Arizona Nurse - April 2021

More documents

Recommendations

Info

Page 18 • Arizona Nurse April, May, June 2021 Virtual Simulation: Impact on Clinical Judgment Amber Kool, MSN, RN The need for newly licensed nurses to safely manage multiple complex patients requires strong clinical judgment skills to appropriately prioritize and delegate (Bittner & Gravlin, 2009). Direct patient care experiences in acute care settings are the typical way nursing students learn clinical judgment. However, these clinical experiences do not always provide an opportunity to collaborate, critical think, or make independent decisions that will improve patient outcomes (Lippincott Nursing Education, 2018). The most recent data from the American Association of Colleges of Nursing suggests that 80,407 qualified applicants were not admitted to baccalaureate and graduate nursing programs with insufficient clinical sites a contributing factor (2020). The COVID-19 pandemic has significantly limited direct patient care clinical experiences for nursing students throughout the U.S. (Logue et al., 2021). There is an urgent need to develop teaching-learning practices that will support the development of clinical judgment as both an augment and substitution for direct care clinicals (Thobaity & Alshammari, 2020). This study investigated the impact of a virtual simulation (VS) (Sentinel U’s Patient Management and Delegation and Prioritization of Care) on clinical judgment in a sample of pre-licensure BSN students. VS utilizes experiential learning as identified by Kolb’s Experiential Learning Theory (1984) to expose the learner to a new experience and requires the student to reflect, thereby integrating the learning into their knowledge bank (McLeod, 2017). As learners reflect on their decisions and reasoning, they integrate their previous experiences and the new knowledge gained through the VS. Design Using a one-group, repeated measures design, a paired-samples t-test was used to measure the change in perceived clinical judgment pre to post-VS intervention. The Skalsky Clinical Judgment Scale measures the construct using a four-point Likert Scale, with ten questions, which include assessing perceived abilities in prioritization, delegation, and communication. Major Findings There was a statistically significant increase in perceived clinical judgment scores from preintervention (VS) (M = 32.17, SD = 4.178) to postintervention (VS) (M = 34.10, SD = 4.992), t (41) = 2.832, p < .007 (two-tailed). The mean increased in perceived clinical judgment scores was 1.929 with a 95%. Discussion The positive results suggest that VS may be useful to support teaching-learning practices related to clinical judgment development. Perceived increases in clinical judgment may make students more confident and encourage them to practice skills further. Further research is needed to objectively measure clinical reasoning and resultant patient outcomes that result from the use of VS as a teaching-learning strategy. Implications for Nursing the Nursing Profession Recent evidence suggests that only 10% of newly licensed nurses score within an acceptable competency range using a performance-based (Kavanagh & Sharpnack, 2021). The most recent practice analyses by the National Council of States Boards of Nursing suggest that newly licensed RNs are increasingly required to make more complex clinical decisions (2015, 2018). COVID-19 exacerbated existing pre-licensure nursing education challenges by further limiting already scarce clinical practicum sites (Dewart et al., 2020). VS may be a useful addition to direct patient care and high fidelity human patient simulation to learn clinical reasoning skills. VS may be helpful as an additional strategy in addressing the critical nationwide shortage of clinical practicum sites. Also, VS may bridge the gap in clinical learning experiences during times when other opportunities may not exist, such as experienced during the COVID-19 pandemic and in times of emergencies and natural disasters. VS may likewise prove beneficial for skill development or assessment within clinical agency orientation and continuing competency efforts. Similar to its use in the academic environment, VS within practice and continuing education provides a safe environment to make decisions without potential harm to patients (Verkuyl et al., 2019). In conclusion, given the evolving technology that underpins VS and its increasing fidelity, the interest in and application of VS in academic and practice environments will likely increase. Nurse leaders will be challenged to implement VS in evidencebased ways and monitor and measure outcomes to assure its value. References American Association of Colleges