Outcomes of Two Statewide Simulation Initiatives

By: Sabrina Beroz and Beth Hallmark

The use of simulation as a teaching-learning strategy has advanced at a rapid pace in the education of nurses. Schools of nursing and hospitals recognize that simulation is an effective way to evaluate performance – ultimately with an eye on improved patient outcomes.

These experiences require requisite knowledge on the science of simulation to meet the learning outcomes and objectives of each scenario. The facilitators have complete oversight and greatly influence the simulation experience. Meeting the challenge are statewide alliances and consortia aimed primarily at training the simulation educator. More broadly, these initiatives are beginning to influence state regulations and research endeavors for simulation-based education.

We focus here on outcomes of two simulation initiatives: The Maryland Clinical Simulation Resource Consortium (MCSRC) and the Tennessee Simulation Alliance (TSA). Three key areas are highlighted: education, regulation, and research.

Let’s begin with education. The impact of statewide alliances on education is huge. Teaching nurse educators the pedagogy of simulation provides insight into the importance of high quality simulations, theory-based debriefing methods, and standards of best practice.

MCSRC was funded to increase the quality and quantity of simulation used in nursing education. A three-day Train the Trainer program was developed following an assessment of prelicensure nursing simulation programs. An evaluation plan was created using Kirkpatrick’s Levels of Evaluation to measure outcomes of the program. Three years of data have shown a high level of satisfaction with the curriculum, a gain in simulation knowledge, and changes in simulation practices.

The TSA has hosted annual simulation conferences each year since 2007. Each year the conference theme focuses on current “hot topics” in simulation education. The first conference, titled “From Out of the Box and Into the Curriculum,” focused on helping faculty integrate simulation into their courses. Since 2007, the conferences have expanded to include an interprofessional component. In September 2018, the TSA hosted the first regional events in the three regions of the state with a viewing of the new documentary “To Err is Human.” After the viewing an expert panel in simulation and patient safety discussed implications for simulation education across academia and practice.

Now let’s turn our thoughts to the impact consortiums and alliances have on research. Advancing the science of simulation requires research on outcomes of simulation-based education at the participant, patient, and system level. The MCSRC conducted a descriptive mixed-method study to assess statewide simulation practices in prelicensure nursing programs (Beroz, 2017). The data provided evidence for the development of a statewide curriculum for the Train the Trainer program. Outcomes for nurse educators include the use of educational theories, theory-based debriefing methods, and standards of best practice.

Lastly, consortia and alliances have a louder voice when advocating for regulation of simulation-based education with state boards of nursing. Currently, the Maryland State Board of Nursing (MBON) has no regulations for the use of simulation in the education of nurses and considers simulation a clinical support activity (Hayden, Smiley, & Gross, 2014). However, the MCSRC continues to provide evidence to the MBON on the state of simulation practices in Maryland.

The TSA has made significant strides in regulation. The Tennessee Board of Nursing (TBON) has approved up to 50 percent substitution of clinical with simulation. The TBON consulted with the TSA in defining regulations schools must follow when they use simulation as clinical replacement. The TSA provided the TBON with the INACSL Standards of Best Practice: SimulationSM as reference for these guidelines, which can be found here.

In conclusion, simulation consortia and alliances are moving states forward by providing health care educators with the tools necessary to implement change in simulation practice, research, and regulations.


Beroz, S. (2017). A statewide survey of simulation practices using NCSBN simulation guidelines. Clinical Simulation in Nursing, 13(6), 270-277. doi:10.1016/j.ecns.2017.03.005

Hayden, J., Smiley, R., & Gross, L. (2014). Simulation in nursing education: Current regulations and practices. Journal of Nursing Regulation, 5(2), 25-30.

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