Benchmarks: An Evidence-Based Approach to Determining Competence of Newly Hired Registered Nurses

Purpose:
The goal of this initiative is to establish an evidence-based pathway for hospitals to accurately determine the length of "precepted" or "orientation" time for newly hired nurses (residents) that is consistent, predictable, and measurable.

Relevance/Significance:
Consensus is evident among leading healthcare organizations (ANA, ANCC, IOM, NCSBN, NIH, QSEN, WHO) as to essential core competencies for healthcare providers. Although there is agreement among leading healthcare organizations, assessment and measurement of competence for residents is overly complex and rely on cumbersome check off lists and lengthy competency performance evaluation packets. As a result, preceptor/preceptee dyads pay little attention to the content in order to "check a box".

Strategy and Implementation:
A multi-state, multi-hospital beta test was conducted to refine components of a nurse residency including benchmarks. The strategy was to test a competency assessment tool that ensures newly hired nurses are competent to safely and effectively care for a full patient assignment without cumbersome and duplicative paperwork. Eleven benchmarks were identified through research of national healthcare organizations position statements on competency (ANA, ANCC, IOM, NCSBN, QSEN, and WHO) and subsequently cross walked with identified core competencies including patient-centered care, evidence-based practice, quality improvement, safety, teamwork and information technology. Over 500 nurse leaders, preceptors, and residents were provided workshops on how to use benchmarks to determine the amount of time required to ensure a resident can function independently without the supervision of a preceptor. An electronic management system provided real-time progress of residents in benchmark achievement.

Evaluation:
Beta test participant hospitals included new graduate and experienced new nurse residents which allowed us to trend data to determine average time needed by newly hired nurses of different educational levels and experience levels. The benchmarks provided an efficient measure of competence that that eliminated extensive orientation for residents by providing a predictable and measurable road map.

Implications for Practice:
Hospitals have typically indicated standard orientation times (8, 12 or 18 weeks) but there has been no evidence to support these are reliable time-frame measurements of competence. Benchmarks provide a consistent, predictable and measurable road map to ensure newly hired nurses are competent.