International Journal of Healthcare Simulation

Background:

We know staff attrition is a core challenge for the NHS with many nurses leaving the profession in the first 2 years post-qualification ^[1]. Health Education England has recently published themes from a national student survey showing that feeling overwhelmed, concerns about mental health and doubting clinical ability are key reasons for students to consider leaving. This echoes findings from local conversations with newly qualified staff, which highlight workload management skills, particularly leading teams in clinical areas (‘coordinating’), as a key source of anxiety. Simulation is used in emergency planning and military settings to prepare staff for managing teams but has rarely been used in healthcare. Yet the national framework for simulation-based education ^[2] supports simulation for workforce design and processes. Working from this insight we piloted a tabletop exercise to introduce and build coordination skills for nursing staff.

Aims:

The aim of the study was to improve retention and resilience of the nursing workforce by increasing confidence in their ability at clinical coordination.

Method/design:

This table-top simulation pilot used a convenience sample of six staff nurses new to the role of clinical coordinator. We drew on clinical governance findings and input from experienced nurse-coordinators to simulate coordinating a shift on a surgical emergency unit. The shift was run in compressed time over 32 minutes followed by a 1.5 hour debrief. During the shift we used ‘injects’ intentionally designed to stimulate learning in:

Problem solving

Decision-making

Clinical processes

Supporting colleagues/workforce resilience

Situational awareness

The pilot was evaluated through peer observation and focus group. Peer observation provided an objective analysis of session content. A neutral party facilitated the focus group, which gathered data on how the training session had been received by participants and evaluated whether learning outcomes were met by content.

Implementation outline:

Participants were assigned to work in pairs. Briefing was provided for session content and timeline. We used a simulated handover of patients for verisimilitude. The 12-hour shift was compressed into 4-minute segments with a ‘countdown’ timer ticking off each segment as the simulated shift progressed. This added time pressure and demonstrated how decision-making skills can be influenced by external forces. The participants had access to the hospital intranet and documented their actions/decisions on a template. Facilitated discussion took place after the tabletop simulation followed by a lunch break and then the focus group.