Registered Nurse Cincinnati Children's Hospital Medical Center Maineville, Ohio, United States
Abstract:
Background: Simulation-based education, including bedside code training ("inSitus") and team training were introduced in the Cardiac Intensive Care Unit (CICU) at Cincinnati Children’s Hospital Medical Center in 2008. Over the next several years, patient census and acuity grew rapidly and staff vacancy rates increased. This led to increased inSitu cancelation rates and discontinuation of team training simulations. CICU leadership identified the benefits of simulation for newly hired staff and all CICU team training. In 2015, this identified benefit led to the expansion of the simulation program in the CICU. To ensure a multidisciplinary approach to this education, a dedicated simulation educator position was created. With the development of this simulation educator position, the need for simulation trained nurse leaders was identified. Further growth of the simulation programs within the CICU led to the creation of a dedicated CICU simulation nurse leader.
Methods: A formal nursing simulation team, consisting of a nurse simulation leader (role established in 2018) and seven simulation nurse facilitators was introduced in 2016. Experience, approachability, and professionalism were critical selection criteria. Formal training in simulation facilitation was provided, identical to those of physicians and advanced practice providers. The nurse simulation leader collaborated with physicians and advanced practice provider content experts to design and implement multiple simulation programs and assumed all administrative responsibility associated with simulation courses. This role was supported by weekly protected dedicated non-clinical time.
Results: Between 2016 and 2021, a total of 57 Team Safety simulations and 96 inSitus were conducted. Multidisciplinary led inSitu simulations with this group of CICU nursing facilitators started in 2016 and run rates were 58%. Following initial unit buy in, there was a slight decrease in inSitus running in 2017 and 2018, 40% and 54% respectively. After a simulation nurse leader with protected non-clinical time was added in 2018, the percentage of inSitus ran in the CICU increased from 40% to 86%. Team safety has run at a rate of 79% to 100% since the start of this program in 2016. The simulation nurse leader has become the primary nursing facilitator for CICU unit-based simulation programs this past year and has facilitated over 50% of inSitus and 80% of team safety.
Conclusion: In addition to having a dedicated simulation educator, having a dedicated and knowledgeable simulation nurse leader and simulation nursing facilitator team and is important for the success of a unit-based multi-disciplinary simulation program. Protected non-clinical time is likely beneficial in developing and sustaining this role.
