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Beyond Survey: Creating a Culture of Staff Competency

November 27, 2018
by Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, Curriculum Development Specialist, American Association of Directors of Nursing Services
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The above scenario is just a simple example of how data from the facility assessment can be used to help address educational needs and improve staff competency in resident care.

Let resident outcomes drive the focus of education.

Facility leaders can determine staff competency deficits by examining resident outcomes. Poor outcomes in a specific care area likely signal a lack of competency and an opportunity for education. For example, if a number of residents have been transferred to the emergency room due to a change in condition, training on how to recognize and address condition changes may be needed to help lower the rate of emergency room visits and may even lower hospital readmissions.

Additionally, initiatives taken through the quality assurance and performance improvement (QAPI) or quality assessment and assurance (QAA) program pinpoint competency-based educational needs, as these programs monitor care areas for improvement. For example, the QAA committee may be monitoring the number of medication errors in the facility. Providing competency education can help to lower the medication error rate, which in turn will improve resident safety and more quickly reduce the problem. Past survey deficiencies may also highlight care areas that need focused training.

Set expectations for staff that training is required and ongoing.

It’s important to act on the observations of educational needs—taken from QAA meetings, for example—and train promptly. At a minimum, plan to offer ongoing competency-based education each month; this ensures a scheduled time block with staff in which to focus on necessary areas for improvement. Also remember that during each training there should be an opportunity to apply the skill under review. If the topic is the staging of pressure ulcers, for example, require staff to demonstrate they are able to use the knowledge by having them stage wound examples. Set the expectation with staff that they should regularly attend these training sessions and that they will be required to demonstrate the covered skill.

Never stop auditing for accuracy.

All training has a life cycle—that is, for every training provided, an audit should always follow. Audits are imperative because they ensure the skills covered in trainings are being put to use when it counts—during care delivery. Choose care areas such as handwashing, incontinence care, and medication administration for audit on a weekly basis. In addition to auditing promptly after training, audit for skills that haven’t been reviewed recently to ensure best practices are being followed. Repeat skills training as necessary.  


In a facility that has a culture of safety and prioritizes resident outcomes every day of the year, education and training aren’t just boxes to be checked, they are an ongoing goal that requires an honest skills inventory that drives staff improvement. Staff competency, although it may seem like an ambiguous goal, is clear as day in the light of resident outcomes.