Let’s Dream a Little Dream About the Future of Clinical Nursing Education
“Sweet dreams till sunbeams find you
Sweet dreams that leave all worries behind you”
The Nightmare
In the spring of 2020, nurses, nursing faculty and staff, and nursing students, stood witness to the unraveling of the entire process of clinically educating the next generation of nurses. And it only took a matter of days. All over the country, clinicals were brought to a complete halt. Though there has been some restoration of traditional approaches, for many, the old way of doing things remains severely challenged. This reality was brought home by a recent survey of healthcare agencies and nursing education programs conducted by the Oregon Center for Nursing in August, 2020. The survey, titled Not Working Well, explored the impact of COVID-19 on the clinical placement of undergraduate nursing students and related issues such as the increase in simulation-based education.
As noted in a previous post, the pandemic has forced nursing education to face severe and long-standing efficiency and effectiveness problems in the entire approach to clinically-based education. Some of the biggest problems are well-known:
The continuous lack of appropriate placements for nursing students;
The inability to control the quality of the learning experience;
The lack of robust and feasible measures for systematically documenting progression toward competence;
The inordinate amount of resources expended on clinical placement and clinical education by nursing programs and healthcare agencies;
The unsatisfactory results of consortiums and sophisticated software in simplifying and improving the process;
The perceived one-way exchange of value between nursing programs and healthcare agencies (students “take” but do not “give”);
The tensions created between and among nursing programs and healthcare agencies as they negotiate perceptions of unfairness and the imbalance between the supply and demand of clinical placements; and
Since COVID, the concern older or medically vulnerable faculty have with being in care settings.
Everyone involved in the elaborate and stressful process of clinical education can tell stories of hardship associated with the problems listed above. Painfully, the pandemic has substantially exacerbated all of these issues as well as the many others not noted here. To put it simply, it is a nightmare and there are no signs of dawn breaking.
The Dream
The current crisis opens a window for a paradigmatic change in the clinical education of nurses. In order to envision a change that radically reshapes and improves the future, we have to dream. In dreams, we can imagine situations we’ve never experienced and explore places that do not exist. Thanks to the rapid growth in the effectiveness, sophistication, and evidence in simulation-based education, we may be in a position to contemplate transitioning the vast majority of clinically-based education from healthcare agencies to fully-simulated acute and ambulatory healthcare systems. If this dream were to come true, what would it look like?
Though the picture is not sharply focused, the outlines of a few key elements are emerging.
Through the combination of standardized patients, wearable simulation technology, high-fidelity mannequins, healthcare staffing, A/R and V/R compatibility, and built healthcare environments, students will be immersed in a full-environment simulation capable of delivering a clinical-like experience without many of the limitations posed by healthcare regulation, public-health crises, surge events, and current lab-based scenario-driven simulation approaches.
Full-environment simulation makes possible a first-in-kind highly engineered learning experience that offers extensive control of all aspects of the clinical experience (e.g. clinical diagnoses, procedures, high-risk events, pace of care, and intensity of milieu) and measurement of all parameters of performance (e.g. clinical judgment, problem-solving, conflict resolution, communication, basic and advanced skills) in the context of a busy hospital unit or ambulatory clinic.
A full-environment simulation designed to support a highly engineered learning experience in a clinical-like setting creates the possibility of a robust replacement for the traditional clinical experience and offers the opportunity to improve the quality and speed of clinical education in a manner educators, students, regulators, and accreditors can trust.
As dreamy as this imagined approach may seem, it should be remembered that the industry that brought us simulation has already reached this pinnacle. On any given day, you may be flying in a 737 piloted by someone who has never flown a 737 in the air before. How is that possible in such a highly regulated industry? Simulation. To be sure, those same pilots have flown other real planes in the sky, but their preparation is heavily supported by extensive training in a simulator that is able to wholistically mimic the flight experience.
Simulation has rapidly emerged as a trustworthy educational approach for the health professions. Even prior to the pandemic, many programs were pushing to explore the limits of simulation-based education as both a critical enhancement to promoting clinical competency and as a solution to the lack of quality and availability in clinical placement. Our industry seems to be poised pedagogically, technologically, and circumstantially for a disruptive innovation that has the potential to significantly impact the quality of clinical education in nursing.
Having witnessed the nightmare of clinical education in 2020, we should not leave things as they are. We have been jolted awake into reckoning with the many weaknesses of our current approach. Though it seems counterintuitive, in our awakened state we need to start by dreaming together - a big diverse group of students, publishers, vendors, providers, academicians, pedagogists, sim experts, business people, regulators, and others - to discover together what a better future can look like. Let’s dream a little dream… and see where it goes.
