Throughout the COVID-19 pandemic, nursing students looking to take the National Council Licensure Examination had no choice but to perform all of their training in simulation labs due to social distancing guidelines.
How does the number of clinical hours spent in a simulation lab affect a new nurse's skillset? Is more time at the bedside training alongside a preceptor in hospitals better? Does less time in a real-life patient setting create the need for stepped-up onsite training once a new nurse joins a hospital department?
And, perhaps most importantly, when considering the nursing shortage and overworked nurses already on the job, does simulation training process help solve the challenges or create more work for the more experienced nurses because they are forced to take on more of a training role while already tending to their own nursing responsibilities?
These questions are getting plenty of attention from nursing leaders in New York hospitals now that state lawmakers passed a bill that would allow training nurses to do up to 30 percent of their clinical training in a simulation lab. The bill is awaiting Gov. Kathy Hochul's signature; signing the bill would speed up the process of qualified nurses being able to take the NCLEX.
If the governor signs the bill before the end of June, the law would go into full effect for the spring 2024 semester.
New York State Sen. Toby Ann Stavisky, chair of the Senate Higher Education Committee and co-sponsor of the bill, said, "These simulated experiences effectively replicate the experience a nurse will face in the field. It is an effective tool that will help New York train and license more qualified, quality nurses to help fill a growing and critical need."
According to a 2022 study published in BMC Nursing, training in simulation labs "can build students' critical thinking, teamwork, and interprofessional core competencies, which makes it a useful teaching design."
What do New York hospital-based nurse leaders think about the efficacy of simulation labs? Becker's spoke with three to get their insight about the pending legislation and how their hospitals plan to bolster orientation strategies for new nurses going forward.
Editor's note: These responses have been lightly edited for clarity and brevity.
Natalia Cineas, DNP, RN. Senior Vice President and Chief Nurse Executive at NYC Health + Hospitals (New York City): It is extremely beneficial to provide students with a safe space to learn when it comes to the practice setting.
The challenging part for practice is not knowing what skills the new registered learned via simulation. There needs to be transparency about that to ensure alignment between what they learned through simulation and what they are learning in a practice setting during clinical placements. This will allow us to supplement additional learning or to also simulate experiences that they may not be able to experience in the practice setting — a blood transfusion, for example.
We need to know what they are learning in the 30 percent of the training time they spend in labs so we can tailor orientations to supplement training and provide the skills they need. Further, at our hospitals, we have a nurse residency program, which starts after orientation to make sure a new nurse's skills are strengthened further.
Also, it's important to really understand that the nursing simulation workforce will need to expand to include more individuals who have the expertise from an academic setting.
Laly Joseph, DNP, MSN, ARNP. Certified Nurse Educator and Vice Dean of Phillips School of Nursing at Mount Sinai (New York City): Simulation will not fast track a student in becoming a bedside nurse but will augment the clinical experience as it provides realistic and context-rich experiential learning in a safe environment.
The American Association of Colleges of Nursing encourages the use of simulation as long as there is direct-care clinical experiences. Simulation is not a replacement for direct patient care but provides opportunities for nursing students to develop their professional skills and critical thinking abilities, thus preparing students to function at a higher level.
[If the bill becomes law], the Phillips School of Nursing at Mount Sinai will continue to partner with the health system to place students in direct care clinical experiences to ensure compliance with the required number of clinical hours in the different specialties.
Maureen White, RN. Executive Vice President and Chief Nurse Executive,and Director of Northwell's Institute for Nursing at Northwell Health (New Hyde Park, N.Y.): While it is beneficial to invest in any effort to help increase our much-needed nursing staff, there still remains a lot to be seen, particularly in how this new proposal will be deployed.
There remains a lot of burden on hospital and nursing schools to conduct these simulations. Once these new nurses hit the frontlines, there may be additional learning curves to overcome.