Endoscopy nurse leaders take a unique training approach.
- Coffee and Conversation, a novel approach to in-service education, serves as an efficient and effective method for providing specialty-specific education and training, improving nurse knowledge, and building staff cohesion.
- It helps preceptors orient and onboard new staff using timely, focused, ongoing continuing education.
Endoscopy procedures used in diagnosis and treatment require well-prepared healthcare professionals, including endoscopy nurse specialists. To address training shortfalls and staff shortages on their endoscopy unit, a team of nurse leaders implemented a successful evidence-based intervention.
The situation
High turnover of experienced nurses on our urban hospital endoscopy unit increased the demands to onboard, train, and support newly hired nurses while maintaining safe, high-quality patient care. With over 50% of the staff considered novice, experienced staff responsibility included providing orientation while also performing advanced endoscopy procedures each day. This added to the stress on core nursing staff, which led to more attrition. As a result, concern developed that the unit would struggle to hire and adequately train new staff in time to avoid compromising patient care.
As senior clinical nurses on the endoscopy specialty unit, we needed to find a more effective approach to onboard new nurse hires while also supporting the core staff. We all agreed that the team needed an educational, morale-boosting intervention.
Our team of nurses designed an innovative, evidence-based staff development series called Coffee and Conversation. We scheduled the series for the beginning of the workday before patient arrival. We aimed to educate all nursing staff in a relaxed environment before the chaotic daily endoscopy procedure schedule. The Coffee and Conversation series used an easy-to-follow staff development format to provide focused specialty-specific education and training without affecting staffing ratios or interrupting patient care.
Why staff development
Staff development, which isn’t new to nursing, provides opportunities for nurses to improve their knowledge, attitude, confidence, and critical thinking skills without impairing staffing or patient safety. Over time, staff development has evolved into a specialty-specific modality to maintain staff competence with the best care guidelines and specialty skill sets. According to Chaghari and colleagues, nurses report interest in education that can enhance knowledge, facilitate job responsibilities, and improve skills for job resilience. Due to a lack of regular staff-development opportunities, our endoscopy nurses experienced knowledge gaps.
Engaging and recruiting nurses
To improve learner engagement, learning outcomes, and knowledge transfer, we used Knowles’ adult learning theory (andragogy) to plan and develop the Coffee and Conversation educational series. This theory asserts that adult learners require active engagement and a focus on process and purpose rather than memorization and testing. Blevins discusses the importance of understanding and utilizing adult learning theory, individual learning styles, and generational differences. We wanted each staff development experience to address individual staff member learning needs.
Engaging the endoscopy staff required finding a workable solution to the lack of a designated time for staff development during the workday. The endoscopy unit is open 5 days a week, nurses work 8- or 10-hour shifts, and a 24-hour call team is available 7 days a week for emergent cases. Patients begin arriving at 6:30 am, and cases run until 6 pm. However, one day a week, cases begin at 8 am, pushing patient arrival time to 7 am. This delayed start time provided the window of opportunity to begin monthly staff development for advanced endoscopic procedures.
We recruited endoscopy nurses using a Coffee and Conversation poster and word-of-mouth campaign. Staff agreed to this learning opportunity, and a continental breakfast with coffee provided an added incentive. We planned, implemented, and evaluated three monthly staff development sessions with a targeted focus on four specific advanced endoscopic procedures: endoscopic muscular resection, electrosurgical cautery unit, argon plasma coagulation, and endoscopic retrograde cholangiopancreatography with Spyglass. (See About endoscopy.)
About endoscopy
Advanced endoscopic procedures require nurses trained to a minimal standard of competency who can work in cohesion with gastroenterologists and colorectal surgeons to provide patients with safe and successful care. Procedure complexity varies based on patient anatomy, diagnostic or therapeutic goal, and unpredictable complications. Procedure time can span from 1 to 4 hours.
