Ensuring Quality Nursing Care

Ever wonder how nurses and physicians learn to manage medical emergencies? In many health care professional educational curricula the age old apprentice model of “See One, Do One, Teach One” is a common methodology. This in essence means that nurses and physicians rely primarily upon learning how to care for patients in clinical settings after they have had a period of “book learning” that theoretically prepared them to provide competent care. Given the infrequent occurrence of emergencies (with the exceptions of those seen in emergency rooms) only a few students may actual be on the unit to participate in an emergency. Thus learning how to manage life threatening emergencies is taught primarily in the classroom. This model of education does not assure providers’ competency.

Can you image an airline pilot learning how to handle emergencies solely through classroom instruction? Given the significant risk to the public, airlines are required to include simulation training in the education of pilots. Commercial pilots must demonstrate competency in managing flight emergencies via simulators at least every six months. Further safety protocols include check rides with expert flight instructors to assure that the pilots are competent.

One would think that perhaps in health care when a person’s well being is often dependent upon the expertise of a provider’s competency there would be a similar quality process in place. Unfortunately, preventable medical errors are so frequent in a 1999 report “To Err is Human” issued by the Institute of Medicine, it was estimated that up to 98,000 people in the U.S. die annually from medical errors. This is equivalent to 245 Boeing 747’s crashing each year in which 400 passengers die. Imagine the public outcry if the flying public was subject to such a high death rate.

Have you heard a protest about the unnecessary deaths and injury that occur daily in our nation’s hospitals? Given the deaths and injuries occurring in hospitals all over the country, the reporting in aggregate numbers does not occur. The extent of the problems with quality of care and the prevalence of medical errors have not drawn the national attention that they deserve. Thus our system of “sick care” has not had the same degree of public accountability.

The National Quality Forum and the Joint Commission on Healthcare Organizations (accrediting agency for hospitals) as well as other national professional groups have launched major efforts to improve the quality of care provided in our nation’s hospitals. “To Err is Human” and a follow up report also by the Institute of Medicine “Crossing the Quality Chasm” are the driving forces for the Institute of Healthcare Improvement’s 100,000 Lives Campaign. This 2006 initiative claims to have saved an estimated 124,000 lives in an 18-month period through care improvement activities conducted in over 3,000 of the counties 7,569 hospitals.

Where does the fault lie? As Harry Truman would say, “The buck stops here!” And in this case it appears to be our nation’s hospitals and their quality monitoring processes used to ensure safe care to patients. The shortage of registered nurses, inefficiency of existing care delivery models, lack of electronic medical records that can be programmed to alert staff to potential errors, health care providers who have not keep current in their practice, and economic pressures have contributed to these quality challenges. Health care provider education is certainly a critical factor in this mix. Registered nurses, physicians and others on the health care team must be educated to be critical thinkers, problem solvers, committed to lifelong learning, and taught how to assess and improve the care they provide.

Fortunately, the apprentice model of educating nurses at the University of Texas at El Paso is a thing of the past. The School of Nursing is 100 percent committed to improving the quality of care provided to our citizens through changing the paradigm of educating tomorrow’s nurses.

A major feature of this new shift is the use of scenario based education. In this model students learn how to care for complex patient conditions without ever stepping foot in a hospital. Through the use of “life like” computerized mannequins students are taught how to assess the most common conditions of patients found in hospitals, to implement an evidenced based plan of care, and to evaluate the outcome of the interventions. The mannequins are programmed by the faculty to simulate a variety of conditions and to introduce complications to teach the students how to manage safely even the most complex patients. The simulated patient’s condition changes depending on the interventions implemented.

By doing this the student is able to learn how to safely provide nursing care in the safety of the Simulation Center. The student can practice repeatedly procedures, assessments, interventions, etc until achieving competency in safely managing the condition or conditions presented. The UTEP students before graduating must demonstrate competency in managing emergencies and the most common diagnoses. This is one method used to insure students are safe and competent nurses thus hopefully contributing to the reduction of medical errors and resulting unnecessary deaths.

Just like the airline industry UTEP’s School of Nursing is rapidly incorporating into its program the use of technology. Such a move provides a rich learning environment for students while not placing any patients at risk. In the near future we will also be using standardized patients who are actors that use a faculty developed script designed to teach the student to interact with a “real live” person. The student is provided lab data and other assessment information. Thus the technique provides another means to teach students how to competently managed selected patient conditions.

Thus, in creating the new health professionals building for the School of Nursing and College of Health Sciences, designers have created spaces and infrastructure that can be adapted to changes in curriculum as they emerge. Our existing simulation centers, currently located on the UTEP campus as well as at Sierra Medical Center and Del Sol Medical Center, are our central hubs of learning activities. The centers are becoming a focus of credentialing not only for UTEP students, but also for health professionals in our Far West Texas region and potentially in Central and South America.

In the immediate future, our primary focus will be educating more BSN and graduate prepared nurses. By 2017, the Upper Rio Grande Workforce estimates El Paso County will need nearly 2,400 new nurses, of which at least 80 percent should be prepared at the undergraduate level. We will continue to expand our traditional and Fast Track BSN options, and offer an LVN to BSN program beginning in summer of 2009, that incorporates online and other instructional technology. The five-year goal is to increase by 125 percent of our existing number of BSN graduates from our 2006-07 baseline of 159 students.

Your School of Nursing is committed to educating the nurses needed for our community to ensure the highest quality of care available is being given. Increasing the number of registered nurses, with a BSN degree, at the bedside ensures a higher quality of care. You can rest assured that the UTEP School of Nursing is committed to its vision of becoming the premier Hispanic-serving School of Nursing in the nation thus contributing excellence in its graduates.