Enhancing Professional RoleCompetency Through Data

Analytics and Evidence-BasedEducation

The American health care system has under-

gone several reforms and is likely to under-

take another reformation soon, given the sociopolitical

landscape. Shifts from fee-for-service (FFS) to value-

based reimbursement (VBR) models continue to trans-

fer a significant percentage of clinical and financial risk

from payers to providers. Value-based models aim to

reduce potentially unnecessary health care costs,

improve the quality of care provided, and increase effi-

ciency.1 This aim cannot be attained unless all health

care providers are completely clear about their account-

abilities and competent in their professional roles.

www.nurseleader.com Nurse Leader 189

Roxane Spitzer, PhD, RN, MBA, MA, FAAN, and Enderson Miranda, MBA, CPHQ

Professional role competency demands that nurses work tothe full extent of their licensure, education, and training.2

Registered nurses must be clear about their professionalaccountabilities, responsibilities, and licensure expectations byadhering to the standards and regulatory requirements fromstate boards of nursing and the American Nurses Association.Lack of role clarity creates variation in practice, which leadsto avoidable errors.

Many of the Institute of Medicine’s reports over the lastseveral years continue to recommend that we must removeunwanted variation in health care practice through the clari-fication of professional role accountabilities and the promo-tion of evidence-based practice.3 In fact, evidence-basedpractice requires full professional role competency.

Professional competency involves practice to the full extentof professional licensure and scope of practice. Autonomousdecision making and critical thinking are essential componentsof the RN scope of practice. Nurse leaders must acknowledgethat nurses can only be fully engaged in their profession andscope of practice in an environment that supports autonomy.However, even if the environment is perfectly conducive for fullprofessional practice, nurses cannot be expected to practicewhat they don’t know, nor can they be completely engaged intheir work if they are not role competent and clear about theirprofessional obligations. Therefore, role competency cannotexist without full engagement, and full engagement cannot existwithout professional role clarity.

Accordingly, nurses and other health care professionals can-not fulfill their legal and ethical obligations if they are not fullyengaged. Gallup’s State of the Global Workplace study reportedthat only 30% of US workers are engaged in their work,4 andinternational figures are even worse. This is a major concern.We need nurses to be fully engaged in their practice as acuityand the aging population increases. Furthermore, ensuringefficient population management across the care continuum isessential to our future and the well-being of our patients. Thereare many different definitions and varying opinions regardingemployee engagement. A widely accepted description statesthat employee engagement is “a desired outcome that occurswhen workers feel a heightened mental and emotional con-nection to their jobs, their manager, their coworkers, and/ortheir organization and its mission.”5 As a result, they are morededicated and more willing to apply discretionary effort totheir work above and beyond the norm to help their organiza-tion succeed.5 The multidisciplinary teamwork required tomeet the total needs of our patients reinforces the demand foran engaged and role competent workforce. All members of thehealth care team must be engaged and fully aware of theirunique roles in this collaborative and yet fast-paced environ-ment. Fortunately, modern health care organizations can pro-vide innovative ways to ensure their teams remain engaged intheir own personal development.

EVIDENCE-BASED PROFESSIONAL DEVELOPMENTAmanda is in the midst of onboarding for her first RN position.As a new baccalaureate graduate, she is comfortable with theskills learned in school and believes she knows her responsibili-

ties. Following a 6-month orientation for a specialty area, she isasked to take a web-based professional competency assessmentprovided by her organization. This assessment is intended tomeasure her behavioral competencies as a professional nurse.Amanda uses her smartphone. At the same time, one of her newpeers, a preceptor, and her supervisor are automatically selected tocomplete a brief assessment of their observations of Amanda’spractice. This process is standard in her organization and comple-ments its onboarding process by providing an opportunity toidentify gaps and measure knowledge of the behavioral require-ments of professionalism. The web-based instrument used theNovice to Expert scale.6 Amanda was shocked to find that herperception of her practice differed substantially from her peer andsupervisor. They saw her as a novice in several areas she believedto be competent. As a new graduate, she didn’t know what shedidn’t know.