Embertson and colleagues stress the importance of endoscopy nurses learning new therapeutic regimens to ensure competence and confidence. Advanced endoscopic procedures include the following:
Argon plasma coagulation
- Electric energy targets GI tissue using argon gas, which allows for a significant effect (treatment) on the area of focus and with proper hemostasis
Electrosurgical cautery unit
- Focused cutting, coagulation, and devitalizing of abnormal tissue in the GI tract
Endoscopic muscular resection
- Removal of precancerous, early stage cancer or other abnormal tissue from the GI tract for diagnosis or treatment
Endoscopic retrograde cholangiopancreatography with Spyglass
- Noninvasive direct visualization and biopsy of pancreatic and bile ducts
- Treatment of difficult stones and strictures
Objectives and formats
The learning objectives for Coffee and Conversation included rationale for each procedure, safe set-up, and use of specialty equipment to collaboratively perform advanced endoscopic procedures with gastroenterologists, colorectal surgeons, and procedural teams. Pre-outcome evaluations noted each participant’s years of endoscopy experience and their baseline knowledge of advanced procedures. After completing three staff-development sessions, a delayed post-outcome assessment evaluated retained knowledge.
We recruited guest speakers with expert knowledge in each advanced procedure to provide focused education. Each 1-hour session included time for didactic delivery of information, visual aids, hands-on activities, case scenarios, query time, and procedure-specific fact sheets.
Increased competence and confidence
Of the 20 full-time nursing staff, 12 participated in the Coffee and Conversation series. The levels of experience among these nurses epitomized the knowledge gap on the unit: 42% had less than 1 year of endoscopy experience; 8%, less than 3 years; 33%, 3 to 5.9 years; and 17%, over 10 years. Benner, who developed the five stages of nursing proficiency (novice, advanced beginner, competent, proficient, and expert), estimated that to be a competent nurse, one must have 3 years of on-the-job experience in the same field.
Comparing pre- and post-outcome evaluations, staff demonstrated an overall increase in knowledge (from 66% correct answers to 75% correct) for each of the four advanced endoscopic procedures. The participants self-reported an increase in knowledge and a greater understanding of the processes and goals for each procedure. With this knowledge gain, staff competence and confidence should improve.
This evidence-based educational series provided novice endoscopy nurses with the necessary foundation to ease into their final orientation stage with the appropriate tools and knowledge for success. The Coffee and Conversation format provides an opportunity to successfully train novice endoscopy nurses to participate in advanced procedures while also decreasing core nursing staff burden to train new hires.
Enthusiastic participation
The American Nurses Association challenges nurses through the standards of professional performance to collaborate with invested stakeholders and use leadership skills to integrate evidence and research into practice to ensure staff competency and high-quality care. By providing a supportive environment, nurse leaders can motivate nurses to embrace lifelong learning as a professional value. Offering practical and engaging educational opportunities helps to ensure staff competence and inspires team camaraderie that influences a positive work environment.
The endoscopy nursing staff enthusiastically participated in the three-part series; Coffee and Conversation. After completion, they reported increased knowledge, confidence, and improved staff camaraderie.
In conjunction with the endoscopy unit practice council, the endoscopy leaders at our organization will continue to provide monthly Coffee and Conversation educational sessions. We’ll use this format for delivering consistent, up-to-date information to increase staff knowledge, help preceptors onboard new staff, and offer focused education for new hires.
Lauri H. Santy is the nurse manager for endoscopy at Saint Francis Hospital and Medical Center in Hartford, Connecticut. Cherry A. Karl is adjunct faculty, and Karen Lucas Breda is associate professor of nursing at the University of Hartford in West Hartford, Connecticut.
American Nurse Journal. 2022; 17(12). Doi: 10.51256/ANJ122248
Key words:
novel in-service education, staff development, continuing education, onboarding, nurse knowledge
References
American Nurses Association. Nursing: Scope and Standards of Practice. 4th ed. Silver Spring, MD: American Nurses Association; 2021.
Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-7.
Blevins S. Learning styles: The impact on education. MedSurg Nurs. 2021;30(4):285-6.
Chaghari M, Ebadi A, Ameryoun A, Safari M. An attempt for empowering education: A qualitative study of in-service training for nursing personnel. Iran J Nurse Midwifery Res. 2016;21(5):498-503. doi:10.4103/1735-9066.193404
Embertson A, Ernst N, Yoder J, Monroe L, Hess M. Development of a nurse-led competency-based program for therapeutic endoscopy: The formation of the nurse product procedure group. Gastroenterol Nurs. 2020;43(6):E217-24. doi:10.1097/SGA.0000000000000501
Knowles MS. Andragogy in Action: Applying Modern Principles of Adult Learning. San Francisco, CA: Jossey-Bass; 1984.
Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 4th ed. Philadelphia, PA: Wolters Kluwer; 2018.
