Content area
Background
Intraprofessional simulation and training in acute care nursing specialties can generate synergies that will promote safe, quality patient care.
Method
Implementation of multiple intraprofessional simulations across the life span allowed for sharing of faculty and simulation resources. Simulations encompassed both adult and pediatric patients and consisted of airway skills, point-of-care ultrasound, and a multi-skills day encompassing vascular access experiences, chest tube placement, and lumbar puncture.
Results
During 5 years, 235 graduate students across three advanced practice nursing specialties participated in the intraprofessional simulation. Learner feedback showed improved confidence, benefit to future practice, and improved clinical judgment via these intraprofessional simulations.
Conclusion
Future development of standardized and validated assessments to evaluate each skill will provide quantitative metrics for each clinical skill set and patient population. Further, additional initiatives will include both continuing and expanding intraprofessional simulation offerings, as well as developing interprofessional simulations with physician assistant and perfusionist colleagues. [J Nurs Educ. 2025;64(7):e64–e67.]
Full text
Modern-day health care presents unique challenges for health care providers, including highly complex patients with multiple comorbid conditions, rising health care costs, and increased provider specialization (Institute of Medicine [US] Committee on the Health Professions Education Summit et al., 2003). Increasingly, advanced practice registered nurses (APRNs) are collaborating across nursing specialties to lead patient care. To provide high-quality care, APRNs must communicate effectively and understand the roles, capabilities, and strengths of their counterparts (International Nursing Association for Clinical and Simulation Learning, 2021).
Intraprofessional education is integral to APRNs learning to collaborate across specialties. By learning with and from other APRN specialties, providers have an increased ability to appreciate the knowledge and skills of other APRN roles, allowing for synergism in patient care. In critical care areas, where patients have life-threatening illnesses or injuries, this collaboration and synergy can facilitate safe, quality care to optimize patient outcomes. To ensure all APRN specialties meet minimum competence, each APRN accreditation board (e.g., Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Program) has specific standards. While these standards are unique for each APRN discipline, there are common skills and knowledge between specialties. Further, the American Association of Colleges of Nursing (AACN) requires adherence to The Essentials: Competencies for Professional Nursing Education aimed at ensuring quality in nursing education, which include an entire domain addressing interprofessional partnerships (AACN, 2021).
Transitioning from bedside nurse to APRN requires an increase in responsibility and knowledge. Particularly in critical care settings, clear communication and a strong understanding of one's own professional knowledge and skills, as well as other APRN roles, will be imperative for the successful shared responsibility of caring for patients. Intraprofessional simulations in primary care settings, including telehealth, have been discussed in the literature (Boothby et al., 2019). Much less is known about the impact of intraprofessional simulations across APRN roles in acute care settings and specialties. Intentional breakdown of silos of graduate student specialties allows cross-pollination of skills and knowledge and must be meaningful and appropriate for all APRN learners.
Simulation activities provide an optimal environment for learning and collaboration across population foci and APRN clinical specialties. Our learning objectives were for students to: (1) apply and practice acute care psychomotor skills in a simulated environment, (2) explore both the common aspects and limitations of acute care skills across populations and APRN specialties, and (3) highlight how various APRN roles can work together in crisis (e.g., airway emergency) using their overlapping expertise.
Teaching Methods
Airway Skills Day
The initial skills day in 2018 included adult-gerontology acute care nurse practitioner (AGACNP) students focused on airway skills. The didactic component was delivered by an intensivist. However, faculty felt it was not targeted to the students' needs. Subsequently, a collaboration began in 2019 with the working premise that acute care specialties of registered nurse anesthetist (RNA), acute care pediatric nurse practitioner (ACPNP), and AGACNP students may encounter patients from a variety of ages and sizes, and therefore, have common skills acquisition needs. For example, the ACPNP routinely encounters pediatric adolescent patients that are adult-sized, and an AGACNP working in a community emergency department could encounter an infant or child they need to stabilize until pediatric-trained providers are available. RNA competencies include patients from across the life span (
Student prebriefing for the airway skills day included preparatory reading and review of airway videos. After the “across the life span” lecture, students were assigned to groups to assure heterogeneity of specialty backgrounds. Students then rotated through three adult and two pediatric stations, a porcine model, and a mechanical ventilation station:
Adult stations: basic life support skills and advanced airway skills, including intubation with various adjunctive tools Pediatric stations: basic life support skills, laryngeal mask airways, and intubation on both child and infant simulators Porcine model: surgical cricothyrotomy and emergent tracheostomy placement Mechanical ventilation station: invasive ventilation management using a test lung
Multi-Skills Day
Based on the success of the airway skills day, the authors sought to expand our intraprofessional education by developing a multi-skills day for the RNA, ACPNP, and AGACNP students in 2019. The skills included: (1) radial arterial catheter placement, (2) three central venous catheter placements (femoral, subclavian, and internal jugular), (3) chest tube placement, and (4) adult and pediatric lumbar puncture. Skills were selected based upon common procedures and population certification standards to meet or exceed individual program requirements. Students were asked to complete evaluation forms at the end of each day assessing their experiences (Figure A, available in the online version of this article).
