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Purpose: This session will describe a new graduate RN orientation program that integrates human patient simulation in competency development for introduction to the medical/surgical specialties in an academic medical center. The program focuses on skill-based learning, critical thinking skills, human factors and patient safety through simulated experiences for a wide variety of high-risk, low frequency clinical events and situations. Methods: This unique residency program was developed to enhance and enrich traditional learning experiences by creating a series of systematic and planned clinical experiences using patient simulations, virtual reality, and computer-based scenarios. In doing so, the program creates a comprehensive approach to assisting transition to competent nursing practice. The program consists of several major components including: * A Learning Center equipped with human patient simulators; * Individualized self-directed learning exercises; * Preceptors; and * Mentors.

Results: Qualitative and quantitative measures indicate that recent graduates with initial high scores of self-confidence quickly lose that sense of confidence after their first simulated experience and report slowly increasing scores of readiness for practice, confidence, and competence. Evaluations of the simulated experiences by recent graduates demonstrate the value of simulated experiences and their applicability to practice. Preceptors and unit leadership report an increased readiness for practice and a more consistent process for skills and competence acquisition. Furthermore, findings suggest that as nurse residents acquire skills they more accurately utilized data and patients' responses to make clinical decisions and intervene effectively. Conclusions and Implications: Learning experiences in this program have strengthened assessment, critical thinking, and clinical skills. Structured evaluations of learning experiences have demonstrated that simulation serves as a highly effective strategy to ensure competency for the low-frequency, high-risk events that can lead to failure to rescue in patients with urgent/emergent needs. Structured learning experiences using human patient simulation can be instrumental in nursing orientation programs.