Nursing Competency Testing-
Providing Constructive Feedback to RN’s after a High
Stakes Mock Code Simulation
Liza Nowicki RN, MSN
Simulation Nurse Educator
Hartford Hospital
Center for Education, Simulation and
Innovation (CESI)
Introduction:
• Low Stakes Formative scenarios:
• ICU core
• General nursing orientation (skills and critical thinking)
• GN residency program
• Specialty specific education
• High Stakes Summative assessment
• Nursing competency testing- Mock code simulation station
HH Competency Day History: • 2012, transitioned from individual skills stations to team based cardiac
resuscitation with the use of simulation.
• ~1300 nurses per year (~6000 to date) have been deemed competent in
a code resuscitation situation through this modality.
• Objectives are based on AHA’s BLS guidelines with some ACLS
medication preparation/administration.
• Novel: the measure shifted from individual performance to patient
survival. Participants are scored as a team (not as individuals) on how
well these objectives are met.
• Ultimate evaluation: a good patient outcome
Scenario Objectives:
• Recognize a change in patient condition and call for help within
30 seconds
• Demonstrate correct technique(s) to ensure adequate patient
ventilation
• Perform Chest Compressions within 10 seconds of recognition of
pulselessness; team places backboard asap
• Employ the Zoll defibrillator properly (per AHA standards) and as
needed for patient case (within 2m30s of start of case)
• Administer all medications that are ordered according to HH
policy for medication administration.
Assessment tool…
Objectives- includes both instructor and manikin assessment, ex.
CPR quality graph trend visible through case
How to provide feedback
• Simulation scenario complete
• Objective assessment tool completed
• Now…. How do we transition to provide feedback?
‘Debriefing’
• Sources for debriefing:
• Self reflection
• Peer feedback
• Manikin results:
• Instructor observations:
• Ideally, feedback may come during the-case from
peers:
• Teamwork/Communication/Leadership- can make
the difference in outcome for this simulated patient.
• It allows the participant to improve the skill while
they are doing it rather than discuss what could
have been done differently.
Manikin based assessment-sample
Conclusions
Skilled debriefers will:
• Support the learners in self/peer evaluation
• Create a positive learning environment
• Provides positive and constructive feedback
• Objective vs Subjective (high stakes)
• Identify additional performance gaps if missed by team (ambu
bag example); provide remediation if team unaware as a whole
Thank you, Questions?
