Introduction: While the National Council Licensure Examination1 and Critical Care Registered Nurse for Pediatrics (CCRN-ped) certification2 assess nursing critical thinking and management related to invasive mechanical ventilation (IMV), neither exam explicitly defines RN competency on the subject. Knowledge competency is typically evaluated by tests, interviews, observation, and simulation, to report one’s ability to apply gained knowledge in a real-world context. Using a mixed methods approach, we sought to define RN IMV-related competency by thematic, contextually informed groupings. Methods: We performed a mixed-methods observational cohort study at a quaternary pediatric referral center to define IMV RN competency. We used Atlast.ti software to thematically analyze representative quotes and data obtained from discipline-specific focus groups (i.e., physicians, advanced practice providers, RNs, and respiratory therapists), electronic surveys, direct observation of ICU work rounds with paired RN interviews, and review of all IMV-related safety events between 01/01/2023 – 6/30/2025. Coding derived from transcribed data was used to generate overreaching thematic clusters that were further refined into competency subdomains. Results: Our analysis yielded the following RN IMV competency sub-domains: 1) autonomous decision making (e.g., assessing and monitoring changes in a patient and knowing when to request help); 2) medical and contextual knowledge (e.g., basic airway anatomy and pulmonary pathophysiology, modes of IMV, level of support, X-ray interpretation, and prevention of ventilator-associated pneumonia and unplanned extubation); 3) technical skills (e.g., off-unit transport, suction, and bag mask ventilation); 4) executive function (e.g., prioritizing 5) interpersonal skills (e.g., understanding one’s role and limitations, engaging in a shared mental model with interprofessional team members, appropriate escalation for help). Conclusions: Upon additional validation, our preliminary definition for RN IMV competency supplies a framework for the development and implementation of educational tools that aim to impact interprofessional team cohesion, frequency of preventable harm, and patient safety.
Corrado et al. (Sun,) studied this question.