I thought we learned that in nursing school!

HouTx, BSN, MSN, EdD · May 4, 2015

As an educator, I think this tread is fascinating. Some very good points have been made re: maintaining competency.

One of the "missing" factors is PROFICIENCY. Basically, the way to maintain a skill is to perform it regularly - use it or lose it. The more complex the skill, the more frequently it has to be performed. But, from some of the PP descriptions, this is not even being considered if nurses are asked to do annual demos for skills that are never used in their areas..... that is a complete waste of time. The logical approach would be to have specially designated nurses who do perform that skill - and use them as a consultant to perform the skill when the need arises. That team would be able to maintain proficiency. This eliminated the "OMG - I haven't touched that in years! Quick, Gimme the procedure manual" situation which , at best, exposes the poor patient to a clumsy & unskilled practitioner.

I advise my educators to keep an 'inventory' of skills for their areas... to determine how often they are actually performed. Then, we work together with nursing leaders to develop strategies for the infrequent skills. OTOH, I ask them to spend MORE time on "routine" competency such as fire drills to ensure that psychomotor skills are addressed rather than just answering a quiz. ?For instance, nurses need to know techniques to evacuate immobile patients, how to shut off oxygen valves or connect portable oxygen canisters to ambu bags.

Fun, huh?

Angeljho, MSN, NP · May 7, 2015

Wait, wait, wait... So no one else is shocked that someone nearly agreed with NOADLS? O.o

Honestly, I'm all for skills fair. However, in my facility it's rushed and competencies aren't evaluated thoroughly; it feels like a waste of time. I only say this because my facility incorporates our skills fair into our work day so one nurse will leave the unit for about 2 hours while another nurse covers. I think our skills fair should be a full day where that's all we do; I know I will definitely get more out of it.

annie.rn · May 8, 2015

Wait, wait, wait... So no one else is shocked that someone nearly agreed with NOADLS? O.o
Honestly, I'm all for skills fair. However, in my facility it's rushed and competencies aren't evaluated thoroughly; it feels like a waste of time. I only say this because my facility incorporates our skills fair into our work day so one nurse will leave the unit for about 2 hours while another nurse covers. I think our skills fair should be a full day where that's all we do; I know I will definitely get more out of it.

This is how it was done by my previous employer. The fair was open all day for two or three days and we were paid to attend. We went on our day off and could spend as much time as we wanted getting everything checked off. If there was something we felt weak in, we could do it over and over until we felt comfortable. It was really top notch. I miss it.

blondy2061h, MSN, RN · May 8, 2015

We did the exact same thing last year. Complete with the foley kits with tightly wrapped towelletes. Does it have a little foil packet of Purrell, too, in case one of your unit's 34 wall mounted dispensers isn't within easy reach?

BrandonLPN, LPN · May 8, 2015

I believe that a major reason for CAUTI is not bad practice with insertion. It is due to nurses who were never educated that irrigating a foley catheter requires sterile technique. This means sterile gloves a sterile drape, sterile NSS, a new irrigation set and a new sterile Toomey syringe, every single time.
Another source of CAUTI is when the drainage tubing comes apart from the catheter and is found
in the bed or on the floor. It is another common and very bad practice to swipe it with alcohol and stick it back in the foley. The straight drainage bag must be replaced.

Sadly, best practice is rarely top priority in most LTC facilities. There are places where I've worked where using sterile supplies and changing the drainage bag each time a Foley catheter is irrigated would get one written up left and right.

sistrmoon, BSN, RN · May 8, 2015

I insert a lot of foleys and I work Onc so I could practically do central line dressing changes with my eyes closed. The other checkoff we had was pressure ulcer measurement/charting/assessment which I did learn from. We have restraint checkoff too which I do so infrequently, it's easy to forget. I wish they did ng tube insertion, IV insertion, and chest tube care.

icuRNmaggie, BSN, RN · May 8, 2015

One hospital that was employed at held skills day during nurses week. The staff were given a raffle ticket for completing each competency skill station. I remember a CNA reviewing proper use of all of the aloe vesta products and signing me off. Everyone received a door prize which were donated by local businesses. There were vendors selling books uniforms and stethoscopes and wellness oils and that sort oc stuff. There were reps from local schools. Lots of free pens. Local businesses donated trays of all kinds of food. It ran for two days and attendance was mandatory as we did the yearly

competencies and we were overstaffed for this

event. All of nursing management was there working behind the scenes. This was in 2003. This hospital was run by the Nurses and they were fierce about education and standards of practice. We had four hours to go the fair. It was just an excellent Nurses Week celebration .

nrsang97, BSN, RN · May 9, 2015

We did the exact same thing last year. Complete with the foley kits with tightly wrapped towelletes. Does it have a little foil packet of Purrell, too, in case one of your unit's 34 wall mounted dispensers isn't within easy reach?

Yes it does. We just switched to those this year. Those towelletes annoy me too.