Authors (including presenting author) :
Tong FH(1), Chiu SH (1), Cardiac Nursing team (1), Jessica Yik WM(1)
Affiliation :
Cardiac Team, Department of Medicine & Geriatrics, Princess Margaret Hospital (PMH), Hong Kong SAR, China
Introduction :
Timely PPCI is preferable treatment for ST-Elevation Myocardial Infarction. Kowloon West Cluster (KWC) hospitals will adopt a cluster-based service model to achieve 24-hour PPCI service by phases in coming few years. Princess Margaret Hospital (PMH) will be the center for supporting PPCI service for all KWC hospitals during off- office hour. This signifies the need on cultivating a competent and flourishing nursing workforce at cluster level or in PMH to address the future challenge. Through SWOT analysis in 2017, areas that need strengthening had been identified: (1) The skilled nursing labor pool was unable to support the cardiac service expansion, (2) The staff competencies in cardiac nursing varied a lot among colleagues. The different working environment and job nature make nurses of Coronary Care Unit (CCU) feel stressed and hesitate when deploying to assist PPCI even they have received Cathlab training before.
Objectives :
1. To build up a competent and flourishing nursing workforce 2. To expand the skilled nursing labor pool to meet cardiac service expansion 3. To boost colleague’s confidence in assisting PPCI
Methodology :
An ongoing enhancement program has been formulated to tackle the identified areas by phases since in 1Q 2017. The required competencies for nurses working at cardiac ward, CCU and Cathlab were stratified. All existing training program were restructured according to the stratified competency level. The eight-day Cathlab Crash training, which is aiming at training up a CCU nurse for assisting Cathlab nurse to run PPCI procedure competently, was integrated into the six-month CCU training not to wait CCU training completed. The Individual Development Plan was introduced to newcomers on their first day of reporting duty to provide them with a clear roadmap of career development in Cardiac setting. Regular nursing grand round was conducted to promote peer group sharing in knowledge & skill. Unlike the past, starting from 2019, RNs with 1-2 years CCU working experience are invited to work with APN to be a speaker of various training such as hand-on training on common cardiac bedside procedures, e.g.,transvenous cardiac pacing procedure. In collaboration with cardiac nursing team of KWC hospitals,the Cardiac Nurse Consultant organized a cluster-based training program for nursing colleagues of KWC hospitals. The Cathlab of PMH also acted as a training center for supporting the development of Cathlab of a sister hospital. With the Management support, training opportunity has extended to colleagues of medical ward of PMH. They would have a 3-month job rotational training in Cardiac ward. On top of the existing six-month Cathlab training and various types of goal orientated refresher trainings, all trained nurses including Crash training would have repeated and intermittent one to two days Cathlab duty shortly following the completion of training starting from Jan 2019.
Result & Outcome :
The growth of nursing workforce and the skilled labor pool have been augmented and widened respectively. 12 training sessions at cluster level completed with 285 attendances from Oct 2019 up to now. There are 62% (Dec 2019) versus 42% (Jan 2017) of nurses can be deployed from ward to assist PPCI. Total 8 M&G RNs have completed the rotation training (May 2018- Dec 2019). Not only did their experience, skills and knowledge enhanced but it also aroused their interests in Cardiac nursing. Among them, one had raised an internal transfer after training and become a member of our team. The remaining nurses may constitute a manpower reservoir for cardiac ward when needed. Besides of APNs and senior RNs, 3 relative junior CCU nurses were empowered through the process of delivering training to colleagues. All nurses welcomed the intermittent and repeated Cathlab duty as it could help them to retain knowledge and skill. It also kept them updated with new technology in Cathlab. They verbalized it did help in reducing their stress as well as hesitation when deploying to Cathlab.
