Health Care Department Operations Manual

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Chapter 1 – Health Care Governance and Administration

Article 4.6 – Professional Workforce: Nursing Services

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1.4.6.7 Nursing Competency Program

  • Policy

    • The California Correctional Health Care Services (CCHCS) Nursing Services Branch maintains a competency program to ensure nursing practice is consistent with the nursing process and practice established by the California state nursing licensing and certification agencies.

    • Licensed and unlicensed CCHCS nursing staff shall demonstrate the knowledge, skills, and abilities required to achieve an appropriate level of competency and perform within their scope of practice.  Nursing staff competency shall promote compliance with CCHCS and California Department of Corrections and Rehabilitation policies and procedures, federal and state laws and regulations, and nationally accepted nursing standards.

    • The competency program includes:

      • Educational programs

      • Competency validation

      • Monitoring for compliance

    • Competency validation occurs on a continuum. This continuum shall include assessment of competencies during the hiring process, during the orientation period, and throughout employment as the requirements of the job and needs of the organization change.

  • Purpose

    • To ensure the following:

    • Competent nursing staff

    • Positive patient outcomes

    • Patient safety

  • Responsibility

    • The Statewide Chief Nurse Executive (CNE) is responsible for statewide implementation of this policy, and the institutional CNEs are responsible for the local implementation of this policy.

  • Procedure Overview

    • The CCHCS Nursing Services Branch shall maintain a competency program to include educational programs, competency validation, and monitoring for compliance to ensure competent nursing staff, positive patient outcomes, and patient safety.

  • Procedure

    • Educational Trainings and Competencies Development

      • Educational trainings and competencies shall be developed by CCHCS headquarters (HQ) Nursing Services based upon internal and external requirements.  Nursing Leadership shall review and update all nursing educational training and competencies developed by Nursing Services, as needed.

    • Education and Competency Validation Components

      • Registered Nurses (RNs)

      • The Nursing Practice Act sets forth the duties that all RNs, regardless of role, population, or specialty are expected to perform competently. Additional education and training shall be provided to the RN in order to maintain and further develop knowledge, skills, and abilities for practicing at the highest level of RN scope of practice. The components include, but are not limited to:

        • Each of the elements of the Nursing Process (assessment, diagnosis, outcome identification, planning, implementation, coordination of care, health teaching and health promotion, and evaluation).

        • The dependent, independent, and interdependent functions identified for the RN in the various health care areas of the correctional nurse setting.

        • Patient advocacy and clinical and administrative leadership as defined for the correctional health RN.

        • Leadership and engagement in striving for quality patient care outcomes.

        • Ongoing development of proficiency in communications with patients, to include evolving practice in effective communication, and communications with the health care team.

        • Ongoing development of proficiency in the use of the Electronic Health Record System for clinical documentation.

        • Emerging health care best practices in areas such as health equity, trauma-informed care, and motivational strategies.

      • Licensed Vocational Nurses (LVNs) and Psychiatric Technicians (PTs)

        • LVNs and PTs shall be provided education and training within their scope of practice and shall be expected to perform competently.  The components include, but are not limited to:

        • Medication management – The LVN and PT follows the six rights of medication administration; is knowledgeable in the medication classifications and common side effects of medications being administered; and provides patient education related to medication indications, use, adherence and side effects.

        • Subjective and objective data collection – The LVN and PT collects data pertinent to the patient’s health or situation.

        • Therapeutic interventions – The LVN and PT provides basic nursing care, treatments, and techniques as ordered or delegated.

        • Patient education and group facilitation – The LVN and PT provides evidence-based patient teaching and employs techniques for facilitating psycho-educational and psycho-social rehabilitation groups.

      • Certified Nursing Assistants (CNAs)

        • CNAs shall be provided education and training within their scope of practice and shall be expected to perform competently.  The components include, but are not limited to:

        • Assisting or providing patients with their activities of daily living.

        • Observing and data collection for changes in the patient’s condition (1:1 suicide watch and suicide precaution), obtaining vital signs, weights, and measuring a patient’s intake and output.

    • Education and Competency Validation Frequency

      • Education and competency validation is conducted:

      • Quarterly for new hires for first year, annually thereafter, and as needed based upon:

        • Quality improvement

        • A performance evaluation

        • Performance improvement plan

        • New policies or procedures

        • When a deficiency is identified

      • Competency validation results shall be part of an employee’s performance appraisals.

    • Education and Competency Validators

      • Nursing clinical staff shall demonstrate competency prior to teaching educational trainings and validating competency of nursing staff.  Methods to acquire knowledge or skills include, but are not limited to:

      • Continuing education programs

      • Review of policies and procedures

      • In-service education

      • Training-for-Trainers

      • Simulation exercises

      • Observation and demonstration

    • Competency Validation Methods

      • Competency validation methods used to measure the abilities of an individual for a specific competency standard include, but are not limited to:

        • Test

        • Skills validation

        • Observation

        • Case Studies

        • Exemplars

        • Peer Reviews by Nursing Professional Practice Council

        • Mock Events

        • Quality Improvement Monitors

      • Some competencies may require a combination of validation methods.  The nursing leadership shall determine the validation methods for each competency developed by HQ Nursing Services.

    • Education and Competency Validation: Documentation and Tracking

      • Nursing staff’s competency shall be documented in the:

      • Supervisory File

      • Proof of Practice (Training File)

      • Education and Competency Tracking Database

  • References

    • California Code of Regulations, Title 22, Division 5, Licensing and Certification of Health Facilities, Home Health Agencies, Clinics and Referral Agencies

    • Nursing Practice Act, California Business and Professions Code, Division 2, Chapter 6, Article 1, Section 2700 et seq.

    • Vocational Nursing Practice Act, California Business and Professions Code, Division 2, Chapter 6.5, Article 1, Section 2840 et seq.

    • Psychiatric Technicians Law, California Business and Professions Code, Division 2, Chapter 10, Article 1, Section 4500 et seq.

    • American Nurses Association, Scope and Standards of Practice, Correctional Nursing, 2nd Edition

  • Revision History

    • Effective: 02/2002

    • Revised: 05/24/2023