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Kept in the dark presentation for conference
- 1. “KEPT IN THE DARK” By Nicola Drayton CNC & Catherine Seager CNS Nepean Emergency Department.
- 2. 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.
- 3. 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.
- 4. 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.
- 5. 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.
- 6. 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.
- 9. Frequency of education received.
- 10. Type of education received.
- 11. Perception of required amount of education.
- 12. 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.
- 13. 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.
- 14. 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.
- 15. 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.
- 16. 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.
- 17. 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.
- 18. 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.
- 19. 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.
- 20. QUESTIONS THANKYOU AND ANY SUGGESTIONS.
Editor's Notes
- Thankyou for the introduction & thankyou for coming to our presentation.Catherine and myself like most of you over the span of your nursing careers have worked night duty both on a rotating roster and permanently for a number of years.After working permanent nights for four years I saw the light & decided to have a change however Catherine continues to work permanent nights & has done for a period of 20 yrs. We had discussed our project many times whilst working night duty and shared our ideas with the CNE’S – however an opportune time arose in running the project when I became successful in becoming the CNC for the department.Our small project looked into how education could be provided whilst working night duty – even though this was aimed at staff working permanent night duty it does not exclude rotating staff.We both work at Nepean Emergency Department which is a tertiary referral hospital in part of swahs. Nepean ED has 32 acute care beds, 3 resuscitation bays, fast track area and 13 bed emss unit. On average Nepean sees 50,000 patients per year 170 – 200 presentations per day.Both of us will be sharing our project with you.
- Main aim was to create an education plan for the ED which was made available to all staff.A literature search supports the difficulties in providing education to night staff and highlights the importance of ensuring that night staff are included in education updates.
- A needs analysis was required to provide valuable insight into how to develop an education plan which meets the needs of appropriate skill mix of staff.Commencing this project provided an opportunity for the development of a supporting CNS portfolio for submission for CNS status.
- The main aim of the survey was to identify the perceptions of nursing staff on the current delivery of education and their perceptions n the need for education on night duty.A career pathway had been developed in the department in ____ it was therefore also important to identify the awareness of the career pathway and if career progression was being achieved.
- It was obvious that any education plan had to meet the needs of all staff with 86% of staff working nights at some stage.
- The ED has two CNE’S which rotate shifts to cover mornings/evenings and weekends – this does not include nights, it was therefore important to identify a person to provide and encourage education on night duty.With only 20% of staff aware of their level of career pathway progression and 48% aware a pathway existed it was necessary to increase awareness of the pathway and review this current pathway.Competency standards are required to be re-assessed yearly, upon review many of these were long overdue especially for staff working permanent nights.This project provided an opportunity to review the current education program and make any recommendations as necessary.
- The first model I was left copies of inservices provided by education staff in the ED and other guest presenters, I was expected to provide these sessions to staff.Difficulties with this I was reading information which I had not developed myself and therefore was not 100% sure of the material I was providing.With no designated inservice time I was attempting to catch staff on their breaks or in the very in frequent down times. Staff were more interested in sleeping than listening to education sessions.I had difficulty in getting staff together in one group to deliver the education – I was therefore only capturing 1 or 2 staff at a time.The education folder on the computer drive allowed staff flexibilty to access material at their own leisure. I was left messages by the education staff when new material had been uploaded and following handover I would inform staff of the new material.The staff felt less badgered and found this more enjoyable, if they had to leave to answer buzzers they wee able to come back without missing on any information.My role in this was to be available to answer any questions and encourage staff to access the education drive.