Today’s nurse practitioner educators stand at the precipice of change, but all too often tradition and antiquated academic policy stifle growth. In order to move the profession forward and train student Nurse Practitioners (NP) in the most cutting-edge, consistent, and egalitarian way, we must consider the use of simulation.
Clinical Hours Remain a (Problematic) Gold Standard
Clinical hours have been the preferred method used to assess proficiency, but access is often limited, as are preceptor experiences. At the undergraduate level, simulation can be used to fill that void and has been proven an effective means of developing critical thinking and decision-making skills.
The National Council of State Boards of Nursing’s (NCSBN) landmark, national, multi-site, longitudinal study of simulation used in prelicensure nursing programs revealed that high-quality simulation can successfully replace up to 50% of the traditional clinical time without any effect on clinical competency, comprehensive nursing knowledge assessments, or NCLEX pass rates.
Yet, advanced practice nursing has been slow to adopt that standard. In fact, the 2022 National Task Force (NTF) for Quality Nurse Practitioner Education, a collaboration between NONPF and AACN, doubled down on its insistence that clinical hours were the only modality for experiential learning when it updated standards requiring a minimum of 750 direct patient care clinical hours.
This is putting a severe strain on an already taxed system. Oftentimes, NP students come into clinical situations illprepared, which puts additional pressure on preceptors. Products such as Shadow Health, iHuman and Objective Standardized Clinical Exams (OSCEs) simply do not suffice. Learners lack the confidence and experience necessary to be successful, but those are skills that can easily be honed in a low-risk simulation-based experience where students can practice and refine essential diagnostic and care competencies.
An Evidence-Based Clinical Approach Requires Its Own Evidence
While evidence already supports a 2:1 clinical-to-simulation ratio for prelicensure nursing students, there has been little data to support its use for graduate programs.
Until now.
In December 2022, Sentinel U announced it had selected four proposals for its second annual Sentinel U Nursing Simulation Research Grant (SUNSRG) program, which focuses on utilizing the Advanced Practice Series® virtual simulation to validate simulation’s efficacy in strengthening diagnostic acumen and patient care management knowledge, while assessing its viability as a tool for Nurse Practitioners (NPs) to demonstrate competency prior to entering a clinical setting.
From family practice nurse practitioner students in rural South Dakota to registered nurses undertaking the masters of nurse practitioner degree program in Australia, SUNSRG’s second iteration proves to be diverse not only in location, but also in practice specialty. The hope is to generate irrefutable evidence of simulation’s value and help set the precedent for its future use in advanced practice academic programs on a wide scale.
The Time to Act Has Come
The benefits of simulation are indisputable. It is widely accepted as a critical component of many nursing curriculums, and the NONPF guidelines clearly state: “curriculum integration of simulation should be based on the ultimate goal of preparing the learner at the highest level and meeting the competency standards set forth by AACN and NONPF.”
We need to take the next step and endorse simulation as a viable replacement for clinical hours, in step with undergraduate nursing programs. The time has come for advanced practice nursing to adopt its use, not just as pedagogy but as a valuable tool for building proficiency, self-esteem and foundational practice skills.
Change only occurs when people try to do things differently. Up until now, simulation has been viewed as a disruptive innovation in advanced practice nursing. As nurse educators, our goal is to ensure our learners are thoroughly prepared and confident when they see patients. In that regard, simulation far outweighs traditional supervised clinical experiences.
If faculty members take the initiative and incorporate simulation into their curricula, industry will follow. It just takes one institution to serve as the vanguard and the journey to better training for nurse practitioners begins.
Laura Gonzalez, Ph.D., APRN, CNE, CHSE-A, ANEF, FAAN
VP of Healthcare Innovation at Sentinel U
