Substitution of Clinical Experience With Simulation in Pre-Licensure Nursing Programs: A National Survey

Purpose:

 Some states allow simulation substitution of supervised clinical instruction.  However, a review of the literature found that a standard substitution ratio for simulation hours to supervised clinical hours does not exist among pre-licensure nursing programs. The purpose of this study was to determine the ratios of simulation to supervised clinical instruction used in pre-licensure curricula.  In addition, this study evaluated the facilitator-to-student ratios used in simulation and supervised clinical instruction.  The study also investigated the rationale for substituting simulation in place of supervised clinical instruction, the person or people that made the decision(s) about substitution, and how the substitution ratio was determined. 

Methods:

The methodology used for this study was a descriptive electronic survey which was sent to over 1400 pre-licensure schools of nursing in the United States (US). 

Results:

Four hundred thirty two (32%) educators responded to the survey, and every State in the US was represented.  Schools of nursing were almost evenly split between using a standardized ratio and not using a standardized ratio when substituting simulation time for supervised clinical instruction time.  There was great variability found in facilitator to student ratios for both simulation and supervised clinical instruction ranging from 1:1 ratio to 1:≥10 ratio.  The most common reason cited for substituting supervised clinical instruction with simulation was faculty “value simulation as a teaching methodology”.  The nursing program director most often decides if simulation will be substituted for supervised clinical instruction; however, faculty most often determine the substitution ratios.

Conclusion: This study was the first to investigate ratios, rationales, and decision makers for substituting simulation for traditional clinical experiences.  The study provided an initial view of current practices related to simulation as a substitution for supervised clinical experiences.  While the study provided a foundation of where schools of nursing are currently, it also uncovered additional questions and revealed areas rich for future research.