Academia to Bedside is a four-part series that focuses on the transition of nursing students from education to their professional role. Part 2 focuses on the role of simulation in accelerating novice nurses to experts.
By: Jean Zavertnik, Judy Murphy, and Justine Dawson
While nursing schools across the country use simulation to provide clinical experiences in a safe, controlled environment, the outcomes of this educational strategy are still to be determined. We interviewed two new graduate nurses and two senior-level nursing students to get their perspectives on the role simulation played in their transition from student to professional nurse.
The first question posed to the new graduate nurses was: How was your transition from student to nurse? One new graduate felt hers was a smooth transition because of a post-baccalaureate nurse residency (PBNR) program. “Simulations done at the hospital are less stressful than at the college. I don’t feel like I am being judged.” The other new nurse stated that her transition was more challenging than she expected: “I had externship experience in the NICU before working as an RN on the floor, and the transition was still challenging.” She added, however, “that the red flags to look for certain concerning conditions, medications, or safety concerns were instilled in me during nursing school and have now become instinct.”
We asked the senior nursing students to describe their transition from classroom to clinical. One student said, “Simulations help to ensure that I get particular experiences like a decompensating infant. There is no guarantee that I would see this in clinical. Having to address the problem without checking with an instructor promotes critical thinking.” The other stated, “I felt I had enough knowledge of the clinical skills from class and lab to be able to serve patients well and focus on providing emotional care and attention.”
The second question we asked both pairs was: What facilitated the transition? Both new graduate nurses thought that a strong orientation was essential to their transition to becoming confident bedside nurses. The senior nursing students felt that simulation prepared them to perform skills and feel more confident in the hospital setting.
Asked about barriers to transitioning to the bedside, one new graduate felt it was overwhelming to take a full clinical assignment. She indicated there was not enough clinical experience prior to graduation. The other nurse struggled with work-life balance, particularly since she had moved to a new state.
While the senior nursing students felt that simulation helped prepare them for clinical, they named several impediments to learning in the lab. One student expressed concern about not knowing where things are located in the simulation and being unfamiliar with the environment. She felt her anxiety would diminish with better orientation and prebriefing. The other senior stated: “It is hard to learn how to communicate with patients or how to pick up symptoms like skin color and adventitious sounds on a manikin. It can seem unnatural, and it never fully looks like how a scenario would be in real life.”
Asked if they thought their education adequately prepared them for the role of bedside nurse, the first graduate stated, “Not really. We had lots of book knowledge but not enough clinical experience. I would have liked to do more simulations with role-play for interacting with other providers.” The second graduate stated, “Simulations were lifelike and instilled assessment instincts that have become so valuable in my critical, quick assessments of decompensating patients – even with patients of a different age from those I worked with in a simulation setting. Walking into a critically ill patient’s room is less intimidating because of the assessment skills I learned during simulation in nursing school.”
The new graduate nurses indicated that simulation was a part of their hospital orientation training. One nurse commented that the one-on-one, learner-centric focus in an interprofessional simulation lab addresses gaps in knowledge or skill: “Simulations in undergraduate nursing could have been more hands on. Students in simulation need to be allowed to fail. They can learn more from this.” The other new graduate stated the unit does mock codes weekly and provides the opportunity to practice skills in a simulation setting upon request if needed. She added, however: “I do wish that this institution provided more educational opportunities throughout my first year as a new nurse, but I feel supported in my role by the charge, resource, and experienced nurses around me every day.”
The transition from classroom to clinical and from student to professional nurse can be challenging. The new graduates and nursing students we interviewed found merit in simulation to prepare them for their nursing role, “but nothing can fully substitute for getting to work with real people.” Through simulation, students have the opportunity to encounter role development experiences to promote the transition from novice to expert. Formal research is needed to support the role of simulation and its impact on producing effective, safe, and proficient practitioners.