Nursing Annual Review


Blog post by SimGHOSTS USA Officer Mark Johanneck.

Roughly 1,500 nurses, nursing assistants and techs, over 450 mock codes, 4 deliberate practice skills stations, 2 high-fidelity manikins, and 175 hours spread over the course of 18 days utilizing 12 rooms.  This is our current undertaking as we bring over 90% of our hospital nurses through the simulation lab as part of their annual review process.  It takes a herculean effort on the parts of the nursing educators and simulation staff as well as support and buy-in from the hospital administration.  All of the time, effort, and resources are well worth it when we know it increases confidence in our nursing staff which in turn improves patient outcomes.

The Joint Commission mandates certain requirements for nursing competency assessment.  A process, Nursing Annual Review, was developed utilizing simulation to centralize and improve our facility’s hospital wide annual competency assessment.  For hospital wide simulation curricula, gaining internal political support is an important part of implementation.  A way to gain internal support is through conduction of a curriculum pilot.   This ensures adequate resources are allocated and sustainability of the program.  The Nursing Annual Review pilot explored curriculum with simulation integration on approximately 300 nurses.  Curriculum topics included, BLS and ACLS focused mock codes, safe patient handling, Central Line Associated Blood Stream Infections (CLABSI) prevention with central line maintenance protocols, restraints, telemetry testing, critical thinking skills, and demonstration of glucose monitoring.  To match appropriate methodologies to objectives, Nursing Annual Review utilized a plethora of simulators ranging from low-fidelity task trainers, such as intravenous arms, to high-fidelity manikins, such as Laerdal 3G.  The results collected demonstrated high face validity and high satisfaction scores from participants with incorporation of simulation into their annual review requirements.   Nurses appreciated having a chance to participate in simulation instead of reviewing content on a Computer Based Test (CBT).  They noted that having the chance to have hands-on, deliberate practice ensured them that their psychomotor skills were sufficient.  Nurses’ denoted anecdotal qualitative comments, such as, “I feel more competent administering lifesaving protocols on the floor after having the chance to practice and receive immediate, formative feedback.”  Another benefit gained from conducting the pilot was that the curriculum facilitator made a point to staff the sessions with nursing hospital leadership, for example the Vice President of Nursing and Patient Safety, Nurse Managers and the Director of Nursing Quality.  This not only provided a way to demonstrate to leadership the importance and necessity of nursing staff having the opportunity for annual hands-on practice, but it also provided a venue for open conversation between administration and nursing staff.  This dialogue was beneficial in multiple avenues, it allowed nursing staff to feel their opinions and feelings were valued amongst administration and encouraged the growth and support of nursing staff for the organization.  Overall, this approach allowed all parties to come together and feel as if they had stake within the initiative.

Once the pilot year was completed and questionnaires’ were collected the overall consensus was that the initiative should be expanded hospital wide.  Our simulation lab is now in the fourth year of being an integral part of the nursing annual review process and I don’t think there is any looking back at this point.  Each year we learn how important and essential this review is for nursing staff.  Some of the interesting teachable moments we have witnessed include uncertainty of the defibrillator functions, confusion around compressions-to-breaths ratio, misperception of pad placement, and one scary incident of manikin mouth-to-mouth resuscitation.  These incidents confirmed the undeniable need for simulation based training.  As we continue forward the interest in simulation hospital wide continues to grow and we look forward to new collaborations and challenges to overcome.