Training Program for Registered Nurses

Abstract

Most operating rooms’ supervisors have experienced scenarios where they do not have enough scrub nurses. This, unfortunately, has led to increased patient anxiety, cancellations, delays, and costly overtime. The shortage of scrub nurses can be solved short-termly through the provision of competency training for registered nurses to enable them to act like and perform the duties of scrub nurses. The current paper provides a literature review of the proposed competency training change.

Keywords: perinatal, research, surgical, training

Chapter 2: Review of Literature

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Credible Sources

The lack of staff in the operating room often impacts negatively on the provision of quality healthcare and on the safety of the patients. Staff shortage can always be solved by employing new and more staff; however, this is not always the case. It is always easier said than done. Apparently, there are a number of issues affecting staff recruitment ranging from the economic conditions of the nation to the hospital’s financial ability. But still, the staff shortage can be solved by training the existing staff on the duties of the staff in cases of shortages. The current paper provides a literature review on the proposed scrub nurses’ competency training program for registered nurses.

The review involves 30 credible sources related to the project; the proposed scrub nurses’ competency training program for registered nurses, published within the last five years. It will include the applicability of these 30 sources, the evidence grade assigned to them, a general appraisal of the findings, and a determination of whether they will be included or excluded from the final list of sources that will be used to inform this Capstone project (See Appendix A - Credible Sources Table which contains the actual review of sources).

The subject of training registered nurses is not something new, given the plethora of research that exists on it. A number of researchers have proposed training of nurses to be multi-skilled professionals rather than being single skilled. A study carried out by Thomas and Boyle (2014) at the Labor and Delivery Department of the University of Chicago’s Medical Centre, opted for a decision of training all its delivery and labor nurses on scrubbing roles. In Thomas and Boyle’s opinion, this department is staffed throughout the day with a mix of surgical technicians and Registered Nurses (RNs).

Nevertheless, this department still experiences a staff shortage of surgical technicians to scrub for emergency cesareans. The shortage led to the unanimous decision to train the exiting RNs in scrub nurse’s roles. In a similar study, Beuzekom and Boer (2012) make a comparison and examine historical differences in nurse staffing in the United States, the United Kingdom, and the Netherlands.

According to Beuzekom and Boer, the profession of perioperative RNs was developed by American nurses and the continuing shortage in personnel led to the establishment of surgical technologist positions. However, the establishment of surgical technologist positions has led questions as to whether it is necessary to have an RN in the OR in the UK and US. The Netherlands has a different approach. It is unlike the UK and US where they staff their ORs largely by technicians. In this study, Beuzekom and Boer assume the duties of scrub nurses are not too technical (more non-technical) and can be easily learned by RNs and technologists with the help of some training.

In a similar study, Mitchell and Flin (2011) identify some of the non-technical (social and cognitive) skills of scrub nurses that are vital in the OR. The authors recommend further identification of non-technical skills vital to the scrub nurse’s role and the organization of training in these identified skills during the development and education of scrub nurses and RNs acting as scrub nurses. These aspects of non-technical skills training have also been emphasized by Mitchell, Flin, Yule, Mitchel, Coutts, and Youngson (2012); Siu, Maran, and Paterson-Brown (2014); McConaughey (2010); and Neily, Mills, Lee, Carney, and West (2010). For instance, Mitchell, Flin, Yule, Mitchel, Coutts, and Youngson have proposed a system known as SPLINTS as a new tool for assessing and training scrub practitioners’ (technicians and RNs) behaviors in the course of surgical operations.

McClelland (2015); McCulloh, Mishra, Handa, Hirst, and Catchpole (2011); and Mitchell, Flin, Yule, Mitchell, Coutts, and Youngson’s (2011) study of scrub practitioner’s non-technical skills reveals that recent failures at organizations affiliated with NHS have emphasized the significance of non-technical skills education in enhancing patient outcomes and clinical performance. However, these skills are advanced on a tacit basis making their assessment difficult. As a solution to this challenge of assessment, McClelland develops strategies to facilitate the assessment of non-technical skills in the process of surgery and to assist scrub practitioners in utilizing a validated non-technical skills assessment framework for scrub practitioners.

