The ups and downs of the simulation spread in nursing ed

With their human-like ways (they breathe, they talk, they sweat, they bleed), patient simulators have earned themselves a valued spot in the education of nursing students across the country. But factors aside from their endearing qualities have also worked to bolster their popularity in recent years.

The UCLA School of Nursing recently catalogued a handful of issues driving the simulation spread in nursing education:

• a limited number of clinical sites,
• an increasing number of nursing programs,
• faculty shortages,
• facilities withholding student access to electronic medical records,
• pediatric settings prohibiting students from administering medications or even taking vital signs, and
• patient safety initiatives cutting back on the number of students allowed on a patient unit or limiting student activity to simply observing patient care.

Patients simulators—and the elaborate campus-based rooms, labs, and “hospitals” they call home—aren’t packing up and going anywhere in the short term. This chronic population will continue to present with an array of symptoms, to require all sorts of care, to experience medical emergencies, and to birth their little simulator babies as nursing students try their best to help them.

Their reality in nursing education poses both advantages and disadvantages. Here’s a brief rundown of both.

Advantage 1: They’re available.

Nursing students obviously need to practice their clinical skills on all sorts of patients to prepare them for professional competency. If clinical sites are growing increasingly sparse, and if those that do offer opportunities are limiting the types of activities students can participate in, patient simulators offer a life-like, at-the-ready alternative to human patients.

Advantage 2: They’re high risk.

Patient simulators are rarely the picture of perfect health. Most are vulnerable and are likely to experience all sorts of clinical emergencies in the presence of a student nurse who conveniently needs to learn how to handle those situations. Such hands-on experiences are, without a doubt, less common in clinical sites involving real patients. And, conveniently, patient simulators can time and adjust their critical situations to coincide with nursing curriculum.

Advantage 3: They aren’t real.

For all their medical fragility, patient simulators can withstand the bad judgment calls, mistakes, and oversights nursing students are undoubtedly going to make as they grow in their education and experience. Sure, they might “die,” but you can count on them to be back fresh, ready, and unharmed for another encounter whenever the instructor or student needs them. In all seriousness, while harming a simulated patient may rattle a more sensitive student to some degree, the experience is going to be much less intense and upsetting than if that patient were human.

Disadvantage 1: They aren’t real.

No matter how realistic the clinical setting, no nursing student caring for a patient simulator is going to mistake the situation for reality. Consequently, the potential exists for a student having an off day to put in a lesser effort or, when in actual clinical practice, to freeze up when a previously pretend experience becomes all too real.

To increase realism, the nursing college at the University of Alabama at Huntsville recently upgraded its patient simulation for end-of-life care to include theater students playing the parts of dying patients’ family members. “We really wanted to challenge [our nursing students] with a scenario that a lot of nurses are uncomfortable with,” said clinical assistant professor of nursing Maria Steele, MSN, RN, APHN-BC. Theater students were instructed not to go over the top in their performance. However, if nursing students failed to answer their questions or act in an appropriate way, “then they could escalate the situation,” acting teacher Karen Baker said.

Disadvantage 2: They’re pricey.

Simulation isn’t cheap. Patient simulators typically run tens of thousands of dollars apiece, and a 2007 study estimated a simulation center set-up to cost more than $875,000. On top of that, according to a National Council of State Boards of Nursing report, annual fixed costs were estimated at $361,425.

“As a nurse who’s been on the front lines,” wrote Lynda Lampert, RN, “I would rather that money go into better clinical experiences, better pay for nurses, lower ratios, and other issues that would go much further toward providing better patient care.”

Disadvantage 3: They’re high maintenance.

Schools need to dedicate space to use and store patient simulators. They need to afford time and money for the training of faculty members to use the equipment. Both the hardware and software of patient simulators need to be maintained. At some point, they will likely malfunction or break down—and, when they do, they will require a completely different type of care professional to mend them.

In a sense, patient simulators are residents who require ongoing housing and expert care.  And unless the state of nursing ed undergoes a drastic, unexpected change, they won’t be discharged for a long, long time.

What are your thoughts on the pros and cons of nursing patient simulators?  Do you think they properly prepare nursing students on how to best provide optimal bedside care to real, live patients?  Leave us a comment below with your thoughts.

For more information on how you can provide an interactive, personalized simulation experience for your students, check out Wolters Kluwer’s vSim for Nursing, co-developed with Laerdal Medical.