• Article
  • June 13, 2018

Using Simulated Training for ICU Float Nurses

How Boston Children's Hospital replaced lectures with interactive, simulation-based orientation classes.

It was more than 10 hours into the content-heavy nursing orientation session on a cold January day at Boston Children's Hospital, but the participants were still very engaged. Their conversations with the instructors were lively. That's when Michael Greenlee realized how different this session was. "We knew we'd hit a home run," says Greenlee, RN, B.S.N., CCRN, a CICU nurse educator at Boston Children's and the project lead for its ICU float pool orientation. "We knew this was something we needed to implement for future orientations."

What made this session different from any other? Greenlee and his team replaced days of classroom lectures with a one-day agenda packed with interactive simulations.

Content and time presented major challenges

The idea was born out of necessity. Traditionally, Boston Children's had selected nurses already working in one of its ICUs to staff its ICU float pool. Therefore, ICU float pool candidates already had familiarity with the hospital and what Greenlee calls its "core curriculum." But when Boston Children's expanded its ICU float pool earlier this year and included three external candidates, the orientation strategy needed to change.

Though the new hires were experienced nurses—a minimum of two years' ICU experience was required—bringing external candidates up to speed on the operations of four uniquely specialized ICUs as well as the team structures, culture and communication protocols at Boston Children's was a massive challenge.

The other primary challenge: the calendar. "We had to figure out how that curriculum could be conducted within the constraints of time," Greenlee says. "We knew we didn't have unlimited time for orientation, so from a budgetary standpoint we knew we had to get them out into the units."

Leveraging technology was key

Fortunately for Greenlee and his team, they weren't going it alone. Prior to the simulation day, the orientation team assigned study modules to the participating nurses through an online educational platform. This allowed the orientation instructors to maximize their time with the participants and gave the nurses a jump on what the simulation exercises would cover.

When it came time to design the scenarios for simulation, Greenlee leveraged the expertise of Boston Children's Hospital Simulator Program (SIMPeds), which has been an integral component of the hospital's training programs since 2001.

"They established the foundation that really enabled my educator team to create this meaningful curriculum," Greenlee says. "They showed us the enormous potential simulation had to convey key concepts."

The result was a single 10-hour class consisting of four simulated scenarios that pose high risks to ICU patients, including:

  • Airway management
  • Sepsis
  • Pulmonary hypertension
  • Meconium aspiration and pneumothorax
  • Emergency situations and roles in a code

Positive feedback leading to expanded use

Greenlee says the feedback from everyone involved in the new orientation process—educators and participants alike—has been positive. "The simulations were helpful, especially in terms of the ICU float pool," says Kai Walmsley, B.S.N., RN, CCRN. "It really helped you adjust quickly to a completely different type of patient and a completely different type of scenario. You need to have that ability when you're in the ICU float pool because every shift you're going to be in a different unit with a different type of patient."

The early success of this educational strategy ensures its ongoing role in future ICU float pool orientation sessions at Boston Children's, according to Greenlee. He adds that the hospital plans to expand the use of simulation to its new graduate nursing orientation agendas, beginning with the upcoming class launching in July.

Additionally, the viability of simulation-based orientation classes paves the way for Boston Children's to continue tapping the external labor market. The hospital plans to soon double the size of its ICU float pool, according to Greenlee.

Send questions or comments to magazine@childrenshospitals.org.