Clinical Competencies, Skills, and Knowledge
CORE COMPETENCIES
Baptist Health defines performance standards based on established profession-wide competencies and training guidelines. This systematic and evidence-based approach is essential to the successful professional development of our students. To accomplish such outcomes, our program requires trainees to develop certain competencies that prepare them for professional practice as identified in Population-Focused Nurse Practitioner Competencies: Psychiatric-Mental Health, (National Organization of Nurse Practitioner Faculties, 2013). The Baptist Health APRN Fellowship Program emphasizes and evaluates the following nine Competency Areas:
Scientific Foundation
Leadership
iii.Quality
Practice Inquiry
Technology and Information Literacy
Policy
Health Delivery System
Ethics
Independent Practice
Scientific Foundation Competencies
- Critically analyzes data and evidence for improving advanced nursing practice.
- Integrates knowledge from the humanities and sciences within the context of nursing science.
- Translates research and other forms of knowledge to improve practice processes and outcomes.
- Develops new practice approaches based on the integration of research, theory, and practice knowledge
Leadership Competencies
Assumes complex and advanced leadership roles to initiate and guide change.
Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care.
Demonstrates leadership that uses critical and reflective thinking.
Advocates for improved access, quality and cost effective health care.
Advances practice through the development and implementation of innovations incorporating principles of change.
Communicates practice knowledge effectively both orally and in writing.
Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus.
Quality Competencies
Uses best available evidence to continuously improve quality of clinical practice.
Evaluates the relationships among access, cost, quality, and safety and their influence on health care.
Evaluates how organizational structure, care processes, financing, marketing and policy decisions impact the quality of health care.
Applies skills in peer review to promote a culture of excellence.
Anticipates variations in practice and is proactive in implementing interventions to ensure quality.
Practice Inquiry Competencies
Provides leadership in the translation of new knowledge into practice.
Generates knowledge from clinical practice to improve practice and patient outcomes.
Applies clinical investigative skills to improve health outcomes.
Leads practice inquiry, individually or in partnership with others.
Disseminates evidence from inquiry to diverse audiences using multiple modalities.
Analyze clinical guidelines for individualized application into practice
Technology and Information Literacy Competencies
Integrates appropriate technologies for knowledge management to improve health care.
Translates technical and scientific health information appropriate for various users’ needs.
- Assesses the patient’s and caregiver’s educational needs to provide effective, personalized health care.
- Coaches the patient and caregiver for positive behavioral change.
Demonstrates information literacy skills in complex decision making.
Contributes to the design of clinical information systems that promote safe, quality and cost effective care.
Uses technology systems that capture data on variables for the evaluation of nursing care.
Policy Competencies
Demonstrates an understanding of the interdependence of policy and practice.
Advocates for ethical policies that promote access, equity, quality, and cost.
Analyzes ethical, legal, and social factors influencing policy development.
Contributes in the development of health policy.
Analyzes the implications of health policy across disciplines.
Evaluates the impact of globalization on health care policy development.
Health Delivery System Competencies
Applies knowledge of organizational practices and complex systems to improve health care delivery.
Effects health care change using broad based skills including negotiating, consensus-building, and partnering.
Minimizes risk to patients and providers at the individual and systems level.
Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders.
Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.
Analyzes organizational structure, functions and resources to improve the delivery of care.
Collaborates in planning for transitions across the continuum of care.
Ethics Competencies
Integrates ethical principles in decision making.
Evaluates the ethical consequences of decisions.
Applies ethically sound solutions to complex issues related to individuals, populations and systems of care
Independent Practice Competencies
Functions as a licensed independent practitioner.
Demonstrates the highest level of accountability for professional practice.
Practices independently managing previously diagnosed and undiagnosed patients.
- Provides the full spectrum of health care services to include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care.
- Uses advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings.
- Employs screening and diagnostic strategies in the development of diagnoses.
- Prescribes medications within scope of practice.
- Manages the health/illness status of patients and families over time.
Provides patient-centered care recognizing cultural diversity and the patient or designee as a full partner in decision-making.
- Works to establish a relationship with the patient characterized by mutual respect, empathy, and collaboration.
- Creates a climate of patient- centered care to include confidentiality, privacy, comfort, emotional support, mutual trust, and respect.
- Incorporates the patient’s cultural and spiritual preferences, values, and beliefs into health care.
- Preserves the patient’s control over decision making by negotiating a mutually acceptable plan of care.
