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Competency Assessment vs Orientation

The Human Resource (HR) chapter of the accreditation manuals include requirements for 'orientation' and 'competency assessment'. How do these activities really differ from each other?

Any examples are for illustrative purposes only.

The Joint Commission's glossary defines orientation as "A process used to provide initial training and information while assessing the competence of clinical staff relative to job responsibilities and the organization's mission and goals." 

Orientation may be further described as an introductory program and/or activities intended to guide a person in adjusting to new surroundings, employment, policies/procedures, essential job functions, etc. Each organization is responsible for determining when and how long a person is considered to be in orientation. 

The requirements found at HR.01.04.01 outline specific topics to be included in an employee's orientation process and documented. For example, orientation to Key Safety Content that must be completed before staff provides care, treatment, and services often include:
  • Fire Safety and response
  • Infection prevention and control
  • Emergency response (code blue, rapid response, etc.)
  • Active shooter
  • Bomb threats
  • Personal safety
  • Emergency Management (internal/external disaster plans)
  • Medical equipment failure and reporting process
  • Utility system disruptions and reporting process
Additional examples may include:
  • Work schedule
  • Employee attendance, time and resource management expectations
  • Employee responsibilities in the event of an internal or external disaster
  • Managing a patient's pain
  • Sensitivity to cultural diversity
  • Patient Rights
  • Code of conduct expectations
  • Infection prevention and control
  • Maintaining privacy and security of protected health information; sometimes referred to as HIPAA training.
While not formally defined, competency may be described as a combination of observable and measurable knowledge, skills, abilities and personal attributes that constitute an employee's performance.  The ultimate goal is that the employee can demonstrate the required attributes to deliver safe, quality care.

Competency assessment timeframes may vary greatly based on the individual's entry skill level and the complexity of the task(s) the individual will be required to safely perform.  For example,  demonstrating competency on performing a bedside glucometer test will take less time to achieve than caring for a patient who has just undergone an open heart procedure that involves managing/monitoring complex equipment and highly refined assessment skills.
Because of the variability involved in both the number and complexity of competencies an individual must be deemed competent, organizations often give consideration to these factors rather than assigning a finite period of time in which competency must be achieved, however, this would be an organizational decision.

When determining competency requirements, consideration should be given to needs of its patient population, the types of procedures conducted, conditions or diseases treated, the kinds of equipment it uses, and applicable law/regulations. Competency assessment then focuses on specific knowledge, technical skills, and abilities required to deliver safe, quality care.

Competency assessments for knowledge and technical skills intrinsic to an individual's professional education are generally not required. For example:
  • Administration of oral, IM or sub-q medications may be intrinsic to professional education, but the use of a programmable infusion pump for IV administration may be a required competency.
  • Basic assessment skills, such as heart/lung sounds may be part of education, but assessment skills required to care for patients on a neuro-surgical unit may require advanced competency assessments in evaluating a patient's neurological status.
  • Basic infection prevention and control knowledge may be part of education, however, knowledge and skills related to sterile technique, sterilization, and high-level disinfection would be competencies expected of an OR Nurse, surgical assistants and sterile processing staff.
For hospitals: Because of the complexities of the healthcare environment, organizations are expected to define competencies for those individuals responsible for maintaining a safe physical environment as well as the equipment available for use. 
Survey activities will focus on the organization's requirements, compliance with evidence-based guidelines, standards of practice and regulatory requirements. The accreditation requirements that address orientation and competency are found in the Human Resource (HR) chapter of the accreditation manual. Each Joint Commission-accredited organization has a copy of the manual containing these requirements.
Manual: Hospital and Hospital Clinics
Chapter: Human Resources HR
Last reviewed by Standards Interpretation: April 18, 2022 Represents the most recent date that the FAQ was reviewed (e.g. annual review).
First published date: August 28, 2017 This Standards FAQ was first published on this date.
This page was last updated on March 18, 2024 with update notes of: Editorial changes only Types of changes and an explanation of change type: Editorial changes only: Format changes only. No changes to content. | Review only, FAQ is current: Periodic review completed, no changes to content. | Reflects new or updated requirements: Changes represent new or revised requirements.
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