“KEPT IN THE DARK”By Nicola Drayton CNC & Catherine Seager CNS

Nepean Emergency Department.

THE PERILS OF WORKING PERMANENT NIGHT DUTY.

No access to educational support from ward or hospital based CNE/NE.

No designated in-service time. Disengagement from education sessions

provided in hours. Difficulties in attending mandatory

training. Feelings of isolation. Decreased career progression.

BARRIERS.

Family constraints. CNE’S predominately work office hours. Inability to attend sessions offered in

hours due to the nature of night duty. Limited time at work to access education. Cognitive impairment due to tiredness. Lack of direction to access/attend

education sessions. Unpredictability of work environment.

PROJECT GOALS.

Provide access to education for all staff working night shift.

Provide opportunities for staff to meet career pathway objectives.

Provide opportunities for staff to complete and remain current with department competencies.

Ensure all education sessions provided in hours are communicated to staff working night duty.

Decrease feelings of isolation. Development of a CNS role with the portfolio

of night duty education.

METHODOLOGY.

Needs analysis to identify the number of staff working permanent night duty & skill mix.

Survey for all ED nursing staff identifying staff attitude of education provided on night duty and career pathway awareness.

Gain Clinical Nurse Specialist status for a permanent night duty staff member with the portfolio of education.

Examine two different delivery methods of providing education.

Survey post implementation of education to assess outcomes.

NEEDS ANALYSIS.

Total number of nursing staff in Emergency Department = 114.

Total number of staff working permanent night duty = 19.

Skill mix displayed in graph.

Skill mix of night duty based on years of experience

0

2

4

6

8

10

12

year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 CNS

Number of Staff

STAFF SURVEY:

The aim of the survey was to gain insight into: Frequency of all staff working night duty. Identify skill mix. Frequency of education received. Type of education received. Perception of required amount of education. Career pathway awareness.

A total of 8 questions were asked that used a rating scale for answers.

Total number of 114 surveys sent out to all nursing staff. 48% return of surveys.

SURVEY FINDINGS:

86% of staff combined work permanent night duty or rotate onto night duty .

80% of staff worked in all of the various clinical roles of triage, resuscitation team leader, resuscitation team member, clinical initiatives nurse and in charge of Emergency short stay.

62% of staff have never received any form of education whilst on night duty.

44.8% of any education received on night duty was informal.

44.8% of staff felt that education should be received on a weekly basis 51.7% on a monthly basis.

20% of staff were unaware of their career pathway.

48% of staff were aware of a career pathway with 20% aware of their career pathway level.

65.5% of staff felt that night duty education would assist them in meeting their career pathway objectives.

RECOMMENDATIONS :

Development of Clinical Nurse Specialist role with portfolio of night duty education.

Compare two different modes of education delivery for night duty.

Re-structure of education program within the Emergency Department.

Increase awareness of career pathways. Develop method of meeting competency

standards for permanent night staff.

Education models:

CNS with night duty education portfolio to deliver education sessions and maintain records.

Creation of education folder established on computer drive in staff huddle for staff to access at any time – records and awareness of this maintained by night duty CNS, including availability of CNS to answer any questions and provide computer support.

OUTCOMES FROM EDUCATION DELIVERY.

72% of staff preferred the computer mode of delivering education than the face to face sessions.

Comments: Allowed more flexibility. Able to choose education session. Not reliant on CNS being available to

deliver session. Felt part of the team. Great to have access to material provided

during the day.

SUMMARY:

An effective, flexible mode of delivering education to staff working permanent night duty and other staff members rotating onto nights has been established.

This has resulted in decreased feelings of isolation and ensures transparency with information shared between all staff.

Clinical Nurse Specialist status was achieved for one senior registered nurse which now maintains the night duty education portfolio.

FUTURE WORK:

Review current career pathway. Encourage and establish further CNS

status for permanent night duty staff members.

Develop method for staff to complete competencies working permanent night duty.

Establish links with other critical care areas to share education material.

Increase the project size.

QUESTIONS THANKYOU AND ANY SUGGESTIONS.