The Little Skills Lab That Could
WHERE TO START
When I took the position of skills lab instructor three years ago, the lab equipment consisted of a sticky, dried up Foley catheter, a bag full of simulated medications, and four aging mannequins that sometimes produced lung sounds if you shook them hard enough. Very few students were attending lab voluntarily; some days there were no appointments at all. I realized very quickly that creativity was necessary to build an environment that students would want to utilize.
Our College is affiliated with an acute care medical center in an urban area. In searching for equipment it became vitally important to connect with central supply. Once they were aware of the need, expired equipment, equipment that had outlived its capital usefulness, and other items became available. The staff made a shelf in the supply room specifically for the skills lab. Every month, items set aside for the skills lab are gathered and utilized by the students. Whether you have an affiliated hospital or not, start with the facilities with which your school of nursing has clinical contracts. Make face to face connections with the supply department and explain the role of the skills lab in nursing education. Don’t be afraid to ask for supplies; the worst they can say is no. Be enthusiastic; once staff sees your appreciation they will go out of their way to put items aside for you. Donation of expired equipment is where we save the most money. For example, our hospital switched IV suppliers this year; all of the original IV tubing and fluids were pulled from the floors to be discarded. Central Supply saved all of it for the skills lab. This translates to thousands of dollars of savings and each student is able to practice with new equipment without feeling like they are “wasting” supplies. Did you know sterile gloves have an expiration date? We get boxes and boxes of expired sterile gloves in every size from our supply department. This is so important for the lab setting; students need to practice sterile glove application multiple times to become proficient. Without the free supplies, students would have to reuse gloves or simulate with non-sterile gloves. One box of 50 sterile gloves costs $92.00 which is quite cost prohibitive when multiplied times 120 students practicing multiple times. Free equipment allows for a better practice experience. The following are some simple suggestions that may help you in your search.
Ask the managers on different clinical units if you can designate a bin for collection of unused, open equipment. Instead of being thrown out it can be used for practice. If the floor has a designated staff member who does inventory and orders supplies, let them know that you would like expired or open and unused equipment. Place a bucket in the med room and have nurses collect empty vials after drawing up medications (just not controlled substances!). Refill the vials with water for practice drawing medications. I use food coloring to make the liquid easier to see for novice learners.
Visit the clinical engineering department in person and ask them if they have older or non-functioning equipment that you might use. My best acquisition was a touch-screen ventilator that had been in a deep, dark corner of the basement. It didn’t function properly for patient use, and was missing a few parts, but it works great for a simulation experience. We were able to get IV poles and over-the-bed tables the same way. Often, this type of equipment is updated and the former equipment is put into storage, never to be seen again. Why not put it to use in the lab?
MEDICAL OFFICES/PHARMACEUTICAL COMPANIES
Private medical offices are a great resource for medication trainers. For example, a local allergy office gave us a box of practice inhalers and EpiPen trainers that are given to them by pharmaceutical reps. The office doesn’t have use for 20 trainers; why not pass some on to the skills lab? A pharmaceutical rep for a popular blood thinner gave us a wonderful 3D trainer; a heart that beats in normal sinus rhythm and atrial fibrillation to demonstrate the difference. Free and fun! Pharmaceutical companies typically have free educational posters that can be used to decorate the lab. All of our cardiac posters were free from pharmaceutical companies and are great teaching aids.
The dollar store can be a great resource for lab supplies. Our hospital uses “bath in a bag” for personal care which cost $2.50 each. When 120 freshman students need to practice bed bath, it can get very costly. Instead, we buy packages of baby wipes at the dollar store and put five wipes in a Ziploc bag; instant “bath in a bag.” Instead of buying individual packages of sterile lubricant for catheterization or NG tube insertion, buy a large tube at the dollar store. It is easy to withdraw from the tube into a syringe in small amounts and much less expensive than individual packets. Purchase your storage bins and baskets at the dollar store. Being organized is a simple way to reduce waste and save money; the equipment will last longer if it is neatly put away each day.
After Halloween is a great time to stock up on discounted wigs, blood, and other costume supplies to outfit your mannequins. False eyelashes and a nice wig turn up the reality factor on a basic mannequin. It’s also fun for your students to meet a new “character” to keep things fresh.
Sometimes you have to be really creative when there is little to no budget for supplies. When I started in the lab we had nothing to use for injection practice. Commercial injection pads are quite expensive so I knew purchasing them was not an option. As I wandered around a thrift store looking for inspiration, I stumbled upon a child’s clamshell lifejacket; basically two pieces of foam covered in stockinet fabric, held together with straps. I bought three, cut off the straps, and had six injection pads for a total of three dollars! These are still in use four years later, haven’t lost their shape, and are able to be rinsed whenever they start getting stained from use.
Your local hardware store is a great place to get inexpensive supplies. I purchased two nuts and bolts organizers for under $25 each and turned them into a 60-drawer medication dispenser. The drawers are a perfect size to fit pills, vials, and inhalers. It looks very organized and the students enjoy “pulling” their medications from the med room.
Use a piece of memory foam to simulate pitting edema. Nothing else looks as real! Chocolate pudding as stool and applesauce as vomit make a scenario more lifelike (and smell much better than the real thing!)
The best advice I can offer in regards to saving money is the least glamorous: reuse equipment. We reuse everything except gloves and masks (I’m afraid to share that many germs on a daily basis!). This means that the students are taught from the very beginning that part of their responsibility in lab is the clean-up and repackaging of the equipment they’ve used. We “re-sterilize” our indwelling catheters (wipe off the lubricant, repackage the kit), empty and dry out our IV tubing and replace the “sterile” caps, refill vials with colored water, and use needles multiple times during the practice session before finally applying the safety cap and discarding. My students learn very quickly not to throw out wrappers! If you reuse equipment, I recommend trying to replace all the parts so that your students learn every step of preparation and use. Students need to know that there is a cap to be removed before they connect that IV tubing; if you don’t use it during practice they will not be familiar with it in a real-life clinical setting. It is really a judgment call as to when it’s time to throw out equipment and start fresh. I can easily get 10 or more uses out of one catheter kit if it is cleaned well before repackaging.
Aside from the obvious savings and benefits to free supplies, the outcome I am most proud of is the exponential increase in lab attendance. For comparison, in April 2014, there was one student appointment to practice the skill of head-to-toe assessment. In April of 2016, 20 students came to the lab for this same skill. In three years’ time, the lab has gone from being open part-time (20 hours a week) with an average of 150 visits a month to being open 54 hours a week, staffed by one full-time instructor and four part-time instructors with an average monthly attendance of 490 students. A typical week has students competing for appointment times and coming in for multiple practice appointments.
A small operating budget does not need to limit your students’ learning experience. Our learning lab has gone from empty to thriving in a short three years’ time by using the suggestions offered in this article. Creativity and persistence are the key to meeting the needs of both your budget and your students, without either being sacrificed. Don’t be afraid to ask for what you need; you might be surprised with what can happen!
This article originally appeared in StuNurse Magazine and was written by Shannon Pranger, former Skills Lab Instructor at St. Vincent’s College.