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From the desk of Adrianne Avillion, DEd, RN

Staff Development Weekly: Insight on Evidence-Based Practice in Education, May 14, 2010

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Editor's note: Welcome to our new feature written by staff development expert Adrianne Avillion. Each week, Adrianne will write about an important issue in the area of staff development or answer reader questions. If you have a question for Adrianne, e-mail her at adrianne1@comcast.net.

Q: I work as the only staff development specialist in a 150-bed community hospital in a rural setting. Since we don't have advanced critical care capabilities, we send our critically ill patients to a larger hospital about 30 minutes away. There have been no adverse consequences to our patients and we are quick to recognize the need for transfer. Recently, some of our physicians have approached administration with the idea to have all RNs become ACLS certified as they think this will let our hospital provide critical care until EMS transports the patient to the other hospital. Our nurses are both indignant and frightened. Most have no critical care background and are concerned about the legal and ethical issues regarding performing ACLS procedures rarely, if at all. The director of nursing and administrator have not yet made a decision. How do I convince them this is a bad and dangerous idea?

A: I agree with you that asking nurses to perform high risk, low volume skills in this type of situation is a bad idea. First, start by arming yourself with available evidence that shows your current procedures of early recognition and quick transport are working.

Then enlist the help of your EMS colleagues and critical care staff at the larger facility. They should be able to help you explain that ACLS nurses need frequent opportunities to initiate procedures such as intubation. Do a literature search to obtain data that supports the idea that critical care skills cannot be safely performed on an infrequent, PRN basis. Have a frank discussion with your director of nursing and share the evidence that you collect. It would also help to include your medical staff in some discussions.

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