Creating a healthcare simulation program from scratch, sometimes with limited funding, is a daunting prospect especially when state boards of nursing and other accrediting bodies are increasingly expecting nursing simulation programs to follow recognized national standards. Simply creating a simulation lab space and coercing clinical faculty to run simulation scenarios will not create a simulation program that meets current best practice or meets the needs of learners. The good news is that there are existing guidelines that will start any program on the right setting, which is the focus of Dr. Kim Baily‘s PhD, MSN, RN, CNE article today!
Start by reviewing the International Nursing Association for Clinical Simulation and Learning (INACSL) Best Practice Criteria. INACSL regularly updates its standards, publishes an online journal and has more than 2500 members worldwide. Do not be overwhelmed by the number of standards and criteria but read through the standards so that as you grow your program you keep the standards in mind.
In 2014, the National Council for State Boards of Nursing concluded from their extensive study that substituting high-quality nursing simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice (Hayden et al. 2014. The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation, 5(2), C1-S64).
The study noted that the key, but sometimes overlooked requirement of substituting nursing simulation for clinical time is that the nursing simulation must be “high-quality”. Following the publication of the above study an expert panel consisting of representatives from International Nursing Association for Clinical Simulation and Learning (INACSL), American Association for Colleges of Nursing (AACN), National League for Nursing (NLN), Society for Simulation in Healthcare (SSH), Boards of Nursing and NCSBN developed a set of guidelines based on data from the NCSBN National Simulation Study and the INACSL Standards of Best Practice.
The following guidelines are a combination of the INACSL, NCSBN and the author’s own experience. The author assumes that a series of planning meetings with all stakeholders have taken place, funding is available and the administration supports the nursing simulation program development.
Documentation: Accrediting bodies and boards of nursing (BON) will require supporting documentary evidence of meeting minutes, resources, curriculum, learner evaluation, scenario development, program overview, faculty qualifications etc. etc. Create an administrative space to file and store documents that may be needed for accreditation or state approval.
Administrative Support: Provide documentation that college administrators and managers support the nursing simulation program and there is funding not only to set up the nursing simulation program but provide for ongoing support. Most manikins and electronic equipment will need servicing, repairs and in time replacement so budgeting should include consideration of these costs. Administrators may only think about lab space, equipment and supplies but equally important if not the most important, is funding for faculty development, faculty release time, technical and administration support.
When faculty are responsible for all aspects of the sim program, the program and learners will suffer. Part time simulation technologist funding may lead to frequent staff turnover since once trained, the technologist will likely seek a full time position with benefits. Such a loss can seriously interrupt a simulation in healthcare program and lead to loss of continuity. Funding for a full time simulation technology specialist position shows a significant commitment on the part of the institution to the clinical simulation program.
Outcome and Objectives: Identify learning needs and expected outcomes. Create measurable objectives matched to the expected outcomes. These objectives may be broad or specific, short-term or long-term. For example, the objectives may relate to overall institutional/program outcomes or to more specific outcomes such as specific learner skills. All outcomes and objectives should be consistent with institution and program outcomes and should include outcomes that relate to integration of simulation into the curriculum.
Participant Evaluation: Evaluations should be guided by desired outcomes and objectives. Document the method used for participant evaluation and whether the evaluation is summative or formative. Formative evaluation is designed to monitor progress toward achieving outcomes and identify and close gaps in knowledge and skills. Summative evaluation is conducted at a specific point in time and should use a standardized format and scoring method.
Physical Space and Equipment: Document that the sim program has sufficient space to operate the program. The space should include debriefing areas, control rooms, preparation areas and massive amounts of storage! Further document that the program has the necessary equipment and supplies to match the outcomes. Funding for consumables should be documented.
Think carefully about equipment needs. For example, undergraduate associate degree nursing programs do not need an $80,000 obstetrics manikin! Fortunately there are a wide variety of manikins available to meet every available educational level. (The lower the cost of the manikin, the lower the cost of repairs and replacement).
Faculty and Staff Qualifications and Development: Document faculty education and experience related to simulation in nursing. Include specific qualifications such as those offered by the Society of Simulation (SSH) and attendance at conferences or workshops. Membership in national organizations such SSH, INACSL or SimGHOSTS should be documented as well as job descriptions. Develop an orientation program for new faculty and staff. Include evidence that each facilitator has the specific skills and knowledge in simulation pedagogy appropriate to the level of learning, experience, and competency of the participants.
Prebriefing and Debriefing: Provide documentation about prebriefing and debriefing methods which support achievement of expected outcomes. There are many debriefing methods in the literature, choosing a single method for an entire program will lead to consistent debriefing sessions for learners. In addition, when the same debriefing method is used throughout a program, experienced faculty will be able to support new faculty, group faculty development may be used which can save the department money and research will be easier since a standardized methodology will be used throughout the program. (Faculty with expertise in the scenario content should be present for all simulations).
Policies and Procedures: Creating policies and procedures assures consistency throughout a program. Write policies as soon as possible and disseminate the policies to all staff. Examples of policies include scenario development guidelines, debriefing methods, prebriefing information, faculty qualifications and development, participant evaluation method, scenario reviews, confidentiality, uniform, tardiness consequences.
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If you are just starting the nursing simulation journey at your institution do not be overwhelmed by the national standards but use them as a guideline to grow your program. Creating consistent practices and guidelines for faculty, support staff and learners will smooth the process. The above guidelines may be useful when providing information to administrators about meeting standards for healthcare simulation programs.
