The following report summarizes the work of this team and the accomplishment of the team’s goal and objectives.

Criteria for partnerships between service and education were developed based on a differentiated practice framework and articulation model. Letters were sent to hospitals in California inviting them to submit evaluation tools and job descriptions utilized for staff evaluation. These evaluation tools and job descriptions were analyzed by Dr. Dana Rutledge to determine whether there was an association with the RN position competencies from the Competency Based Role Differentiation Model. The primary question addressed in this analysis was to what extent the competencies exist in practice and to what extent they can be measured and validated. The analysis of the job descriptions indicated that the competencies exist, in varying degrees, in the practice setting. It was also determined that the most frequently documented areas of practice were nursing process, safety, professional growth, patient/family teaching and leadership and management. For the pilot phase, the committee decided to focus on the competencies in two of these functions namely teaching and leadership/management within the care provider and care coordinator role.

An invitation to participate as a pilot site was sent to all agencies manifesting the competencies in their job descriptions. From this invitation three pilot sites were selected. Dr. Sarah Keating, Chairperson of CSPCN, was named project director. As part of the selection criteria, the selected pilot sites needed to demonstrate evidence of differentiation at the staff nurse provider and care coordinator levels. Each participating site selected senior ADN and BSN students, staff nurses (usually within one year of graduation), and supervisors or preceptors to document whether behaviors existed that demonstrate practice at the defined levels of competencies. One medical-surgical unit in each health care setting was identified as the focus of the alpha site project. Each site submitted the project to their respective Institutional Review Board (IRB) committees to assure that the project was in compliance with their policies.

Tool kits were developed for pilot sites including evaluation criteria and tools. Evaluation criteria were based on the definitions found in the competency-based role differentiation model as well as educational competencies specified by the National League for Nursing, Council of Associate Degree Nursing (2000) and the American Association of Colleges of Nursing, Essentials of Baccalaureate Education for Professional Nursing Practice (1998). These materials were made available at site meetings with the project director and via the website to designated pilot sites and others.

Dr. Sarah Keating, Chair of CSPCN, was project director for the alpha sites. Three partnerships were developed for the purpose of evaluating the utility of California’s Framework for Competency-Based Role Differentiation for nursing practice and education. A one-year alpha phase of the project for tri-partnerships of clinicians and educators from a clinical setting, an associate degree nursing program and a baccalaureate nursing education program were identified. Alpha demonstration sites were Fresno, Sacramento, and San Bernardino. They were asked to evaluate the utility of the teacher and leadership functions within two competency-based differentiated roles, care provider and care coordinator in clinical practice and nursing education.

Following initial start-up meetings, each site gained institutional approval for data collection. This delayed some sites’ ability to move forward until mid-2001 or later. Finally, trying to coordinate the schedules of the subjects (senior students in ADN and BSN programs and new graduates) and the data collectors proved difficult in some sites. Each student was asked to complete the tool as a self-evaluation. The pilot sites varied in the number of students participating and the way data was recorded. One site had a consultant who recorded observations whereas the other two sites utilized staff clinicians/preceptors.

The results of data analysis from the three sites were compared for inter-rater reliability as well as the utility of the competency based role differentiation model. For each observation, the competency based role tool was completed as well as a demographic data form for each student and RN. All participants received a code number to assure anonymity. Data collected were sent to the Project Director and was analyzed by Dr. Dana Rutledge.

A total of 21 observations were made. Data showed a variability in competencies with new graduates showing a tendency to have more observed behaviors in "competent" categories and students tending to have "novice" behaviors. For the care coordinator role, new graduates were more likely to have demonstrated these behaviors than students were. These results were as expected and validate that the tool (based on the competency-based model) is useful for others evaluating competencies in clinical settings. Anecdotal reports from observers indicate that students were more likely to miss cues in patient interactions that could lead to different outcomes. Implications from the pilot study are that senior students may be viewed as true novices and should not be expected to practice beyond this level until additional experiences occur.

Data collectors were not stable in all sites, leading to communication breakdowns at times. While written instructions for use of the data collection tools were provided, data collectors’ interpretations differed on tool use. The quality of communication between the project office and sites varied. Electronic mail became the preferred method and most efficient for communication.