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Still on the aspect of non-technical skills, Aggarwal, Undre, Moorthy, Vincent, Darzi, (2012) and Kassab, King, Hull, and Arora (2010) advocate for comprehensive training for surgical teams through the use of a simulated operating theatre project. The project will enable the assessment by experts of technical and non-technical performances of surgeons and circulating staff. The scenario will enable junior surgeons and RNs to act as scrub nurses to benefit from the process by learning new technical skills within a realistic environment.

Bogdanovic, Perry, Guggenheim, and Manser (2015) carried out a study using thirty-three surgeons and scrub nurses from different hospitals and specialties that completes previous studies on scrub nurses’ non-technical skills. The study highlights the vital role of coordination and brings to light the methods in which situational variability requires surgical teams to conduct themselves adaptively. In a more related study, Burton (2011) emphasizes on the significance of the non-technical skills of scrub nurses in enhancing the quality of surgical performance. The study advocates for the idea that in situations where there are few scrub nurses, these vital skills should be impacted on the available RNs through comprehensive training.

In a study of 158 operating room scrub nurses from seven general hospitals within South Korea, Jeong, Cho, and Park (2012) discovered that regular educational and training programs within hospitals are vital in ensuring that nurses are multi-skilled and can work in any area within the hospital as the need may arise. In another study by Lipponen, Tossavainen, Turunen, and Smith (2014) the authors found out that operating room mistakes occur due to shortcomings in training caused by issues like emotional distress, overtime work, and other potential factors that lead to errors in the OR team. In a similar study, Makary, Sexton, Freischlag, and Holzmueller (2013); Makary, Sexton, Freischlag, and Holzmueller (2010) focus their study on issues relating to wrong-site surgery resulting from a communication breakdown. The authors link these issues to the lack of scrub nurses and lack of adequate training for those who act in their place.

Seavey (2010); Wunderlich, Sloan and Davis (2012); Undre, Sevdalis, Healey, Darzi and Vincent (2011) and Undre, Koutantji, Sevdalis, Gautama and Selvapatt (2013) propose a collaborative approach to dealing with the issue of staff shortage where the personnel of the sterile processing department is trained on basic but vital OR duties given the close working relationships between these two departments. The training will focus on minimizing misunderstandings and errors and equipping the sterile processing personnel with skills to work as OR technicians/scrub staff. Foster (2013); Timmons and Tanner (2012); Thornley (2010); focus on a different type of training.

That is, a multidisciplinary in replicated obstetric cases which would result in improved midwifery and obstetrician knowledge. This training unlike organizing annual or monthly one-off competency training should take place every morning as a strategy of dealing with staff shortage. Brush, Sochalski, and Berger (2014) and Corwin (2013) suggest that in addition to training of RNs to act as scrub nurses, foreign nurses could be recruited as a response to the nurse shortage scenario.

Studies by McDonald, Waring, Harrison, Walshe, and Boaden (2010); Nielsen, Goldman, Mann, Shapiro, and Marcus (2011); Osborne (2013); Sadahiro, Hamazaki, Miyawaki and Yoshimitsu (2012); Sevdalis, Undre, Henry, Sydney, and Koutanji (2014); Sevdalis, Undre, Henry, Sydney, and Koutanji (2011); Shauna, Senter, Hawkins, Zhao, and Doody (2012) show that today most recruits in the nursing field come with more than one skill in addition to their areas of specialization. But still, the area of scrub nurse competency training for registered nurses remains under-researched and there is little evidence-based research existing in it. However, as it was earlier stated, the nursing sector is moving towards multi-skilled professionalism, and this, even without considering the scrub nurses staffing shortage, necessitates the need to implement this project.

