Clinical scenarios: enhancing the skill set of the nurse as a vigilant guardian.

Patient safety is enhanced when nursing staff recognize and respond to subtle changes in a patient's condition. In this quality improvement project, simulated clinical scenarios were conducted with staff nurses on a multi-specialty surgical unit. Scenarios were developed from actual patient situations as well as from calls to the rapid response team. Nurses were given the opportunity to practice assessment, critical thinking, and communication skills. Pre- and post-project surveys were used to assess nurses' perceived level of confidence and skill in handling emergency situations. Post-project survey data showed that nurses perceived that the scenario exercises improved their confidence and skill in managing critical patient situations. In addition, the findings supported the continued use of the scenarios as a teaching strategy. The scenarios have increased nurses' awareness of early signs of patients' conditions deteriorating and have the potential to decrease the number of patient situations that escalate to emergencies.