Critical thinking development is essential to nursing students as they prepare to enter the nursing profession. Simulation has been proven to help develop critical thinking skills in nursing students (Goodstone, Goodstone, Cino, Glaser, Kupferman, & Dember-Neal, 2013). Simulation is a safe environment to prepare student nurses for new experiences.
Teaching delegation has been a challenge as nursing students do not typically interact with unlicensed personnel with the case method delivery strategy as commonly used in nursing programs. Because healthcare settings utilize a variety of nursing skill mixes, preparing students to delegate appropriately is vital for the students’ success in future employment settings.
Nursing students must learn to delegate effectively to ensure patient safety. Ineffective delegation can lead to fragmented patient care and adverse patient outcomes (Puskar, Berju, Shi, & McFadden, 2017). The ANA and National Council of State Boards of Nursing have issued a joint statement on delegation practices (American Nurses Association). Principles of delegation are clearly defined including the five rights of delegation: Right task, Right circumstances, Right person, Right directions/communication, and Right supervision/evaluation. With proper implementation, delegation can free the nurse to care for more complex patients care needs.
Utilizing scenarios to allow students to practice the five rights of delegation, enhances the students’ self-efficacy regarding delegation (Josephsen, 2013). The Delegation Simulation specifically prepares students to achieve outcomes desired by future employers including communication, teamwork, and autonomous critical thinking (Numminen, Laine, Isoaho, Hupli, Leino-Kilpi, & Meretoja, 2014).
During the Delegation Simulation, senior nursing students are paired as a Registered Nurse (RN) and Licensed Practical Nurse (LPN) to care for one stable patient and one patient in the Emergency Department (ED) setting. The different levels of nurse preparation are utilized so students become familiar with varying roles and responsibilities in healthcare systems. Each student is responsible for preparation for either the RN or LPN role as they are not aware of their role assignment before the simulation. Students receive report from the night shift nurse and then begin caring for the stable patient in the critical access hospital. Utilizing a small hospital setting exposes students to a different health care environment. After starting care of the stable patient, the RN of the dyad receives report of an ED admission. The dyad balance cares appropriately between the stable and unstable patients while adhering to appropriate responsibilities.
The focus of the simulation is proper delegation, prioritization, and time management. The Quality and Safety for Education of Nurses (QSEN) competencies of patient-centered care, teamwork and collaboration, and patient safety are integrated into the simulation (Dolansky, Schexnayder, Patrician, & Sales, 2017). Students have the opportunity to not only participate in the simulation but also observe. Observers learn differently from, but equally to, traditional role participants by conceptualizing the learning experience and connecting with the team (Bonnel & Hober, 2016). Each student has the opportunity to participate experiencing two patient scenarios; and then also observe two additional patient scenarios. The added scenario exposure increases the students’ patient care experience exposure. The observer role is valuable for peer review and debriefing as students learn from others’ successes and mistakes (Bonnel & Hober, 2016).
The debriefing model utilized for the Delegation Simulation is ‘debriefing for meaningful learning’ (Dreifuerst, 2015). This debriefing model focuses on the simulation scenarios and not the students’ responses (right or wrong) during participation. It also encourages the students to self-reflect for future use improvement. The debriefing session is facilitated by an experienced faculty member. As facilitator, the faculty member encourages the students to critically think through the scenario and identify key components.
The Delegation Simulation utilizes multiple facets of nursing to prepare the students for the Capstone internship. This complex simulation encourages teamwork, delegation, prioritization, patient safety, and communication.