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Going the extra “MILE”

Continuing education for MICU nurses

Hammer, Bernice, RN, CCRN; Sterling, Michelle, BSN, RN, CCRN; Stromack, Jennifer, MSN, RN, CCRN; Brown, Leah, MSN, RN, CNS

doi: 10.1097/
Department: Professional Enrichment

Bernice Hammer is a clinical lead at Sharp Memorial Hospital, San Diego, Calif.

Michelle Sterling is a clinical MICU nurse and advanced clinician at Sharp Memorial Hospital, San Diego, Calif.

Jennifer Stromack is a clinical nurse, advanced clinician, and MICU clinical coach at Sharp Memorial Hospital, San Diego, Calif.

Leah Brown is a clinical nurse specialist at Sharp Memorial Hospital, San Diego, Calif.

The authors have disclosed no financial relationships related to this article.

Lifelong learning, one of the hallmarks of professional nursing practice, is a dynamic process that involves challenging conventional wisdom, integrating divergent points of view, and finding opportunities for practice-based study and self-reflection.1 Continuing education helps nurses develop the critical-thinking skills and flexibility needed to deliver high-quality patient care.2 To help foster continued skills development in medical intensive care unit (MICU) nurses, the advanced clinician (AC) group at a 656-bed hospital in San Diego, Calif., developed a MICU interactive learning experience (MILE) to educate on the facility's rapid infuser for blood product administration.

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Learning station design

Providing professional development and educational opportunities to meet the learning needs of clinical nurses poses several challenges, especially in a high-acuity ICU environment. Critical care nurses need to stay current on rapidly changing technology, new patient therapies, and complicated medication regimens, but many have only limited time to devote to education opportunities. Current staffing trends make it difficult for nurses to attend learning events and professional activities while keeping up with patient loads and assignments.3

Other factors that influence the success of continuing-education activities are the amount of preparation and motivation of learners as well as educators, accurate assessment of educational needs, planning and implementation, facilities, and instructor evaluation and feedback.4 Learner-directed activities allow professionals engaging in continuing education to determine the pace of the learning activity.5,6 Self-direction is considered an attribute of successful lifelong learning.7,8

The MILE is a multimodal learning station based on the concept of learner-directed education. It provides a convenient educational opportunity that is current, relevant, efficient, and specific to the MICU environment. The MILE was developed by the MICU's AC group, which includes 13 clinical nurse experts whose key job responsibilities encompass educating staff, preceptoring, mentoring, and presenting programs that resolve a nursing practice issue or knowledge deficit. Championing new technologies and evidence-based practice initiatives, as well as improving patient and unit outcomes, also are vital parts of the role. The AC group works in conjunction with the MICU's clinical nurse specialist (CNS) to maintain ongoing competence and facilitate the continuing professional development of over 90 staff RNs. Each AC leads a group, or district, of 6 to 10 RNs in achieving their professional development goals.

The AC group reviewed the annual learning needs assessment results and recognized the need to create learning opportunities for additional topics. Additionally, they sought to create an innovative type of learning experience that would foster genuine interest and engagement from clinical nurses and generate a sense of ownership and investment in each nurses' own professional development.

MILE development included conceptualization of a dedicated room reserved for presenting a quarterly rotation of learning topics derived from the annual learning needs assessment. The AC group conducted a literature review to explore blended learning modalities, improve nursing staff engagement, and investigate the prior successes of nursing education rooms at other institutions. The AC group agreed on the MILE as the name of the education room because of its reminiscence to the phrase “going the extra mile” and implication that nursing education is a marathon, not a sprint.

The AC group agreed to coordinate and present the inaugural education topic, with the development of subsequent subject matter presented by individual ACs with their RN districts. Staff involvement from each AC's district was paramount in establishing the foundation of a self-directed learning experience.

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The AC group developed an electronic survey that was emailed to staff prior to implementing the first MILE room to assess the MICU nurses' perception of and satisfaction with education provided on the unit. The completed preimplementation surveys were tallied to obtain baseline levels of agreement with the following statements using a 1-5 Likert-like scale: My educational needs are currently being met on the unit; I feel involved in unit-based education; I have the resources to advance my professional development; I feel that education opportunities are easily accessible; and, Current education offerings on the MICU are satisfactory. This survey was repeated 1 year later to determine staff satisfaction, involvement, and success in creating a culture of learning through the MILE.



