Virtual Clinicals – Lessons Learned

By: Jasline Moreno, MSN, RN, CHSE, Montgomery College and Tammy Schwaab, MS, RN, CHSE, Carroll Community College

With more than a year having passed since the onset of COVID-19, it is important that we pause to reflect on this unprecedented moment in nursing education. As nurse educators, we participated in an unplanned experiment using virtual clinical experiences to replace 100 percent of traditional clinical education. We are engrained as educators in the practice of reflection. Kolb’s experiential learning theory tells us that to live through an experience is not enough. We must also reflect to draw conclusions that will inform our future practice. This is our attempt to identify the lessons learned by nursing education from the past year.

Spirit of Collaboration

The uncertainty of the past year made us vulnerable like never before. We were asked to lead nursing programs in creating virtual clinical experiences that would meet program outcomes. We had to be innovative, brave, and resilient. How did we manage this? We bonded together, through state and national networks of simulation educators. This network of professionals, all working toward the same goal, made us stronger and wiser and helped lay the foundation for how programs would proceed during the months ahead. Our most important lesson learned is that the simulation community is highly cohesive, supportive, and collaborative.

Standards of Best Practice

At the start of the pandemic, we were required to transition into a virtual environment overnight, and we were uncertain about how to begin. The INACSL Standards of Best Practice: Simulation℠ provided direction to create a strong foundational framework for virtual clinicals. Based on these standards, we understood that structured synchronous prebriefing and debriefing sessions would be essential to all virtual clinical experiences. By following the INACSL standards while developing experiences, we attempted to maintain high-quality teaching and learning to meet student learning outcomes. The primary lesson learned is, principles within the INACSL Standards of Best Practice: Simulation can be applied across the curriculum wherever clinical conversations occur. 

Faculty Development & Reflective Learners

Following recommendations of the NLN (2015), we advocated for debriefing and clinically focused conversations across the curriculum, not limited to the sim lab. The past year provided a unique opportunity to lead faculty development efforts related to engaging students in reflective conversations. Faculty were educated on the importance of psychological safety, prebriefing, and debriefing, and were challenged to create learner-centered experiences that fostered critical thinking.

As clinical conversations became more common across the curriculum, self-reflective skills became more innate for our learners. As we reenter our clinical facilities, faculty, acknowledging the value of metacognition, are incorporating these questions and conversations into their clinical instruction. We realize that our efforts in the past year, although tremendous, are only a beginning step toward transformative change in nursing education.

Lessons Learned to Inform Our Future Practice

Our experiences this past year were similar to a pilot test, an informal, multisite experiment of replacing 100 percent of clinical experiences with virtual strategies. It is of critical importance that we evaluate the past year and its impact on both faculty and students. What went well? What did not go well? What have we learned that we plan to incorporate into our future educational practices? As we move to a new normal, we will need to be intentional and strategic to ensure that we find value from the experiences of the past year.


References

INACSL Standards Committee (2017, December).  INASCL Standards of Best Practice: Simulation℠: Operations.  Clinical Simulation in Nursing, 13, 681-687.

National League for Nursing in collaboration with International Nursing Association for Clinical Simulation and Learning. (2015). Debriefing across the curriculum [NLN Vision Series]. http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/nln-vision-debriefing-across-the-curriculum.pdf?sfvrsn=0.

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