SON, ECMC partner to improve novice nurses’ clinical judgment

The School of Nursing is working to improve novice nurses’ clinical judgment in critical situations through a “high-fidelity simulation” training program in partnership with the Erie County Medical Center.

The ongoing program involves entry-level ECMC registered nurses and supervisors visiting labs at the School of Nursing every month and working with “high-fidelity mannequins” that simulate human symptoms in an effort to prevent “failure to rescue” situations in hospitals.

“ECMC wants to help improve clinical judgment and decision-making skills of their nurses,” says Donna Fabry, clinical associate professor and coordinator of pre-licensure programs at the SON.

“Nurses are so busy multi-tasking and prioritizing patient care during their shifts that sometimes important cues are missed that are signaling deterioration in their patient’s condition.”

The hope is that participation in the program will enhance the nurses’ ability to recognize and analyze subtle changes in patient condition and help guide their actions to improve patient outcomes, Fabry explains.

“What’s happening is seven hours into their 12-hour shift, all of a sudden, the patient’s blood pressure bottoms out and you call a code,” she says.

“What happened during those previous seven hours? Why didn’t those nurses catch those cues?”

At their disposal is the School of Nursing’s simulation lab, which includes high-fidelity mannequins in a realistic hospital environment. The mannequins simulate real patients: speaking, breathing, having a pulse and blood pressure, and reacting in real time to the actions of participants. The nurses must respond to the mannequin as if it were a real patient.

The training in nursing clinical judgment addresses what researchers have described as a “deficit in entry-level nurses.” Studies have shown that 76% of these nurses did not meet expectations of good clinical judgment, Fabry says. The research also indicates that 50% of these entry-level nurses were “directly involved in errors” and 80% of employers were not satisfied with the decision-making abilities of novice nurses.

“Simulation is a teaching method that allows us to provide these newly hired nurses with realistic critical patient scenarios and support them through the decision-making process, giving them tools to better recognize and respond to cues in the clinical setting,” says Kelly Foltz-Ramos, director of simulation and assistant professor in the School of Nursing.

The simulation activities are overseen by Fabry, Foltz-Ramos and Catherine M. Mann, assistant dean for undergraduate studies and clinical associate professor of nursing. These activities are organized in collaboration with ECMC nurse educators Mary Rhinehart and Sarah Maggio as part of the medical center’s orientation process for new hires.

The initiative’s main objective is to improve the novice nurses’ clinical judgment skills and confidence level when making clinical judgments in practice, Mann explains. The clinical team integrates the National Council of State Boards of Nursing Clinical Judgment Measurement Model to break down and interpret subtle patient and environmental cues as a patient condition changes. The nurses’ ability to identify these changes depends on their knowledge level, past experience and context of the situation. Early, proper identification of changes leads to prioritization of actions, nursing interventions and positive patient outcomes, Fabry says.

ECMC normally sends between six and 24 newly hired registered ECMC nurses to UB for the training. While the program is currently on hold due to the COVID-19 crisis, UB anticipates resuming the collaboration when the university is open again for on-campus learning.