Staff Competency Starts with Knowing Your KSAs

The complexity of the health care environment requires that staff in the facility participate in educational programs that ensure they have the knowledge, skills and abilities (KSAs) to provide individualized care promoting the health, safety and welfare of the resident population.

There are competencies required by federal nursing home regulations, state nursing home regulations and other governing institutions for persons working in healthcare organizations. Some of the organizations overseeing rules and laws that apply to staff and leaders include the Occupational Health and Safety Administration, the U.S. Equal Employment Opportunity Commission, the Medicare and Medicaid Integrity Program, State and Federal labor laws, State and Federal Building codes, and practice rules for licensed, certified and registered professionals.

The Requirements of Participation outline specific competencies needed by nursing and all staff within a facility. The Implementation Checklist outlines the specific F Tags in which nursing staff and all staff competencies are described. Designing training and education programs, that coordinate with resident population needs, facility requirements, state and federal regulations and standards of practice, is expected. The overall premise is that staff have the knowledge, skills and resources to provide care and services to the resident population.

Need to Know Definitions:

Competency – is a measurable pattern of knowledge, skills, abilities, behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully. This is not dependent solely upon qualifications or licensure.[1]

Knowledge, Skills and Abilities (KSAs) – KSAs are knowledge, skills, and abilities that a staff member needs to possess in order to perform the duties of their position, aligning with their respective roles and responsibilities.

Knowledge – the understanding of concepts, the subjects, topics, and items of information that a staff member should know at the time of employment, annually or as determined necessary.

Skills – capabilities or proficiencies developed through training or hands-on experience. Skills should be measurable and observable.

Abilities – traits or talents that a person brings to their role or the facility or the job position.

All personnel who work in a long-term care facility are required to have specific knowledge and demonstrate their understanding of specific topics. There are many types of competencies expected of health care team members. While research indicates numerous functional and core competencies, skilled nursing facilities have specific competencies that are:

  • Mandatory for all Staff – These include the mandatory competencies from the Requirements of Participation
    • Preventing and reporting abuse, neglect, and exploitation
    • Change of Condition identification and notification
    • Dementia management
    • Infection Control
    • Resident rights
    • Person-centered care
    • Communication
    • Cultural competency
    • Other areas as identified through the Facility Assessment
    • HIPAA
    • QAPI
    • Emergency response (Fires, etc.)
    • Fall Prevention
    • Operation of exit alarms
    • Reporting changes in residents’ conditions
    • Competencies identified by the assessment of residents’ needs
    • OSHA
  • Mandatory for Nursing Staff – In addition to the mandatory competencies for all staff, the RoP outlines other nursing competencies
    • Competencies related to an approved nurse aide training and evaluation program
    • Medication management
    • Basic nursing skills
    • Basic restorative services
    • Skin and wound care
    • Pain management
  • Clinical Knowledge – Standards of Practice
  • Core Clinical Competencies
    • Clinical systems
    • Incident/Accident
    • Dialysis
    • Nutrition
    • Physical Assessment
    • MDS Process and Care Planning
    • Respiratory care
    • Other areas as identified through the Facility Assessment
  • Annual Training Requirements and Competencies – Per federal, state and job specific requirements
  • Facility Identified Competencies
    • Other areas as identified through the Facility Assessment
    • Facility Mission and Strategic Goals
    • Market place needs
    • Partnership requirements and expectations
    • Quality outcomes
    • QAPI outcomes and PIPs
  • State-Specific Requirements, as applicable

Leadership Considerations

The above is not an all-encompassing list; rather, providers must review its served resident population, clinical systems, technology, resources and standards of practice to develop the competency requirements for licensed and non-licensed staff.

  1. Providers must identify the residents’ needs and determine, beyond the required topics, what knowledge, skills, abilities, behaviors and other characteristics are needed.
  2. For each job category, determine the mandatory and core competencies necessary for optimal performance and quality outcomes. These competencies need to align with the respective job description.
  3. To determine competency levels and needs for staff, facility leaders may follow the below general process to target specific competencies and training needs, including:
    • Based upon the facility assessment and mandatory requirements
    • Competencies are related to your facility mission
    • Current policies and procedures for resident care and quality outcomes
    • Utilize policies and procedures as a foundation for competency development
    • Follow the KSA approach needed for individual performance and improvement needs
    • Incorporate competency process into your overall training plan
    • Align competencies with staff job descriptions
    • Incorporate competency review and monitoring process per the facility Quality Assurance and Performance Improvement Plan

Competence is a complex concept, especially in health care. At the very least, competency in health care requires evaluation of both an employee’s ability to meet job expectations and subsequently to deliver continuous, effective care and quality outcomes for your residents.


Director of Education


[1]Centers for Medicare & Medicaid Services State Operations Manual, Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 173, 11-22-17):


Pathway Health provides your organization the insight, expertise and knowledge to help ensure quality clinical outcomes to reach your desired goals.

Visit or 877-777-5463.