Outsourcing Simulation for Experiential Learning: Thinking Outside the Box

By 2025, approximately 8 million people in the United States will be over the age of 65 (Federal Interagency Forum on Aging Related Statistics, 2016). This is a costly projection as individuals in this demographic currently total more than $157 billion for inpatient hospitalizations (Federal Interagency Forum on Aging Related Statistics, 2016). Therefore, educators must rapidly prepare a workforce that is not only qualified, but cost-effective, primarily by increasing the number of Nurse Practitioners (NP) graduates. While this is an ideal solution in concept, the logistics are creating multiple problems. Initiatives from the American Association Colleges of Nursing and the Institute of Medicine have increased enrollment in Doctor of Nursing Practice (DNP) programs. In fact, between 2015 and 2016, DNP enrollment increased nearly 15% and graduates increased nearly 19% (American Association of Colleges of Nursing, 2017). However, the preceptor model used since the 1960’s to educate NP students has not adjusted to the increasing numbers of students. (Aronowitz, Aronowitz, Mardin-Small, & Kim, 2017; Giddens et al., 2014; LeFlore & Thomas, 28 2016). As recently as 2015, the American Association of Colleges of Nursing APRN Clinical Training Task Force identified a concern from practicing NPs on the inadequacy of clinical opportunities and the problems inherent with the traditional apprenticeship-models (American Association of Colleges of Nursing, 2015a). The Task Force recommended use of simulation to alleviate clinical site disparities and exhaustion of the limited number of available, qualified preceptors (American Association of Colleges of Nursing, 2015). However, use of simulation, which has been shown to be highly effective in prelicensure education, is not allowed as clinical substitution in NP education (National Task Force on Quality Nurse Practitioner Education, 2016; Alexander et al., 2015; Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). Currently, the National Task Force on Quality Nurse Practitioner Education allows simulation to augment the hours required of direct patient care clinical experiences (National Task Force on Quality Nurse Practitioner Education, 2016). This ability to augment provides another opportunity for educators to create learning experiences that NP students may not encounter in the clinical setting.

This aging population will also require the care of bedside nurses. For prelicensure programs, the numbers of new graduates entering the workforce continues to increase (American Association of Colleges of Nursing, 2015b). However, this momentum could be interrupted. From 2012-2016, approximately one-third of qualified applicants were turned away from nursing programs for issues including lack of faculty (28%) and lack of classrooms (9%). The greatest barrier to allowing admission of qualified applicants was a lack of clinical placements (44%) (National League for Nursing, 2018). A similar opportunity for experiential learning is through simulation. When specific guidelines are followed, including a dedicated space, qualified faculty, and the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice, there is no difference in outcomes between simulation and traditional clinical experiences (Alexander et al., 2015; Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).

Use of simulation-based learning, however, creates an additional problem. Many institutions do not have the necessary human resources available to dedicate to the application and demonstration of nursing knowledge through simulation. Considering the time to develop faculty and continue education to maintain current knowledge, the organizational commitment is considerable. One institution in the northeastern United States recognized the potential of simulation in graduate nursing education (Mason-Barber, 2018; Gore, 2016; Giddens, 2014; Mompoint-Williams, 2014) alongside an absence of trained simulation faculty within their university. This innovative group used grant-funding to outsource scenario development and facilitation to a simulation consulting company. This foresight allowed students to have the learning experience of simulation that was conducted by experts using the INACSL Standards of Best Practice. This company also provided a sustainability plan through faculty development simulation training programs.

Following debriefing, the students completed anonymous, electronic surveys using the valid and reliable Simulation Effectiveness Tool-Modified (Leighton, Ravert, Mudra, & Macintosh, 2015). Student evaluations (n=56) from these experiences selected “Strongly Agree” for “I am better prepared to respond to changes in my patient’s condition” (79%), “I am more confident in my ability to prioritize care and interventions” (79%), “I am more confident communicating with my patient and family members” (79%), and “I am more confident in my ability to teach patients/families about their illness and interventions” (75%). Furthermore, the importance of reflective learning through simulation debriefing was evaluated in the post-simulation survey. The overwhelming majority selected “Strongly Agree” for “Debriefing contributed to my learning” (84%), “Debriefing was valuable in helping me improve my clinical judgment” (84%), and “Debriefing provided opportunities for me to self-reflect on my performance during simulation” (87.5%). Recognizing the importance of debriefing in the learning process further emphasizes the necessity for facilitators trained in the pedagogy and Best Practices of simulation.

Other options are also available for simulation integration, including community partnerships. For universities and community colleges, creating a reciprocal relationship can provide access to simulation facilities, equipment, and trained educators. This can also be a wonderful opportunity to build student recruitment strategies for AA-BSN programs. Additionally, simulation facilities are available in many hospitals and could be used in partnership with educational institutions. Therefore, while there can be barriers to offering simulation to nursing students, there are strategic opportunities available when thinking outside the box.

This brief presentation will summarize the details necessary to outsource simulation as well as provide an opportunity for participants to develop a plan for increasing simulation at their home institutions.