Purpose for the program:   To provide opportunities to safely practice specialized care and behaviors for infrequent but potentially catastrophic obstetrical problems requiring emergency attention.  By using simulated scenarios as part of our annual competencies our goal was to provoke each learner to demonstrate their nursing assessment, medical knowledge, technical skill as well as use effective teamwork behavior.

Proposed change: Challenge our nursing staff and allow them to make mistakes in an enviroment that is both safe and supportive with no real harm to patients. Discover performance and knowledge gaps, focus education and increase confidence in managing emergent situations.

Implementation, outcomes and evaluation: The first 2 groups of nurses completed the competency day and simulations in September of 2011. The nurses were actively engaged in their learning and were willing participants in the scenarios. Staff were asked to complete an evaluation after the program and these will be reviewed after each competency date as well as after all staff have completed the simulations. The leaders will meet after each date to review and debrief regarding what went well and what we can do better. The multidisciplinary participation was invaluable. The goal is to further explore ways in which we can have these simulations be truly multidisciplinary, with each discipline meeting their learning objectives.

Implications for nursing practice: This is a safer way for staff to practice their assessment and technical skills as well as teamwork behaviors. It is hoped that by practicing in this safe environment our care in these situations, when they do occur, will be safer for the patient and the staff will feel more competent and confident in their skills. We also identified gaps in knowledge regarding some systems (how to get certain infrequently used items from the main OR) that the leadership team will address in the coming months.

Keywords: simulation, psychological safety, obstetrical emergencies, competencies, team work