Best Practices Identified

The best practices of scrub nurse’s competency training for RNS are best illustrated by the study conducted by Thomas and Boyle (2014). In this study conducted at the Labor and Delivery Department of the University of Chicago’s Medical Centre, a decision was arrived at to train all the department’s delivery and labor nurses on scrubbing roles. According to Thomas and Boyle, the labor and delivery department is staffed throughout the day with a mix of surgical technicians and Registered Nurses (RNs). Despite this, the department still had staffing shortages in the area of scrub nurses. As a remedy to this situation the existing RNs were trained on scrubbing duties. An assessment of this initiative later proved that its role was vital in reducing the scrub nurses staffing challenges.

Another example of best practice is illustrated in the best way by McClelland (2015); McCulloh, Mishra, Handa, Hirst, and Catchpole (2011) and Mitchell, Flin, Yule, Mitchell, Coutts, and Youngson’s (2011) study of scrub practitioner’s non-technical skills. In this scenario, strategies were developed to facilitate the assessment of non-technical skills in the process of surgery. These strategies also assisted scrub practitioners in employing a validated non-technical skills assessment framework for scrub practitioners. The third example of best practice can be drawn from the study by Bogdanovic, Perry, Guggenheim, and Manser (2015) that utilized thirty-three surgeons and scrub nurses from different hospitals and specialties. The study recommended a competency type of training for nurses to enable them to perform scrub nurse duties.

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Evidence Summary of Literature Relevant to the Chosen Topic

Evidence summary of literature relevant to this study is driven by the assumption held by a number of nursing practitioners and researchers that evidence-based practices (EBP) dictate the conscientious utilization of up-to-date evidence in arriving at decisions about patient care (Bogdanovic, Perry, Guggenheim, and Manser 2015). The rules of EBP require practitioners to assess clinical guidelines, research, and other information resources focused on superior quality findings and utilize the results to nursing practice. Based on these specifications of EBP, the literature utilized in this study has been summarized into three categories; (1) those agreeing on the need for training as an initiative to deal with staffing challenges, (2), those focusing on training RNs and other OR staff on non-technical scrub nurses roles, and (3) those focusing on simulations and collaborative approaches to training.

Evidence of Need for Training and Aspect of Technical Skills in the Include Literature

The literature that has been included, seem to agree on two related points; first, there is a need for training of existing staff as a measure of dealing with nursing staff shortages. Second, this training should focus on the non-technical skills aspect of scrub nurses. For instance, Thomas and Boyle (2014) carried out a similar type of competency training and realized its benefits. This training was motivated by the lack of staff to handle emergency Caesarean operations. The result of this study showed that training of RNs to handle scrubbing duties is effective in dealing with the issues of staff shortage, especially in the OR. Additionally, today the nursing environment sees few people opting to work in the perioperative room. The challenge with this is that this area of nursing practice will remain understaffed for quite some time.

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Another underlying feature among the selected resources is their emphasis on non-technical skills of perioperative nurses, especially scrub nurses. There is an underlying assumption that the non-technical skills of a scrub nurse are vital and should be known by all RNs. This position is held by Beuzekom and Boer (2012); Mitchell and Flin (2011); Mitchell, Flin, Yule, Mitchel, Coutts, and Youngson (2012); Siu, Maran, and Paterson-Brown (2014), McConaughey (2010) and Neily, Mills, Lee, Carney, and West (2010). These authors view these skills as important and thus, as such that should be possessed by all RNs.

Evidence of Simulations and Other Forms of Training

Apart from the need of training and the focus on the non-technical aspect of training, a number of nursing studies based on EBP have emphasized the importance and the need for collaborative training and the use of simulations (Siu, Maran, and Paterson-Brown (2014); McConaughey (2010); and Neily, Mills, Lee, Carney, and West (2010). Simulations are relatively new and have been tried, tested, and proved beyond a reasonable doubt to work. Simulations have been effective in the OR, and young surgeons and perioperative room nurses have benefited from it.

A simulation is a form of training and when used in competency training RNs, it is bound to realize the same positive results. Based on EBP, these aspects of collaborative training and simulation make the studies on them relevant to the topic of discussion. Therefore, these three aspects of training have influenced the inclusion of these sources as primary towards the realization of this project. The sources that were left out failed to consider these aspects of training.

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