of Nursing. (2019). Nursing shortage. Retrieved from https://www. aacnnursing.org/news-information/fact-sheets/ nursing-shortage Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. JONA: The Journal of Nursing Administration, 39(3), 142-146. doi:10.1097/nna.0b013e31819894b7 Dewart, G., Corcoran, L., Thirsk, L., & Petrovic, K. (2020). Nursing education in a pandemic: Academic challenges in response to COVID-19. Nurse education today, 92, 104471. https://doi. org/10.1016/j.nedt.2020.104471 Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in Competency: A Defining Moment in Nursing Education” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1, Manuscript 2. DOI: 10.3912/OJIN.Vol26No01Man02 Lippincott Nursing Education. (2018, June 7). Turning new nurses into critical thinkers. Combining Domain Expertise With Advanced Technology | Wolters Kluwer. https://www.wolterskluwer. com/en/expert-insights/turning-new-nurses-into critical-thinkers Logue, M., Olson, C., Mercado, M., McCormies, C.J., (January 31, 2021) “Innovative Solutions for Clinical Education during a Global Health Crisis” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1, Manuscript 6. DOI: 10.3912/OJIN. Vol26No01Man06 National Council of States Boards of Nursing. (2015). 2014 RN Practice Analysis: Linking the NCLEX- RN Examination to Practice - U.S. and Canada. 62. https://www.ncsbn.org/15_RN_Practice_Analysis_ Vol62_web.pdf National Council of States Boards of Nursing. (2018). 2017 RN Practice Analysis: Linking the NCLEX- RN Examination to Practice - US & Canada 72. https://www.ncsbn.org/17_RN_US_Canada_ Practice_Analysis.pdf McLeod, S. (2017, February 5). Kolb’s learning styles and experiential learning cycle. Retrieved from https://www.simplypsychology.org/learningkolb.html Sentinel U. (2020, November 30). Nursing prioritization exercises. https://www.sentinelu. com/solutions/prioritization-and-delegation/ Skalsky, K. (n.d.). Skalsky Clinical Judgment Scale validity. American Sentinel University Thobaity, A., & Alshammari, F. (2020). Nurses on the Frontline against the COVID-19 Pandemic: An Integrative Review. Dubai Medical, 1-6. https:// doi.org/10.1159/000509361 Verkuyl, M., Hughes, M., Tsui, J., Betts, L., St- Amant, O., & Lapum, J. L. (2017). Virtual gaming simulation in nursing education: A focus group study. Journal of Nursing Education, 56(5), 274- 280. doi:10.3928/01484834-20170421-04 NOW HIRING! Day and Night Shifts For the following positions: • Certified Nursing Assistants • Registered Nurses • Licensed Practical Nurses • Assistant Director of Nursing The Caring House is a state of the art facility with excellent nursing patient ratios. 12 hour shifts with great benefits and a very generous amount of PTO. Qualified applicants must have: • AZ State Certification as a Nursing Assistant & CPR Certification • AZ State Licensure as an LPN or RN & CPR/BLS certification • AZ Dept of Public Safety Fingerprint Clearance Card Please apply at WWW.GRHC.ORG/CAREERS Email Ylesia Jones at YJONES@GRHC.ORG or Call 520-562-3321 EXT. 1712 or 520-610-0595. Email Mark Walter at WWALTER@GRHC.ORG or Call 520-610-8923 (for questions on the Assistant Director of Nursing position)
April, May, June 2021 Arizona Nurse • Page 19 Practice Tips for the Independent Nurse Practitioner Because of AzNA nurses can say YES YES YES Michelle M. Anderson DNP, FNP-BC, APRN, FAANP NPI Vice-President fnpmma@yahoo.com Reprinted with permission RN Idaho, February 2021 Full practice authority has been in place in Idaho since 1998 (HB662) with removal of the Board of Medicine governance of nurse practitioners (NPs). In 2003 legislation passed removing physician supervision and the rule amendment was adapted in 2004. With this opportunity comes the option for independent NP practice. The Global Signature Authority Bill (S1240) passed in July removing some further barriers to independent practice. Owning and operating your own NP business is not for the faint of heart. Having the ability to manage all things with a side order of business acumen is incredibly important. According to data from the U.S. Bureau of Labor Statistics, about 20% of U.S. small businesses fail within the first year (Gustafson, 2020). So, given these types of statistics for failure, why even bother? NPs are not educated in graduate school on how to run a business, at least most are not. This is unusual considering how many other types of programs offer some of these options. How can you plan for success when you are never taught the basics? One way to work past this is to reach out directly to the Small Business Administration (SBA). They often offer classes, courses, and counseling to new business owners or potential business owners. They