During most prelicensure nursing programs, students are expected to manage a case load of only one or two patients at a time. But when these new nurses’ transition to the real world of nursing, their caseloads increase dramatically. It’s not uncommon for a new graduate nurse to take care of six to eight patients per shift.1
According to research, around 60% of new RNs feel they aren’t prepared to manage and organize patient care after graduation. And, thanks to the resulting feelings of inadequacy and unpreparedness, many new RNs leave their first jobs — and even the nursing profession — within their first year.
However, a new simulation method developed by the authors of a study in Nursing2021 has been shown to increase new nurse proficiency and confidence in dealing with multiple patients. Known as the boss method, this learning tool can help prelicensure nurses better prepare for clinical practice.
What is the boss method in nursing?
The boss method describes a set of guidelines to be used during patient care simulations. The tool guides student nurses on which tasks and skills are necessary for patient care during each hour of an assigned shift. As a student nurse works, the boss tool provides detailed guidelines for several aspects of patient care, such as:
- Checking for safety issues
- Conducting a thorough room assessment
- Identifying safety issues before starting routine head-to-toe assessments
- Stopping and observing the patient’s surroundings
The BOSS approach to nursing simulation
After developing the boss tool, the study author integrated it into several patient care simulations completed by 44 senior BSN students. Before beginning the exercise, students also completed a presurvey regarding their perceptions of their own abilities to care for four or more patients in one shift. Each simulation was completed as part of a phase, and each nursing student completed a survey about their experience after each simulation.
First, student RNs participated in an independent simulation on campus. Each exercise lasted four hours, with participants switching roles and starting over after the allotted time. The student nurses were assigned four patients per simulation, each with varying degrees of acuity. This phase of the project provided student RNs with 64 hours of simulation experience using the boss tool.
Next, students received 42 total hours of team nursing experience in a long-term care, subacute rehabilitation facility. Each team was assigned six or more patients and used the boss method to provide appropriate care. Each team nursing simulation occurred over six hours.
Finally, all 44 student nurse participants worked in a hospital setting with a BSN-prepared nurse preceptor for a total of 120 hours of patient care experience. Each student was observed and monitored using the boss tool.
Preparation for nursing practice
Before participating in any simulation, the nursing students completed a presurvey gauging their perceptions of their own abilities to care for multiple patients. The results of this survey showed that 54.55% of project participants believed they were not ready for a caseload of four or more patients. However, after completion of the simulations:
- 48% believed the simulations helped improve management and organizational skills.
- 76% believed simulation and the use of the boss tool helped improve their ability to care for six or more patients.
- 96% thought they were prepared to handle four or more patients after 120 hours of hospital work experience.
These results showed that nursing students felt more prepared for actual nursing practice after using the boss method in patient care simulations. Other nursing schools could use this method to help prepare their own graduates for life outside the classroom.
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