Time to Proficiency in the NICU

Abstract

Background:

Respiratory therapy expertise is central to quality patient care in the neonatal intensive care unit (NICU). According to Benner’s Stages of Clinical Competence, healthcare providers pass through 5 level of proficiency: novice, advanced beginner, competent, proficient, and expert. Prior and during orientation, orientees are novice to the area they scheduled to orient in. This does not mean they do not have knowledge, but rather that they lack the fundamental competencies to work in that area. Staff that have completed a basic orientation progress from novice to advanced beginner during resourcing, advance to competent when resourcing in that area is complete, and grow in proficiency over time. The goal of this project was to determine the length of time is takes a NICU respiratory therapy orientee to reach self-proclaimed proficiency; defined as being confident in their ability to care for NICU patients, complete NICU tasks without assistance, and understand the pathophysiology of NICU diseases

Methods:

All respiratory therapists with a minimum of 1 year respiratory therapy experience who began NICU orientation between May 2016 and May 2018 completed a voluntary online self-assessment regarding ability to perform skills and knowledge of disease processes directly before orientation, after orientation, one year after orientation and two years after orientation. Education included 12 h of didactic, 20 online learning modules, 4 h hands-on equipment, with competencies and checkoffs consistent throughout.

Results:

Voluntary online participants (N = 55) pre orientation self-professed ability to care for a neonate based on skills and knowledge ranged 1–3 (2.5 average) with 1 being limited ability and 5 being able to independently complete all tasks and understand the care required. Post orientation (n = 49) ability to care for a neonate ranged from 3.0–4.0 (3.50 average), one year post (n = 52) ability to care for a neonate ranged from 3.5–4.5 (4.0 average, and two years post orientation (n = 48) 4.0–5.0 (4.75 average).

Conclusions:

While orientation consists of brief education, some didactic, equipment, and getting the competencies and checkoffs completed within a brief period of time, actually growing therapists’ knowledge takes time and effort. Before we can expect our therapists to be completely functional, and comfortable, in a unit we need to provide additional education, opportunities, and experiences with other trained professionals as resources until they can reach proficiency.