Bringing sim to the classroom: Making up for clinical shortages

“Clinicals" are experiences in which nursing students follow real nurses around and interact with real patients. It's an invaluable opportunity for nursing students to get hands-on experience with patients in the workplace. But the clinical shortages are not only affecting current nursing students and the experiences available to them; they are also depressing nursing school enrollments, as schools turn applicants away because of the lack of clinical sites available.

Clinical simulation in nursing education help bring real-life scenarios into the classroom, allowing students to hone their clinical reasoning skills and boost their confidence when they officially enter the nursing workforce. Plus, the National Council of State Boards of Nursing (NCSBN) published an award-winning and groundbreaking study that found that up to half of traditional clinical hours in pre-licensure nursing programs can safely be replaced by high-quality patient scenarios for students in the form of nursing simulations.

Incorporating simulation in nursing education can be particularly effective at enabling nursing students to make real, actionable meaning out of knowledge gained in the classroom. Simulation as a means to transforming nursing education has also been codified in National League for Nursing (NLN) Vision series documents for the better part of the last decade.

With limited clinical opportunities, more and more programs are looking to manikin-based and virtual simulations to supplement clinical instruction and bring simulation to the classroom- and it's paying off.

Nursing simulation beyond the sim lab

The methods used to clinically train nursing students have unfortunately not changed much in 30-some years. In fact, the traditional model used by many nursing schools dates back to the 1930s. That model of clinical nursing education entails a faculty member overseeing a group of six to eight (or 12, in some cases) students on an acute care unit for a 4- to 8-hour shift; each student may provide care to one or two patients while they shadow the nurse leaders of their group. But some call this "a haphazard approach to learning," and there have been calls to find more new ways to effectively train nursing students to be ready for today's demanding health care environment. to better prepare them for today's health care environment.

"The area of simulation has been researched extensively looking at how learning is maximized in this environment, including the design characteristics of how this can be achieved. This body of research in simulation has far exceeded any emerging research on learning in the clinical setting," writes Nicole Harder, Associate Editor of Clinical Simulation in Nursing and Assistant Professor, College of Nursing, Faculty of Health Sciences at the University of Manitoba, Winnipeg, MB, in Canada. "If the evidence reveals that our current clinical model is not producing the experience and outcomes we desire and that simulation has demonstrated the ability to meet many of those outcomes, we then owe our nursing students and their patients to have the experiences that benefit their learning the most."

But the clinical simulation in nursing education we"re talking about shouldn't just be taking place in a sim lab silo.

Instead of just practicing simulations in the sim lab, instructors should be connecting those simulation activities back to the courses and other material being learned in class. Simulation learning should be captured and integrated into the curriculum; sim lab instructors should work with nursing instructors and administrators in charge of charting the curriculum.

The NCSBN report notes that "written short-term and long-term objectives for integrating simulation into the undergraduate curriculum and evaluating the simulation program" should be planned out in nursing program.

"Simulation, as with any teaching strategy, should have some clear connections to students learning outcomes that are mapped back to the curriculum plan and then the subsequent plan of learning outcomes," Sue Forneris, PhD, RN, CNE, CHSE-A and Excelsior Deputy Director, NLN Center for Innovation in Simulation and Technology.

It's important to use the findings of these simulation activities and integrate those findings into the curriculum, Forneris added. Rubrics can be developed to assess students” acquisition of knowledge, skills or attitudes that might be gained through that simulation experience. That information needs to be captured throughout the program, then used in terms of evaluating the effectiveness of the activity.

“Simulation is an extremely sophisticated teaching activity and therefore, it shouldn't be just an experience," Forneris continued. “There should be some way to measure the learning that occurred in that activity," then instructors need to be “looping that information back to the course, back to the program."

vSim for Nursing: Realistic nursing simulation scenarios for your class

Instructors can tie simulation scenarios into their curriculum and train today's nursing students to be prepared for complicated patient scenarios they will face on the job with Lippincott vSim for Nursing. vSim for Nursing prepares students for clinical with realistic nursing simulation scenarios. Endorsed by the NLN, this platform allows students to practice on virtual patients in a virtual hospital setting. It helps students to hone their critical thinking and prioritization skills treating the virtual patient in vSim for Nursing, chart the patient's record in Lippincott DocuCare, and - if your program also uses Laerdal Medical manikins - refine their skills in the sim lab while caring for the same patient. 94% of faculty agree that vSim accurately depicts actual clinical scenarios.

“vSim has been a benefit for both students and faculty. Having students go through real-life simulations increases their engagement and leads to improved learning," said Shannon Vorlick, RN, MSN, PNP, and faculty member of Trident Technical College's nursing division. “Students are better prepared for what they might encounter in the real world of nursing. It also helps faculty better identify areas where students need improvement."

“It's a really great experience in making decisions under patients” real-life changes and it's really the closest thing we"ve had in lab to real-life clinical experience," said Laura Gubrud, a nursing student at Quinnipiac University.

Lippincott also offers a guide that provides strategies for use of vSim for Nursing in programs across all types of nursing education. It provides faculty with ideas on how to integrate vSim into existing curricula and offers ways to develop and/or enhance current teaching strategies.