To address major faculty shortages, schools of nursing are reexamining how they provide clinical undergraduate education in the hope of finding ways to use faculty resources more efficiently
To this end, researchers from the NYU College of Nursing (NYUCN), funded with a grant from the Robert Wood Johnson Foundation’s Evaluating Innovations in Nursing Education, have just completed a two-year evaluation of the use of hi-fidelity human patient simulation as a substitute for half of a student’s hospital clinical experience in four medical-surgical nursing courses.
The main purpose of the evaluation was to document the impact of NYUCN’s use of simulation on faculty capacity, faculty quality of work life, and student experience. The findings show that the NYUCN model increased faculty capacity by 60 percent, which has allowed the college to increase student enrollments in the face of severe faculty shortages without affecting the quality of clinical education. These findings are significant for the future of nursing education.
A 2011 survey of more than 87 percent of nursing schools by the American Association of Colleges of Nursing showed that more than 60,000 qualified applicants were turned away from baccalaureate nursing programs largely due to insufficient clinical teaching sites and lack of faculty.
“Using simulation to substitute for up to 50 percent of the hospital clinical experience for medical-surgical nursing students is an effective and efficient use of scarce faculty and clinical site resources,” says Hila Richardson, principal investigator for the evaluation and professor at NYUCN. “This is significant as the nation faces a need for 1.2 million additional nurses to fill new positions and replace those retiring.”
In a simulation setting—using a computerized patient simulator in a replica of a hospital room—students are given patient scenarios in which they are expected to provide the full range of nursing care appropriate for their level of education. Thus, students are allowed to implement the clinical decision-making and nursing care steps on their own, but without the risk of harm to patients. At the end of the session, which is often videotaped, the students debrief with the faculty member to reflect on what they learned and how they would perform differently.
In the evaluation—conducted by Lloyd Goldsamt and Janie Simmons of the National Demonstration and Research Institute—the NYUCN researchers found that faculty quality of work life and student confidence and competence are not adversely affected by the use of simulation, whether as an adjunct to or substitution for hospital-based clinical learning.
“The projected demand for nurses with increased education levels amidst a faculty and clinical teaching site shortage requires the nursing education community to embrace models that move beyond the traditional nurse clinical education of the past decades,” explains Richardson. “The changes in the clinical teaching environments, the need for highly educated and technical nurses, the diversification of the workforce, and the work future nurses will do calls for the type of innovative clinical model that is used at NYUCN.”