The Importance of Competency Assessment
Maintaining competency is a core professional obligation for nurses, while leadership is responsible for verifying and monitoring staff proficiency. Competency is essential to meet regulatory guidelines, provide patient safety, and ensure the highest level of care. Donna Wright defines competency as the integration of knowledge, skills, judgment, values, and beliefs required to perform a role safely and effectively in alignment with professional standards (Wright & Covelli, 2021). The achievement of compliance with competency assessment requires a strategic collaborative approach between nurses and organizational leadership.
At Jefferson Abington and Lansdale Hospitals, the nursing professional development (NPD) team is responsible for validating competency of the emergency department nurses. The NPD team chooses competency assessments on a yearly basis based on mandatory regulatory requirements, identified areas needing improvement, and high-risk, low frequency circumstances.
According to the Emergency Nursing Scope and Standards of Practice (ENA, 2023, 3rd ed.), “the ability to perform at the expected level requires a process of lifelong learning. Registered nurses must continually reassess their competencies and identify needs for additional knowledge, skills, personal growth, and integrative learning experiences.” Education builds the foundation for competency. Without education, competency cannot develop, but education alone does not guarantee competency.
The NPD team is tasked with providing regulatory-required hospital annual education as well as emergency department–specific education in areas such as trauma, cardiac, and neurology. Since competency is the application of education into practice, it seemed natural to try to blend skills testing with meeting the educational requirements and needs of the department in one designated day.
Previous Competency Structure
Jefferson Abington is a large suburban Philadelphia hospital with an emergency department that sees more than 90,000 visits annually. The department has 85 beds and employs approximately 160 nurses and 60 patient care technicians. Given the size and pace of the department, achieving timely completion of annual mandatory education and full compliance with completing competencies has been a persistent challenge.
In the past, the NPD team attempted several different structures to conduct annual competency validation. Each structure involved various modalities that allowed for hands-on return demonstrations. An example of one of these structures was staff attending a four-hour hands-on session biannually. Another structure consisted of staff attending quarterly competency sessions; this involved staff attending a two-hour hands-on session. With both structures, staff were required to complete these competency sessions outside of their scheduled clinical hours, which made them a big source of staff dissatisfaction.
In addition to completing their annual competencies outside of their clinical schedule, staff were also required to complete regulatory and unit-specific education. This education would need to be completed in between patient care during the workday or at home on their own time. With the previous structures, staff often complained about the number of hours spent in addition to their scheduled clinical hours fulfilling their requirements. Staff compliance with timely completion became exceedingly difficult, resulting in constant reminders, frequent emails, and oftentimes write-ups for incomplete assignments.
With both modalities, the NPD team struggled with time constraints and employee noncompliance. The compliance rate for staff completing their competencies by the assigned date was approximately 70%. This led to the need for the NPD team to hold multiple makeup sessions. Despite the additional sessions, 100% compliance was never quite achieved.
Additionally, the department’s leadership/administration team also found these structures challenging. Tracking compliance, managing schedule changes, making payroll adjustments, and the time spent enforcing the discipline process for noncompliance was especially frustrating. We knew we needed to find a better structure; one that would work for everyone involved and increase staff satisfaction.
Solution: A Scheduled Competency and Education Day
After much discussion on how to improve the structured delivery of mandatory education and competencies, it was decided that every RN staff member would receive one 12-hour scheduled paid competency and education day. To help with staff satisfaction, this day would be counted as one of their regularly scheduled clinical days for that week. To accommodate 160 RNs and not compromise the clinical schedule, the competencies would be held once a week over the course of four months, and each session would be limited to 10 participants. The months of March, May, September, and November were chosen to not interfere with summer vacation schedules, when scheduling can be notoriously difficult.
The competency/education day had both hands-on and computer-based learning. Interactive experiences and gamified learning, such as escape rooms and “beat the clock,” were included to keep staff engaged. The NPD team proposed the new structure to leadership for buy-in. “The institutional culture must value training as an investment and, in this sense, must promote an environment conducive to learning, which in turn must facilitate the professional development of nurses and, with it, improve their care for patients and for the organization” (Ortega-Lapiedra, Barrado-Narvión, & Bernués-Oliván, 2023). We were fortunate enough to have a department leadership team that supported trying this system.
Initially, the scheduled competency/education days were posted for staff to pick a convenient date of their choosing. After being posted for a few weeks, any staff member who did not sign up was assigned an open slot to attend. After implementing this system, our competency compliance rate went from 70% to 100%, with no need for makeup sessions.
Every staff member attended their scheduled date and completed their work within the assigned time. If the staff completed their assigned material early, they could use the additional time left to complete other education such as trauma education hours, and CPR certifications. Compliance with our trauma education hours also successfully reached 100%. Leadership was incredibly happy with the outcomes of this structure.
Further Considerations
After implementation, the staff was asked to give feedback on their thoughts about the new structure. The results demonstrated increased staff satisfaction from having a scheduled day incorporated into their clinical work week. The additional hours allowed them time to focus and absorb the material without distraction, and being given the opportunity to select the day they wanted to attend also led to staff satisfaction. The night shift staff expressed that they would like a later start time option since all sessions started at 7 a.m. The following year, this was implemented by changing the start time to evening shift on the third week of each competency/education month.
