Day one:
Spent my morning at a session that introduced TeamSTEPPS facilitated by TeamSTEPPS trainers Tammye Erdmann MSEd, BScIT, RN, CHSE and Cathy Peterson, BSN, RN.
I have wanted to bring TeamSTEPPS into my lab classes and sim lab for a very long time, but I needed to learn more about it and understand the components of it. I gained a great deal of knowledge about the processes. I think TeamSTEPPS would make a great framework for building simulation scenarios, too. The tools such as SBAR and I PASS THE BATON to set up the scenario and patient information. Using the briefing model as a guide for developing the (pre-) brief for the students. TeamSTEPPS even has a debrief checklist.
So added to my to-do list for future development – planning/developing a communication scenario for first quarter students.
Dr. Kristina Thomas Dreifuerst RN, ANEF, CHSE: Afternoon presentation regarding debriefing across the curriculum. Great concepts. I have heard some of this before (at IMSH), but she presented more detailed guidance and examples of classroom discussion using a debriefing methodology rather than simply lecture and rapid fire questioning. Her emphasis is on Socratic questioning and the focus on why rather than what. (How is important too)
Dr. Suzie Kardong-Edgren RN, CNE, ANEF: Moving towards high stakes evaluation using simulation. This is a hot and complex issue. Nursing faculty love to test students-sometimes too much IMHO. And skills testing is (IMHO again) a pretty big sacred cow. (funny coming from the lab instructor). While I agree we need to measure competency in nursing grads in some way BESIDES choose one of 4 answers, I don’t think the measure of a nurse is his or her ability to perform a skill while being evaluated is the pinnacle of nursing assessment.
High stakes testing in simulation can be used in some ways for good-that is measuring how well a student can pick up changes in a patient’s status or perform the appropriate assessment. But in order to do it in a rigorous and consistent manner, the evidence, according to Dr. Edgren, shows that several elements are necessary. A SHARED MENTAL MODEL among faculty is critical. But yet it’s the last thing most nursing programs have. You have hawks and doves as evaluators- and the lack of consistency can put a high stakes evaluation program at risk. Getting all faculty on board for what the evaluation is measuring, how it is measured and then moving on to establishing consistent cut off scores is a lot of work.
The faculty need to review many videos to get a baseline for the “range of behaviors” and to establish cut off scores. In addition, it’s essential for there to be a large number of stations with different raters to ensure a balanced evaluation.
This process in the end needs to develop a “legally defensible model” because if a student’s nursing school career is based solely on high stakes simulation evaluation, then the program needs to be prepared for students to challenge the process- and there are litigators dedicated to helping these students out.
Personally, while I think done correctly this process could provide nursing with a valuable way to determine competency, I think that a competent nurse looks like a lot of different things in a lot of different settings. NCLEX is by no means the best measure of this but it’s what we have now. With the increase in delegation of tasks and skills -and considering that many of the skills we hold as so crucial to nurses to perform perfectly we now often rely on family members to perform in the home or UAPs in the clinical setting. Being a nurse is so much more than good sterile technique. In addition, many nursing skills take years to get “good at” with deliberate practice and experiencing variations in setting.
One school shared their process of using high stakes skills testing in their program because the students would be taught and tested on skills in the beginning of the program and then by their last quarter would have skill decay, the practice partners were saying they had to “teach them everything again”. So they gave them a high stakes skills evaluation- meaning, no chance for remediation or make up or retest- failure meant failure. (usually skills testing is performed until mastery is demonstrated). That seemed like a dramatic response to that issue. Often the hospitals will say- “Oh we just want them to be able to think critically, we can teach them skills” and then turn around and complain “these new grads don’t know how to do any skills”…. but it’s all a symptom of a critical issue in nursing ed- filing the gap between what the schools are capable of (especially with the challenges of getting enough clinical placements for students, the lack of good learning experiences for students once they at the clinical sites and the overwhelming amount of information we need to dump into the student’s heads in such a short time) and what the practice partners/hospitals expect from students. The advent of residency programs has greatly supported this transition (and were mostly developed in response to the high attrition rate of new nurses who leave nursing completely in the first year), but not all hospitals can provide that. This is an issue that won’t go away soon and I think simulation will play larger role in resolving it.
Jocelyn Ludlow PhD RN CHSE CNE CMSRN 