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Page modified April 03, 2008

Report on the Quality Assurance Audit 2000

January 29, 2001

Executive Summary

The promotion of continuing competence among the membership is an integral part of the College of Nurses of Ontario’s (CNO) Quality Assurance (QA) Program. In response to legislative and Regulatory requirements, the QA Program has implemented a Reflective Practice component which provides opportunities for nurses to address areas requiring improvement. In doing so, the program requires that all members complete a self-assessment, obtain peer feedback and develop, implement and evaluate a learning plan. Members are also required to maintain written documentation of their participation in Reflective Practice. As a statutory body, the QA Committee is required to ensure that nurses are participating in the QA Program.

In fulfilling this monitoring function, the QA Committee directed CNO staff to conduct a mandatory audit of 2,500 members. The main objectives of the Audit are to validate participation in Reflective Practice and to obtain feedback on the benefits and effectiveness of participating in the program. Results will also be used to inform evaluation activity insofar as the limitations associated with the absence of anonymity are considered.

In general, the findings show:

  • A significant number of nurses identify the purpose of the program as promoting continuous lifelong learning as well as helping nurses remain competent. Results show that 69.8% believe the QA Program is effective in enhancing the quality of practice.
  • A significant number of nurses are participating and meeting the requirements of the Reflective Practice program. More specifically, the majority of nurses are maintaining written documentation of their self-assessment, peer feedback and learning plans, with 69.7% maintaining records of all three steps. Results also suggest that maintaining documentation is a positive step toward following through on the learning plan.
  • The majority of nurses report benefiting from completing a self-assessment, obtaining peer feedback and implementing a learning plan. Completing a self-assessment and developing a learning plan are perceived to be more difficult than obtaining peer feedback. However, nurses still report some discomfort when approaching peers for feedback, especially when the peer is a friend.
  • Identifying strengths. (90% specified a strength). While the self-assessment and peer feedback processes are assisting nurses to identify their strengths, nurses appear to have familiarity with their strengths regardless of conducting a formal self-assessment and peer feedback. There are several similarities in terms of the strengths resulting from self-assessment and peer feedback. Examples include communication skills and a strong interest in client care.
  • Identifying learning needs. (82.6% and 68.4% specified a learning need from self-assessment and peer feedback, respectively). The self-assessment and peer feedback processes are used to assist nurses identify learning needs. However, similar to the previous finding on identifying strengths, findings show that self-assessment and peer feedback are not providing nurses with new information about learning gaps. This suggests that self-assessment and peer feedback serve to corroborate areas in which nurses have already identified as learning needs. Learning needs tend to relate to job knowledge, enhancing computer skills and communication skills.
  • Developing learning plans. (89.0% specified a learning objective; 84.6% specified an outcome). For a significant number of nurses, learning objectives are developed based on day-to-day reflection. This corroborates previous findings and suggests that nurses are actively reflecting in practice outside of the Reflective Practice program. The self-assessment process is more likely to be used to identify learning objectives than is peer feedback. This suggests that stronger linkages need to be made between using peer feedback results and the learning plan. In their comments, nurses suggest that forms or checklists be developed to facilitate the peer feedback process.
  • The majority of nurses report having implemented the learning plan (87.4%). In contrast to previous findings, a greater number of nurses report not creating a learning plan prior to CNO’s (43.8%). This suggests self-assessment and peer feedback have a greater impact in facilitating the development of a learning plan than identifying strengths and needs. However, nurses report they refer to their learning plans infrequently and suggest that reminders be published in Communiqué.
  • Impact on practice. (81.4% provided specific detail about the impact). 88.8% of nurses evaluated their learning plans and 85.7% report that their learning plan enhanced the quality of their practice. When nurses were asked to describe how the learning improved or changed their practices areas of impact include the acquisition of a new skill, increased application of knowledge, change in delivery of care and the ability to apply new knowledge in their practice.
  • Tools and resources. The Self-Assessment Tool is most commonly used for self-assessment and peer feedback. The Professional Profile ranks third after agency system options. The results from the self-assessment are used by a significant proportion to create learning plans (84.6%). Nurses rely on other people to assist in implementing learning plans. In-services, journals and books are also popular resources.

The results are supportive of the Reflective Practice program. The findings serve to validate participation among members to the degree that nurses provided specific detail describing their participation in each step. Findings will be also be used in evaluation to inform program indicators and as a basis for planning evaluation activities.

 

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