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Given an invasive device, infusion medication and fluid administration, and the risk for serious complications such as infection, extravasation, nerve injury, and air embolism, it is critically important that nurses and other health-care providers involved in the speciality are educated and competent. Competency is defined as a required level of effective performance in the work environment defined by adherence to professional standards, including knowledge, skills, abilities, and judgment based on established science (Gorski et al., 2021, p. S205). Competency assessment is the process used to verify an individual's performance. Competency integrates the following aspects of performance related to patient care:

Competence is assessed using different methods, yet there is no single tool or method that “guarantees” competence (ANA, 2021). A variety of methods are used, including written tests and direct observation of a skill, whether in the work setting, in a skills laboratory, or through use of simulation (Table 1-3). Competency assessment requires a checklist that includes objective, measurable assessment of the actual performance, such as specific criteria or critical behaviors, and the criteria for achieving success in the performance. To ensure a careful and rigorous assessment of a nurse's competency, it is critically important that the “competency assessor,” often referred to as the nurse preceptor, is competent with the skill being assessed (Gorski et al., 2021, p. S29).

Table 1-3 Assessing Competency
Methods of Assessing Competency
  • Direct observation by a competent supervisor, designated evaluator, instructor, or preceptor while the employee/student demonstrates the skill in the work setting—preferred for invasive infusion therapy procedures
  • Observation by a competent supervisor, designated evaluator, instructor, or preceptor while the employee/student demonstrates the skills in simulated settings, such as simulation laboratories and mock drills using clinical scenarios
  • Instructor-led or electronic-based delivery of content with written tests to assess the knowledge aspect of competency

Competency validation should occur before providing patient care (e.g., upon orientation or the “onboarding” process to the organization) and on an ongoing basis based upon the associated risk and known problems, concerns, and/or outcomes within the organization. Risks and concerns that may drive additional competency validation include clinical outcome data (e.g., increase in infection rates), occurrence or sentinel event reports, implementation of new equipment or technology, evaluation of patient satisfaction (e.g., problems with peripheral IV placement), or changes in patient populations. When the health-care organization chooses to measure or validate specific competencies, it should do so in a thorough and ongoing fashion, including looking at new, significant, and/or high-risk practices, interventions, or activities that are unfamiliar to staff members.

Documentation of Competency

Competency is documented on forms or checklists that focus on objective and measurable performance of the competency. The health-care organization establishes what constitutes competency (e.g., percentage of performance) and when additional education and/or competency assessment is required. Components of a competency form include:

All professional nurses are accountable and responsible for all parts of the tasks associated with infusion therapy and for tasks that are delegated to the licensed practical/vocational nurse or technician for care rendered to the patient.

Infusion and Vascular Access Teams

The INS supports the concept of specialty teams (e.g., infusion team, vascular access team) for VAD insertion, management, and surveillance. The team is defined as a group of highly competent clinicians centrally structured within the facility charged with the goal of accuracy, efficiency, and consistency for the delivery of infusion and vascular access services (Gorski et al., 2021, p. S197). Advantages to specialized teams include greater first-attempt peripheral intravenous catheter (PIVC) insertion, reduced need to escalate from a PIVC to a CVAD, reduced cost, and reduced complications (Gorski et al., 2021, p. S24). Early vascular access is an important component of many teams' responsibilities, is critical to vessel health and preservation, and involves assessing the patient's needs for vascular access when he or she is admitted to the hospital. Some teams perform all peripherally inserted central catheter (PICC) and midline insertions, conduct daily surveillance of each catheter and dressing, perform dressing changes, troubleshoot catheter problems, provide formal and informal staff education, and conduct outcome monitoring. Nurses with specialty training and education are also placing nontunneled CVADs. Some infusion teams may limit interventions to CVAD placement only, whereas the general nursing staff perform care and management of the catheter.

Specialty Certification

Professional nursing certification programs have long established their value and importance to health-care organizations and to patients and their families. The American Board of Nursing Specialties (ABNS) was formed in 1991 with a mission to promote the value of specialty nursing certification to all stakeholders. Certification, as defined by the American Board of Nursing Specialties (ABNS) (n.d.), is the formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards identified by a nursing specialty to promote optimal health outcomes. Nursing certification has become a high priority, especially in hospitals that pursue and attain designation through the Magnet Recognition® or Pathways to Excellence® programs of the American Nurses Credentialing Center (ANCC, n.d.; Solomon, Lahl, Soat, Bena, & McClelland, 2016).

Whereas basic nursing licensure indicates a minimal professional practice standard, certification is a mark of excellence, validates nursing knowledge and skills, and protects the public. In a study examining the value of certification in Magnet and non-Magnet hospitals, the top three values of certification reported by nurses were personal accomplishment, validates knowledge, and personal satisfaction (McLaughlin & Fetzer, 2015).

The INS provides certification specific to infusion therapy with the designation of CRNI® (certified registered nurse, infusion). Other certifications that include components of infusion therapy are as follows: