Learnings, Musings, and Next Steps from Texas Smart Hospital Site Visit

Lessons Learned

Thirty state Champion Nursing teams are committed to increasing nursing education capacity to educate, build, and deploy the nurse workforce of the future. Teams are comprised of representatives from nursing education, state workforce offices, state departments of labor, consumers (often AARP state offices), local business, philanthropies, and others. The Center to Champion Nursing in America (CCNA) provides ongoing technical assistance and fosters collaborative learning experiences that link the teams and allow them to share best practices and lessons learned with their peers in other states.

In December 2009, teams from across the country gathered in Arlington, TX to explore the use of simulation in nursing education. Teams visited the University of Texas-Arlington’s (UTA) School of Nursing Smart Hospital. Participants were impressed that this simulated hospital could actually accommodate “real” patients in a disaster situation. The group's blog entry describes their site visit experience, the questions that it raised, and the application possibilities in their own states. We thank Mary Lou Brunell of Florida, Lisa Wright Eichelberger and Ben Robinson of Georgia, Martha Conrad and Jane Mahowald of Ohio, Gail Stuart and Susan Williams from South Carolina, and Sondra Flemming from Texas for this submission.

Clinical Education 

Texas is grappling with many of the same issues that nurse educators are facing around the country. In HB 3961, the Texas legislature has called for research related to the outcomes importance of supervised clinical experiences. With required clinical hours ranging from 400 to 1400, it is hard to justify the funding for such a wide variance, without adequate evidence.

The Texas Board of Nursing does not have the 25% limit on simulation in nursing education program. UTA uses up to 50% simulation (30% undergraduate) with a 98% NCLEX pass rate, 90% retention rate and a 40% minority student population.

The AARP/CCNA visit to UTA’s School of Nursing Smart Hospital affirmed that the work we are doing in South Carolina with regard to simulation education is headed in the right direction. Specifically we need to continue our effort to identify the highest priority clinical experiences without exposure to which we would not want our students to graduate. The UTA Dean and faculty reinforced the importance of defining what we want our students to learn and master rather then focusing on number of hours devoted to clinical time. It makes far more sense to build simulation scenarios around selected experiences and desired competencies so that all students can be guaranteed the same or similar content.

Faculty Resources

UTA started out with nursing faculty running their own simulations but are now moving to clinical simulation staff which consists of BSN prepared nurses. Ongoing development of faculty is critical to the success of integrating simulation into the curriculum. We discussed the value of partnering with local agencies that can also use the smart hospital as well as other disciplines that can help financially support the continuing operation of the site.

Ah-Hah Moments/Take-aways

I realized how much I didn’t know about simulation but am delighted to hear about the great things going on in the use of simulation in nursing curricula. I learned about the example of how students could be helped to perform nursing intervention in a constructive manner so that retention in the nursing program, graduation and successful nursing practice could occur. Otherwise the students would have failed out of the nursing program because the differences in practice would not be identified in the usual clinical practice setting (what a fantastic contribution to nursing education!) I had several take-a-ways from this great opportunity: 1) Success remains in the human factor—don’t forget it. How you orient and transition faculty to incorporate simulation is critical. Possible use of simulation practice faculty. 2) Research must be done—we need to know the outcomes and what is required to be competent. 3) There is not strong evidence that simulation expands education capacity.  In programs that have already doubled enrollment it is allowing them to maintain at that higher capacity. 4) Use of standardized patience actors provides the human factor. 5) Sustainable funding—consistent challenge.

Other Musings and Questions

What struck me most about this visit were not the differences but the similarities in what colleges of nursing are wrestling with in relation to simulation. Issues of needs assessment, faculty training and setting up a laboratory are common to all of us. We need more opportunities and forums to exchange ideas and lessons learned. It also is clear that we need to think strategically and regionally (and ultimately nationally) in order to make the best use of scare resources. And most of all we need an evidence base for this new teaching methodology. I believe the most important outcomes related to simulation will be focused on quality of care and patient safety. But to research this we need clarity of expected competencies, ways to measure them and agencies to fund this research. The potential is enormous. We need the focus and collaborative sharing to make simulation transformative for nursing and this we surely can do?

Simulation effectiveness is not about simulation and space. It’s about designed learning activities that generate the development of clinical reasoning skills in the learner. What are the resources needed to effectively develop simulation education? How do we develop faculty to deliver effective simulation? Is simulation effective? Will simulation advance the nursing workforce? Can we use simulation to develop faculty?

The CCNA created an opportunity to explore high level simulation. The idea exchange generated many questions… beyond individual schools, colleges and universities. How can states work collectively to increase the nursing workforce and what do we do nationally to create new venues to prepare the nurse for tomorrow’s needs?

Simulation is interesting…it’s exciting…it’s even fun…and nearly everyone is jumping on board but does it make a difference? Do we get a return on investment of technology and other resources?

Do we all need to create a unique model of simulation? What are the lessons learned?

Effective simulation in nursing education begins with assessing the need of the student.  What will it take to education competitive nurses? Can simulation advance nursing practice and education? We think so… it’s time to add research to the answer.

We must study the impact of simulation on student competency. What about using simulation to develop faculty? What is fundamental to teaching /learning using the tools of simulation education?

Next Steps

Georgia needs to conduct a statewide survey of simulation services so that we can determine the need for regional centers and also the potential for collaboration on research and sharing of resources such as funding for technical support personnel. Our state AARP office may have funds to help convene a state wide meeting.

The site visit stimulated me to proceed with the state assessment of stimulation activities and sites in Ohio so that regional and interdisciplinary partnerships can develop.

As the Department Chair of a new BSN program (SC) in the process of developing and expanding the program’s simulation center, the UTA faculty and visit to the Smart Hospital provided me with an additional way to use our home care room, for example, as a setting to practice health promotion and teaching or having crucial conversations, even delivering “bad news” to a patient or family member.