Pandemic Adaptation
As in all facets of higher education, the coronavirus disease 2019 pandemic required us to abruptly pivot and rethink our approach to skill acquisition for our collective students. There was an initial moratorium of all on-campus activities as the school and university sought to understand the full scope and impact of the contagion. However, as critical members of the health care team, the school successfully petitioned to allow small, specified groups of students and faculty on campus to move forward with required psychomotor and simulation activities to avoid delays in graduation and sorely needed expansion of the workforce. Thus, in late summer 2020, we were able to resume a series of sessions with smaller groups of students, utilizing physical distancing when possible and appropriate personal protective equipment. Most students were able to participate in both the airway and multi-skills activities in 2020. Student evaluations were not collected during 2020 due to the variable and adaptive formats utilized.
Point of Care Ultrasound
In 2022, the AGACNP students underwent a 1-day training with skills practice on the utilization of point-of-care ultrasound (POCUS) in the acute and critical care setting. Use of this imaging modality allows for bedside screening for injuries and acute pathologies (e.g., hemorrhages, effusions, air leaks) to facilitate diagnosis, intervention, and response to therapies (Mathews et al., 2018). We share the pilot data from this event here.
Outcomes
Since 2018, 235 students have participated in the airway or multi-skills days simulation events (RNA, n = 47; ACPNP, n = 49; AGACNP, n = 166). Gender distribution of male students was 21% for RNA (n = 10), 10% for ACPNP (n = 5), and 25% for AGACNP (n = 41). Age at time of matriculation ranged from age 24 to 37 years for RNA, age 23 to 51 years for ACPNP, and age 24 to 62 years for AGACNP. Student program types included Doctor of Nursing Practice (RNA, n = 47; ACPNP, n = 5; AGACNP, n = 4), Master of Science in Nursing (ACPNP, n = 32; AGACNP, n = 118) and postgraduate certificate (ACPNP, n = 12; AGACNP, n = 44).
Student evaluation data were obtained for the airway days in 2018, 2019, and 2023; as well as from multi-skills day in 2019, 2021, and 2022 and the first POCUS education day in 2022. The first year that included only AGACNP students had a low response rate of 25%, but other sessions' response rates ranged from 65% to 100%. Figure 1, Figure 2, and Figure B (available in the online version of this article) display response rates. Completion of the evaluation forms was highly encouraged but not required. Student name and specialty track were optional; thus, data are reported from the entire cohort and not parsed by specialty.
Student assessment of the airway skills days was very positive, with the majority reporting they agreed or strongly agreed that they had achieved the learning objectives and found the learning event useful in their future professional trajectory (Figure 1). Similarly, student evaluation of the 2019, 2021, and 2022 multi-skills days was positive (Figure 2). For the pilot POCUS skills day in 2022 (n = 23 of evaluations completed), all but one student reported that they agreed or strongly agreed that they had achieved the objectives and found it a positive learning experience (Figure B).
Discussion
Intraprofessional education shapes master's and doctoral students in a learning environment with two or more specialties, such that these professionals may learn from, with, and about each other to improve collaboration and quality of care for patients (Granheim et al., 2018). Among different educational approaches, realistic clinical or procedural skills simulation supports cross-specialty education when groups of learners from different backgrounds share knowledge, skill levels, and past experiences for a common collaborative goal or outcome (Gellis et al., 2018). A cross-specialty, simulation-based team training workshop was implemented to improve knowledge, application, and clinical decision making for the acute adult and pediatric populations. Critical to the success of both initiatives was the engagement and inclusion of NP (nurse practitioner)/CRNA adjunct and clinical faculty, along with the authors, who are the program directors. Most recently, we added senior RNA students to assist in specified skills stations to facilitate their growth in the teaching role of the APRN.
The collaboration allowed for cross-specialty interaction during the simulations, as well as improved confidence and skill levels for inexperienced providers and key principles of effective communication across specialties. The initial success has provided the evidence to support expanding the training to add skills (e.g., POCUS), additional resources, and facilitators. Trainee competency with POCUS is now mandated in certain acute care specialties and has the potential to transform health care delivery through its diagnostic expediency, efficacy, and low-cost structure.
Looking forward, we plan to obtain more granular data by creating QR codes that will allow students to evaluate each skill station, along with a summary evaluation. Future plans include the development of standardized and validated assessments to evaluate skill competence. Such assessments will include evaluations of knowledge acquisition, knowledge application, technical skill demonstration, and integration into clinical practice.
Lastly, as we consider additional opportunities to promote collaboration and team building, there is the opportunity to partner with our physician assistant and perfusion colleagues. Physician assistants, perfusionists, and APRNs increasingly provide quality care for patients with multi-system acute and chronic diseases, all within the confines of a fractionated health care system. The expansive growth of these professions over the past 2 decades has placed them at the epicenter of these collaborative initiatives. To achieve national goals of reducing siloed care, institutions must augment and create new avenues of delivery that buttress the principles of collaborative care cross-specialty, and interprofessional simulation holds great promise for training individuals and teams of diverse health care backgrounds and specialties for the current and future workforce (Labrague et al., 2018).
Conclusion
In health care environments, implementation of effective teamwork strategies acknowledge that the team is not the sole element; however, it must be instituted interdependently with a fair and just culture and visible, engaged leadership. We sought to exemplify that leadership via the initiation of these cross-training events. Simulation and collaborative models can offer innovative approaches to advanced practice education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice environment of the nation's evolving health care system.
The authors thank the staff of the Simulation Program at the Emory Nursing Learning Center, without whom these collaborative efforts would not be possible.
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