A Concept Analysis of Competency in Nursing
Abstract
A small hospital operates with an eight-bed multi-service intensive care unit (ICU) staffed with an entirely baccalaureate-prepared registered nurse (RN) staff. The average daily census most months is 1.5 patients. On a rare occasion the census swells to six patients, but on many days there are no patients at all. Even when patients are present they are frequently not critically ill, but are merely there for "closer observation." The ICU nurses float to the nearby ward or perform computer-based training exercises during the slow periods, which are frequent. The nurse manager and staff development officer (SDO) are concerned about the impact of a dwindling patient population on the competency of the nurses to perform certain low-volume, high-risk procedures, such as invasive hemodynamic monitoring via the Swan-Oanz pulmonary artery (PA) catheter. The last patient requiring a PA catheter was over 6 months ago. Hospital administrators are reluctant to reduce such services, fearing loss of revenue and loss of status. The nurse manager and SDO consider options; they employ mannequin simulators, self-learning packages, and computer-based simulations. They even enter an agreement with a local Veterans Administration (VA) hospital to utilize their nurses in the VA ICUs, where the patients are more critically ill. This agreement generates problems of its own; the shifts of the nurses working at the VA must be covered, and the VA itself goes through a period where invasive monitoring is rarely used. It is common for a nurse to perform a 2-week tour at the VA and not observe a Swan-Oanz catheter at all. In addition, the VA nurses are anxious to maintain their own competency and are reluctant to give up complex patients to a "visitor."
Document Details
- Document Type
- Technical Report
- Publication Date
- Nov 15, 2004
- Accession Number
- ADA427827
Entities
People
- Tammi L. Potter
Organizations
- Southern Illinois University Edwardsville