Thursday, 15 July 2010
Learning Objective 1: Discuss the challenges faced when nursing staff are cross-trained as a strategy to address health human resource and patient care issues.
Learning Objective 2: Describe the importance of strategies such as adequate time for competency development, mentorship from experienced peers, and education to the success of nursing staff cross-training.
Cross-training of nurses is a strategy that is being used in health care settings to address human health resource and patient care issues. Nephrology nursing competency requirements are diverse and vary from the care of general nephrology, peritoneal dialysis, hemodialysis or renal transplant patients to a combination of these patient types. Inpatient unit nephrology nurses often have the broadest focus and utilize an amalgamation of competencies to provide care. In planning an Incentre Nocturnal Hemodialysis (INHD) program, our inpatient nephrology nurses were mandated to receive additional training in hemodialysis procedures. These nurses were previously equipped with general nephrology, peritoneal and renal transplant competencies. Little remains known about the effectiveness of cross-training of nurses. As such, a study was designed to explore the perceptions and experiences of registered nurses performing multiple roles in nephrology care provision.
A qualitative descriptive design using content analysis was employed to explore RN experiences and perceptions associated with a multi-skilled approach to nephrology patient care delivery. Key informant interviews using a semi-structured interview guide were conducted.
The following 3 key themes emerged from a sample of 17 registered nurses: 1) building competence/confidence through mastery of hemodialysis equipment and practices; 2) achieving a sense of enhanced holistic care delivery through increased autonomy; and 3) gaining confidence and accepting the new role over time.
Implications for Nursing:
This qualitative study suggests that inpatient nephrology nurses who are asked to take on hemodialysis skills are encouraged by the experience and perceive themselves to be more competent when caring for admitted dialysis patients. Key to this success is the provision of adequate time for competency and knowledge mastery, and strong mentorship from experienced peers.