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The challenges of education for critical care nurses

The challenges of education for critical care nurs
Photo: The challenges of education for critical care nurs
David Robertshaw MSc (Critical Care) BSc (Hons) RN and Academic Lead for Health and Social Care, at the University of Derby Online Learning (UDOL).

Critical care is a great place to work as a nurse as it provides a variety of challenges and is very diverse – meaning every day is different. It is one of the largest nursing specialties across the World, due to the need for adequate levels of staffing when caring for very sick patients. Clearly managing such patients requires a high level of skill, knowledge and experience and this is often obtained through participating in a post-basic course on critical care. Historically, these courses were often provided by the healthcare institution in which the person was working but there has been a trend towards Universities and other Higher Education institutions providing these. This is due to the increasing professionalisation of nursing between 1990-2010 during which time the level of qualification nurses leaving training with has increased. In the UK, nursing became degree-only in 2013 which means the post-qualification courses students take are likely to be at Masters Level.

So why should a critical care nurse undertake post-qualification study?
From the perspective of patient outcomes it has been shown (at least in the neonatal context) that nurses in critical care who have specialist qualifications can have a positive impact on outcomes 1. It’s for this reason that several regulatory bodies and organisations, including the Australian College of Critical Care Nurses (ACCCN, 2006), Faculty of Intensive Care Medicine (2013), and the British Association of Critical Care Nurses (2010) recommend minimum levels of critical care nurses with specialist qualifications. Despite these recommendations, it’s difficult to actually determine how many people have specialist qualifications in critical care. One study reported Australian intensive care units (ICU) have been 55-78% specialist qualified nurses 2. The census of nurses with specialist qualifications is not routinely collected, with information being held by healthcare providers rather than a central registry.

In the USA, nurses have a system of ‘credentialing’ whereby critical care nurses spend between 1,750 and 2,000 hours at the bedside followed by an examination after which they may use the post-nominal letters ‘CCRN’. These credentials are granted by the American Association of Critical Care Nurses rather than an educational institution. In other countries, such as the UK, Australia and New Zealand a postgraduate education route is offered with formal University qualifications. The biggest issue is that there is no clear definition of the sphere of critical care nursing practice and there is a significant variation in duties between critical care environments making it difficult to determine a curriculum which would suit all entrants. This is despite competency frameworks and position statements issued by the European Federation of Critical Care Nursing Associations, the UK Critical Care National Network Nurse Leads Forum and the Australian College of Critical Care Nurses. There is a considerable need for consensus across education providers to work to a standardised curriculum that is available in a limited outline form, but not often followed.

The Australian Health Workforce Committee describe a qualified critical care nurse as someone with a postgraduate qualification in critical care nursing (Australian Health Workforce Advisory Committee 2002) which Rose et al (2008) 3 defined as being a “post-registration award at a minimum of certificate level obtained by successful completion of an accredited critical care programme (over the   duration of 6 months) at a hospital or tertiary institution”. This qualification could be anything from a Certificate to a Masters degree and could be taught in a variety of formats. The European Federation of Critical Care Nursing Associations state each course should have a minimum of 50% practice and employ a variety of delivery methods including classroom teaching, simulations, OSCEs and online learning 4.

As a programme leader for an online learning nursing studies programme, I passionately believe in that mode of delivery and its suitability for postgraduate nursing qualifications. There are challenges around developing clinical skills and testing clinical competency, but we are able to overcome these by forging strong links with practice providers. The links with clinical educators who support students in practice are invaluable and it is they who can determine clinical competency. In this partnership education providers can through programmes of study enhance students’ analytical and problem solving skills ensuring practitioners are able to make decisions and judgements informed by evidence. Online learning as a mode of delivery permits learners from across boundaries to join together and share best practice: a critical care nurse in Brisbane could learn alongside one in Perth, but also in Abu Dhabi, Hong Kong, New York and Manchester.

Ultimately, whatever mode of delivery is employed, postgraduate qualifications in critical care are needed. There are shortages of qualified and experienced nursing staff, and healthcare providers can provide financial or career incentives to promote postgraduate courses to critical care nurses. By doing so, providers will retain staff and develop an engaged and skilled workforce. These nurses can then provide a higher standard of care based on evidence and rigour, improving outcomes for patients. They also become the leaders of the future and can in turn work with new staff and students to encourage them to become highly qualified, skilled and engaged colleagues in critical care which I believe is the best environment to work in as a nurse.

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