Evidence has shown that simulation is a useful tool in teaching because it provides a safe and engaging environment for learning (Norman, 2012). A key component of adult learning is active participation in the learning process which results in increased engagement in and effectiveness of the learning process (Reime et al., 2017).
The National League of Nursing has advocated for the use of simulation as a teaching methodology in nursing education for many years. Simulation can take many forms from complicated scenarios with high fidelity mannequins to the straightforward teaching of psychomotor skills. Simulation provides a safe environment for situated cognition (learning in context) for newly hired nursing staff, away from call bells and away from the stress of the hospital floor (NLN, 2015). In this environment they are free to make mistakes, ask questions, become familiar with technology, and learn the skills needed for safe and competent practice. During simulation newly hired nursing staff become more competent with clinical skills and develop the self-efficacy and confidence that facilitates their transition to a new workplace with new technology (Lamers, Janisse, Brown, Butler, & Watson, 2013).
The training and retention of newly hired nursing staff poses challenges to all nurse educators. One way to address the challenges is to incorporate experiential learning via simulation in the onboarding process and completion conference for all newly hired nursing staff (Everett-Thomas, Valdes, Fitzpatrick, & Birnback, 2015).
A high proportion of newly hired nursing staff on the medical-surgical units is new graduate nurses with no nursing experience or nurses with no acute care nursing experience. Thus this new nursing staff is unfamiliar with the acute care environment, and /or related technology. Studies indicate that 35% to 60% of new graduate nurses quit in the first year of nursing due to discontent, inadequate support, and insufficient training (Hommes, 2014).
All newly hired nursing staff is required to attend an onboarding experience with a nurse educator before they can begin orientation on their units with their preceptors. The new hires also attend a completion conference at the end of the orientation process to ensure that all competencies are completed. To increase the confidence and competence of newly hired nursing staff the standardized use of simulation during the onboarding process and completion conference was implemented.
Previously an unoccupied room on one of the med-surg units was used for the orientation process including the completion conference. The barriers and challenges of this practice were: the lack of availability during high census periods, the ringing of call lights, the noise, and distractions of the unit activity, visibility to patients and families, absence of necessary technical equipment and lack of continuity of environment. The unoccupied rooms on the unit did not provide an appropriate or effective atmosphere for the learning process. Therefore the onboarding experience and completion conference are now conducted in the simulation lab to improve the confidence, self-efficacy, technical skills and safe nursing practice of the newly hired nursing staff.
The theoretical model used for this project was Bandura’s theory of Self Efficacy, as it supports practices to increase confidence, self-efficacy, and behavior changes necessary to enhance competency and safe practice in clinical skills ("Nursing theory( SET)," 2012).
Simulation provides an arena for individualized attention during the learning process. It also offers an environment for addressing diversity in learning needs and styles with the ability for individualized student instruction (Lamers et al., 2013).
All newly hired nursing staff is provided with an evaluation questionnaire that is composed of eight questions using a visual analog scale and distributed via paper or computer formats. The instrument was developed by the nurse educator and reviewed by four content specialists. The questionnaire assesses the outcome of using simulation in the onboarding process and the completion conference by evaluating: self-confidence of staff, competency in clinical/technical skills, satisfaction with the simulation experience, and staff perception of preparation for safe nursing practice.
The data being collected reveals that newly hired nursing staff is satisfied with the use of simulation during the onboarding process and the completion conference. “Going to the simulation lab was the best part of the onboarding process.” “Using the ceiling lifts was helpful.”“ Now I know how to use the PCA with confidence.” All newly hired nursing staff reported increased confidence in competency of clinical and technical skills after the simulation experience. All of the newly hired nursing staff felt that they were well prepared with the skills necessary for safe nursing practice.
Our experience of utilizing simulation in the onboarding experience demonstrates its value as a tool in developing nurses that are confident, competent, and capable of exemplary nursing practice. New formats for incorporating simulation in the onboarding process and completion conference are being explored for the future.