The IIAR Revolution: How One Nurse's App is Transforming Clinical Education & Saving Costs

P<0.000: A Nurse Entrepreneur Cracks the Code on Measuring Critical Thinking

In nursing, we know critical thinking is paramount. It’s the bedrock of safe patient care in high-pressure environments like the ED. But how do we measure it? How do we move beyond subjective assessments and truly quantify this essential skill during a nurse's transition to practice? For decades, this gap has challenged educators and leaders. That is, until a nurse entrepreneur decided to build a solution from the ground up.

The Challenge: A Persistent Gap in Nursing Science

While we have tools to assess competency, confidence, and skills, objectively measuring the dynamic process of critical thinking has remained elusive. This isn't just an academic problem; it directly impacts how effectively we train new nurses, support preceptors, and ensure readiness for complex care demands. Recognizing this critical need, nurse innovator Jen Wilde embarked on a mission not just to teach critical thinking, but to measure it.

The Solution: The IIAR Model © & a Custom Mobile App

Jen developed the IIAR Model© (Identify, Intervene, Assess, Reassess) – a novel, structured framework designed to guide clinical reasoning and task management, especially for novice nurses in fast-paced settings like the ED. But the real innovation was bringing IIAR© to life through a custom-built mobile application.

This wasn't just another e-learning tool. The app integrates:

• The IIAR© framework for structured decision-making.

  
  

• Just-in-time micro-learning videos and checklists.

  
  

• Real-time performance tracking for task efficiency.

  
  

• Standardized preceptor feedback using a 1-4 rubric linked to the IIAR © steps.

  
  

The Entrepreneurial Journey: Grit, Vision, and External Funding

Bringing this vision to reality required true entrepreneurial grit. Faced with initial challenges securing internal funding for software development, Jen pursued and secured a substantial HSSA grant, demonstrating the external validation and potential impact of her idea. This journey highlights the perseverance often required for "conscientious disruptors" to challenge the status quo and introduce novel solutions, even navigating hurdles like compliance reviews.

The Results: Statistically Significant Impact

A pilot study of the Train-the-Trainer (T3) program using the IIAR © app yielded powerful, statistically significant results:

• Enhanced Critical Thinking: Preceptor evaluations using the app showed IIAR © scores significantly improved (p<0.000), indicating measurable growth in critical thinking. Residents reported better prioritization and anticipation skills.

  
  

• Increased Confidence: Residents' self-reported confidence increased significantly from pre-test to mid-test (p=0.000), stabilizing by the post-test, suggesting the program rapidly builds competence.

  
  

• Improved Proficiency & Efficiency: The time residents required for patient encounters decreased significantly (mean reduction ~21 mins, p=0.0024), while their ability to manage more complex cases increased (p<0.000).

  
  

• Potential ROI: The program demonstrated potential for a 50% ROI through reduced orientation time, translating to significant cost avoidance per nurse.

  
  

The Takeaway & Future Directions:

Jen Wilde's work proves that nurse-led innovation, combined with technology and entrepreneurial determination, can solve long-standing challenges in our profession. The IIAR Model © and app offer a data-driven method to not only teach but also measure critical thinking, bridging the gap between education and practice. With ongoing research expanding its use to students, providers, and IENs, this initiative is poised to make a lasting impact on how we develop the next generation of confident, competent, and critically thinking clinicians.

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