HealthMarch 26, 2017

Limited clinical sites for nursing students: Simulations are the answer

A key part of nursing education is participating in "clinicals," which is basically following real nurses around and interacting with real patients.

This is an invaluable opportunity for nursing students to get hands-on experience with patients in the workplace. But the reality is, not all hospitals are able to accommodate the demand from nursing education programs to have unlicensed trainees throughout their facility. The U.S. is suffering from limited clinical sites for nursing students, and those limitations are posing problems at nursing schools that are having to limit their student enrollments, and in those wishing to go into specialty areas like maternity-pediatrics or psychiatric-mental health.

But there is a silver lining to the issue of having limited clinical sites for nursing students: there is a growing acceptable of nursing schools replacing clinical hours with virtual simulations, which allow students to experience many different patient scenarios hands-on, from the safety of the classroom.

Simulations can take place of clinical sites

U.S. nursing schools turned away 68,938 qualified applicants in 2014, according to AACN's report on 2014-2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.  And the greatest challenge to enrollment capacity identified by the National League of Nursing (NLN) is a widespread lack of clinical sites for nursing students.

This dearth of clinical sites not only limits enrollment, but also denies students the real-world preparation they need to manage critical patient scenarios in nursing practice. With the U.S. nursing shortage projected to grow to as high as 260,000 registered nurses by 2025, your nursing program cannot afford to turn away qualified students or compromise their clinical experience

But a critical conclusion from a National Council of State Boards of Nursing (NCSBN) study (Hayden et al., 2014) is that up to 50% of simulated learning can be effectively substituted for traditional clinical experience in all core courses across the pre-licensure nursing curriculum without compromising learning outcomes.

In a traditional-type clinical experience in a clinical placement site, the nurse instructor takes a group of nursing students to the placement site where each student is assigned one or two patients to care for that day. The instructor has to run from student to student to be with him or her as a task or psychomotor skill is performed, such as medication administration, injections, among other types of skills.

The results of this traditional clinical experience is that the instructor is exhausted, students have been exposed only to the clinical issues of a few patients and, more often than not, the student does not get to make decisions. Due to this lack of decision-making, it is difficult to assess whether or not the student has understood the complexity of the health care environment and the need to multitask and problem solve - critical skills for clinical practice.

The time is right to transform, create, innovate, and embrace experiential learning for nursing students; let them learn and be immersed in their full scope of practice; and rehearse the critical decision-making, delegation, prioritization, and teamwork skills that are essential for beginning professional nursing practice, in a safe, nonthreatening environment. Simulation labs offer all of this and more.

7 Reasons to appreciate simulation labs

Simulations labs are designed to set up nursing students for success when they transition to the work environment. Here's how:

1: Simulation labs provide clinical opportunities.

Rather than slash the number of nursing students they are accepting and further exacerbate the looking nursing shortage because of limited clinical placement sites in hospitals, nursing schools are turning to simulation labs for hands-on clinical practice opportunities.

2: They provide vulnerable "patients" to practice on.

Simulations give nursing students a variety of patients to perform procedures on, even some of the most vulnerable patients that students may not even get to work on in a real clinical placement. For example, most parents aren't going to volunteer their babies for nursing students to practice their skills on. But dynamic infant simulators allow nursing students to practice techniques necessary in the NICU and postpartum unit.

3: They make room for failure.

Simulation labs offer nursing students freedom they wouldn't have with actual patients. Rather than being overly cautious in a real clinical placement setting, students practicing on manikins are able to act out what they think is best for the patient. If they're wrong, no one gets hurt-and a valuable lesson can be learned for when they are performing the treatment or procedure on an actual human being.

4: They allow for objective reflection.

Part of the simulation process involves nursing students later watching videos of themselves in different patient scenarios and then discussing what went right and wrong. Such objective debriefing offers valuable opportunities for learning.

5: They offer practice on important but uncommon events.

The chances of a patient experiencing a heart attack or stroke while a student nurse is on a clinical rotation are pretty low, yet nurses still need to know what to do in such high-stakes scenarios. Simulation labs allow for as much experience with these situations as nurse educators deem necessary.

6: They improve safety and reduce risk of harm.

Practice might not make perfect, but it goes far in promoting patient care and safety. As Joan M. Cover, MSN, RN, CNOR, reflected in ADVANCE for Nurses writes: "[A]fter watching the student nurses interact in a typical simulation lab within a community college nursing program, I believe there may be a chance the increased simulation practice scenarios may lead to improved patient safety and reduce the risk of error and patient harm in the future."

7: They work.

Students who replaced up to 50% of their clinical hours with simulation showed no less clinical competency or nursing knowledge than students who had traditional clinical experiences with no simulation, according to a study published in the July 2014 issue of the Journal of Nursing Regulation.

Fortunately, several exemplary programs have proven effective in integrating simulation into their curricula and can serve as models for other nursing schools and programs.

For example, New York University's use of clinical simulation in its undergraduate nursing program in lieu of 50 percent of students" clinical hours resulted in a 50-percent increase in faculty capacity at the university, and a resulting expansion of enrollment from 613 students in 2007 to 900 in 2012. It had no negative impacts on faculty work life or student outcomes.

Lippincott's vSim for Nursing provides clinical opportunities

To continue to provide the mandated and much needed clinical training for nursing students, clinical education must be redesigned to align with the resources available.

The simulation technology needed is available right now for today's nursing students, to better prepare them for direct patient care.

Designed to simulate real nursing scenarios, Lippincott"s [vSim for Nursing], co-developed with Laerdal Medical, allows students to interact with patients in a safe, realistic environment, available anytime.

Based on simulation scenarios developed jointly with the NLN, each course area includes a variety of patient diagnoses and situations requiring complex decision-making and reasoning.

As nursing programs across the country struggle to balance the conflicting realities of the declining availability of clinical sites and preceptors with the need to sustain or increase enrollment numbers in pre-licensure programs, simulation clinical experience is an efficient, safe, and cost-effective means by which students can develop beginning clinical competence, as well as confidence in their clinical practice knowledge and skills.

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