Best Practice: Implementation of a comprehensive Procedural Sedation Program for Interventional Radiology and Catheterization Lab nurses through shared governance
Best Practice, Mercy Medical Center, Baltimore, MD
Mercy Medical Center shared governance councils drove the implementation of a procedural sedation education program that improved nurse confidence, competence, and physician satisfaction scores.
Kim Dorsey, BSN, RN, CCRN, CLIN IV, a staff nurse on the Interventional Radiology unit and the Cardiac Catheterization lab for the past 31 years at Mercy Medical Center, Baltimore, MD, has been involved in the divisional and unit-based Practice Council for most of her working years, having chaired it in the past. She is also an active member of her unit-based shared governance council.
Identifying the Problem
A well-established, robust shared governance team thrives in the Interventional Radiology and Cath Lab areas. The interprofessional team includes nurses, some of whom are division council representatives; radiology staff; and often the medical director. Monthly meetings address departmental issues and develop solutions for those concerns. The meeting agenda follows the professional practice model, and during a discussion about care delivery, a nurse voiced concern about the varying degrees of comfort levels among nurses administering procedural sedation.
Some nurses did not feel confident in sedating higher-acuity patients, even though they were qualified to give sedation and the patients were stable enough to receive it. Additional discussion with physicians revealed they, too, noticed differences in comfort levels among the nurses. Furthermore, these disparities were thought to be contributing to lower nurse-to-physician interaction satisfaction scores. Through the shared governance process, the team worked to implement a solution.
Developing the Education Program
Shared governance allows for authority in decision-making to have an impact on practice. The team felt they needed a more comprehensive education program to ensure competency and confidence in administering procedural sedation. Specifically, they wanted to know whether there would be a difference in perceived importance, confidence, competence, and satisfaction following a structured sedation education program.
A subgroup of the shared governance committee started with a literature search. The findings showed that while evidence and practice standards from the American Nurses Association, the American Society of Anesthesiologists, and the Association for Radiologic & Imaging Nursing spoke to the need for competence in sedation pharmacology and airway management, there was no clear definition of what constituted adequate education to positively impact nurse confidence levels. Because of this evidence gap, the shared governance subgroup worked with their nurse researcher and developed a research question as well as an institutional review board protocol.
Implementing Two Key Interventions
The subgroup recommended two interventions, which the shared governance committee supported. Because of financial implications, nursing administration allocated funds for this initiative. The first component required each nurse to complete the Certified Sedation Registered Nurse program. This certification was a 10-hour course that included a pretest, online modules, and a post-test. Once nurses completed the certification, each one was paired with a certified registered nurse anesthetist or anesthesiologist for a hands-on practicum in airway management.
Impressive Results
The results were impressive. The research study included a validated pre- and post-survey evaluating knowledge, confidence, competence, and satisfaction. Through collaboration with the hospital statistician, data analysis demonstrated a statistically significant change in mean scores (using a p-value ≤ 0.05) after completion of the program.
The autonomy of shared governance allowed the unit to change and improve sedating protocols, positively impacting nurses’ confidence and competence with procedural sedation. In addition, this impact improved communication and relationships with physicians. The working environment also improved, as reflected by nurse-to-physician interaction satisfaction scores that continue to be above the benchmark.
When a hospital supports shared governance, it allows everyone to come together, take control of an issue, participate in solving the problem, and show improvement through practice changes that ultimately improve patient outcomes. The power of shared governance in nursing can achieve remarkable things.