Susan has been working in the same facility for over 20 years.Her hospital is a respected ANCC Magnet® organization, andshe enjoys working there. She considers herself an expert in allskills and professional behaviors related to her role and hopes tocontinue advancing on their career ladder. Susan’s organizationrecently decided to implement a new web-based 360-degreeassessment to fulfill their ongoing peer review requirements, aspart of their Magnet re-designation.7 Her hospital wanted to getmore value from the time they invested in collecting peer feed-back. When Susan received her gap analysis results, she noticedthat she needed remediation in the areas of communication, lead-ership, and delegation. This is not unusual with experiencednurses, who often focus their energy on taking care of theirpatients and not so much on interacting with new nurses, build-ing interpersonal and leadership skills, or staying up-to-date withthe massive amount of changes that health care chronically goesthrough. Her organization’s 360-degree assessment process pro-duced concrete and actionable recommendations for Susan that canmeaningfully impact her practice and desire to continue advancingwithin the organization.

Susan and Amanda are in very different stages in theircareers. Nevertheless, both have been empowered throughspecific feedback to engage in their professional development.This is a crucial moment in their journey for lifelong learn-ing. We, as health care leaders, must ensure that these profes-sional opportunities are not wasted. Immediate action mustbe encouraged to keep the momentum going.

There are different ways in which organizations can act toensure the continued development of their nurses. Threefactors are the most important when considering an effectivesolution to address gaps in role competency: timing, conven-ience, and relevance of content.

1. Timing. The learning activity must take place in atimely manner. Health care workers, especially nurses,are very busy professionals. It is guaranteed that othertasks and obligations will fill their schedule if too muchtime passes. Educational content needs to be available tothem immediately.

2. Convenience. Our society has seen substantial advancesin technology within the last few years. Fromsmartphones, to smart TVs, to smart cars, we are used to

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on-demand, on-the-go, real-time access in almost allaspects of life. The acceptance of advanced technology hasbeen embraced by all generations, from Millennials toBaby Boomers. Therefore, it is imperative that remediationbe available online via computers and mobile devices.

3. Relevance of Content. The Internet has revolution-ized the speed in which content becomes available, andthe amount of educational resources obtainable online isamazing. However, this abundance of information canpresent a serious challenge. Professionals need to cutthrough the noise and information overload to focustheir time on tailored, meaningful education resourcescreated from evidence-based content.

Fortunately, advances in technology are providing us withresources that fit all these criteria. Evidence-based adaptivelearning solutions are revolutionizing the continuing educa-tion industry. For instance, these solutions can use algorithmsto create millions of crosswalks that connect specificevidence-based content to each person’s unique behaviors,competencies, or area of opportunity, automatically recom-mending tailored on-demand educational content at theirfingertips. Furthermore, adaptive learning solutions use adultlearning principles that encourage the user to choose educa-tional content based on their interests, thus creating pathwaysof professional development that are most meaningful to thatindividual. New content crosswalks are then created sponta-neously by the algorithms based on the learner’s choices,ensuring a personalized development experience.Additionally, adaptive algorithms automatically update everytime the learner satisfactorily completes his or her assignededucational activity and corresponding knowledge checks,generating newly curated and personalized recommendationsfor ongoing learning based on the most up-to-date results.

David Sackett, the founder of the Center for Evidence-Based Medicine at the University of Oxford, UK, is widelyconsidered the father of evidence-based medicine. He createdmany invaluable resources to enhance evidence-based prac-tice, including the Cochrane Collaboration global researchcommunity, with the goal of ensuring that clinicians use thebest available research to treat their patients. According toSackett and his colleagues, evidence-based practice is "theintegration of the best research evidence with clinical expert-ise and patient values."8 Figure 1 is an illustration of thatdefinition, reinforcing that all 3 components need to worktogether in order for evidence-based practice to exist.Adaptive learning solutions help support one of the 3 foun-dational pillars of evidence-based practice by ensuring thatrecommended educational content is constantly curated andupdated based on the best available research evidence.

Evidence-based adaptive learning solutions are not exclusiveto direct-care nurses. They also provide tailored education anddata analytics to management and executive leadership, provid-ing key insights into areas of strength and opportunity. Thesesolutions support concepts of life-long learning and continuedimprovement. Management insights are often used for leader-ship development and frequently include expanded 360-degreevariables such as input from direct-reports.

DATA ANALYTICS AND ORGANIZATIONALINSIGHTSFrom an organizational perspective, these professional devel-opment activities produce an enormous amount of usefuldata that can provide valuable insights. The education depart-ment can organize training workshops based on areas ofcommon need across the organization, directors can analyzeareas of opportunities within their departments, managers canengage in data-driven shift allocation based on actual compe-tencies, mentors can be assigned to individuals based onpaired competencies, hospital systems can compare resultsfrom different hospitals and analyze development trends, andso on. The possibilities are truly limitless.

