Date of Award

Spring 2022

Project Type

Clinical Doctorate



Program or Major


Degree Name


First Advisor

Cathleen Colleran


Identifying and

Enhancing Key Competencies for Emergency Nursing in Rural Alaska:

A Quality Improvement Project

Denise Plano

University of New Hampshire

Faculty Mentor: Cathleen Colleran, DNP

Practice Mentor: Lynn Van Vactor, RN CPHQ

Content Expert: Marianne Murray, DNP

Date of Submission: April 19, 2022


BACKGROUND: Rural nurses practice in challenging environments that include remote villages and towns. They are faced with providing emergency care to patients without the resources that are available at larger tertiary hospitals. Low volume and high-risk scenarios challenge the nurse's ability to maintain competencies and respond to emergent patient needs. Identifying the most critical competencies to maintain and evaluating rural nurses' perception of those competencies is the purpose of the project. The setting for identifying and educating rural emergency nurses is in the state of Alaska, where access to healthcare is further encumbered by topography and vast expanses of ice fields, mountains, and inclement weather. If life flight services is unable to fly due to weather restrictions, it is up to the rural nurse to stabilize and provide a higher level of care with less resources.

METHODS: Expert emergency nurses (RNs) with 5 years or more experience working in a tertiary hospital in Alaska were surveyed to understand what they believed the top competencies are for rural emergency nurses. They rated 12 Rural Nurse Organization (RNO) context-based competencies and 12 National Emergency Nursing Association (NENA) skills-based competencies and narrowed them to the top 6. From this information, a gap analysis was prepared and sent to Critical Access Hospital (CAH) nurses and nurses practicing in standalone rural clinics. These rural emergency nurses scored their perception of competency in these areas on a 5-point Likert scale. Additionally, the nurses were asked to score their perception of competency regarding critical thinking, clinical reasoning, and clinical judgment.

INTERVENTIONS: Several educational interventions were designed based on the gap analysis outcomes. The first educational intervention is a system learning platform module that will allow all hospitals in Alaska to address competencies related to the uniqueness of rural practice and the integration of critical thinking, clinical reasoning, and clinical judgment. Further, a statewide initiative in partnership with the Alaska State Hospital and Nursing Home Association and Providence Alaska Medical Center will provide additional venue options to continue with competency training to address the findings from the gap analysis.

CONCLUSIONS: Rural nursing practice and competencies are unique. The rural emergency nurse must understand how the complexities of the rural healthcare setting impacts the ability to perform in an emergency setting. Clinical judgment is essential and supports the rural nurse in attaining and maintaining competency.

Keywords: Rural Nursing, Emergency Nursing, Competencies, Clinical Judgement

Included in

Nursing Commons