newly hired nurse also reported being unable to access orders or the hospital discharge summary in the electronic record and was unsure about the procedures for medication and enteral feeding administration. In a separate incident, another newly hired nurse was unable to use the intercom system to call for help during a medical emergency and had difficulty locating emergency equipment, such as an AMBU bag. Other staff members also reported uncertainty about emergency procedures and the use of the intercom system. The SDC confirmed that while there was a process for orientation and competency validation, it was inconsistently applied, and documentation was missing for some nurses. Interviews with administrative staff revealed a lack of clarity regarding who was responsible for ensuring competency validation, and no completed competency checklists could be found for two of the nurses involved.