The “Expertise Advancement System for Primary Care Nurses” is implemented to improve nurses’ clinical expertise and encourage staff development. Studies confirm that the clinical skill rating system can determine nurses’ skills and create a learning climate that increases professional values and capabilities. For years, the percentage of nurses at this unit who won promotion remained unsatisfactory. The main reason for lack of promotion was low case report writing and review pass rates. Clinical nurses often complained about writing difficulties, which led to their reluctance towards advancement. The intention of improving the situation and seeking viable solutions motivated this unit to organize a project team responsible for coaching our nurses in case report writing. The goal was to improve their writing skills as well as the review pass rate of their case reports, thereby driving their development in clinical expertise and enhance the integration of clinical practices so that patients can receive high quality nursing and care.
This study was conducted in three stages, namely, planning, execution and appraisal. In the first stage: the project team was created. Through interviews and literature review, the team members uncovered the following reasons for the low case report writing rates among nurses at this unit: 1) inadequate writing composition skills, 2) lack of mentor guidance, 3) lack of educational programs for case report writing at the unit, 4) low motivation for writing reports, and 5) absence of a report writing climate at the unit. In the second stage: the project team was engaged in discussions and outlined viable solutions by using a decision matrix and examining their viability, convenience, required manpower and costs, and effectiveness. Based on the results of their analysis, the team decided on and implemented the following solutions: 1) boosting awareness of the significance of the advancement system to promote the climate that encourages case report writing, 2) providing seeded mentors and creating a faculty database, 3) planning case report writing programs, 4) meeting with staff willing to write and setting deadlines for the completion of case reports, and 5) arranging experience sharing by staff whose case reports have passed reviews. In the third stage: the team compared the results before and after the project implementation and conducted appraisals based on the list of accepted case reports for November 2013 published by Taiwan Nurses Association.
During the project implementation by the unit, 11 case reports were completed and submitted for review in June, 2013. Appraisal results show that 8 of the reports passed the review by Taiwan Nurses Association at the end of November, 2013. Our staff became more aware of the importance of nursing expertise through case mentors provided and programs related to case reports planned and launched by the project team, experience sharing, awareness raising activities regarding the significance of the expertise advancement system, and the creation of a culture that encourages report writing. As a result, staff followed the arrangements by the project team and actively participated in related programs and case report writing Staff’s case report writing rate increased from 18% to 64% and their review pass rate from 33% to 72.73%, both surpassing the 50% project target. The results proved the significant effectiveness of the project implementation.
As the project progressed, it was noted that staff writing case reports were three times more than mentors. To maintain individual coaching and coaching quality, it was sometimes necessary to request mentoring support from external entities. This was in fact one limit of this project. Therefore, training mentors and creating a mentoring faculty database is the next target of the unit. In addition, education and training for nurses, their clinical experiences and a climate that encourages advancement all have an impact on the development of personal capabilities. In this sense, the review pass rate of case reports is directly linked to the improvement of the ability to assess clinical professional nursing. The project implementation successfully reduced the difficulty of writing case reports, boosted confidence in writing reports, and created a culture that encourages report writing at the unit. All of these incorporated into patient-centered holistic nursing in clinical practices can achieve effective nursing and enhance the ability to analyze and deal with patient problems, thereby improving quality of care provided by nursing staff.
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