In the midst of staffing shortages and ever-increasing patient acuity, an increasing gap in knowledge and practice was present amongst the staff of an intensive care unit (ICU). As a tertiary-care facility, the requirement to provide high-quality evidence-based care was a priority. In response to this need, a program called the professional practice update (PPU) was devised by the clinical staff. The goal of the PPU was to create an ICU clinical RN lead, evidenced-based professional development opportunity utilizing both class-room based learning and simulation scenarios resulting in increased clinical competency, professional practice ownership, and improved patient outcomes.
Relevance/Significance:
There were no formal positions devoted to education and in the time of need, a team of ICU clinical RNs completed a competency assessment to determine gaps in clinical knowledge. Specialty-specific learning needs were identified and utilized to shape the PPU program. It was also acknowledged that a collaboration amongst clinical RNs, educators, and physicians was necessary to create a comprehensive learning experience. By engaging all clinical experts, embedding evidence-based nursing practices, and modifying current education strategies to support adult learning the PPU was developed and supported professional autonomy enculturation.
Strategy and Implementation:
A group of engaged clinical RNs chose relevant topics to include in the PPU based upon the findings of the competency assessment as well as the results of a qualitative needs assessment. The method of delivering information and validating clinical competence was chosen based upon previous practice, known performance opportunities and available resources. Simulation was chosen to validate competence of high-yield, high-complexity skills and class-room based learning was leveraged to provide new knowledge.
The clinical RNs partnered with nursing leadership and physicians to create the education and competency validation stations. Each clinical RN who lead the PPU had their competency and ability to teach validated by one of the partnering physicians. Nursing leadership assisted with class enrollment, scheduling and communicated with all staff the importance and relevance of the PPU. The 8-hour training day was also made mandatory to meet regulatory requirements, ensure staff competence and promote elevation of professional practice.
Evaluation/Outcomes:
The success of the PPU was evaluated using data from the General ICU and Advanced Dysrhythmia Interpretation Prophecy® Assessment in 2017 and 2018. In 2017, the mean score for Advanced Dysrhythmia Interpretation was 68% (n=77) and in 2018, the mean score was 78.8% (n=72). For General ICU knowledge, in 2017 the average score was 73.6% (n=77) and in 2018 increased to 77.6% (n=72). The increase in both scores demonstrates an overall increase in clinical knowledge.
Implications for Practice:
Due to the leadership of the RNs who created the PPU, their peers were inspired to improve their professional practice and obtain specialty certifications. From 2017 to 2018 the number of certified RNs increased 47% in the ICU. The PPU format also spread to other inpatient units. Additionally, the RNs who led the PPU remain actively involved in policy revisions and practice changes throughout the hospital. They are the leaders of their profession.
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