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Innovative Simulation Roadmap for Faculty to Prepare Advanced Practice Registered Nurses for Entry Into Practice
Abstract
Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?
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Simulation is an effective pedagogy and is used extensively in prelicensure nursing education. Advanced practice nursing (APN) programs also use simulation as a component of their curriculum even though APN accreditation and certification organizations do not allow students to substitute simulation hours for the minimum 500 clinical hours. There is a lack of rigorous research studies supporting the benefits or describing the outcomes of using simulation in APN programs. This article presents the results of a descriptive survey on the use of simulation in APN programs in the United States and Canada. Data obtained from the survey provide a base for current simulation use, so do data on the use of the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice as an organizing framework for the implementation of simulations in APN programs. The results of the survey include courses in which simulation is used, modalities of simulation used, purposes for simulation use, and the number of hours of simulation. Data on barriers to simulation use and faculty educational needs are provided. Key findings include the following: 98% of respondents report using simulation in their APN programs, and 77% of respondents support the replacement of a percentage of clinical hours with simulation. The results from this study provide a base to build further rigorous research on how simulation can enhance the education of APN students, improve knowledge transfer, impact behaviors, and improve outcomes. In addition, the outcomes of this study may help educators develop training and support systems that can enhance the quality of APN simulations. © 2018 International Nursing Association for Clinical Simulation and Learning
Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system.
Many nurse practitioner specialties are requiring that basic primary care be included in their curricula. However, some experienced faculty within the specialty lack primary care experience. With a national shortage of nursing faculty, it is more important than ever to maximize available resources without overtaxing faculty workloads. Revision of our primary care practicum allowed nurse-midwifery faculty to lead a primary care clinical conference, using Family Nurse Practitioner (FNP) faculty as primary care experts. We revamped the clinical conference time to simulate clinical visits to guide the students through the clinical reasoning process. Low-fidelity simulation allowed students time to take a systematic approach to patient assessment, planning, and charting. The FNP "experts" were used to critique student chart notes prior to grading. This collaborative approach to the primary care clinical conference was well received by students, faculty, and preceptors and was quick and inexpensive to implement. [J Nurs Educ. 2013;52(xx):xxx-xxx.].
Background:
The purpose of this pilot study was to develop and implement a Web-based, e-Visit simulation experience for nurse practitioner students and evaluate student satisfaction and perceived learning.
Method:
The convenience sample consisted of 26 senior-level Master of Science in Nursing students in the Pediatric Nurse Practitioner and Adult-Gerontology Nurse Practitioner programs. A Likert survey was used for evaluation that measured items from 1 (strongly disagree) to 5 (strongly agree).
Results:
Students reported that the simulation cases closely resembled real-world patients (97%; M = 4.42, SD = 0.69), providing them with a better understanding of complaints commonly addressed via telehealth services (96%; M = 4.46, SD = 0.57). Accuracy of diagnosis and treatment on first attempt was 95%.
Conclusion:
A Web-based, e-Visit simulation can be a useful learning experience for nurse practitioner students with knowledge gained that is transferable to real clinical situations. [J Nurs Educ. 2018;57(5):304-307.].
Clinical placement for nurse practitioner (NP) students is difficult due to an increase in demand for clinical sites and qualified preceptors, and the nursing faculty shortage. The American Association of Colleges of Nursing supports the use of simulation with standardized patients as an adjunct to traditional clinical placement for NPs. In this article, we describe an innovative standardized patient simulation experience implemented in a family NP master’s of science program. The purposes of this experience were to provide alternative clinical opportunities and formative feedback for NP students and to identify gaps in students' diagnostic reasoning. Lessons learned through this experience are included.
To review use of simulation in the education of advanced practice nurses and to describe an innovative simulation program for family nurse practitioner (NP) students.
The literature was reviewed using MEDLINE and CINAHL searches for descriptions of simulation programs for advanced practice nursing (APN) students. A description of a simulation program in a family NP program was provided.
The literature on the use of simulation in primary care APN programs is scant, but simulation seems to represent an active learning strategy that would be of benefit to primary care APN students in increasing knowledge and confidence about the management of clinical situations. Students can also work with faculty to create simulation experiences based on the knowledge of their own learning needs and expertise in specialty areas of nursing.
More information about the use of simulation programs for APN students is needed along with more information about educational outcomes.