The COVID-19 pandemic had a massive effect on learning and academic organizations. Undergraduate nursing programs had to pivot quickly from providing in-person education to digital or hybrid models. Clinical partners were forced to suspend in-person clinical encounters due to the patient surge, lack of personal protective equipment, resources, and preceptors, as well as the choice to not expose inexperienced students to critically ill COVID-19 patients. However, students still needed to continue the clinical learning experience. So, how did they do it?

Simulation. Healthcare simulation in nursing education is not a new concept. It’s been used historically to teach and verify competency through the creation of real-world situations and experiences. The simulation-based learning framework focuses on a learner-centered approach to teaching skills, collaboration, clinical decision making, prioritization, communication, and critical thinking to support clinical judgement in patient care (Kubin, et al, 2020; Lee, et al., 2019).

There are several types of healthcare simulation tools and scenarios used in education today, including whole-body manikins—either static, where the manikin does not respond to the learner, or high-fidelity where it does—to task trainers or actors who portray patients, to simulated healthcare scenarios using augmented and virtual reality software platforms.

With the move from in-person to the virtual classroom settings due to the pandemic, virtual simulation (VS) has moved front and center and enabled many students to experience a realistic experience through digital tools, from the comfort and safety of their homes. These programs provide authentic experiences for students to interact, learn and enhance their clinical decision making, collaboration, and clinical judgement skills (Lioce et al., 2020). Schools of nursing have adopted virtual simulation tools as their go-to alternative to clinical experience. Responding to the needs of educators and students, VS product developers have collaborated with many educators to synthesize new and enhanced simulation programs that optimize the student learning experience.

Forethought and the move to utilizing healthcare simulation as part of the curriculum made a big difference in how many nursing schools responded to the pandemic. The Society for Simulation in Healthcare supported the use of simulation as a viable, evidence-based, alternative to in-person clinical experience several years earlier (Foronda, et al., 2018; Foronda, et al., 2020; Verkuyl and Hughes, 2019), while the National Council of State Boards of Nursing had previously recognized that in-person clinical experience could be difficult to obtain, even before the pandemic, so recommended that simulation could be used as substitute for up to half of the clinical hours of experience required in undergraduate education (Hayden, et al., 2014). 

Both these decisions enabled clinical experiences to continue for nursing students despite the COVID-19 pandemic. As researchers start to look at the clinical competence of the students who graduated during this historical time, it will be interesting to see how simulation and virtual education stacks up against in-person learning and clinical experiences.

Now that students are headed back to in-person, hybrid learning, and clinical experiences, simulation will continue to evolve and be adopted. In fact, healthcare organizations have recognized that simulation is an effective way to teach new skills and assess and insure competency of all nursing staff.

Nursing education demonstrated it could evolve quickly to meet the needs of its students during a health crisis. And the collaboration and innovation of simulation product developers, educators, learning management systems and technology has positioned nursing education well to support the future of healthcare.
 

References
Foronda, et al., (2018). Student preferences and perceptions of learning from vSIM for Nursing. Nurse Education in Practice, 33, 27-32.

Foronda, et al., (2020). Virtual simulation in nursing education: A systematic review spanning 1996 to 2019. Simulation in Healthcare, 14(1), 46-54.

Hayden, et al., (2014). The NCSBN national simulation study: A longitudinal randomized controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5: S1-S40. 

Kubin et al., (2020). Fostering prioritization using a blended group and individual simulation approach. Nurse Educator, 45(1), 7-8.
Lee, et al., (2019). Effects of simulation-based learning on nursing student competencies and clinical performance. Nurse Education in Practice, 41, 102646.

Lioce, et al., (2020). The Terminology and Concepts Working Group(eds). Healthcare Simulation Dictionary (2^nd ed.). Rockville, MD: Agency for Healthcare Research and Quality.

Verkuyl M., and Hughes, M. (2019). Virtual gaming simulation in nursing education: A mixed-methods study. Clinical Simulation in Nursing, 20(C), 9-14.