This poster details the multi-year competency assessment journey of ambulatory care clinics within a large multistate healthcare system and provides recommendations for an implementation process that is outcome-focused, meaningful, and sustainable. Competency validation is crucial for ensuring safe, high-quality patient care. Due to inconsistent competency practices, standardization was necessary. Donna Wright's competency assessment model was chosen for the entire organization. Despite its widespread use, there is limited evidence supporting its effectiveness and recommendations for implementation in the ambulatory care setting.

The Scope and Standards of Practice for Professional Ambulatory Care Nursing states that the registered nurse attains knowledge and validated competencies that reflect current ambulatory care nursing practice. Nurses are responsible for maintaining competence and the employer is accountable to provide an environment conducive to competent practice. Assurance of competency is a shared responsibility of the profession, nurses, professional organizations, regulatory agencies, employers, and other key stakeholders.

Prior to selection of Wright's model, methods for measuring competence in the ambulatory care clinics were suboptimal and inconsistent, raising concerns about staff competence. There was a lack of standardization in competency identification, implementation, documentation, and evaluation. There were misunderstandings regarding the distinction between competency and education. In some cases, competencies were being assigned rather than identifying the root cause of the problem, such as a process issue, which resulted in limited return on investment.

The complexity of the medical group significantly influenced the implementation of Wright's model. In 2021, a transformation occurred in the competency process with the introduction of an electronic platform. This enhanced transparency and accountability in reporting to leaders and key stakeholders. In 2023, the medical group began aligning with the organization using Wright's model. Leadership opted for a service line approach, starting with primary care, which was challenging as it involved 3,000 clinical staff across four states. Resources were developed and housed on a SharePoint page within the organization's intranet. The following years, additional service lines were added.

Determining the effectiveness of the competency program included applying sound rationale for competency selection, utilizing baseline data, and 6- and 12- month goals. A REACT workbook was used for competency assessment. For the first time, leadership was provided with reports delineating which teammates completed the competencies. Although only one competency was chosen per service line, the perception was that it was time-consuming.

In 2025, the same service lines utilized the REACT workbook, and the brainstorming process was streamlined using surveys to identify new, changing, problematic, or high-risk/low-volume topics which were prioritized through surveys. Steering committees were dissolved per executive leadership direction, and communication shifted to monthly forums, area leader meetings, and direct emails from nursing professional development. A centralized REACT SharePoint page was maintained for updates.

One of the greatest challenges is ensuring that staff are competent to care for patients in an ever-changing healthcare environment. Competency assessment is integral to ensuring patient safety. This journey reflects a dynamic and evolving approach to competency development, emphasizing adaptability, system alignment, and continuous improvement.

Adrianne Waters-Fechter MSN, RN, NPD-BC

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