Nursing Challenges and Clinical Competency Quiz

Medical-Surgical Nursing Competencies

• Entry-level nursing programs prepare nurses to practice competently in various medical-surgical settings
• Competency in adult medical-surgical patients requires a strong background in anatomy, physiology, chemistry, microbiology, pathophysiology, and pharmacology
• Emphasis on correlating nursing care rationales with physiological and pathophysiological bases of selected diseases for better interpretation of data, critical thinking, and clinical decision-making
• The Academy of Medical-Surgical Nurses (AMSN) is the recognized leader in medical-surgical nursing
• AMSN's mission is a dynamic community of medical-surgical nurses committed to quality patient care through professional development, certification, scholarship, and advocacy
• AMSN values dedication to the well-being of nurses and their patients
• AMSN promotes innovation and collaboration with interdisciplinary teams and external stakeholders to achieve common goals
• AMSN advocates for medical-surgical nurses and patients from the point of care to the boardroom and from the payer to the legislative arena

Strategic Plan

• AMSN's strategic plan focuses on achieving the mission of commitment to quality patient care through professional development, certification, scholarship, and advocacy
• This plan guides the work of AMSN

Competency Gaps

• New graduate nurses sometimes demonstrate an academic-practice gap
• Acute care agencies report new graduates take longer to achieve clinical competency despite increased onboarding and training resources
• New graduates lack expected knowledge and competency in patient/care management, holistic patient care, interprofessional care, professional concepts, and nursing teamwork and collaboration

Clinical Judgment

• Clinical judgment is the observed outcome of critical thinking, and decision-making based on nursing knowledge
• Nurses use clinical judgment to observe and assess presenting situations, identify concerns, and generate evidence-based solutions
• Clinical judgment is a required competency in the increasingly complex environment of nursing practice
• The American Association of Colleges of Nursing (AACN) emphasizes clinical judgment as an important attribute of professional nursing
• Clinical judgment directly influences patient care outcomes and is often based on nursing knowledge, critical thinking, and clinical reasoning

Clinical Judgment Measurement Model (CJMM)

• NCSBN developed the CJMM to measure clinical judgment in new graduate nurses
• The CJMM measures a registered nurse's ability to recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes

Evidence-Based Nursing Care

• Evidence-based practice is the foundation of professional nursing practice
• Medical-surgical nursing uses evidence-based practice principles to provide high-quality, cost-effective care to patients and families
• Evidence-based care considers the best available evidence, clinical expertise, and patient preferences
• Steps in the evidence-based process include developing the question, searching and collating evidence, evaluating evidence quality, integrating evidence into practice, evaluating outcomes, and disseminating evidence

Medication Administration Errors

• Medication administration errors are a critical patient safety issue
• Qualitative research suggests medication knowledge, fatigue, workload, and interruptions are primary causes of medication administration errors
• Nurses perceive multifactorial and system-related causes of medication errors

Patient-Centered Care

• Patient-centered care is a benchmark for acute care facilities; the IOM report highlighted its importance
• Patient-centered care focuses on providing respectful and dignified care for patients and involves patient participation in decision-making
• The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patient experiences regarding care
• The Joint Commission (TJC) includes patient-centered care concepts in accreditation standards
• The Beryl Institute emphasizes patient-centered culture in healthcare settings

Patient Safety

• Joint Commission's National Patient Safety Goals focus on areas to improve patient safety; identifying patients correctly and improving staff communication are core goals
• Nurses must use accurate patient identification throughout the patient experience, especially during assessments, procedures, and medication administration

Interprofessional Collaboration and Communication

• Interprofessional collaboration is crucial in medical-surgical settings, especially with high-acuity patients
• Effective communication, including SBAR, among interprofessional teams is important in acute care settings; this includes healthcare providers, pharmacists, and social workers
• Educational programs are focused on educating the future healthcare workforce collaboratively and in interprofessional medical settings

Quality Improvement and Informatics

• Quality improvement and safety in healthcare are essential for safe, effective care
• Technology plays a crucial role in quality and safety improvement and patient centered care