Questions Regarding Substitution of Simulation for Clinical

Abstract

Two long-standing questions regarding the use of simulation in nursing education came to the forefront during the COVID-19 pandemic: ''How much supervised clinical experience can be replaced with simulation?'' and ''What ratio should be used to count these hours?'' Within the United States, leaders and faculty at national, state, and institutional levels weighed the evidence and came to a range of decisions about how to proceed. Many of the conversations about how much supervised clinical experience could be replaced with simulation focused on the National Council of State Boards of Nursing National Simulation Study (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014) which demonstrated high-quality simulation could be successfully substituted for up to 50% of supervised clinical experience. Although there remain inconsistencies in how policy makers apply this research (Breymier et al., 2015), it is generally accepted that some combination of supervised clinical experience, along with simulation, produces positive learning outcomes. However, there has been additional controversy around what ratio should be used to count simulation hours used to replace traditional supervised clinical hours. Several studies demonstrate simulation offers a more concentrated learning environment than traditional supervised clinical experience (Curl et al., 2016; Sullivan et al., 2019). These studies suggest simulation is twice as potent as traditional supervised clinical and it may, therefore, be reasonable to count each hour spent in simulation as two hours spent in traditional supervised clinical. Without considering what learning objectives are best addressed using which teaching strategy, there is a risk of reducing the Clinical Simulation in Nursing (2020)-, 1-2

The NCSBN 2022 Environmental Scan: Resiliency, Achievement, and Public Protection

“…Educators have been left with many questions in the wake of clinical site closures during the pandemic. What ratio of clinical hours to simulation hours can be used to substitute for clinical experiences ( Haerling [Adamson] & Prion, 2021 )? What are the outcomes of traditional supervised clinical experiences ( Leighton et al, 2021 )?…”

Pedagogical Techniques in Planning Educational Experiences for Clinical Nurse Specialist Students

“…However, it is important to note that some national certification bodies require a minimum number of direct-care clinical hours for examination eligibility purposes. 8 Some state boards of nursing regulate the number of clinical learning hours that can be completed via simulation in their state-based schools of nursing, but this is largely limited to prelicensure education. The National Council of State Boards of Nursing does allow simulation for a portion of prelicensure student hours.…”

“…None of the American Association of Colleges of Nursing's current task forces are developing statements that would curtail the use of simulation. However, it is important to note that some national certification bodies require a minimum number of direct-care clinical hours for examination eligibility purposes 8 . Some state boards of nursing regulate the number of clinical learning hours that can be completed via simulation in their state-based schools of nursing, but this is largely limited to prelicensure education.…”

In-Situ Simulation for Intensive Care Nurses During the COVID-19 Pandemic in Italy: Advantages and Challenges

“…The restrictions related to the COVID-19 pandemic had altered the traditional training experience and severely limited the opportunities for supervised clinical training ( Adamson & Prion, 2020 ; Ingrassia, Ferrari, Paganini, & Mormando, 2021 ). The massive increase of nursing staff required a rethinking of the usual educational strategies for newly acquired nurses.…”