Continued Competency

The characteristics of a properly designed and effectively functioning continued competency assessment process should include a clear definition of expectations, provide consistency, and be useful and ongoing. The most successful continued competency programs have emerged from adult learning theory. Based on the work of Kolb (1985), the theory focuses on the principles that motivate adults to learn and maintain currency, and describes key requirements in assessing the methods and realities of continued competence for healthcare professionals.

Research has shown that a combination of methods including technical, critical-thinking, and interpersonal skills is the most appropriate mechanism to assess continued competency. 

Methods of Verifying Continued Competency

Method​ ​Measure
Observation of daily work​ Technical skills​
Return demonstrations​ Technical skills​
Peer review​ Interpersonal and critical-thinking skills​
Case studies​ Critical thinking skills​
Simulation​ Technical and critical thinking skills​
Self-assessment​ Critical-thinking skills (values and beliefs)​
Exemplars​ Critical-thinking and interpersonal skills​
Presentations​ Technical, interpersonal and critical-thinking skills​
Refresher courses​ Design specific to correct deficiency​
Post tests​ Cognitive skills in the technical domain​
Mock drills​ Technical, interpersonal and critical-thinking skills​
Skills checklist​ Technical, interpersonal and critical-thinking skills​
QI monitors​ Technical, interpersonal and critical-thinking skills​

Job Description-based Assessment
A performance assessment tool or evaluation form should identify both the job-related criteria and the criteria for the behavioral expectations of the individual.  The form should emphasize the generalist skills of the job, special skills required to perform the job, an objective scoring mechanism, and an action plan for improving deficiencies.  The assessment form should reflect clinical practice and anesthesia-related administrative, educational, or research activities as appropriate. The form should include any competencies that are expected across the organization.  Job description-based assessment tools can also be used to orient new personnel.

CRNA Competency Assessment Tools
The evaluation process for an individual CRNA should be outlined in a policy and procedure manual.  The process should be conducted according to defined procedures within specified time frames.  Results and conclusions should be tracked over time and monitored for effectiveness. Accountability for data collection related to practitioner outcomes should be a component of the assessment and may be the responsibility of the individual CRNA as well as the organization.

Professional practice is more than the sum of isolated tasks: It requires a defined knowledge base from which a practitioner makes critical decisions on why, when, and how to perform or not perform certain tasks.  There may be overlap in scopes of practice of healthcare professionals, and this overlap is appropriate based on individual education and training.

Competency models for the CRNA should describe the particular combination of skills, knowledge, and behaviors that reflect quality of care.  Identifying and measuring these specific competencies is complex and multifaceted.  It is essential that a competency model be built on the inherent professional roles and responsibilities of the CRNA and incorporate the types of skills, knowledge, behaviors and expected outcomes specific to the individual’s practice.

CRNA Competency Assessment Documents

Document​ ​Verifying Entity
Licensure​ State Board of Nursing​
Certification​ Council on Certification Computer Adaptive Testing Examination​
Recertification​ Council on Recertification​
Continuing education​ Per requiring body​
National Practitioner Data Bank query​ Facility requirement​
Advanced practice registration, if any​ State Board of Nursing​
Credentials​ Facility bylaws 
Human resources/medical staff requirement 
Accreditation standards​
Privileges​ Facility bylaws 
Human resources/medical staff requirement 
Accreditation standards​
Malpractice insurance query​ Insurance carrier/policy​
Orientation checklists​ Facility policy​

Essential Elements of Competency Assessment
Nurse anesthesia competency statements should reflect the broad range of abilities that link generic knowledge to the essential activities and skills that are descriptive of clinical or other anesthesia-related practice.  The goal should be to create a process and environment that maximize the potential for competent practice.

Customize Assessment Based on Job Description
The competency assessment should define inherent or unique provider responsibilities and expected behaviors, and may include shared competencies with other disciplines.

Ensure Consistent Assessment Process
The assessment should use a common theme across the organization, but be flexible enough to address individual groups and specialty practices.

Ongoing Process
The process should be continual and reflective.