Clive Humby said in 2006 that “data is the new oil.”9 Hewas correct then, and his assessment continues to prove truetoday. Much like oil, data are valuable in their crude form,but they are astronomically more precious when refined intoinsightful information. It is imperative that organizationsleverage the right tools to mine their oil wells.

A 2014 Oxford Economics study reported that 53% ofexecutives indicate that workforce data are a key competitivedifferentiator, yet only 38% of these executives believe theyhave ample workforce data to understand their organization’stalent strengths and vulnerabilities.10

The adaptation of solutions to offer optimal value does notstop at the individual level. Assessment and data analytics solu-tions need to be customizable to allow each organization tomeasure the behaviors and competencies most applicable totheir own professional practice models. These solutions oftenreduce countless hours in laborious and antiquated legacyassessment systems, provided that managers and leaders areproperly trained for their efficient and effective utilization.

THE BOTTOM LINEAs health care leaders, we must create an environment thatensures a committed and engaged workforce that gives its

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Figure 1. The 3 Pillars of Evidence-Based Practice (EBP)

best each day. We should pursue opportunities to leveragedata-driven and evidence-based solutions that can add valueto our employees, our patients, and the overall organizationwe serve. Professional role competency and evidence-basedpractice together can promote behaviors that meet the chal-lenges of today and tomorrow. Health care changes andreforms will always be a variable in our industry, so we mustbe prepared to deal with whatever challenges come our way.Our work is to evaluate, educate, empower, and engage ouremployees to reach their highest potential. This will improvemorale, retention, patient care, and promote a positive bottomline. Evidence-based adaptive learning solutions are a remark-able advantage to support and advocate for lifelong learning:a professional necessity. NL

References1. Kuhn B, Lehn C. Value-based reimbursement: the Banner Health Network

experience. Front Health Serv Manage. 2015;32(2):17-31.2. Institute of Medicine. The Future of Nursing: Leading Change, Advancing

Health. 2011. http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed January7, 2017.

3. Stevens K. The impact of evidence-based practice in nursing and the nextbig ideas. Online J Issues Nurs. 2013;18(2):4.

4. Gallup. State of the Global Workplace: Employee Engagement Insights forBusiness Leaders Worldwide. 2013. http://www.gallup.com/businessjournal/165233/engaged-workplaces-engines-job-creation.aspx?g_source=STATE_OF_THE_GLOBAL_WORKPLACE_2013&g_medium=topic&g_campaign=tiles.Accessed January 8, 2017.

5. Miller HS. The 10 Best Practices for Enhanced Employee Engagement. LosGatos, CA: The Henry Miller Group; 2014.

6. Dreyfus SE, Dreyfus HL. A Five-Stage Model of the Mental Activities Involvedin Directed Skill Acquisition. Berkeley, CA: Operations Research Center,University of California, Berkeley; 1980.

7. American Nurses Credentialing Center. 2014 Magnet Application Manual.Silver Spring, MD: American Nurses Credentialing Center; 2013.

8. Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-BasedMedicine: How to Practice and Teach EBM. 2nd ed. Edinburgh, UK:Churchill Livingstone; 2000.

9. Palmer, Michael. Data is the new oil. ANA Marketing Maestros blog,November 2006. http://ana.blogs.com/maestros/2006/11/data_is_the_new.html. Accessed April 12, 2017.

10. SAP SuccessFactors. Oxford Economics. Workforce 2020: The LoomingTalent Crises. 2014. http://www.successfactors.com/en_us/lp/workforce-2020-insights.html. Accessed January 8, 2017.

Roxane Spitzer, PhD, RN, MBA, MA, FAAN, is Editor Emeritusof Nurse Leader magazine, and is on the board of governors ofOnSomble, Inc., in Nashville, Tennessee. Enderson Miranda, MBA,CPHQ, is president of OnSomble, Inc., and a graduate student ofEvidence-Based Healthcare at the University of Oxford, UK. Hecan be reached at enderson.miranda@onsomble.com.

Note: This research did not receive any specific grant from fundingagencies in the public, commercial, or not-for-profit sectors.

1541-4612/2017/ $ See front matterCopyright 2017 by Elsevier Inc.All rights reserved.http://dx.doi.org/10.1016/j.mnl.2017.03.009

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