Improving Quality and Safety Through Simulation for Ambulatory Nurse Orientation and Competency Validation

Purpose:
Our medical group consists of over 180 practices located in VA and NC. Prior to 2012 there was no orientation for new staff or annual validation of competencies. Low tech and mobile simulation equipment is now utilized for training to improve the quality and safety of care provided patients.

Relevance/Significance:
A gap analysis to assess staff education needs identified knowledge deficits related to infection control, medication safety and emergency situation management. Due to a geographically challenging situation innovative and mobile education and training was provided. A monthly orientation for new hires provided classroom training and skill stations. Additionally site specific annual skills were implemented and competency training and validation was done at the practice site level.

Strategy and Implementation:
Simulation is a valuable resource in the training of clinical staff. Low tech and mobile simulation equipment is especially innovative as well as taking the "skills day" to practice sites. Once education needs were identified, equipment was purchased to foster hands on training and a monthly required clinical orientation program was established. Classroom training is followed by simulation stations that include injections, PPD placement, BPs measurements, emergency care, nebulizer treatments, ear irrigations, suture and staple removal and wound care. In addition an annual "skills day" is provided to individual practices and annual skills training varies based on identified needs. Medication safety and BP measurements are always required.

Evaluation:
A course evaluation is emailed to each clinical orientation participant following class. Review of results show that 92% of participants rate the overall program as a "4" or "5". Comments on the survey are very positive about the subject matter presented and the use of simulation for the skills stations. From the comments,additional educational opportunities are identified.

Implications for Practice:
New hire orientation and annual skills competency validation are an integral part of ensuring safe, quality nursing care. Use of low tech and mobile simulation equipment facilitates competency validations in a large geographically challenging clinical staff model.