U.S. Army Professional Filler System Nursing Personnel: Do They Possess Competency Needed for Deployment?

Military Medicine, Feb 2006 by Rivers, Felecia M, Wertenberger, Dana H, Lindgren, Katherine

The objective of this study was to identify the perceived readiness of U.S. Army Professional Filler System personnel in regard to nursing competency and readiness for deployment. A purposive sample of research participants (N = 131) from two military treatment facilities assigned to Great Plains Regional Medical Command responded to an electronic Readiness Estimate and Deployability Index (READI). The READI measures self-reported competencies in six dimensions of nursing readiness. Descriptive statistics and one-way analysis of variance were used to analyze the data. Although the research surveyed three levels of nursing skills (registered nurse, licensed practical nurse, and certified nursing assistant), the study results were noted to be quite parallel across the groups. Significant differences were noted throughout the six dimensions of the READI and between the two military treatment facilities in the dimensions of operational nursing competencies and personal and psychological readiness. Findings support the need for a structured core competency tool to provide succinct focused training to ensure deployment readiness.

Introduction

As early as the Revolutionary War, nurses have responded patriotically to care for troops in wartime situations. The need for educated health care providers to function in humanitarian missions, wartime, and military operations other than war (MOOTW) is well documented in the literature.1'3 Professional Filler System (PROFIS) nursing personnel must maintain competency skills and functions critical to their individual roles in a deployed or field status. These nursing roles include critical care, preoperative/postoperative care, anesthesia care, radiology, laboratory, pharmacy, nursing/personnel management, emergency trauma management, and other diverse medical nursing roles, including the fields of pediatrics and obstetrics/ gynecology. In the past, nursing personnel have relied on clinical experiences in a military treatment facility (MTF) to maintain their competency for deployment status. However, the differences between nursing skills in a MTF and in a deployment hospital have broadened. Nursing personnel now use skills during deployment that are not routinely practiced in a MTF. Several noted differences include specialized care in a fixed facility versus general nursing care in the combat setting, high technology versus low technology in a field environment, automated equipment versus manual equipment, and moderate to high diversity in care scenarios in the combat setting.4,5

Presently, core competency skills of PROFIS personnel have not been defined. The purpose of this research study was to identify the perceived readiness of U.S. Army PROFIS personnel for deployment with respect to nursing competency skills and to identify skills that were beyond those used routinely in a MTF by using an electronic version of the Readiness Estimate and Deployability Index (READI) and a core competency tool currently used in a MTF, for comparison.

Previous Related Works

The original READI is a paper-and-pencil questionnaire that measures six dimensions of individual readiness, i.e., (1) clinical nursing competency, (2) operational nursing competency, (3) soldier/survival skills, (4) personnel/physical/psychosocial stress, (5) leadership and administrative support, and (6) group integration and identification. In the development of the READI, subject matter experts in each of the identified areas developed questions for the initial READI survey. Validity for the items was estimated with content validity-testing techniques using eight content experts. The experts rated each individual item on a scale of 1 (low) to 4 (high). The mean ratings were 3.6 for clarity, 3.6 for relevance, and 3.6 for uniqueness. Changes to the questions were made on the basis of the recommendation of the subject matter experts and were incorporated into the initial version of the READI.5,6 The READI was refined on the basis of results of internal consistency and test-retest reliabilities from a pilot test with a sample of 31 Army nurses. The test-retest reliabilities and internal consistency reliabilities for the six subscales were as follows. The nursing competency scale had 28 items (r = 0.71; α - 0.94). The operational nursing competency scale had six dichotomous unsealed items (r = 0.48). The soldier and survival skills scale had 10 items, which demonstrated the strongest psychometric results (r = 0.83; α = 0.91) among all of the scales. The personal/physical/psychosocial scale had eight heterogeneous items (r = 0.78; α = 0.73). The leadership and administrative support scale had four items (r = 0.69; α = 0.83). The group integration and identification scale had three dichotomous items (r = 0.69; α = 0.72).6 The result of this testing was a revised, 105-item, survey tool that measures self-reports of cognition, affect, perception of psychomotor skills, and physical ability related to the six areas of nursing readiness. The READI was deemed to be a valid reliable tool to be used in the military population.