IV. Clinical Experiences
Fellows have the opportunity to train in a variety of behavioral health settings, use multiple therapeutic interventions, and conceptualize cases from different theoretical orientations. Fellows function as members of the interdisciplinary team, attending and contributing to relevant meetings as scheduling allows. Fellows are encouraged to integrate their prior academic coursework and professional experiences into their clinical training at Baptist Health in order to strengthen their overall learning outcomes.
- 20% of the curriculum is focus on clinical scholarship including inter-professional seminars, Psychiatry Grand Rounds, NP seminars, Journal Review, and fellows’ Capstone project.
- 80% Clinical Rotations
- Capstone Project will be presented and the end of the 2 year fellowship. The purpose of the Capstone Project is to allow the fellow to identify an area of need for practice change and an opportunity to translate research into practice. The project will be presented to the selection committee and BBH Leadership.
Assessment and Intervention
Fellows receive didactic and supervised training in case conceptualization skills, clinical interviewing, diagnostic assessment, and medication management. Training complexity in each area is based on developmental level.
Treatment and related therapeutic services are guided by evidence-based practice, which integrates empirical research into current clinical work. Treatment decisions are made in the context of individual patient characteristics, preferences, environment, and culture. In addition, interventions are tailored to accommodate these distinctive elements in order to provide client-centered and comprehensive behavioral healthcare. Thus, a primary emphasis of the fellows’ training is to consider unique lived experiences and diversity to enhance their case formulations and subsequent interventions.
Tracks and Rotations
Adult/Adolescent Inpatient Units
Adult/Adolescent Consult Liaison Service
Emergency Department
Telehealth
Outpatient (Bridges Program)
Substance Use Disorders
Orientation and Schedule
APRN Fellows are introduced to Baptist Behavioral Health through a comprehensive orientation to the hospital system and training program during their first few weeks. Fellows receive provider EHR training in addition to didactics reviewing key components and standards of documentation. Fellows are provided a tour of facilities and introduction to the clinical team. Following this initial onboarding, fellows shadow preceptors and other clinical staff throughout their daily routines. This period of observation serves to develop the fellows’ familiarity with the department prior to engaging in any independent clinical work.
V. Supervision
Supervision is an essential training component emphasized throughout the practicum, across tracks and rotations. The Baptist Health APRN Fellowship program adheres to a developmental and experiential model of supervision, which may be characterized as a “mentor–mentee” approach. Within this framework, clinical preceptors are professional role models that allow fellows to observe their clinical practice, afford various training experiences matched to fellows’ developmental level, and provide feedback on related performance. Whenever possible, supervision is enhanced through direct observation of the fellows’ clinical work and critical thinking. The supervisor also encourages the growth of trainees’ individual strengths and autonomy over the course of the program. Accordingly, training is structured to promote increasing independence to enrich fellows’ evolution as APRNs.
Individual Supervision
Fellows will receive at least one hour of individual supervision weekly with a Psychiatrist either on-site or virtually (Zoom). In practice, fellows are often afforded more supervision as a result of the program’s training model and teaching philosophy. APRN fellows will have access to supervisors with varied areas of expertise and specialties. The supervision process involves a combination of direct and indirect observation (e.g., performing intake interviews, individual/group treatment, and medication management). Fellows seek regular consultation with preceptors to guide clinical decisions. The supervision hour may take on various forms, such as discussing conceptualizations or treatment recommendations, incorporating process-style dialogue, rehearsing clinical interventions, and reviewing documentation. This direct observation of students provides essential information regarding their development of competencies. The program acknowledges the significance of establishing quality supervisory relationships and the impact of such interpersonal dynamics on learning outcomes. Baptist Behavioral Health staff seek to foster an open and safe training environment, in which candid feedback from fellows is welcomed and integrated into their clinical experiences.
Group Supervision
Fellows will participate in one hour of group supervision each week. This meeting is conducted by a psychiatrist and held on-site or virtually (Zoom). Group supervision is a valuable teaching and mentoring experience. Fellows practice observational learning, perspective taking, and modeling professionalism. Further, this unique structure of supervision provides opportunities to build upon critical professional skills such as peer feedback/supervision, public speaking/presenting, and interpersonal effectiveness. Through a group format, fellows may also participate in an active dialogue about ethical issues and case conceptualization. During group discussions, fellows are asked to consider peer and multidisciplinary perspectives in order to maximize the effectiveness of social learning opportunities.
The training program’s group supervision primarily focuses on:
- Acclimation to Clinical Environment
- Training Questions/Concerns
- Ethics in practice
- Clinical Case /Assessment Presentations
- Professional Development
- Fellow Wellness
Group supervision includes informal presentations that review treatment and assessment cases. The meeting also addresses updates related to the hospital/department and current events that may affect clinical practice. In line with Baptist Health’s appreciation for culture and individual difference, diversity discussions regarding current EBP and fellows’ personal experiences/insights may occur.
