Evaluating nurses’ clinical skills, clinical reasoning, and problem-solving abilities should be a continual process in every facility to maintain safe and quality patient care (Burns, 2009). Each facility has its own requirements for annual competency evaluation; this may be addressed through a centralized mechanism that provides annual review days and online modules, or annual competencies may be evaluated at the divisional or unit level.
Hospital-wide competencies may be insufficient for perianesthesia nurses given the specialization of perianesthesia areas. Deciding which skills require a competency is the first step. Then it is important to determine which competencies need regular or annual review and how the review will be accomplished. In some cases, regulatory and accrediting bodies provide guidance and stipulate which skills require an annual review. In other cases, the frequency of review may depend on the unit and facility resources, as well as the acuity of the patient population. Low-volume and high-risk clinical skills and reasoning should be reviewed more regularly than high-volume, low-risk clinical skills. Low-volume items need consistent review to maintain a basic level of competency so that if a particular patient need or device is seen infrequently, the nursing staff is still prepared to competently manage the care when it does arise. In perianesthesia areas, where the patient population is vast, there may be several clinical skills that are high risk and low volume and even some that are high risk and high volume. Unit-specific competency completion should be tracked by the perianesthesia educator or administrative team, and made available for charge nurses when they are making patient assignments. A competency grid placed within charge nurse reference material can be useful so that, when a particular type of patient that requires a certain competency is expected in the PACU, the charge nurse has a quick reference as to which nurses are competent to care for that type of patient.
In addition to unit-specific competencies, PACUs should require basic life support (BLS) and advanced cardiac life support (ACLS) certification. If the scope of service includes pediatric patients, pediatric advanced life support (PALS) certification should also be maintained by the nursing staff. These certifications assure a unit-wide and standardized competency for patient emergency response.
Perianesthesia nurses can maintain competency through continuing education, specialty certification, BLS, ACLS, and PALS certification. In addition, the department should identify unique clinical skills required for providing safe, quality patient care and assure competency in these areas through regular review and evaluation of every nurse. Competency review should be mandatory, nonpunitive, and continuous (Burns, 2009). Staff nurses can work together with the administrative team to develop and implement these competency reviews to create a successful program.