The Effect of Simulated Tutorials on Clinical Competency for Nursing Students

Background and Significance: The impact of a new graduate nurse (NGRN) leaving employment within the first year costs a hospital system around $40,000 per year and contributes to a decrease in staffing and patient care outcomes (Fink, Krugman, Casey, & Goode, 2008). Job turnover rates of NGRNs are between 30-50% within their first year of employment due to work demands, workloads, incivility, lack of confidence in nursing skills, and inadequate knowledge of managing multiple patient conditions (Institute of Medicine, IOM, 2010). Regulatory administrators are pushing nursing educators to explore new educational pedagogies to enhance the preparatory learning process for the student nurse and improve retention of the NGRN. Benner (1984) stages of clinical competency provide a framework for this study on the phases of learning through formal training, policy adherence, application, and synthesis of a novice nurse. The preceptorship experience has been identified in the research as an educational modality that allows students to gain workplace experience, autonomy to the nursing role, and promote management of patient care through the development of clinical competency skills (Benner, Sutphen, Leonard, & Day, 2010; IOM, 2010.). The long-term goal of this project is to assist nursing educators with an innovated teaching modality (simulated clinical skills tutorials, SCST) that produces a sound, competent, generalist graduate nurse able to function independently as a registered nurse through demonstrated competency on the NCLEX-RN.

Specific Aims and Research Question:

The primary objective of this study is to assess a research-based intervention (SCST) to bridge the academic – clinical practice gap. This objective will examine the effects of the SCST intervention used in a preceptorship experience on student competency, preceptorship outcomes, and NCLEX-RN pass-rates compared to a traditional preceptorship experience with no SCST intervention.

Research Question: What is the effect of simulated tutorials on clinical competency for nursing students?

It is hypothesized that the comparison group receiving an additional teaching modality that incorporates psychomotor, affective and cognitive skills (Shepard, 2014) during their preceptorship experience will demonstrate improved clinical competency, course outcomes, and higher NCLEX-RN scores than the comparison group. The implementation of SCST has a minimal program cost compared to the financial loss of high turnover rates within the first year of practice for NGRNs.

Identified aims of this study include:

Aim #1:  Using a quasi-experimental design, with data collected longitudinally, to determine the effect of the SCST intervention, used in conjunction with a preceptorship experience, has on student competency, perception of the intervention, and NCLEX-RN pass-rates in Iowa community colleges.

Rationale and Approach: Study findings aim to aid academia and practice leaders-educators with tangible data that can assist in the development of teaching resources and remedial support to secure and sustain a novice workforce. The 2014 State of Iowa NCLEX-RN pass-rate were 4% lower than the national average pass-rates. State initiatives seek to improve Iowa’s nursing students’ performance on the NCLEX-RN exam to ensure a state nursing workforce able to provide competent care to the community populations.

Aim #2: Identify psychomotor, affective, and cognitive skills themes in the student nurse preceptorship experience.

Rationale and Approach: Students psychomotor skills will be assessed through the preceptorship outcomes and course evaluation. Affective skills will be measured using the Casey-Fink Readiness for Practice Survey (2008) assessing students’ comfort/confidence with practice skills. Cognitive skills will be reported from the (NCLEX-RN) results. This study will aid in the identified education to practice gap of job related skills acquisition of the student nurse during the preceptorship experience to promote improved patient outcomes as a result of a clinical competent NGRN entering the workforce (Benner et al., 2010; Shepard, 2014; Wolff, Regan, Pesut, & Black, 2010).