Based on the results of the annual needs assessment, the entire AC group decided the first MILE would provide focused training on using the blood rapid infuser because of the device's high-risk low-volume use. Subsequent MILE rooms were initiated by small groups of two to four ACs, and staff involvement was encouraged by the entire group throughout the quarter. The subsequent topics included the hemodynamic monitor for continuous cardiac output monitoring and intra-abdominal pressure monitoring.

The AC group used a standardized process and organizational structure to maintain consistency across every MILE educational topic and room. The rooms were set up to include and promote self-directed learning, and included at least two learning modalities (poster, video, hands-on tools), as well as pre- and posttests and an educational plan approved by the CNS prior to initiation. Finally, rooms included an evaluation of the individual educational topics using Kirkpatrick's Levels of Evaluation.9

The general flow through the MILE room steps is consistent. Emails, flyers, and preshift huddles announce the new quarterly topics to staff. (See Mile markers.) For example, our blood rapid infuser setup began by having each RN who entered the room sign in with their credentials to get credit for attending. RNs would then fill out a pretest to assess their baseline knowledge of rapid blood infusion. The next step would bring them to a mock setup of the device. A skeleton model was attached to the blood tubing and machine. RNs would read directions on how to set up the device and then execute what they learned, providing them with hands-on setup experience. Video resources were also available. RNs would then complete a posttest to assess learning and station evaluation. Staff are encouraged to attend during any down time on their shift, before or after their shift, or if they are on the unit for other meetings or classes. Staff may attend the MILE room in groups or alone. Upon completion of each MILE, the pre- and posttests and station evaluations are tallied and reviewed by the CNS. The scores and staff evaluations are discussed by the CNS and AC group to determine if any appropriate changes need to be implemented for subsequent educational rooms.



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Learning evaluation

Nurses' comments included in the evaluation revealed a positive reaction after finishing a MILE education session. Comments indicate nurses' appreciation of being able to “review on the job,” and the “hands-on” component. Pre- and posttests also indicate that learning occurred during the session with improved posttest scores achieved for each topic. An increased level of familiarity and confidence in the use of the blood rapid infuser became apparent shortly after the first MILE. Three patients in the MICU experienced significant bleeding episodes. The nurses quickly identified the need for the blood rapid infuser. They confidently set it up, potentially saving lives by using their recently increased knowledge and skills. In 2018, the results of an annual Culture of Safety and Employee Engagement Survey showed that RNs feel involved in patient safety (92% favorable) and that they have access to the resources needed to do their jobs effectively (87.5% favorable). The MILE supports patient safety and increases nurses' confidence and competence, which may have had an impact on these scores.



After implementation of the MILE, the electronic education survey was repeated 1 year later. Results showed that MICU nurses were still satisfied and interested in continuing education. Nurses' attitudes toward being involved, and the accessibility of education opportunities were rated as slightly improved. (See Preimplementation survey results and Postimplementation survey results.)

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Future plans

Providing continuing-education opportunities for staff is a challenge for a variety of factors. A consistent challenge is the reluctance of staff to attend classes or other education opportunities outside of their scheduled shifts. Providing education during work hours also presented its own set of challenges. A busy ICU leaves nurses with little time and opportunity to leave their patients, even for 15 minutes, to attend educational opportunities; only 30% of the MICU nurses at the authors' facility have participated in at least one of the three MILE trainings so far. The plan to increase participation includes moving the educational area to a more central location for ease of accessibility, posting the learning tools that were used in the MILE on the unit website, creating a bulletin board in the conference room that showcases the MILE topic.

The AC group planned to keep one patient room designated for the MILE, but challenges arose when every room was needed to accommodate patients during high census. The AC group strived to set up the MILE in a conference room or at the end of the hallway. However, the MILE steps and educational materials seemed cramped and participation dropped off.

Although time and space provided challenges to the MICU AC group, three topics have been covered successfully in the MILE. Staff evaluations have been positive and review of infrequently used devices and therapies in the MICU has increased the knowledge and skill of the nurses working in a demanding high-acuity environment. The MILE successfully supports ongoing education. However, clinical nurses within the AC districts have been slow to adopt the additional challenge of assisting with the creation of a MILE topic. The focus in the coming year will be to encourage clinical staff to participate in the setup and development of the MILE so that they can enhance their own professional development.

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