The Impact of a Perioperative Elective on Practice Workforce Development: Content Analysis.

PURPOSE: Developing strategies to educate, employ, and retain newly graduated nurses in perioperative (periop) settings is paramount to addressing a succession crisis with unprecedented vacancy rates. The purpose of this study was to explore the impact of a prelicensure periop elective on the decision of participants to seek and accept a periop position upon graduation and to describe their transition to practice experience. DESIGN: This study used qualitative descriptive methodology. METHODS: Virtual semistructured interviews were conducted in 2021 with 20 recent graduates of an accelerated prelicensure nursing program who completed a periop elective course. Questions focused on if they did or did not seek and accept a periop position upon graduation and, for those who accepted, explored their transition to practice experience. Data were coded using conventional and directed content analyses. FINDINGS: Three themes emerged via conventional content analysis: the impact of a prelicensure periop elective, the periop environment, and recommendations for faculty and hiring managers. Concerning directed content analyses, participants used the coping factors of situation, self, support, and strategies to navigate career transitions. CONCLUSIONS: A periop elective course delivered through academic-practice partnerships appears to be a successful strategy to address the succession crisis. Graduates were prepared to make informed decisions about entering the periop specialty.

An Examination of the Career Choices of Nursing Graduates After Completing a Perioperative Elective.

In light of the perioperative nursing shortage, academic leaders at a mid-Atlantic school of nursing and leaders of three health care systems implemented an academic-practice partnership with the goal of increasing interest in this specialty. Nursing researchers used a descriptive study design to collect data from nursing alumni who participated in the perioperative elective between 2017 and 2021. They found that 25 (38%) of 65 graduates who participated in the elective entered perioperative nursing and 38 (68%) of 56 graduates who answered a question on considering future employment as a perioperative nurse indicated they would do so regardless of their current employment status. Graduates who participated in the elective and experienced a perioperative capstone placement had low anticipated turnover scores and intended to remain in a perioperative position. Academic and health care leaders should consider academic-practice partnerships as a strategy to recruit and retain perioperative nurses.

Simulation for Neonatal Endotracheal Intubation Training: How Different Is It From Clinical Practice?

INTRODUCTION: Neonatal endotracheal intubation is a critical skill that is difficult for learners to acquire even with simulation-based training (SBT). Trainees prefer clinical experiences over SBT. The objective of the study was to explore the differences between SBT and clinical practice in acquiring neonatal intubation skills to inform mannequin design and to improve fidelity. METHODS: A basic qualitative study using semistructured interviews was conducted to determine the experience of newly competent trainees (second- and third-year neonatal-perinatal medicine fellows) and their instructors in developing intubation skills. Participants were asked to compare learning through SBT with clinical practice in terms of context, equipment, and environment. Their responses were analyzed using an inductive approach. RESULTS: Thirty-two participants (20 fellows and 12 faculty) indicated that SBT does not equal the real experience. Specifically, the look, feel, and function of the simulators differ enough from the real patient and the clinical environmental that they do not elicit the desired learning responses. The clinical environment prompted heightened emotions and had a chaotic atmosphere that was not fully captured by SBT. Participants suggested that programs use SBT in the initial phases of training only to gain basic skills and they provided several solutions for mannequin and SBT session design. CONCLUSIONS: Simulation-based training does not fully prepare neonatal-perinatal medicine fellows for neonatal intubation. Mannequins with unique active features, such as multiple airway configurations, slipperiness, secretions, and softer textures should be developed. Realistic environments that replicate the interprofessional nature and stressors of the clinical environment might better prepare learners for the complexity of clinical practice.

Evaluation of Communication and Safety Behaviors During Hospital-Wide Code Response Simulation.

INTRODUCTION: To understand the baseline quality of team communication behaviors at our organization, we implemented institution-wide simulation training and measured the performance of safety behaviors of ad hoc teams in emergent situations. METHODS: Clinicians participated in 2 interprofessional video-recorded simulation scenarios, each followed by debriefing. Using a standardized evaluation instrument, 2 reviewers independently evaluated the presence or absence of desired team safety behaviors, including escalating care, sharing a mental model, establishing leadership, thinking out loud, and identifying roles and responsibilities. We also scored the quality of sharing the mental model, closed-loop communication, and overall team performance on a 7-point scale. Discordant reviews were resolved with scoring by an additional reviewer. RESULTS: A total of 1404 clinicians participated in 398 simulation scenarios, resulting in 257 usable videos. Overall, teams exhibited desired behaviors at the following frequencies: escalating care, 85%; sharing mental models, 66%; verbally establishing leadership, 6%; thinking out loud, 87%; and identifying roles and responsibilities, 27%. Across all reviews, the quality of the graded behaviors (of 7 points) was 2.8 for shared mental models, 3.3 for closed-loop communication, and 3.2 for overall team performance. CONCLUSIONS: In a simulation setting with ad hoc teams, there was variable performance on completing safety behaviors and only a fair quality of graded communication behaviors. These results establish a baseline assessment of communication and teamwork behaviors and will guide future quality improvement interventions.

Improving Communication Through Resident-Nurse Shadowing.

BACKGROUND: Previously, reduced resident hours, multiple ways to communicate (text paging, calling), and fewer opportunities for face-to-face communication had led to increased frustration from residents and nurses in our institution about communicating and prioritizing patient care needs. It was thought that a shared understanding and improved teamwork and communication between residents and nurses might be achieved if the residents could watch the nurses' workflow and observe their care priorities. OBJECTIVES: To understand the experience of residents and nurses who had participated in a novel 4-hour nurse shadowing experience conducted during the first year of pediatric medical residency in a children's hospital. METHODS: We undertook a basic interpretive qualitative study by using semistructured interviews to formally evaluate the shadowing program by examining the experiences of both the first-year residents and the nurses being shadowed. Residents and nurses who had participated in the past 3 years were eligible for inclusion in the study. RESULTS: Seven themes emerged that supported the overarching theme of improving communication between residents and nurses. Shadowing led to improved resident understanding and appreciation of nurses' work. Both residents and nurses experienced enhanced relationships as they discussed opportunities to improve care delivery. Residents reported practice changes after shadowing a nurse. Peer relationships formed among the dyads that extended beyond the shadowing experience. CONCLUSIONS: Shadowing a nurse proved to be a valuable experience that had an impact on participants and potentially a positive impact on patient care.