The Impact of Simulation-Based Training on the Self-Confidence of New Nurses in the Care of Acutely Deteriorating Patients and Activation of the Rapid Response Team

Background: New nurses report a sense of being unprepared and low levels of self-confidence. Simulation-based education is frequently used as a strategy to address this low level of confidence and to improve patient safety by providing high-fidelity training in a safe environment.

Purpose: The purpose of this DNP scholarly project was to assess if new nurses’ participation in high-fidelity simulation-based training increased self-confidence and nurse-initiated activation of the Rapid Response Team (RRT) when caring for the deteriorating patient.

Methods: A quality improvement (QI) design using the FOCUS PDSA framework was the basis for implementation. The target population was new nurses on two units at a Level One Trauma Center. New nurses participated in a 70-minute high-fidelity simulation (HFS), developed and validated over 10 years through multiple PDSA cycles, of a deteriorating patient. Two measures were used in this project. The change in new nurse self-confidence was measured by Grundy’s C-Scale, and the change in the percentage of staff-initiated RRT calls vs auto-triggered was calculated three months after simulation participation.

Results: Twelve nurses participated in the simulation. All showed an improvement in self-confidence from pre-simulation to immediately post-simulation measurement. Using a Wilcoxon signed-rank paired data test, participants’ confidence scores on all five items of the C-scale showed a statistically significant improvement from pre- to immediately post-intervention as well as five months later. The difference in the percentage of staff-initiated RRT calls three months post-simulation was increased on Unit B, while Unit A showed a decline in staff-initiated RRT calls when compared to auto-triggered RRT calls.

Discussion: This QI project’s simulation intervention was effective in increasing self-confidence scores between pre- and immediately post-intervention. Five months post-intervention, this increase was sustained. However, how this increased self-confidence by the new nurses was translated into practice when activating RRT calls cannot be interpreted by this data as many factors could have influenced RRT call patterns in the pre-and post-simulation period. Though a small test of change, the evidence in the literature review and these results do suggest that inclusion of HFS should be considered to be embedded into the existing Nurse Residency Program. This would allow an opportunity to use HFS to build self-confidence in the care of the deteriorating patient over time of a defined cohort of participants to evaluate the benefits of HFS on new-nurse self-confidence and activation of RRT in an academic medical center.