Improving Nurse Competency in Childhood Immunizations

Purpose:
The issue was the public health nursing staff's lack of competency in childhood immunizations. The strategic goal was stated as "by 7/1/11 the rate of public health nurses that have reached competency as described in the Benner Stages of Clinical Competence will increase from baseline to 100%."

Significance:
The KCHD was moving toward a multi-disciplined public health nurse workforce. The range of clinical competency in understanding the childhood immunization schedule with all its nuances and vaccine administration ranged from novice to expert. Generally, confidence in their nursing judgment was low.

Strategy and Implementation:
A Plan, Do, Check, Act Cycle was implemented to determine the best way to reach the goal of 100% of nurses competent in childhood immunizations. A team consisting of nurses, nurse managers, and support staff was established. An AIM statement was developed. Benner Stages of Clinical Competence was used to determine baseline skill levels and to measure skill acquisition for each nurse. The team used quality improvement tools to help better understand the problems and potential solutions, such as flow charting, fishbone analysis and force field analysis. After examining the current approach carefully, a potential solution was identified that could enrich the learning expereince and meet the strategic goal. It was collectively decided that a pod model, whereby expert nurses mentored a small group of novice and advanced beginner nurses would lead to a faster rate of competency. Ample clinical opportunities were provided as well as frequent skill reassessment and training plan adjustments.

Evaluation:
After 5 months using the pod/mentoring model, 80% of the nurse workforce (including experts) were at minumum competent in childhood immunizations. This was a 55% increase from the previous method used, which was a one on one model. As of this writing, 100% are targeted to reach competency by 7/1/11.

Implications for Practice:
Continuous quality improvement tools are effective in guiding strategic goals to fruition. For this strategic goal, the tools helped our team test and prove the theory that learning would be enriched and nurses would become competent at a faster rate using the pod/mentoring model.