Competency in rural emergency nursing

Abstract

The purpose of this clinical project is to improve nursing competency in the emergency room (ER) of a small, rural hospital in Minnesota. The problem of developing and maintaining competency is challenging in this specific situation because critical skills are performed infrequently. The project methodology focuses on simulations of typical, critical ER patient scenarios where nurses are able to practice in a low-risk, but realistic, situation. Tools developed to support nursing performance include protocols from national, evidence-based standards, incorporating principles of teamwork adapted for small teams. Measurements of performance, teamwork and staff satisfaction were made utilizing questionnaires, rating scales, incident reports, and open discussion in real time and during simulations. System changes that should continue to support and improve nursing performance include reorganization of work flow, patient flow, relocation of equipment and medications, and a cultural change that incorporates concepts of competency and teamwork.