IMPLICATIONS AND CONCLUSIONS
Although projects to date have varied in
topic and urgency of the clinical issue, the
most successful projects have been those that
are nursing-sensitive and data driven and have
a clear performance gap. Strong evidence
bases with benchmarking data and clear target
conditions provide students with greater
clarity in the topic and RCA process, resulting
in more appropriate recommendations for improvement.
As noted from the project evaluations, our
health system partners have found great value
in the RCA student team’s presence on the
unit. This was evident by the liaisons’ high rating
of impact on outcomes and overall value
of the A3. In addition, the fact that many
of the units have had multiple teams and
have implemented the team’s recommendations
is an indication of the success of the
projects. Students are provided with an excellent
opportunity to learn about the RCA process
and QI in an active learning experience
while simultaneously finding satisfaction for
completing a project that potentially changes
practice.
This type of experience should enhance
nursing practice for our new graduates as
they transition to the role of staff nurse.
Unit liaisons reported the desire for further
engagement of staff nurses in the student
RCA projects in all aspects, including data
collection and routine updates. This reflects
the desire to minimize the theory/practice gap
by developing competencies to “use data to
monitor the outcomes of care processes and
use improvement methods to design and test
changes to continuously improve the quality
and safety of health care systems” among
nurses providing direct patient care.8(p133)
Future projects could identify a staff nurse
champion on the unit who could be an additional
resource to the student RCA team. The
staff nurse champion could provide greater
insight into the unique characteristics of the
unit that need to be considered when developing
appropriate recommendations for
improvement.
Although there are several benefits for implementation
of such QI projects, there are
also a few notable limitations. Specifically, this
type of project requires commitment from the
faculty and the unit liaison. Students first encounter
with the RCA process occurs in this
course, so they require close guidance. Faculty
spend about an hour eachweek with each
student team to ensure continued progression
and that the work is meeting the stated needs
of the unit (eg, identifying the root causes of
the initial issue).
Another limitation results from the timing
of the course semesters. Some of the work
would benefit from teams lasting longer than
the 14-week academic semester. Unit liaisons
reported difficulty in moving forward with
implementing recommendations because of
multiple priorities and limited resources.
Student projects may have greater impact on
the outcomes if student teams assisted in the
implementation phase of the work. Specifically,
units would have an RCA student team
in the fall semester, with an additional student
team in the winter semester with the primary
purpose of assisting with implementation of
one of the RCA recommendations. A structured
handoff would be required between
the 2 student teams. Students in the second
semester would be able to further develop
the implementation plan—designing educational
materials for staff nurses, collecting
process and outcome measures in all phases
of the project, evaluating outcomes, and creating
a process for ensuring sustainability of
the change. In this new project, unit liaisons
would play a more active role in the implementation
phase, with unit leadership ensuring
that resources are available for successful
implementation.Greater engagement from
the unit leadership and staff nurses may also
improve sustainability of the recommendations,
resulting in additional improvements in
patient outcomes.
Findings from this evaluation provide support
for engaging undergraduate students in
the QI process through an active learning
experience, a competency required for successful
nursing practice. The RCA process
implemented at our institution has resulted
in students “experiencing” the QI process,
rather than just discussing it during didactic
sessions. The impact on patient care, as noted
by our unit liaisons and detailed in the specific
exemplars, provides even greater support for
continued implementation.