Getting It Into Every Shift: Rolling Out Blended Training on Failing High-Flow Nasal Oxygen to Day and Night Staff
Student Name
Master of Science in Nursing Program, Aspen University
N584: Curriculum Development, Implementation and Evaluation
Instructor Name
Month Day, Year
Getting It Into Every Shift: Rolling Out Blended Training on Failing High-Flow Nasal Oxygen to Day and Night Staff
A well-designed continuing education program can still fail if it reaches only the nurses who happen to be available on a quiet weekday. The program designed in the previous module, a 15-minute online module, a 30-minute in situ simulation and a 15-minute debrief on recognizing failing high-flow nasal oxygen therapy, must reach 88 nurses working on a pair of medical-surgical units in a composite hospital, a third of whom work nights. This paper sets out the plan for implementing it: the timeline and schedule, responsibilities, anticipated barriers and how they will be addressed, and measures that tell the educators whether delivery matches the plan.
Timeline and Schedule
Implementation runs over ten weeks after a two-week preparation period. During preparation, the professional development specialist finalizes the online module, trains four co-facilitators, two respiratory therapists and two charge nurses, in running the scenario and debriefing, and pilots the simulation with two volunteer nurses on each unit. The live program then offers simulation sessions four times a week on each unit: two day-shift sessions at 1:30 p.m., after lunch breaks and before afternoon admissions, one evening session at 7:30 p.m., and one night session at 2:00 a.m., when census activity is usually lowest. Each session takes a pair of nurses, and sessions are posted on the unit scheduling system so that charge nurses can plan coverage. At this rate, all 88 nurses can complete the program within ten weeks, allowing for cancellations.
Roles and Responsibilities
The nurse managers of both units sponsor the program, set the completion expectation and approve paid time for the online module. Charge nurses identify which pairs can be released for each session and cover their patients with the help of a float nurse scheduled for the session hour. The professional development specialist coordinates the schedule, tracks completion and facilitates or supervises debriefing. Respiratory therapists co-facilitate and answer clinical questions. The informatics nurse builds a documentation prompt for respiratory rate and the combined index for high-flow patients, timed to go live in week four, so that practice change is supported by the record.
Anticipated Barriers
Four barriers are likely. The first is census surges, which cause simulations to be canceled. The plan accepts cancellations but tracks them and adds make-up sessions when completion falls behind. The second is night shift, whose nurses are often excluded from education. Scheduling a session at 2:00 a.m., with a night charge nurse trained as a co-facilitator, addresses this directly. The third is turnover: new nurses will join during and after the ten weeks. The online module and simulation will become part of unit orientation for all new hires. The fourth is skepticism from experienced nurses who feel they already know high-flow therapy. The online module opens with the unit's own anonymized safety reports, which demonstrate the gap without singling anyone out.
In situ simulation carries particular logistical risks. A review of in situ simulation noted that designs vary widely and that the most important consideration is fitting the design to the setting's resources and clinical demands (Martin et al., 2020). The plan therefore keeps the scenario simple, stores all simulation equipment in a labeled bin kept in the unit's education room and clearly marks simulated items to prevent any confusion with real supplies or medications.
Communication with staff will reinforce the schedule. The nurse managers will introduce the program at staff meetings on both units and explain why it focuses on recognition and escalation, using the unit's own safety data. A short notice in the unit huddle each day of the rollout will name the nurses scheduled for that day's session, and completion will be recognized publicly at the end of the ten weeks. Visible support from managers and charge nurses signals that the program is a priority rather than an optional add-on to an already busy shift.
Measuring Implementation
Implementation should be measured separately from effectiveness, so that if the practice outcome does not improve, the team can tell whether the program failed or was never delivered. Proctor et al. (2011) distinguished implementation outcomes such as acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration and sustainability from service and patient outcomes. Four are most relevant here. Penetration is the percentage of eligible nurses who complete both parts of the program, with a target of 90% by week ten. Fidelity is whether sessions follow the scenario and debrief structure, checked by the specialist observing one in four sessions with a short checklist. Feasibility is tracked through the number of scheduled sessions canceled and the reasons. Acceptability is measured with a three-item survey after each session. Weekly completion reports by shift go to the nurse managers so that gaps, for example on nights, can be addressed quickly.
Sustainability planning begins during implementation. After ten weeks, a quarterly refresher simulation will be offered, the scenario will be added to orientation, and the unit practice council will review chart audits of documentation, the measure that will show whether the performance outcome the program was planned around has been reached (Moore et al., 2009).
Budget
Costs are modest. The largest is paid time: 88 nurses for one hour each, plus float coverage for session hours, and co-facilitator time for about 90 sessions. Materials include printing pocket cards and bedside criteria cards and modifying an existing task trainer and monitor display. The informatics build is absorbed by the informatics team's existing work plan. The total is small relative to the cost of a single delayed escalation that ends in an emergency intubation and intensive care admission.
Conclusion
Implementation turns a design into an experience every nurse actually has. The plan for the high-flow program schedules short in situ sessions across all shifts, assigns clear roles, anticipates cancellations, night shift, turnover and skepticism, and measures penetration, fidelity, feasibility and acceptability so that the team knows whether the program is reaching the nurses who need it. With a documentation prompt in the record and a sustainability plan in place, the program is positioned to change practice, which the evaluation in the next module will test.
References
Martin, A., Cross, S., & Attoe, C. (2020). The use of in situ simulation in healthcare education: Current perspectives. Advances in Medical Education and Practice, 11, 893-903. https://doi.org/10.2147/AMEP.S188258
Moore, D. E., Green, J. S., & Gallis, H. A. (2009). Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. Journal of Continuing Education in the Health Professions, 29(1), 1-15. https://doi.org/10.1002/chp.20001
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7
How this N 584 Module 6 example is structured
Aspen does not publish N584 module prompts, so check your classroom for the exact instructions. This example sets out the timeline and schedule, assigns roles, anticipates barriers with responses, measures implementation separately from effectiveness, estimates costs and plans for sustainability.
N584 Module 6 questions, answered
What does N584 Module 6 usually ask for?
N584 covers the implementation of a continuing education program, so a plan covering schedule, roles, resources, barriers and delivery measures is a typical module task. Check your classroom for the required elements.
Why measure implementation separately from outcomes?
If a program does not change practice, measuring implementation shows whether it failed or was simply not delivered as planned, for example because night shift nurses never attended.
How can education reach night shift nurses?
By scheduling sessions during the night at quieter times, training night charge nurses as co-facilitators and providing online components that can be completed at any hour.
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