Group meetings are held on Fridays from 12:00 PM to 1:00 PM in a Baptist Health conference room, a private office, or virtually (Zoom) unless otherwise noted. This schedule is subject to change fellows are provided advanced notice of any scheduling adjustments
VI. Didactic Seminar
Didactics and related trainings are an integral part of the Baptist Health APRN fellowship. This curriculum provides a strong foundation of scientific knowledge that may be integrated into clinical training. Fellows participate in a weekly, hour-long didactic seminar, held either on-site or virtually (Zoom). This educational forum provides an overview of a variety of clinical experiences. Didactic subjects survey a range of evidence-based practice and case material in Behavioral Health. In addition, topics related to culture, diversity, and multidisciplinary professions are presented. Fellows are required to attend all didactics, as well as any supplemental training opportunities the hospital system requires. Fellows who are unable to attend a didactic will inform the Director of the APRN Fellowship. If the didactic is not rescheduled, fellows will complete an alternative activity to supplement missed material.
VII. Evaluation of Competencies
Baptist Health views evaluation and feedback as essential components of the learning process. Ongoing evaluation of fellows occurs informally and formally, through regular supervision, review of written work, feedback from multidisciplinary staff, patient report, self-evaluations, direct observation data, and summative evaluations. In collaboration with fellows’, Baptist Health’s clinical supervisors identify training goals and discuss evaluation processes. Consistent evaluation practices serve to address specific training needs that may arise and encourage the fellows.
Formative, Summative, and Programmatic Evaluations
APRN fellows are evaluated throughout each semester rotation to ensure their performance levels match Baptist Health quality expectations and patient needs. Areas of evaluation include the nine domains of profession-wide competencies as outlined by Population-Focused Nurse Practitioner Competencies: Psychiatric-Mental Health, (National Organization of Nurse Practitioner Faculties, 2013).
Formative evaluations are less structured means of skill appraisal and occur across rotations. These include making documentation revisions, supervision dialogue focusing on training goal progress, and informal feedback following indirect or direct observation. Additionally, an ongoing discourse with the fellows program is sought throughout the year, as appropriate, to inform evaluations.
Summative evaluations are the formal and measurable assessments of fellow competencies, which occur at the end of each quarter. This is a benchmark rating for overall progress and serves as an opportunity to highlight areas of potential growth. Summative evaluations are informed by multiple sources of data (e.g., direct observation, supplemental rotation performance, case/research presentations, supervision participation, professionalism, and competency rating scales). The evaluation rating measure uses a 5–point Likert scale, ranging from “0” (“Unsatisfactory”) to “4” (“Exemplary”). The scale requires that raters objectively assess the relationship between a competency area and the fellows’ observable behavior.
The training program conducts regular programmatic evaluations to inform annual quality performance assessments. Fellows are asked for feedback regarding their experience throughout the academic year, during regular supervision and summative reviews of competency. At each formal evaluation period, fellows complete summative evaluations of their primary clinical supervisors, supplemental rotations, and the overarching training program.
Preceptors will review summative evaluations with fellows. This quality performance assessment serves to provide data for continual improvement and enhancement of the training program.
Case Presentations
Fellows engage in periodic formal case presentations as well as a Capstone Project focused on a practice change opportunity at the completion of the 2 year fellowship program. Presentations focus on a clinical case including assessment, diagnostic formulation, and treatment plan. Additional guests, including staff psychologists, counselors, administrators, and other multidisciplinary staff may be invited to attend. Fellows are provided written feedback on their presentations through clinical supervisors’ completion of the presentation rating form. Areas of evaluation include content, organization, and delivery. Specifically, oration style, knowledge base, presentation structure, effectiveness of visual aids/supplementary materials, use of empirical literature to support assessment/intervention choices, and ease of answering discussion questions will be assessed.
VIII. Clinical Training Faculty
Faculty preceptors are PMHNP/APRN’s, psychiatrists, and psychologists.
IX. Policy and Procedure Compliance
Baptist Health policies and procedures support the organization’s mission to provide quality health care services in a safe atmosphere that fosters respect and compassion. This is accomplished through respecting patient rights and acknowledging personal responsibility in upholding an exceptional standard of care. All Baptist Health policies and procedures apply to fellows. Such procedural documentation is provided during trainee onboarding and included in the Training Manual.
