Understanding the role of accreditation standards in the provision of care in a hospital environment is a daunting task for a graduate nurse. Because nurses are providers who spend the greatest amount of time with hospitalized patients (DeLucia, Ott, & Palmieri, 2009), several areas of a health care accreditation survey are likely to affect staff nurses. In particular, two of these areas include a survey of the environment of care (EOC), where nurses provide direct care to patients, and an audit of the patient care record (provision of care [POC]), where nurses document the care that is provided to patients. In addition to demonstrating an understanding of the nurse's role in minimizing patients' safety risks in the health care environment, learning to document appropriately is arguably one of the most challenging skills for the novice nurse (Hofler & Thomas, 2016). Applying the principles of the nursing care process, as demonstrated through documentation, is often lacking by the graduate nurse due to limited practical experience and guidance.
In an effort to prepare nursing students for expectations of an onsite visit from a health care accreditation surveyor, the health system and school of nursing piloted a two-phase educational initiative. The goal of this initiative was to provide the soon-to-be graduate nurses with opportunities to apply health care accreditation standards pertaining to EOC and POC (The Joint Commission, 2019) in real-time clinical settings and situations.
Implementation of the learning activity focused on senior-level nursing students enrolled in the school of nursing's baccalaureate nursing degree clinical capstone course. The overarching objective for the capstone course is to prepare students for entry into practice and to assist them to transition seamlessly from student to professional nurse. Phase one, consisting of two modules, included an intensive training laboratory for all capstone students. Module one involved a systematic review of the health system's electronic health record in a training environment using an itemized list of documentation standards and a mechanism for recording discrepancies or inconsistencies found in the medical record. In module two, small groups of students practiced environmental scans under the guidance of an experienced quality auditor in simulated patient care areas, where infractions to standards were replicated.
Phase two culminated in the practical application of the learning activities from the training laboratory in the live patient care environment. This phase was limited to students who volunteered to participate due to the importance of maintaining strict quality control. Students in this group performed EOC audits on patient care units and in the hospital's active electronic health record. The student volunteers used audit tools, for which they received training in the simulation laboratory and through one-to-one training by an experienced RN auditor employed by the health system.
All 123 students enrolled in the capstone course successfully completed phase one for 8 hours of credited clinical time. Nineteen students who volunteered for phase two of this education opportunity completed 73 EOC audits in the health system's three hospitals and 193 POC audits in the health system's electronic health record. These 19 student volunteers earned approximately 270 hours of clinical time for their efforts. Informal feedback from the students involved in this activity was overwhelmingly positive. Comments included simple appreciation for the opportunity to participate in thoughtful reflections regarding their own practice, documentation, and being more cognizant of the audit and accreditation process. Anecdotally, we know that exposure and opportunity to observe practice facilitates student learning.
By creating partnerships between the health system and the school of nursing, students became active members of the health care team while also learning and reinforcing the skills of the profession. Preparing graduate nurses who understand the accreditation process for health care entities and embrace the practice of continuous compliance leads to fewer new staff nurses intimidated by health system auditors or onsite visits by representatives from accrediting bodies. This also results in providing safer care for patients.
Rebeka Watson Campbell, PhD, RN, CNE
J. Michael Leger, PhD, MBA, RN,
The University of Texas Medical Branch
School of Nursing
Renee A. Kearby, MSN, RN, CPHQ
The University of Texas Medical Branch
- DeLucia, P.R., Ott, T.E. & Palmieri, P.A. (2009). Performance in nursing. Reviews of Human Factors and Ergonomics, 5, 1–40. doi:10.1518/155723409X448008 [CrossRef]
- Hofler, L. & Thomas, K. (2016). Transition of new graduate nurses to the workforce: Challenges and solutions in the changing health care environment. North Carolina Medical Journal, 77, 133–136. doi:10.18043/ncm.77.2.133 [CrossRef]
- The Joint Commission. (2018). 2018 hospital accreditation standards. Oak Brook, IL: Joint Commission Resources.