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MAGNET
Improving the Efficiency of Annual Critical Care Nursing Competencies by Incorporating High-Fidelity Simulation

By Marygrace Zamora MSN, RN, CCRN, Professional Practice Leader, and Courtney Villarreal, MSN, RN, CCRN, Professional Practice Leader, Houston Methodist Baytown

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Excessive costs from non-productive hours remain a challenge in critical care units, especially during annual nursing competencies. Historically, these competencies employed a traditional format with multiple stations and validators, resulting in high labor costs and a resource-intensive setup for a three-day event. Each nurse would often spend about two and a half hours waiting between stations. The purpose of this project was to transform annual competencies and improve efficiency by replacing traditional stations with an unfolding patient scenario using high-fidelity simulation.
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The Plan-Do-Check-Act model guided this project. The plan involved replacing fragmented stations with one comprehensive patient scenario using high-fidelity simulation, requiring nurses to demonstrate all skills for competency validation and eliminating idle time. Implementation reduced the number of validators from 18 to four, with cross-training in all skills. To ensure individual competency, only four nurses attended each session, with tasks and questions assigned randomly. Sessions were facilitated for active participation, and pre-session emails outlined expectations and the new format. Each session was timed to meet the one and a half-hour target.

The previous format took about two and a half hours per nurse, with six stations per day and 18 validators over three days — totaling 144 validator hours. Approximately 106 nurses attended, adding up to 265 nursing hours. Costs reached $11,678.55 for nurses and $8,832.96 for validators — approximately $20,511.51 total. The new simulation format reduced nurse time to one and a half hours, validator hours to 36 and participant hours to 159, lowering costs to $9,215.37.
The new format added gaming elements to engage nurses. Central and unit-based educators observed the process, and medical-surgical educators plan to adopt it for future competencies. With support from critical care leaders and nurses, this approach will be sustained. The project was shared through interprofessional shared governance.

Using high-fidelity simulation with a comprehensive patient scenario improved efficiency by reducing non-productive hours and costs. Evaluations showed strong approval: 98.9% of participants agreed the competencies were engaging, informative and promoted teamwork, and that they enhanced critical thinking and clinical judgment.
Staff feedback highlighted patient condition flow, knowledge checks, hands-on experience, interactive simulation and teamwork-based learning as favorite aspects. 97.8% would recommend simulation for future competencies or training.
This change supports Magnet’s focus on knowledge, innovation and improvement. As a Magnet-recognized organization, we strive for nursing excellence and process improvement. This innovative approach delivered significant cost savings and strengthened critical care competencies for the future.
This change could not have been as successful without the generous help of the following nurses: Tracey Reyes RN, BSN, CCRN-CMC-CSC; Herminia Matthews RN, BSN, CCRN; Geraldine Cachero RN, BSN, CCRN; and John Mariano RN, BSN, CCRN.