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Self-Assessment of Competency Regarding Standards of Practice

Tonya F. Allendorfer

Ferris State University

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Abstract

A self assessment of competency in regards to the American Case Management Association

(ACMA) standards of care. In preparation for graduation from Ferris State University (FSU) I

have reflected on my nursing practice. I have developed a professional plan with goals, actions,

and an evaluation plan for each standard of care for utilization management. As my education

and nursing career expands I want to grow in competency. I have included a timeline to assist

me in achieving my goals.

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Self-Assessment of Competency Regarding Standards of Practice

I am fairly new to the utilization review department, but I have an extensive background

in nursing. I believe I can be successful in any career path I choose. During high school I

volunteered as a candy striper at Hurley Hospital. After graduation, I worked in group homes as

well as nursing homes while attending nursing school. I studied nursing at Mott Community

College. Once I started the clinical portion of my education, my nursing career began. I was a

student nurse tech at Lapeer Hospital. I then took my licensed nurse boards and worked in a

rehabilitation unit as I continued my education for registered nurse. Upon graduation, I worked

for a year in a progressive care unit before I transferred to McLaren Flint. I worked most of my

career in the hospital's intensive care unit. I also spent a couple of years as an agency nurse,

traveling to different hospitals and working different units. All of this experience has made me

the nurse I am today. Currently I am trying my hand at utilization review, which is a subset of

case management and working on my bachelor degree at FSU.

Standards of Practice

Collaboration

The ACMA lists collaboration as the first standard of practice. This is the center of

utilization review. A utilization review nurse speaks with patients, nurses, social workers,

physicians, case managers, families, registration, and third party payers on a daily basis. This is

an area I naturally excel in. I have a very social personality, and do not like to be closed up in

my office. I enjoy being out on the unit floors and feel I benefit from being part of loop. Many

nurses are intimidated by physicians, but I am not. I spent most of my career educating residents

and making calls, waking up physicians at all hours of the night. I meet this standard of practice

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easily because I enjoy people as well as being out on the hospital floors absorbing what is going

on with the patients.

Communication

Communication and Collaboration go hand in hand. The most important role in

utilization review is preparing a case for each patient. For each patient I am reviewing, I have to

paint a picture of the patient that can be read by anyone. This picture needs to be easily pulled

apart by lawyers. I have to show the sense of fear that the patient felt when they arrived at the

emergency department(ED). I need to fully understand why the ED doctor thinks the patient

needs to be admitted. I also have to understand the attending physician’s thoughts and plan of

care. It is my job to document the necessity of this plan for the patient. My documentation

needs to take into consideration the ideas and thoughts from all the interdisciplinary teams as

well as the patient's family. Because of my clinical experience, this utilization review standard

of care has been easy for me to achieve.

Facilitation

The third standard of practice ACMA lists in facilitation. Facilitation is “the

development of a safe and effective plan of care through early identification and thorough

assessment of the patient’s needs" (American Case Management Association, 2007). The

InterQual book is a reference that offers suggested interventions for each diagnosis. If a

physician chooses not to use an intervention, they must provide documentation as to why it is

contraindicated. I am able to facilitate by screening the patients chart for appropriate orders for

each diagnosis. If I find the orders fall short of the suggested interventions, I then have a

discussion with the physician about the patient’s plan of care. I am able to meet this standard,

but I often use the InterQual book as reference.

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Coordination

According to ACMA (2007) coordination " Elicits and incorporates the expectations of

patient’s, physicians, healthcare team members and payers in the planning process". I

communicate the patient’s plan of care to the payers. For example, if an elderly patient who

lives alone, has a hip replacement surgery does not feel strong enough to return home. The case

manager sets the patient up for sub acute rehabilitation. I review the physical therapist's notes,

physician orders, and the case manager’s assessment as to when the transfer to the sub acute

facility would be available. I then provide the payers with this plan. In this way I meet the

coordination standard of care.

Advocacy

I have met the advocacy standard of care in an indirect way. There are instances that I

review a case that does not meet hospitalization needs. Such an instance would be the patient is

not sick, but that they are unsafe to be home alone. From experience, I know the insurance

companies will not authorize a stay of this nature. I need to build a portfolio that includes all the

reasons why a person may not be safe alone at home and the options case management is

pursuing for this patient. After presenting my case to my manager, I can sometimes send it to an

outside company for another physician to review. If this outsourced physician agrees that the

patient is an unsafe discharge, I have a stronger case to keep the patient safe in our hospital until

a proper discharge can be arrange. It is in this way I am an advocate for the unprotected.

