Some of the Joint Commission elements of performance can be fulfilled very simply — keeping documentation that includes the dates of assessments, the methods used to determine competency, the signatures of those performing assessments and the signature of the employee assessed.

On both core-competency validation forms and in unit-specific validation forms, however, at least 20% of the time one or more of those items was missing, the OIG report shows. Overall, RN competency documentation was not complete at 15 of 29 facilities.

The biggest— or at least the most serious — problem is the lack of action by facilities when RNs do not demonstrate competency in a skill, according to the report. The Joint Commission requires that hospitals take action when competency expectations are not met. In the report, investigators looked at 349 RNs and found that 58 had been recorded as not meeting competency in a skill. Of those, 41% (24 nurses) were not required to take any action to address that deficiency.

When presented with the report, VA officials concurred with all of the OIG’s findings. According to Under Secretary for Health Robert Petzel, MD, VA has developed a VA Nursing Handbook now in the approval and distribution process. The handbook establishes specific RN competency assessment requirements designed to ensure consistency among facilities. The handbook is expected to be fully distributed by the end of 2012.

VA officials said the agency will require verification of competency-validation documentation through an annual RN Competency Validation Report to be submitted by Veterans Integrated Service Network (VISN) for evaluation by the Office of Nursing Services (ONS).

The ONS also will develop a standardized competency-assessment tool for use during random reviews of facilities.

VA officials noted that local policy will continue to dictate actions to be taken when validation of competencies is not met. The VA Central Office will send a memorandum to VISNs, however, requesting the development of local policy that establishes appropriate action to be taken at the facility when that happens.

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