With the success of this new structure, the plan was replicated in a smaller emergency department at Jefferson Lansdale Hospital in 2025 with much success. Over the past year, these two affiliated emergency departments have started sharing NPD staff to better align their practices. While the affiliated hospital is much smaller, it had also struggled with compliance and staff engagement. Transitioning to a 12-hour competency and education day enabled the completion of mandatory competencies and required education while providing additional time for targeted learning to address identified knowledge gaps. These 12-hour days were prescheduled for nursing staff from March to October, allowing time for rescheduling dates if needed. The smaller hospital also easily achieved a 100% compliance rate in 2025 with this new structure.
Discussion
This innovative approach to competency and education in the emergency department demonstrates that a structured, collaborative approach between nursing staff, leadership, and nurse educators can overcome barriers to competency assessment in high-volume emergency settings. This structure has been proven to work in both large and small settings, where the competency and education needs are extensive. Making a structure like this successful will rely heavily on the leadership team being invested in staff development, ultimately creating a healthier, safer work environment for the patients and the staff. Healthcare organizations should consider adopting similar innovative strategies to meet competency and education standards without compromising staff morale or patient safety.
References
Emergency Nurse Association. (2023). Emergency Nursing: Scope and Standards of Practice (3rd ed.). Jones and Barlett Learning.
Mrayyan, M., Abunab, H., Abu Khait, A., Rabada, M., Al-Rawashdeh, S., Algunmeeyn, A., & Abu Saraya, A. (2023). Compency in Nursing Practice: A Concept Analysis. BMJ Open. doi:10.1136/bmjopen-2022-067352
Ortega-Lapiedra, R., Barrado-Narvion, M. J., & Bernues-Olivan, J. (2023). Acquisition of Competencies of Nurses: Improving the Performance of the Healthcare System. International Journal of Environmental Research and Public Health, 20(5). doi:10.3390/ijerph20054510
Stavropoulou, A., Kelesi, M., Baltagianni, M., Sigala, E., Tsapnidou, E., Gerogianni, G., & Katharakis, G. (2025). The Impact of Continuing Nursing Education on Nurses' Knowledge and Quality of Practice: A Systematic Review. Health Professions Education, 377-386. doi:10.55890.2452-3011.1346
Wright, D., & Covelli, V. (2021). The Ultimate Guide to Competency Assessment in Health Care (4th ed.). Creative Health Care Management.
Zaitoun, R. A., Said, N., & Tantillo, L. d. (2023). Clinical Nurse Competency and its Effect on Patient Safety Culture: A Systematic Review. BMC Nursing. doi:10.1186/s12912-023-01305-w
Disclaimer: The views and opinions expressed in this article are solely those of the contributor and do not necessarily reflect the official policy or position of ANPD.
Lori Ischinger, MSN, RN, GCNS, CEN, CPEN, SANE-A
Nursing Professional Development Specialist, Jefferson Abington Hospital
Lori Ischinger has more than 28 years of nursing experience. She earned her ASN (1997), BSN (1999), and MSN (2010) from Gwynedd-Mercy College. Lori has spent the majority of her bedside career in the Emergency Trauma Center at Jefferson Abington Hospital, serving as a registered nurse and a forensic nurse examiner. She holds certifications as a certified emergency nurse (CEN), certified pediatric emergency nurse (CPEN) and sexual assault nurse examiner-adult and adolescent (SANE-A). She is passionate about education and has taught in both academic and clinical settings. For the past six years, Ischinger has worked as an educator and nursing professional development specialist at Jefferson Abington Hospital, where she combines her clinical expertise with a desire for advancing nursing education and professional growth.
Valerie Miller, MSN, RN, CEN, TCRN
Nursing Professional Development Specialist, Jefferson Abington and Jefferson Lansdale Hospitals
Valerie Miller is a nurse professional development specialist for Jefferson Abington and Jefferson Lansdale Hospitals. She has more than 20 years of experience in emergency nursing and a master’s degree in nursing education. She is both a certified emergency nurse and a trauma certified registered nurse. Her current role focuses on staff onboarding, continuing education, practice improvement, and nurse professional development. She is also adjunct faculty at Montgomery County Community College in Blue Bell, Penn.
Linda Seliga, MSN, RN, CEN, TCRN, CPEN
Nursing Professional Development Specialist
Linda Seliga, MSN, RN, CEN, TCRN, CPEN, is a seasoned nursing professional with more than 38 years of experience spanning critical care, emergency medicine, and nursing education. She began her career in intensive care units before transitioning into emergency nursing. Her role developed from bedside nurse into leadership roles. Seliga currently serves as a nursing professional development specialist in a large emergency trauma department. She has pioneered orientation programs that individualize onboarding and significantly improved specialty certification rates among staff. Her work includes implementing and developing evidence-based guidelines, shaping departmental policies, and advancing professional practice models. Seliga holds her master’s degree in nursing management and leadership from Western Governors University and is a certified instructor in BLS, ACLS, and PALS. She is an active member of the Emergency Nurses Association and is committed to fostering clinical excellence and lifelong learning within the nursing community.