Resource Management

Health care reimbursement changes are constant. Each insurance company and Medicare

has its own set of rules and regulations. The physicians are too busy to keep up to date on this

information. It is my responsibility to review the admission of a patient and decide which status

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and diagnosis they should be processed under. I then must provide the information to the

patient's insurance company in the form that they request whether it be an email, fax, or a phone

call. I am able to meet the resource management standard of care with my daily interactions

between insurance companies.

Accountability

I take pride in meeting the accountability standard of practice. In order to stay current in

the ever changing Medicare regulations, I attend Webinars and read articles on the current

changes. I want to make sure I fully understand each new rule and apply it effectively. Follow

through is an important aspect of this standard in my personal practice. I must often follow up

on patient orders, discharges, and procedures. If a follow up is missed, it could mean a loss of a

few thousand dollars reimbursement for the hospital.

Professionalism

My professionalism has really increased in my transfer to my new position. I have to

educate physicians in reimbursement requirements they may not be aware of. I feel I need to

look appropriate, speak with confidence and knowledge, and have an attitude of cooperation to

have the respect of the healthcare team. After reviewing the eight standards of care for my

specialty, I feel I have achieved all of them. I am representing myself, my employer, and nursing

in a professional way.

Professional Development Plan

Collaboration

My goal to maintain competency in the collaboration standard of care is to cross train. In

the future I would like to spend a day cross training with the case management department. I

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interact with them on a daily basis and I think it would enhance my position to understand their

role more thoroughly. This goal would assist me in collaboration.

Communication

In order to advance my career and maintain competency in the area of communication, I

would like to take an effective communication class as an elective. I interact with physicians and

other third party payers and need to sound professional. I also need to discuss cases with

physicians and a communication class would help me approach them appropriately. It would

benefit me to speak as a leader and make me more confident in formal presentations.

Facilitation

I am learning the resident's schedules of the different units. My facility is a teaching

hospital and I would like to make daily rounds with the residents. It would be an educational

opportunity for all of us. I would be kept up to date on each patient, as well as learn some

clinical information. Together with the resident, we would review each patient and I would

educate them as to what the reimbursement requirements are for each patient and their diagnosis.

This would be the best way to maintain the facilitation standard of care.

Coordination

My goal is to expand my skill set in my new department. I plan to accomplish this task

by learning how to direct admit patients into the hospital. A physician's office or another facility

will call a special line to my department. The utilize review nurse will decide if it is an

appropriate direct admission, or if the patient should be seen in the emergency department first.

There is a whole process to direct admitting a patient to the hospital and I feel I would benefit

from fully understanding it.

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Advocacy

On a more personal note I have a nephew with Down Syndrome. I have done a lot of

research on special needs children and they are generally undertreated. I try to attend his

medical appointments and advocate for him, and future patients. We do not live in an area that

specialists are very convenient. Every time I update a physician on the special needs of a Down

Syndrome child another special needs child may benefit from the education. This is the most

important standard of care for me. My goal is to volunteer at the Special Olympics.

Resource Management

Right now my unit is in discussions with a commercial company for the next contract.

My goal is to be a part of this committee the next time they negotiate a contract. It would show

initiative and possibly make me stand out. Many people in my department feel this is a stressful

task, but I think it would be insightful. I would like to discuss why certain diagnosis deserve to

be hospitalized. I have an extensive background in critical care and could easily give examples

of what the complications of medical situations could be. I feel I would be an asset to the

committee.

Accountability

Accountability is an important standard of care for me. By joining the ABQAURP

(American Board of Quality Assurance and Utilization Review Physicians) I would receive their

magazine, which provides excellent update articles. It also provides access to their website,

which is the most current and interactive. I could ask the utilization review physician’s questions

in this format. This would be a goal I would be interested in striving for to maintain the

accountability standard of care.

Professionalism

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A large element of professionalism is knowledge. A bachelor degree is only a

recommendation for my current position, but I feel education is always valuable. My desire of

achieving my bachelor degree is both a personal and career goal. I believe it will help others to

perceive me as a professional.

