The nursing shortage is expected to reach an all-time high by 2024, with a projected 1.1 million RN vacancies (American Association of Colleges of Nursing, 2017). This shortage places pressure on nursing programs to train and graduate nursing students to meet the demand. As this problem is compounded by a shortage of qualified nursing faculty, institutions are hiring more adjunct or part-time faculty to teach the clinical component of required courses (Jetha, Boschma, & Clauson, 2016). The increase in novice faculty transitioning from direct patient care to the academic setting prompts the need for orientation, training, and faculty development.
Often, clinical faculty begin teaching without formal education related to guiding the learning of prelicensure nursing students in the clinical environment. These expert nurses transitioning to the academic clinical faculty role have limited to no experience or education in pedagogical practices (Jetha et al., 2016). Nonetheless, many nursing programs do not offer formal orientation for expert nurses during this transition. In addition, there is no consistency among schools of nursing in the content or teaching strategies used for clinical faculty orientation (Ross & Dunker, 2019).
Although simulation has been well established in the nursing literature as an effective strategy to prepare nursing students for clinical-based situations, there is limited empirical support for the use of simulation to train clinical nursing faculty to develop competence in their new role as educators. However, clinical faculty have identified simulation as realistic, valuable, and helpful in preparing them for clinical teaching while supporting their self-efficacy and confidence (Ross & Dunker, 2019). The purpose of this educational innovation project was to develop and pilot six simulation scenarios designed to support new clinical faculty in their transition from expert clinician to novice clinical educator. The simulations are focused on Quality and Safety Education for Nurses (QSEN) competencies. The purposes of the project were to determine nurse educator students' perceptions of, self-confidence in, and satisfaction with simulation-based learning experiences (SBLEs) designed for novice clinical nursing faculty.
DEVELOPMENT AND IMPLEMENTATION
Master's-level nurse educator students, 15 weeks from graduation and enrolled in a final course on teaching and learning in the age of technology, developed and participated in six SBLEs for clinical faculty education using as a framework the QSEN competencies (Safety, Quality Improvement, Evidenced-Based Practice, Informatics, Teamwork and Collaboration, and Patient-Centered Care; Cronenwett, Sherwood, & Barnsteiner, 2007). Twenty-one nurse educator students who had no previous teaching experience were randomly divided into six groups of three to four students. The groups were assigned one QSEN competency and provided with resources developed by the QSEN Academic Clinical Practice Taskforce (clinical scenarios, goals, and problem-solving strategies; Dunker, Manning, & Knowles, 2017).
Using their assigned competency as a framework, each group created one full SBLE with learning objectives; a presimulation worksheet that outlined the setting, equipment, and supplies; and the clinical scenario with a storyboard based on two- to three-minute intervals, roles and responsibilities, and actor scripts. Scenarios were based on a traditional faculty-led inpatient clinical practicum environment with one faculty member and a group of undergraduate nursing students in a variety of clinical specialties (e.g., adult medical-surgical, pediatric, maternal-child health). Similar to an actual clinical environment, the SBLEs presented challenges that required participants to maintain patient safety, provide quality care, and use evidence-based practice. The SBLEs were designed to evaluate the novice educator's ability to make appropriate clinical decisions in the faculty role and included medication administration, supervising a nursing student during a sterile procedure and managing unprofessional student behavior in the clinical setting.
At the end of the semester, the nurse educator students were randomly selected to participate in their peers' SBLE. All student groups had the opportunity to run their own SBLE, actively participate in one SBLE, and observe four SBLEs. Each simulation had four to six roles to which the students were randomly assigned (novice clinical nurse educator, staff nurse, undergraduate nursing student, patient, and family member). Each SBLE lasted approximately 25 to 30 minutes and was followed by a 30-minute debriefing session that took place in the simulation center.
The students and two faculty facilitators conducted the debriefings. Open-ended questions were used (e.g., What went well? How could you have handled the situation differently? Describe the objectives you were able to achieve), along with National League for Nursing (NLN) Simulation Innovation Resource Center's (SIRC, 2015) guided/reflection questions for simulation. All students participated in all debriefings, regardless of their role in the simulation. Though the nurse educator students facilitated all debriefing sessions, feedback from experienced course faculty was also given at this time.
EVALUATION
The nurse educator students were invited through the Blackboard learning management system to complete an evaluation survey, which included the NLN Student Satisfaction and Self-Confidence in Learning Survey (Jeffries, 2008) and faculty-developed open-ended questions. Of the 21 participating nurse educator students, 15 completed the survey (71 percent response rate; permission was granted by the NLN tool to adapt this survey for the nurse educator population). The survey has 13 five-point Likert-style questions with high reliability previously established (Jeffries & Rizzolo, 2006) for satisfaction ([alpha] = .94) and self-confidence ([alpha] = .87).
Overall, the results of the survey were positive. Twelve of the nurse educator students (80 percent) found the SBLEs to be valuable for learning the role of clinical faculty; all 15 identified that the debriefing helped them obtain a greater level of understanding of QSEN concepts for the simulation. Qualitative comments centered around creativity, environment, and debriefing and substantiated the benefits of this activity. Ultimately, participant learning was enhanced during the SBLEs, and the feasibly of simulation use for novice educators was evident. In response to the noted benefits and positive feedback, faculty have implemented SBLEs as part of a senior-level nurse educator teaching practicum course curriculum to facilitate the role transition from expert clinician to novice clinical educator upon graduation.
CONCLUSION
Nurses transitioning into clinical faculty roles need support, resources, and training. In this project, clinical faculty role preparation in nurse educator students was enhanced through the development of SBLEs that address clinical faculty roles and responsibilities and student issues that arise during undergraduate clinical rotations. For novice faculty, entering the clinical setting for the first time can be a stressful experience. Utilizing simulation to help novice clinical faculty adapt to their role allows these individuals to gain requisite knowledge, skills, and attitudes in a safe environment. Furthermore, using the QSEN competencies as a framework helps faculty in creating an environment that maintains quality and safety.
Utilizing simulation teaching strategies to train clinical nursing faculty is one example of how academic institutions can develop and support the growth of faculty who teach students in the clinical environment. It is clearly documented in the literature that faculty who are supported through orientation and provided resources while teaching clinical have higher retention rates, an enhanced learning environment, and more positive student outcomes (Ross & Dunker, 2019). This QSEN-based simulation innovation can be used with novice clinical faculty during the orientation period to foster their role development and competence.
Based on comments from the evaluation, faculty have revised the simulations. Asked if they felt confident that the simulation covered critical content necessary for the role as a clinical nurse educator, two students did not. For this reason, the SBLEs were modified to include specific objective outcomes. Moreover, the faculty reformatted all six simulations using the NLN simulation template to organize the SBLEs, provide specific roles, identify props, establish presimulation work, and offer debriefing suggestions (NLN SIRC, 2015). Lastly, the simulation scenarios were modified for generalizability to all inpatient settings, rather than specialized populations.
Recommendations for future evaluation include a formal research study to explore the effects of simulation on novice clinical faculty's anxiety as well as their confidence and competence in clinical education. A study of clinical faculty perceptions about the effects would be helpful after faculty have completed their first semester of teaching. Because of lack of research in this area, both quantitative and qualitative data are needed to evaluate and empirically support the efficacy of this teaching strategy.
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