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assist with the training. For example, a CRNA who's particularly adept at starting IVs could teach that skill to the nursing staff. Keep it simple when documenting competencies by using checklists to quickly note if a staff member demonstrates competence or non-competence in a particular task. There is a drawback to scheduling competency training and testing on a single day, however. It assesses competencies at a single point in time and doesn't provide a full picture of a staff member's performance. In addition, staff members can be coached on the spot, so it might not rep- resent an accurate reflection of their skills. So instead of trying to com- plete competency testing on a single day, consider setting aside some time to review necessary skills during workdays. Have an experienced staff member who's demonstrated excellence in a task — that CRNA with the knack for starting difficult IVs, for example — observe staff members and sign off that they're doing it correctly. That way, competen- cies are observed in real-time in actual clinical settings. It's a more accu- rate assessment of skill levels and it also streamlines the testing process without having to dedicate time to the task during everyone's day off. Demand accountability. Give staff ownership of the competency assessment process and put the onus on them to fulfill the test- ing requirements. Establish hard deadlines for completing assess- ments, and rely on the staff members to complete knowledge-based testing or to set up times to get observed performing specific clinical tasks by the required dates. You also need to determine consequences for noncompliance, including a poor reflection in annual evaluations and perhaps freezes on pay increases. Be religious about demanding that staff complete annual competencies and keep completed test results on file. When accreditation surveyors tour your facility and ask for the paperwork, it needs to be at your fingertips. 4 Staffing S 2 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U l y 2 0 1 6