Action Plan

My action plan will assist me in attaining my goals. The first goal I have is to cross train

in the case management department. I would like to set up a meeting with my director. She is

the one to set up the actual cross training day with someone from case management. I would like

to complete this fairly soon, before spring. My second goal is to take an effective

communication class. I need two cultural enrichment classes to graduate from FSU. I will look

into which classes would fill these requirements for my summer 2014 session. My third goal is

to begin daily rounds with the residents. At my facility, the new residents begin in July every

summer. I feel that by July I will be accustomed to my new position this would be a good time

to initiate this goal. My fourth goal is to learn how to direct admit patients. I have already begun

working on this by orientating with someone for a day. My fifth goal is to volunteer at the local

Special Olympics. Every year my nephew participates, I will let my sister in law know now that

I would like to volunteer with her this year. I will make sure she lets me know when she is sent

the sign up information. The thumb area Special Olympics is in June 2014. My sixth goal is to

be a part of the negotiating committee for our contract with Health Plus. We are in negotiations

now and I believe it is a three year contract. I will discuss my objective at my yearly evaluation

with my manager and plan to be on the next committee in December 2017. My seventh goal is

to join a professional organization. I have chosen ABQAURP. I can join online and if I do it by

the end of this year I can use it as a tax deduction and start my professional year off in the right

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way. My final goal is to obtain my bachelor degree. I have five classes before I can graduate

from FSU. I like to take one class a semester, so I am on pace to graduate in spring of 2015.

The best way to obtain your goals is to have a plan of action, which I have done.

Evaluation Plan

An effective evaluation plan is a useful tool in assessing career goals. It is a time for self

reflection. A good time would be when I finish my bachelor’s degree. I will need to decide if

staying in utilization management is a good choice for me. I will need to consider whether or not

I would like to continue my education and if so what direction I would like to pursue. This is a

time in my life in which many choices will need to me made, so it seems natural to take this

opportunity to pause and reflect on my goals. My initial goal was just to obtain my bachelor

degree, now that I am close to finishing my degree, it is time to refine my goal. A good plan

grows and changes as you grow as a person.

As I recently made a change in the type of nursing I am doing, another time for an

assessment would be following my yearly evaluation from my department manager. As I

become more familiar with the new job, I will learn what necessary skills and personality traits

are needed. With the feedback from my manager we can together decide what skills I need to

master for my current position. I would use this meeting as an opportunity to review my goals

for accomplishing the standards of care for my current career choice. Many of the goals I have

set for myself need to be discussed and approved by my manager. This would be the ideal time

for that discussion. After a year in my current position, I should have a better understanding of

what is expected and can start re-evaluating my goals for maintaining competency in the

standards of care. I have designed an easy to read layout of the goals, actions and timeline. I

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plan to keep a copy of this in my office. I will refer to it prior to my yearly evaluation and will

update it and keep it as an ongoing working career plan.

Conclusion

I choose nursing as a career because it is a very diverse profession. There are many

choices and directions a nurse can take. Developing a working career plan with appropriate

goals centered on the standards of care will assist me in making decisions as I grow as a

professional. In order to be successful one must have a plan and a way to evaluate the plan. This

assignment as prepared me to be a successful professional registered nurse.

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References

American Case Management Association. (2007). Standards of practice & scope of services for

hospital/health system case management. Retrieved from www.acmaweb.org/Forms-

StandardsFINAL.pdf

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Table 1

 

Standard of Care GoalsGoal Action Timeline

Cross Train  Set up date with director 3/14

Communication Class  CE elective, FSU Summer 2014

Physician Rounding  New residents start 7/14

Direct Admits  Orientation  In progress

Special Olympics  Saginaw, MI, volunteer 5/14

Negotiating Committee  Discuss with manager 12/17

ABQAURP  Online registration 12/13

BSN  5 classes needed, FSU  5/15

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CHECKLIST FOR SUBMITTING PAPERS

CHECK

DATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40]

3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41]

4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42]

5. Margins: Did you leave 1” on all sides? [p. 229]

6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59]

7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]

8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.

9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]10. Typeface: Did you use Times Roman 12-point font? [p. 228]

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11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170]

13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this:

“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1).

Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]

15. Paraphrase: A paraphrase citation would look like this:

Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007).

It may also look like this: Bell-Scriber (2007) found that……

[p. 171 and multiple examples in text on p. 40-59]

For multiple references within the same paragraph see page 174.

16. Headings: Did you check your headings for proper levels? [p. 62-63].

17. General Guidelines for References:

A. Did you start the References on a new page? [p. 37]

B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same.

C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE

18. Did you follow the assignment rubric? Did you make headings that address each major

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section? (Required to point out where you addressed each section.)

19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?

21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone?

22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?

23. Did you check to make sure there are no hyphens and broken words in the right margin?

24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?

25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement?

26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data…..

27. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.”

28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

29. Did you have other people read your paper? Did they find any areas confusing?

30. Did you include a summary or conclusion heading and section to wrap up your paper?

31. Does your paper have sentence fragments? Do you have complete sentences?

32. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

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________________________________________________________DATE:________________

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

________________________________________________________DATE:_______________