A 57% nursing burnout rate when combined with current turnover rates hovering around 18%, highlights the importance of the development and retention of highly skilled nurses. Demands continue to rise for efficiency and precision, and healthcare organizations must ensure that nurses possess essential clinical skills and stay motivated to reach their full potential. This article by Melissa Tully, BSN, MHPE, RN-BC will discuss the concept of push vs pull strategies to inspire and motivate nurses to retain a high standard of clinical care through the use of healthcare simulation.
Healthcare simulation and technology such as artificial intelligence (AI) and virtual reality (VR), have become a key tool to increase motivation. The question remains: How can educators and healthcare systems best inspire and motivate nurses through healthcare simulation? Should an adaptation of a push strategy be driven by external forces or a pull strategy that relies on intrinsic motivation? What motivates nurses more—external pressure to meet standards or the drive to excel in their profession?
The Push Strategy: External Motivation through Structured Education
A push strategy focuses on external factors that compel individuals to take action. In healthcare simulation for nurses, the push approach uses annual competency programs, required skill labs, and online modules. The goal is to push learners to reach predefined competencies, often set by regulatory standards, organizational needs, or accreditation bodies.
Advantages of the Push Approach for External Motivation
1. Ensures Consistency and Compliance
The healthcare industry operates within a highly regulated framework. A push strategy guarantees that all nurses meet essential standards for Accreditation by Joint Commission. An enforced uniformity through structured clinical simulation programs means organizations reduce variability in performance and ensure nurses achieve baseline competencies. The push approach is most useful to onboard new hires or to update staff on protocol changes.
2. Addresses Knowledge Gaps
Nurses may not always recognize areas that need improvement. A push strategy identifies these gaps through assessments and structured feedback and enables instructors to target specific deficiencies. For example, AI-driven simulations assess nurse performance in real-time and provide data on areas that require further development.
3. Maintains Accountability
When healthcare simulation scenarios link to required completion, accountability becomes clear. Nurses understand that their performance in clinical simulation directly affects job roles, promotions, or licensure renewals. The external pressure motivates them to stay engaged and participate fully.
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Challenges of the Push Approach
While the push strategy ensures that nurses meet competency requirements, the push strategy can also feel rigid or burdensome. Push strategy may lead to disengagement, where learners view clinical simulation as a mere task, another online module, or a redundant skill lab rather than an opportunity for growth. Without a personal connection motivation may fade and reduce long-term retention of skills and impact skill decay.
The Pull Strategy: Foster Intrinsic Motivation
In contrast, the pull strategy sparks intrinsic motivation to make clinical simulation personally relevant and engaged. Pull approach encourages nurses to take ownership of their development and draws learners into clinical simulation by highlighting the value in enhancement of personal skills and professional growth.
Advantages of the Pull Approach
1. Personalized Educational Pathways
With the use of AI and VR technology, healthcare simulation becomes highly individualized. AI algorithms analyze performance data and tailor healthcare simulations to each nurse’s unique strengths, weaknesses, and career goals. A personalized approach taps into intrinsic motivation, as nurses feel more connected when the process aligns with their professional aspirations. New technologies that are in the jagged frontier are biofeedback and cognitive states.
2. Encourages Lifelong Learning
The pull strategy fosters a mindset of continuous development. When healthcare simulation is a requirement, nurses seek opportunities to enhance their skills proactively. VR platforms offer immersive experiences, increasingly asynchronously, to practice complex procedures in a risk-free environment. With new technology, such as Meta/RayBans, Just-in-time training will be another advantage. Mixed reality training and guiding will be done at the nurse’s station, and possibly before engaging in a low-volume, high-risk procedure; an expert coach, a checklist, and mixed reality visual will be provided. Many variables also naturally attract nurses to training when they do not have real-world pressure.
3. Creates a Sense of Ownership
When nurses actively engage in their development, they feel a stronger sense of ownership over their growth. Empowerment leads to higher levels of satisfaction and motivation. The pull strategy aligns healthcare simulation with nurses’ intrinsic values, whether focused on delivery of better patient outcomes, improvement of leadership skills, or advancement of clinical expertise.
Challenges of the Pull Approach
While motivation increases for self-directed learners, the pull strategy may not work for everyone. Nurses with heavy workloads or those who prefer more guidance may struggle without the structured support provided by the push strategy. Additionally, personalized simulation requires investment in AI and VR technologies, which may not be accessible for all healthcare systems.
Integration of Push and Pull: A Balanced Approach
While both strategies offer distinct advantages, the most effective way to inspire and motivate nurses through healthcare simulation involves the combination of the two. A hybrid model allows organizations to benefit from the structure and accountability of the push approach while fostering the intrinsic motivation encouraged by the pull strategy.
Blend Structured and Personalized Education
Consider a scenario where nurses complete a set of core competencies through healthcare simulation—a clear push strategy. After completion of these competencies, they gain access to advanced, self-directed modules tailored to their own interests for upskilling, such as leadership, advanced clinical procedures, or emergency management. AI-driven simulations then adapt to individual progress and offer feedback to help nurses improve based on real-time performance. Nurses who wish to specialize can explore additional VR simulations and be provided with immersive environments to learn and engage in complex patient scenarios. To build on this blended approach ensures that all nurses meet essential clinical standards and encourages professional development, which results in greater motivation and long-term retention of skills.
The Use of Technology to Support Both Strategies
Technology plays a crucial role in both push and pull strategies. AI-powered simulations provide instant feedback and allow educators to monitor progress and adjust objectives as needed. VR environments create a sense of immersion, where nurses practice scenarios repeatedly until they master critical skills. These tools enhance both structured, competency-based training and self-directed, exploratory learning.
For example, an AI simulation system could “push” nurses with assignments to required modules. At the same time, the system can “pull” learners with the offer of optional advanced scenarios to explore based on their interests. This dual approach balances external motivation with the internal drive for self-improvement.
Conclusion
Inspiration and motivation of nurses through healthcare simulation requires a balance between external structure and internal engagement. The push strategy ensures consistency and accountability, while the pull strategy fosters personal growth and ownership over development. The integration of these approaches and the use of technologies like AI and VR, healthcare organizations can create clinical simulation programs that meet regulatory requirements and inspire nurses to pursue lifelong learning and excellence in patient care. Read more:
Developing the Lifelong Healthcare Simulation Professional with The 60 Year Curriculum
References
- Kyaw, B. M., Saxena, N., Posadzki, P., Vseteckova, J., Nikolaou, C. K., George, P. P., Divakar, U., Masiello, I., Kononowicz, A. A., Zary, N., & Tudor Car, L. (2019). Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of medical Internet research, 21(1), e12959. https://doi.org/10.2196/12959
- Sim, J. J. M., Rusli, K. D. B., Seah, B., Levett-Jones, T., Lau, Y., & Liaw, S. Y. (2022). Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis. Clinical simulation in nursing, 69, 26–39. https://doi.org/10.1016/j.ecns.2022.05.006
- O’Leary, K. J., Sehgal, N. L., Terrell, G., & Williams, M. V. (2012). Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement. Journal of hospital medicine, 7(1), 48–54. https://doi.org/10.1002/jhm.970
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