Developing Nursing Excellence in Critical Care Units
By Paula Kreiss, RN
Mat-Su Regional Medical Center, in Palmer, Alaska, opened to serve its 80,000 area residents in January 2006. As they transitioned from a local community hospital to the next level of regional acute care, nursing administrators wanted to ensure that care within the new building matched its state-of-the-art patient delivery architecture. To serve the fastest-growing borough in Alaska, just an hour away from tertiary care centers in Anchorage, Mat-Su Regional needed to develop its team of physicians and nurses to care for more critically ill and injured patients within the new facility rather than transfer them to competitors. The Critical Care Unit sought certification for nurses to both educate them and validate this new level of care. By the end of the first year of operation, more than 50 percent of the registered nurses in Mat-Su Regional’s ICU were certified critical care nurses (CCRNs).
Michael Zielaskiewicz, chief nursing officer for Mat-Su Regional, acknowledged that it’s quite unusual for a hospital ICU to have this high a percentage of CCRNs. He credits the unit’s director, Wendy Williams, RN, for creating an internal atmosphere that encouraged professional development. He explained, “Whether transitioning from an old hospital to a new one, from a primary level of care to a tertiary level of care or assisting staff to embrace change and maximize their talents, leadership is the key. Ms. Williams provided that exemplary leadership to Mat-Su Regional’s ICU.”
Besides a strong, education-minded, empowering leader who looks to the future, several other key elements were in place to develop this certification infrastructure:
1. Nursing staff with a desire to maximize evidence-based care for patients
2. A dedicated, fully credentialed ICU educator
3. A supportive mentoring intensivist
4. Administrative and organizational support
Research conducted by the ICU and the Education Department’s leadership revealed the accessibility of online training programs, perfect for staff thousands of miles from the nearest medical school or outside the contiguous United States. They selected the Essentials of Critical Care Orientation (ECCO) program developed by the AACN for their organization-based learning.
To ensure staff commitment to this educational enterprise, the hospital agreed to purchase the program for those critical care nurses who were interested. In return, each nurse signed a contract stating that she would sit for the CCRN exam within one year of starting the program or repay the cost to the facility. Eleven of the 12 nurses who signed contracts followed through to sit for the exam. The certification process also spurred them to continue their studies independent of the ECCO program and renewed their commitment to career education as a means to provide better care to their patients.
The intensivist support was critical to the nurses’ success as well. John Brady, MD, uses his daily rounds to create a healthy teaching environment. Each day, he demonstrates the impact of evidence-based care, remaining at the bedside with the nurse until all questions are answered and he is sure the nurse can fully manage the patient. He teaches and mentors to give the nurse a firm understanding of why this particular treatment is being used, how to troubleshoot problems and most importantly, to feel comfortable with the patient and the level of care being delivered. Within the Mat-Su Regional Critical Care Unit, he has stated many times that “nurses are my eyes and ears.” He includes nurses’ judgment and expertise in his decision making, thereby validating the critical care nurse’s essential role in patient treatment and care.
To reward the steps taken by the ICU nurses, Mat-Su Regional reimbursed the fee for those nurses who passed the exam and established 50 cents an hour “certification pay” for as long as the nurses maintain their certification. In addition to numerous internal celebrations as each nurse passed the exam, the ICU posted a plaque within the department displaying their names.
“While the monetary incentives certainly validated the efforts of our certified critical care nurses,” Williams said, “the drive to create positive change in our organization, to commit to developing clinically and professionally, brought a host of other benefits to our department and most importantly, to our patients. It increased morale, bolstered confidence and renewed pride in our mission. It’s a great reminder that we all thrive through learning and growing, and that education needs to be the cornerstone of
Saint Francis Hospital and Medical Center Nurses Take Pride in Wall of Honor
Certified nurses at Saint Francis Medical Center include (front row, from left) Michelle Drabkin, Denise Oullette, Jae Lorenzet, (second row) Kim Davis, Ann Lauren Banda, Deborah Webster, Denise Grieco and Vanessa Yi. CCRNs not pictured are Ellen Duell, Kristen Davis and David Maver.
