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54
NOV / DEC 2014
I
Healthcare Journal of NEW ORLEANS
The pressuresof the healthcare environ-
ment lead to high risk potential for medical
errors. The factors of complexity, the current
shortage of nurses, the nursing faculty short-
age, the nursing expertise gap in clinical prac-
tice, and concerns for patient safety and legal
liability create an environment where nursing
students do not have the opportunity to de-
velop and master, while still in the academic
environment, the critical thinking, clinical
decision making, clinical judgment, caring
practices, and organizational skills actually
needed in an entry-level nursing position.
Clinical learning experiences in nursing no
longer function the way they were intended.
Simulation (low, medium, and high fidel-
ity) has shown promise for the development
of skills needed for practice. While much
Transition to Practice:
Using Simulation to Transform
Nursing Education
in the U.S. health care system and practice
environment
will require equally profound
changes in the education of nurses
(emphasis
added) both before and after they receive their
license”.
2
It ismy pleasure, in thismonth’s col-
umn, to present the findings of two studies: the
landmark National Council of State Boards of
Nursing’s (NCSBN) National Simulation Study
and the TexasWoman’s University Simulated
Hospital Environment StudyApplying Space
Industry Techniques, both of which have been
presented at Sigma Theta Tau International
(STTI) Nursing Honor Society Research and
Biennial Conferences.
The NCSBN research is a longitudinal, ran-
domized, controlled study designed in three (3)
phases to examine the effects of substituting
high quality simulation for traditional clini-
cal hours in prelicensure nursing programs.
The study included incoming nursing students
from10prelicensure programs fromacross the
country, including associate degree and bac-
calaureate programs inNevada, Florida, Indi-
ana, Maryland, Kansas, Pennsylvania, Missouri,
Mississippi, South Carolina, andWashington.
Phase I began in 2010 with a survey to de-
termine the prevalence and type of simulation
activities used in professional nursing preli-
censure programs including types of equip-
ment, courses, and faculty training. Phase II
randomized nursing students entering in fall
2011 into three (3) groups: clinical as usual
(control); 25% simulation; and 50% simu-
lation. Students remained in their assigned
groups through study cohort graduation in
The transition process from nursing student to practicing nurse
is complex and challenging for nurse educators, nursing service
leaders, and especially for the new graduate nurse. New graduate
nurses practice in an environment that is vastly different from
the one I began in over 40 years ago. The types of patients cared
for on the typical medical-surgical floor in a hospital in 2014
would have often been in the ICU in 1975. Today’s novice nurses
are faced with complex, high acuity patient populations in
circumstances where there may be serious shortages of nurses.
For the new graduate nurse, this translates to care challenges that
are often well beyond their entry level preparation.
1
information about the use of simulation ac-
tivities is available in the nursing literature,
research on the effectiveness of simulation
on actual preparation for practice is lacking.
Additionally, simulation studies still primarily
focus on task training using brief scenarios
lasting less than one hour. No studies are avail-
able that report development of true simulated
hospital environments with the complexity
that exercise the abilities needed by nurses
to care for multiple patients whose needs
evolve over time in an atmosphere of con-
stant change. Students are often aware of the
focus of scenarios prior to their participation
in the simulation, limiting the need to think
on their feet.
The Institute of Medicine (IOM) report,The
Future of Nursing, insisted, “major changes