Lack of Documented Nurse Competency Could Put VA Patients at Risk

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By Stephen Spotswood

WASHINGTON — Gaps in VA’s nurse-competency practices might be putting patients at risk, according to an investigation by VA’s Office of the Inspector General (OIG). The report found that nurses went years without being assessed for their proficiency on equipment, and, many times, when they failed to demonstrate competency, VA hospitals took no action.


A dialysis unit at VA Healthcare Upstate New York, VISN 2. Making sure nurses are trained on equipment has been a local issue. Photo from VISN 2 website.

Using data from a Combined Assessment Program (CAP) review conducted between April 2011 and September 2011, OIG investigators analyzed how VA hospitals assess the competency of their registered nurses (RN), how they define competency and how they respond when nurses fail to meet one of the requirements.

This most recent review builds upon previous reports on VA RN competency. A review in 2009 found that 24% of facilities evaluated did not meet Joint Commission competency requirements and lacked documentation of annual assessment and validation of registered nurse (RN) RN competencies.

A healthcare inspection found that nursing staff were not competent in the use of telemetry-monitoring equipment to ensure that correct patient parameters were set and that alarms would sound to alert staff to problems. Another inspection found that lack of RN competency on a cardiac-monitoring unit was known by hospital managers, who had no system in place to correct the problem.

Another review in 2010 found that, of 168 RN competency records reviewed, 19% did not have evidence of competency evaluation. Other reviews identified RN competency issues in dialysis, mental healthcare, long-term care, spinal-cord injury, endoscopy-procedure areas, the operating room and the cardiac-catheterization laboratory.

This most recent review found VA facilities still out of compliance with RN competency-assessment guidelines.

RNs are required to be assessed and validated at least every three years or more frequently, if required by local law or policy. Although all of the VA facilities investigated had policies in place for RN assessment, it was not always clear who had the responsibility to conduct the assessments on a timely basis. Also, methods and documentation requirements were not always addressed.

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