CCRN certified RNs in the Medical-Surgical/Trauma Unit at Saint Francis Hospital and Medical Center, Hartford, Conn., are pictured in front of their CCRN Wall of Honor, which was inspired by Charlotte Farris and Baylor University Medical Center. The MSICU management team, consisting of Cathy Roy, RN, MSN, and her assistant nurse managers, Ann Lauren Banda, RN, CCRN, and Jae Lorenzet, RN, CCRN, created the Wall of Honor in May 2006 with five other CCRNs. Currently, there are nine CCRNs, with several others studying for their CCRN certification. “We are hoping to implement some incentives for recognition, in order to encourage our nurses to achieve excellence through certification,” Banda said.
Creating a Culture of Certification: Nurses Share Their Best Practices at NTI Roundtable
This year at NTI, 50 nurses participated in a roundtable to share their best practices for creating a culture of certification. Following are several suggestions contributed by participants; we’ll share more in future issues.
“We have established a culture of ‘appreciation’ regarding taking the test for certification. To help potential CCRNs overcome that fear of ‘potential failure,’ I coordinated several offerings: 1. Review sessions; 2. Roundtable small group discussions; 3. Individual coaching sessions; 4. E-mails and notes of encouragement; and 5. Congratulatory notes after nurses passed the exam.”
“We have a certification luncheon recognizing all nationally certified RNs with multiple activities, door prizes and a keynote speaker. This kicks off Nurses Week, and the day of the luncheon is declared Certified Nurses Day at the facility.”
“I identify specialty certification as an expectation of the job/role of my nursing staff educators (clinical nurse educators) and collaboratively establish a timeline and development (personal) of a plan of action to move them forward to certification, including professional organization membership, a prep course and a national conference.”
“We reinforce the culture of ‘doing the right thing,’ from MDs to staff. If we keep the patient at the center and ‘do the right thing,’ certification is a natural outcome.”
“We are building certification into our culture, i.e., incorporating certification into the clinical ladder. One example: To qualify for clinical nurse III you must be certified in your specialty.”
“I lead by example. As a manager I had been encouraging my staff to become CCRN certified for a couple of years. No luck. I decided last year that the best example for my staff to become certified was to become certified myself. Last December I sat for the exam and passed. Since then several staff have approached me about taking the exam and two have taken it.”
“At each chapter meeting we ask anyone who recently passed a certification exam to identify themselves so that we can all celebrate their success.”
“As a manager, I have worked to create a culture of certification by making it part of our unit’s culture of professional development. We have a Wall of Fame that is displayed in the unit for MDs, families and other disciplines. I have a CCRN Christmas dinner; we reimburse staff and pay for CCRN exams. We highlight new CCRNs in our hospital’s monthly newsletter.”
Revised CCRN SAE
The 60-item CCRN Self Assessment Exam has been revised and is now available for purchase online.
The SAE includes the following features:
• Items in same format as computer-based testing
• Items in same percentage as CCRN Adult Test Plan
• Rationale displays once answer is selected
• 90-day access without “finishing”
• When you finish – you receive a score report in the same categories as the certification exam
The CCRN SAE may be used for assessment or study. It also may be used during each renewal period for 15 CERPs, with a passing score of 70 percent.
ACNPC Pilot Exam Completed
Recently, a number of students in acute care nure practitioner programs volunteered to take the AACN’s ACNPC pilot certification exam. Their participation helped AACN Certification Corporation evaluate the performance of the exam and conduct an in-depth item analysis, a crucial step toward seeking state approval of the exam. AACN thanks the ACNP program directors who spread the word about the exam to their students and to those students who volunteered to take the test. Those who participated were entered in drawings for a Palm Pilot.
The winners are:
• Program Director: Paula McCauly – University of Connecticut
• Student: Susan Wroblewski – University of Wisconsin, Madison
Do You Qualify for CCRN-E Status?
If your CCRN expired due to not meeting direct bedside hours because you were working exclusively or primarily in the remote ICU (virtual ICU) environment, you have until Dec. 31, 2007 to apply through the Review and Appeals Process to be reinstated under the CCRN-E status. For more information, refer to the CCRN-E Renewal Handbook at www.certcorp.org > What’s New.
Nurse Manager Study of Practice Survey Conducted, Drawing Winners Announced
AACN Certification Corporation and AACN jointly conducted a national survey of practice of first-line nurse managers from Critical Care, Progressive Care, Emergency and Medical/Surgical areas. The implications of the research results will be evaluated and discussed at the fall board meeting. Participants completing the surveys were entered in two drawings. Following are the winners:
Winners of a $50 gift card
Winner of an NTI 2008 Main Conference Registration
Congratulations, and thank you to everyone who helped with this study of practice!