Improving the Simulation Experience for Students

By: Angela Hollingsworth, DNP, RN, CEN, NEA-BC, University of Alabama in Huntsville

As nurse faculty, we all strive to give our students the utmost experience in simulation, but what do we do to improve the experience? Our group of three faculty found three ways to improve the simulation experience. 1) We limited the number of students in the simulation experience to two. 2) We compressed the time allowed for responding to the patient’s needs. And 3) we debriefed at the bedside, with an overall class debriefing at a later time.

Limiting the time for the experience was agreed upon because studies have shown that nurses under pressure report high stress levels and more mistakes (van der Vegt et al., 2020), Debriefing at the bedside allowed the students to self-reflect on their performance (Verkuyl et al., 2020). All of these ideas worked, and one student proclaimed that this was the first time “I felt like a real nurse.”

We set up three rooms, one for a patient with sepsis, one for a patient with a dislodged tracheostomy tube, and one for a patient with a kinked chest tube—all concepts that had been taught in class. The students were evaluated on their ability to perform the concepts in a simulated setting. Each student was given 15 minutes in each room to identify the issue, take care of the patient, then debrief with the faculty member. Students were limited to two in each room so that there was no time to stand in a corner and watch. Faculty gave a hand-off report prior to the students going in and after the students picked the primary nurse. Students did a great job with finding each issue and saving their patients’ lives. During debriefing at the bedside students asked questions and reflected on what they could have done better.

We learned from this experiment that each student felt responsible for taking care of their patients but felt comfortable having a peer to help troubleshoot. Students were able to make decisions under time pressure and self-reflect on their performance without worrying about possible embarrassment in a group debriefing. This was a great experience that saved time for students and faculty as well.


van der Vegt, A., Zuccon, G., Koopman, B., & Deacon, A. (2020). How searching under time pressure impacts clinical decision making. Journal of the Medical Library Association, 108 (4), 564-573. doi: 10.5195/jmla.2020.915

Verkuyl, M.A., St-Amant, O., Hughes, M., Lapum, J., & McCulloch, T. (2020). Combining self-debriefing and group debriefing in simulation. Clinical Simulation in Nursing, 39, 41-44. doi:10.1016/j.ecns.2019.11.001    

3 thoughts

  1. Love it! I teach in a practical nursing program but think any of the three scenarios you describe would be appropriate for that level, too. I plan on implementing this with our current cohort in the end-of -semester simulations we are doing next week.

  2. Excellent practical advise, I am new to simulation so appreciate the useful suggestions, Thanks so much, Karen

  3. This sounds like a great way to focus learning. Are you able to share how the rest of the class was able to participate and whether those students who were in the simulation joined their class for the more detailed debriefing?

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