Are Simulators as Effective for Nursing Students as Actual Clinical Experience?

Sep 23, 2014, 9:00 AM

In the last 15 years, the availability of high-fidelity simulation has slowly begun to transform the clinical education of the nation’s nursing students. Schools that once relied on the combination of classroom education and hands-on experience in a clinical environment began to mix in time in a simulation lab, where nursing students could work with highly sophisticated mannequins able to display a range of symptoms and react in real-time to treatment.

Such simulation labs offer many advantages to nurse educators, including the ability to replicate a range of patient situations, thus allowing students to practice specific nursing skills without having to practice their budding skills on actual patients.

But how effective are simulators at training the next generation of nurses? That’s a question that the National Council of State Boards of Nursing (NCSBN) has a particular interest in answering, because the state boards it represents are asked with increasing frequency to permit nursing schools to replace on-the-ground clinical time with simulation.

In pursuit of an answer, NCSBN conducted a full-scale study, tracking 666 nursing students for two academic years, beginning in Fall 2011, and then for six months longer as they began their work in the nursing profession. During their nursing school experience, one-quarter of the students had traditional clinical experiences with no simulation, another quarter had 25 percent of their clinical hours replaced by simulation, and the remaining half had 50 percent of their clinical hours replaced by simulation. At various points during their training and subsequent work as nurses, all study participants were assessed for clinical competency and nursing knowledge.

The researchers found no statistically significant differences between the three groups on any of the measures, during nursing school or after, which the researchers conclude “provides strong evidence supporting the use of simulation as a substitute for up to 50 percent of traditional clinical time.”

The findings could help nursing schools solve a problem in finding sites for suitable clinical experiences. “The identification of appropriate and available clinical education sites is becoming more difficult as nursing and other health care enrollments grow,” says Pamela Jeffries, PhD, RN, FAAN, ANEF, an advisor to the study, president of the Society for Simulation in Healthcare, and a Robert Wood Johnson Foundation Executive Nurse Fellows program alumna. “Most are filled to capacity, and emerging technologies are further straining their resources. Clinical education must shift strategies. These study results offer educators the liberty to use more simulation experiences, particularly for those low-incidence, high risk critical behaviors all nurses need to learn and experience. With the right training, a dedicated team, and adequate resources we can confidently increase simulations to alleviate the growing shortage [of] clinical space, knowing that we will not adversely affect educational outcomes.”

Read “The NCSBN National Simulation Study,” published in July by the NCSBN’s Journal of Nursing Regulation.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.