Improving Nurse Competency In Childhood Immunizations

Background:  The Kane County Health Department aimed to develop a multi-disciplined public health nurse (PHN) workforce.  The initial assessment of PHN competency revealed a gap in knowledge relating to childhood immunization.  The range of clinical competency in understanding the childhood immunization schedule with all its nuances ranged from novice to expert. Individual confidence in nursing judgment was low.   

Significance:    The AIM Statement:  By 7/1/11 the rate of KCHD’s PHNs that will have reached competency as described in the “Benner Stages of Clinical Competence” will increase from baseline (25%) to 100%.

Setting: Local Health Department

Population: Children. Note that the strategy used to attain nurse competency in childhood immunizations could be used to attain nurse competency in any nursing intervention.

Project Description: Initially, a PHN, expert in childhood immunizations, was paired with a PHN, novice in childhood immunizations, to help advance competency level. After 9 months, this one on one model resulted in only 25% of PHNs being competent.  Continuing to use Benner’s novice to expert skill acquisition model,  a point of distribution (POD) model was also implemented whereby a grouping of an expert, advanced beginner and novice worked together to learn and develop competency in childhood immunization.  After 3 months, each PHN performed a self assessment and discussed their progress and further training needs with the expert and clinical supervisor.  As PHNs reached competency they only attended clinics if they felt they needed to, in order to give more opportunity to those who had not reached competency.

Results/Lessons Learned:  After 8 months of using the POD model, 100% of the PHN workforce was competent in immunizations. Benner’s stages of clinical competency and the POD model were effective tools to assist PHNs in gaining competency. The POD model provided structure and support to nurses learning a new skill and provided a sense of camaraderie amongst nurses. The PDCA  model provided the vision needed to reach a goal that initially seemed overwhelming.