Monday, 18 November 2013
Stephanie Madeline Wright, DNP, RN, MSN, MBA
College of Nursing - Department of Physiological and Technological Nursing, Georgia Regents University, Augusta, GA
Jeanette Merriweather, RN, DNP, CNE, CNN
CON - Department of Physiological and Technological Nursing, Georgia Regents University, Augusta, GA
Learning Objective 1: The learner will be able to identify factors which contribute to high nurse turnover ratios for new nursing graduates.
Learning Objective 2: Discuss the benefits of a senior, undergraduate critical care course using simulation and models clinical reasoning to prepare nursing graduates for transition into practice.
The current healthcare environment is chaotic, complex and ever changing. Patients are living longer and suffer from more acute, complex conditions. Given the high incidence of medical errors, rising healthcare costs and increasing concerns for patient safety, the Institute of Medicine is challenging institutions of higher learning to adequately prepare nursing graduates to be successful in the current healthcare climate. To meet the challenge, the IOM (2010) recommends that nursing programs incorporate into their curriculum an emphasis on patient safety, evidenced-based practice, inter-professional teamwork and collaboration, as well as acute care nursing principles. According to McGaughey (2009), graduate nurses are not adequately prepared to recognize early signs and symptoms of patient deterioration due lack of training, confidence and empowerment in the care of the acutely ill. McGaughey (2009) finds that 54% of ward based patients have acute clinical signs that are missed, mismanaged or misinterpreted resulting in admission to the intensive care and contributing to more than 1/3 of the deaths that occur outside the ICU.
Furthermore, high nursing graduate turn-over has also been attributed to the lack of adequate preparation in the care of acutely ill patients in the clinical setting. Job dissatisfaction, mandatory overtime, worsening nurse to patient ratios, perceived low pay, lack of administrative support and feelings of unpreparedness among nursing graduates contributes to high nursing turnover (York & Smith, 2007). Wolfe et al., (2010) contend the ever expanding role of nurses have made it essential for new graduates to transition into practice in the workforce seamlessly. Offering an advanced medical surgical critical care course that incorporates evidenced-based teaching strategies such as simulation and the Outcome Present State (OPT) model of clinical reasoning can help bridge the gap between undergraduate nursing education and transition into clinical practice, creating a win-win situation for all.
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