Sarah Webb: You Can’t Handle the Truth: Chains of Command


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Webb delineates the case for experience over hierarchy in advanced resuscitation scenarios.

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Sarah Webb: You Can’t Handle the Truth: Chains of Command

  1. 1. Why can’t nurses take command?
  2. 2. Critical Care Nurses
  3. 3. Advanced Life Support 2013 Training Requirements: Advanced life support The advanced life support (ALS) course must be completed during introductory, basic and advanced training and develops advanced skills in managing cardiac arrest and other medical emergencies. While the course covers advanced resuscitation skills, it is also designed to develop leadership and team skills in managing such emergencies. ALS teaches skills that are required during training and by specialist anaesthetists. If the trainee does not attend a specific ALS course, their hospital department may organise a similar course or study as approved by the supervisor of training. The supervisor of training is not responsible for organising the course but should assist the trainee.
  4. 4. The Truth…
  5. 5. Nurses and resuscitation leadership Source Purporse Setting Design Findings Gilligan et al. (2005) Do nurses with ALS training provide good team leadership in cardiac arrests Five UK EDs Prospective quasiexperimental 57 participants in simulated scenarios Lin et al. (2009) Is a senior nurse more skillful at resuscitation 1200 bed metropolitan medical centre, Taiwan Cross-sectional observational study 55 head nurses Kirk (2006) Review of the Rapid Response Team 10 acute care hospitals U.S. Literature review Makinen et al. (2007) Assess resuscitation skills to facilitate an educational program 2 University Hospitals Sweden and Finland Observational, convenience sample of 150 nurses Nurses trained in resuscitation leadership had superior non-technical skills. Clement s& Curtis (2012) Assess the impact of nursing roles in trauma and in hospital resuscitation Australia Literature review Nurses involved in trauma and other resuscitations contribute to effective communication, leadership and team work, which ultimately impact patient outcomes. • • • • Nurse’s time to defibrillate were equal to those doctors with ALS training. Recommendation that experienced nurses assume the ALS leader role where a senior doctor is not available. Age, work experience related to skills in assisting with CPR. Nursing leadership ensures clear definition of roles and responsibilities. 13 papers 18 papers
  6. 6. Traditional chains of command Awareness of each other’s Non-technical skills
  7. 7. Dr Michael DeVita, University of Pittsburgh
  8. 8. ! ! S Should Critical Care nurses take a leadership role in resuscitation? E Y Teach ALS and CRM Empower Ask Mentor
  9. 9. References • • • • • • • • • Churchman JJ, Doherty C (2010) Nurses’ views on challenging doctors’ practice in an acute hospital. Nursing Standard. 24, 40, 42-47. Date of acceptance: March 5 2010. Clements, A., & Curtis, K. (2012). What is the impact of nursing roles in hospital patient resuscitation? Australasian Emergency Nursing Journal. Eastwick-Field, P. (1996). Introducing nurse-initiated management of cardiac arrest. Nursing standard (Royal College of Nursing (Great Britain): 1987), 10(26), 46. Foot, C., Host, D., Campher, D., Tomczak, L., Ziegenfuss, M., Cohen, J., & Nunnink, L. (2008). Moulage in highfidelity simulation-A chest wall burn escharotomy model for visual realism and as an educational tool. Simulation in Healthcare, 3(3), 1-5. Gill, F. J., Leslie, G. D., Grech, C., & Latour, J. M. (2012). A review of critical care nursing staffing, education and practice standards. Australian critical care. Gilligan, P., Bhatarcharjee, C., Knight, G., Smith, M., Hegarty, D., Shenton, A., . . . Bradley, P. (2005). To lead or not to lead? Prospective controlled study of emergency nurses’ provision of advanced life support team leadership. Emergency Medicine Journal, 22(9), 628-632. Numata, Y., Schulzer, M., Van Der Wal, R., Globerman, J., Semeniuk, P., Balka, E., & FitzGerald, J. M. (2006). Nurse staffing levels and hospital mortality in critical care settings: literature review and meta‐analysis. Journal of advanced nursing, 55(4), 435-448. RPN, R., & Alberto, L. (2006). Consensus Forum: worldwide guidelines on the critical care nursing workforce and education standards. Crit Care Clin, 22, 393-406. Stein L (1967) The doctor-nurse game. Archives of General Psychiatry. 16, 6, 699-703.