As academics, we must identify areas where we fail to prepare new graduates as residency-ready and find effective strategies to close the transition-to-practice gap. With clinical practice evolving faster than education can respond, we must intentionally and strategically find ways to improve student outcomes and ultimately improve transition to practice (Kavanagh & Sharpnack, 2021). Competency-based education is one educational strategy that emphasizes student learning outcomes through skill mastery of identified key competencies. These competencies are measurable. They assist in bridging the transition-to-practice gap and support a strong, ready-for-residency nursing workforce (National League for Nursing [NLN], 2023). Alignment of critical competencies that ensure positive patient outcomes is essential for safe patient care.
One area of critical importance is developing competence in patient resuscitation efforts. Studies have identified deficiencies in resuscitation skills when not practiced beyond initial training (Oermann et al., 2011). Evidence supports ongoing, frequent practice of resuscitation skills over extended time frames to sustain competence. Oermann et al. (2022) argue that the evidence for competence is stronger and more effective when repeated in spaced-out sessions. Their study documented the gap in cardiopulmonary resuscitation (CPR) skills performance and reasoned that completing a traditional Basic Life Support (BLS) course may not be enough to develop and maintain skills effectively. Repetitive skills practice, combined with feedback, enables learners to enhance their performance (Oermann et al., 2022).
The Ursuline College Breen School of Nursing and Health Professions, a small, private college in Ohio, was one of 12 schools of nursing to pilot the integration of the Resuscitation Quality Improvement (RQI(R)) Program for BLS certification of undergraduate nursing students. The RQI Program, an innovative program developed by the NLN in collaboration with the American Heart Association and Laerdal Medical, provides students an opportunity to practice their skills with CPR on a quarterly basis (NLN, 2021).
During initial implementation of the RQI pilot, students were guided through the self-registration process and oriented to the eLearning platform. Once the eLearning component was completed, students scheduled a hands-on session in the Health Resource and Simulation Center. For most student participants, use of the RQI Program was their first exposure to BLS, and many needed hands-on instruction and support to learn the basic skills of compression and bag mask ventilation. Therefore, the first skills session was scheduled with a faculty member. After a short in-person lesson, students were able to complete the initial skills performance with minimal difficulty. Students who had completed an in-person BLS course in the past were able to utilize the RQI Program with minimal to no faculty support.
As students progressed to the first quarterly refresher modules, difficulties were identified with the interface between the RQI platform and the Desire to Learn learning management system. As interface issues were explored, it was identified that moving from self-registration to institutional upload of students, as well as changes to the Sharable Content Object Reference Model (SCORM) packages, would be required to allow for seamless entry and ongoing completion of requirements. (SCORM packages are a collection of technical standards for eLearning software products that show programmers how to write their codes to be compatible with other eLearning software.) Once the interface issues were corrected and tested, the process for student utilization of the system included an institutional upload of participants on the 1st and 15th of each month. Although most students were self-pay, the institution had the option to allow organizational pay for certain participants.
During the pilot phase, 78 students utilized the system. Feedback from the student participants was positive and focused on the concise and adaptive nature of eLearning and their growth and confidence in skills with the quarterly hands-on practice. Student comments included: "With responsive feedback, personalized course content, and quarterly skills check offs, the RQI Program provided and continues to provide the right tools to obtain and maintain a BLS licensure"; "has given me the knowledge to care for patients and the confidence to act in critical moments"; and "Quick and efficient yet never lacking in the depth of material, I know that my knowledge will only continue to grow after each interaction with the RQI system, ultimately making me a better nurse."
As the nursing program's RQI initiative transitions from pilot to process, the next step is the creation of a policy to govern integration into the clinical health requirements for all undergraduate nursing students. Considerations include assessing the framework of costs using a student pay model versus a program fee, determining how to manage students who already have BLS certification through the American Heart Association but without RQI designation, and ongoing tracking of students who have already achieved BLS with RQI designation from clinical partners. Areas for future exploration include formal measures to evaluate students' growth in confidence and competence and the ability for the certification to transfer to a clinical partner's RQI program. In addition, although nursing students engage in cognitive training on optimal team roles in a resuscitation event, opportunities exist to transform the hands-on portion to provide students the ability to integrate team roles into a team-based approach to care through simulation and interprofessional education experiences. Information about participation in the RQI Program is available on the NLN website at https://www.cprnursinged.org.
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