have an online learning center dedicated to a lot of the needed basics to get you on the right path. there is a strong state-wide voice for nursing nurses influence laws, rules and Scope of Practice You have made it through graduate school so utilize the brains you were given and knowledge that you have. Running a business has a lot of common-sense aspects to it. You must bring in more than you put out. You must remember to offer exceptional customer service. Equally important is having the team that you work with be engaged with the practice. A welcoming and knowledgeable receptionist and an engaging and skill oriented medical assistant or nurse are invaluable. Make sure their viewpoint is heard and acknowledged. Hire the right people into positions so you are not micromanaging the practice all the time and able to focus on the part that is the true joy – patient care! Enough cannot be said about credentialing and billing. A good biller and/or billing system is worth their weight in gold! This is how the money is collected and how you stay afloat. Compliance with the insurance companies’ requirements and awareness of the changing landscape is sometimes more than you can keep up with. Bringing in people to do the things you are not sure how to do is a smart business decision. Stay focused on your goals. Important at the start is the creation of a business plan with 1, 3, and 5-year goals. The SBA offers a free course and worksheets to get you started. You should know where you want to go and have a plan on how to get there. This may involve the number of patients associated with the practice, successful attainment and loyalty of staff or even the ability to simply hire staff. You might want to look at space and potential for growth. And above all else, you want to make sure to manage your overhead. Planning helps keep you profitable. YES YES promotion of a healthy Arizona nationally accredited continuing education Marketing of a new practice is tough for most of us, largely because we are taught in the beginning of our nursing career that everything we do is for someone else. This may be true to a point, but this is the part where you really need to shine. In order to shine you have to be willing to talk about how amazing and skilled you are and how wonderful your practice is. This might involve something unique you offer that another practice does not, or just how accessible you are to your patients. As NPs we are renowned for our listening ability. That is a phenomenal marketing point as most patients want to be heard. We are taught early in NP school that 90% of the time the patient will tell us what is wrong if we ask the right questions and listen to the answers. Another strong marketing point is to be genuine. Market in areas that are of interest to you. Perhaps you can volunteer as the healthcare provider at a sporting event, or belong to a Chamber small business group, but whatever you chose, be genuine about it. You do not need to be a guerilla marketer to be a successful business owner. Be good to your patients and they will be good to you. Word of mouth on care is such a huge way to grow a business. Take time to get to know your patients and they will recognize that and refer other like-minded patients your way. If your passion is young family care then cultivate that. Also know your limits and set up a good referral network. Your referral is an extension of you as the patient is trusting that you are sending them to another good provider. Finally, belong to your state and national NP organizations. They have access to additional resources you may need or additional expertise. Most questions that you come across have already been asked and these organizations can help save you some leg work. If nothing else, they can put you in contact with other independent NPs for support. Although you are doing this independently, you do not have to do it alone. Take that first step, do it with purpose and knowledge, confidence, skill, and finally grace. References Gustafson, K. (2020, August 7). What Is the Bureau of Labor Stats Small Business Failure Rate in 2020? LendingTree. https://www.lendingtree. com/business/small/failure-rate/ YES collaboration on the local and national level www.aznurse.org YES nurses have access to mentors and role models aznurse.org/JoinToday
Page 1 and 2: One Profession. Many Roles. The Off
Page 3 and 4: April, May, June 2021 Arizona Nurse
Page 5: April, May, June 2021 Arizona Nurse
Page 8 and 9: Page 8 • Arizona Nurse April, May
Page 10 and 11: Page 10 • Arizona Nurse April, Ma
Page 20: Health Professional Resources Healt

Arizona Nurse - April 2021

Create successful ePaper yourself

Delete template?

Save as template?