Clinical Simulation Training to Increase Medical Surgical New Graduate Registered Nurse (NGRN) Confidence and Competence When Caring for Deteriorating Patients: A Quality Improvement Project

Problem: Patient harm from preventable cardiac arrest continues despite implementation of Rapid Response Teams (RRT) in the hospital setting. Medical surgical NGRNs lack adequate practice experience to prepare themselves with the competency skills necessary to manage high acuity patients in a complex healthcare environment. An awareness of a lack of readiness for practice leads to low NGRN self-confidence. Deficiencies in NGRN self-confidence and clinical competence lead to an inability to recognize and respond to patient complications with subsequent ineffective use of the RRT. Failure to Rescue (FTR) is one of the top three medical errors committed by NGRNs. Current evidence supports additional education on deteriorating patients within the residency period using clinical simulation training (CST). Purpose: The purpose of this project is to increase NGRN self-confidence and clinical competence when caring for deteriorating patients using CST embedded within a NGRN hospital residency program. Methods: This quality improvement (QI) project focused on delivery of a pre-scenario educational module and deteriorating patient simulation experience with structured debriefing to medical surgical NGRNs. Results: Knowledge, satisfaction, and self-confidence scores increased post-project. Post-project competence scores did not meet minimum expected requirements. However, participants reported increased self-awareness of deficiencies and opportunities for improvement leading to enhanced assessment skills and clinical judgement. Conclusions: Clinical simulation can increase NGRN self-confidence and competence by offering practice and self-reflection leading to improved outcomes for deteriorating patients.Keywords: recognition of deteriorating patient, new graduate registered nurse, clinical simulation, confidence, competence, rapid response