Training and assessment tips for ED nurses

Nurse Leader Insider, March 4, 2005

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If you've ever wondered what sets ED nurses apart, then you've never been to the unit on a busy Saturday night. These fast-moving, quick-thinking nurses must be generalists and knowledgeable in so many different skills-which makes assessing their competency a challenge.

"ED nurses have to be ready for anything that walks through that door," says Patricia Walters-Fischer, RN, BS, a 10-year veteran of nursing who most recently worked at Children's Medical Center Dallas.

Because ED nurses must be prepared to handle all situations, they must have a wider spectrum of knowledge, says Walters-Fischer. The clinical educators at Children's agree, so to meet this need they modified some of the facility's education, training, and competency assessment programs to be more effective in the ED, says Penny Williams, RN, director of emergency services for the medical center.

"One of the ways that we help nurses prepare for caring for different patient populations is by giving them clinical practice guidelines," says Williams. For instance, if a child comes in with sickle cell anemia and a fever, the nurse can refer to the guidelines for the usual management of that disease process. The guidelines list the skills, knowledge, and tests necessary for caring for that patient. The skills listed within the guidelines are monitored throughout the year and assessed annually, says Williams.

Another resource vital to the training and competency assessment of ED nurses is the preceptor. Williams explains that within critical care settings there are multiple caregivers involved in the care of the patient, and seasoned ED nurses often function as preceptors and give newer nurses the valuable feedback that they need.

Handling those tricky high-risk, low-volume skills

Another way the clinical educators at Children's train and assess competency for difficult high-risk, low-volume skills is through monthly critical care meetings, says Williams.

Critical care sessions are used to update ED staff on the information and skills they need to know. This is done through lecture and discussion, and there is time built in to provide psychomotor review of skills that are infrequently used, says Williams.

The meetings are lead by clinical educators and are for all critical care nurses. The nurses must attend a minimum number of meetings, and if they do not meet the requirement, they will not be assigned to critical care areas.

Attending physicians and trauma surgeons also often frequent the meetings to listen to the nurses' concerns, talk about any issues, and brainstorm possible solutions. "It is a very participative session, and it is a collaborative from both the medical and clinical sides," says Williams.

A lot is accomplished through this group setting because it gives everyone the opportunity to talk to one another and address any common concerns, says Williams. "In fact, it is one of the most well-attended staff counsels in our department," she says.

The critical care meetings are also perfect for assessing staffs' competencies. This can be done by

  • observation
  • simulation
  • verbalization

Children's is also implementing a skills lab that will be offered on a quarterly basis. It will be used to assess nurses on low-volume, high-risk skills they did not have the chance to practice in real time, says Williams.

Source: Adapted from Competency Management Advisor (February 2005), published by HCPro, Inc.

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