A QuEST for Nursing Clinical Activity Exposure: Comparison of the Military Treatment Facility and a Civilian Level I Trauma Center

Introduction Most military nurses work day-to-day in Military Treatment Facilities (MTFs), caring for a low volume of non-trauma patients until tasked to deploy. Military-civilian partnerships (MCPs) were established to increase opportunities for trauma exposure and high acuity patient care that are often lacking at MTFs but are essential for deployment readiness. In a near-peer conflict, deployed medical teams can expect to hold patients for days before evacuation and must be proficient in prolonged casualty care. Current Air Force nurse readiness checklists do not quantify expeditionary skills performed in the MCP or elsewhere, thus failing to provide senior leaders with objective data on the clinical currency of deployable nurses. This study aims to compare clinical exposure and prolonged casualty care skills accomplished by Air Force nurses in their primary duties at the MTF and in the Las Vegas-MCP at a Level I trauma center utilizing the Quantitative ­Expeditionary Skills Tracker (QuEST). Materials and Methods Air Force nurses who participated in readiness programs at the Las Vegas-MCP utilized QuEST to record skills and assessments performed during their 2-week training. Participants completed an identical QuEST at their home station MTF over 2 weeks for comparison. The mean of total skills and high acuity skills accomplished at the MCP and the MTF were compared. Nurses assigned to an acute care setting in the MTF—emergency room (ER), intensive care unit (ICU), medical-surgical inpatient unit (MSU)—were also analyzed separately. Additionally, the clinical units within the MCP were compared to identify which units offer the greatest opportunity for skill acquisition. Data were analyzed using univariate and bivariate statistical tests with a significance level set at 5%. Results A total of 107 Air Force nurses rotated through the Las Vegas-MCP and participated in this study. Nurse specialties included ICU (20.6%), ER (11.2%), MSU (15%), and others (53.2%). The mean total skills performed (251.88±211.365 vs. 97.145±154.342, P <.001) as well as high acuity skills performed (43.50±41.577 vs. 11.64±29.558, P<.001) were significantly greater in the MCP than the MTF. Among the nurses who work in a MTF ICU, ER, or MSU, the mean total skills in the MCP when compared to the MTF revealed differences with varying significance, but the mean of high acuity skills was significantly greater at the MCP (47.06±27.078 vs. 24.34±39.72, P<.001). The comparison of clinical units within the MCP revealed the Medical ICU had the greatest total skill density and greatest high acuity density. Conclusion This study highlights the shortcomings of MTFs to provide a clinical environment that resembles prolonged casualty care for Air Force nurses and exposed the need for increased nurse participation in MCPs or more robust MTF experiences. This study also demonstrated the successful implementation of QuEST to provide objective readiness data to senior leaders and build a framework for other non-provider and enlisted data reporting procedures.