The University of San Francisco: School of Nursing

The Bridge - USF School of Nursing Newsletter

The Bridge - USF School of Nursing Newsletter

Summer 2009 - Vol IV Issue 1

School of Nursing Pilots 50% Simulation Program

The School of Nursing is piloting the first program in California to substitute 50 percent of students’ pediatric and obstetrics clinical hours with time in the simulation lab.

After having success with a 25 percent substitution—the maximum currently allowed by law—the school received the go-ahead from the Board of Registered Nursing to increase the lab time to half last fall. The board will evaluate the pilot program.

“This is case-based scenario-driven, it’s as close to a real experience as possible so that students can learn at a bedside in a way that allows them to practice, to correct their errors, and to have an opportunity to reflect on what happens and the consequences of their actions,” said Judith Lambton, associate professor and chair of the department of family health.

Lambton said a number of factors led her to consider a simulation component for junior-level nurses, including the reality that obtaining pediatric rotations for students is becoming increasingly difficult. Few Bay Area hospitals offer in-hospital pediatric services, so the number of beds is low, she said. Adding to the difficulty is that growing nursing school enrollment is increasing the competition for those limited slots and parents are reluctant to have their children taken care of by student nurses. Additionally, she said, hospitals have become more reluctant to let students do a lot of hands-on intervention, especially with vulnerable populations such as pediatric and obstetrics patients.

During clinical rotations, students may spend a lot of time waiting and may not ever see a patient with a particular diagnosis. In the simulation lab, students are kept busy the entire time and are guaranteed to see patients with a given condition. Instructor Susan Pauly-O’Neill, for example, focuses her simulation lessons on the cases students need to have experience with and builds each lesson to be increasingly complex. The first week in simulation, a baby needs vaccinations during a well-baby appointment. The second week is a trauma situation in the emergency room. By the end of the semester, students are dealing with a patient with multi-organ failure who requires various intravenous lines.

“Each time they come to me, it gets harder and harder, which is not what happens in the hospital,” Pauly-O’Neill said. “Students come in scared into simulation, but they leave better prepared for the outside.”

In studying and analyzing students’ simulation experiences, Lambton has found that students’ confidence levels grow significantly during that time. In simulation, they are expected to be nurses, not simply observers. The simulations, for example, include things such as wrong physician orders, which teaches students to recognize medical errors.

Of course, said Lambton, there are subtleties of the clinical experience, such as the human interaction, that cannot be replicated in a simulation lab. In fact, one of the downsides of simulation is that for it to be truly effective, students must suspend disbelief, she said.

Still, Lambton remains cautiously hopeful that simulation will be a good way to prepare students—she plans to continue to study, question, and evaluate USF’s experience with simulation to determine how best to prepare students to meet patients’ needs.

“The question is whether 50 percent is too much or whether it is better,” Lambton said. “That’s what we’re trying to answer right now.

Back to The Bridge Summer 2009 Issue Home Page