Getting in S.T.E.P. with simulations: simulations take educator preparation.

PAMELA R. JEFFRIES, DNS, RN, FAAN, ANEF, delivered the first Debra L. Spunt Endowed Lecture at the NLN Education Summit 2007 on September 29 in Phoenix, Arizona. This article is adapted from her presentation. The NLN Foundation for Nursing Education and Laerdal Medical Corporation established this annual presentation in appreciation for the leadership of Debra L. Spunt, DNP,, RN, FAAN, who died on March 9, 2007. DR. SPUNT, an assistant professor and director of the clinical simulation laboratories at the University of Maryland School of Nursing, led the University of Maryland's participation in the three-year NLN/Laerdal Simulation Study that culminated in the book Simulation in Nursing Education: From Conceptualization to Evaluation. Dr. Jeffries, associate professor of nursing at Indiana University School of Nursing, Indianapolis, was project director. Janet L. Grady, DrPH, RN, will present the second Debra L. Spunt Endowed Lecture at the NLN Education Summit 2008 in San Antonio. THE USE OF SIMULATIONS as a teaching-learning intervention in nursing curricula has increased greatly during the past decade. Nursing students, clinicians, and educators are in strong agreement about the importance of this effort. Typically, nursing students are taught theory in one course and clinical skills in others, such as fundamentals. They are assigned to clinical settings to apply what they have learned and to think on their feet while caring for real patients. This traditional model does not provide opportunities to practice skills and think critically in a safe environment. On clinical units, students are expected to recognize alterations and deterioration of patients and to intervene quickly, even though they have not had sufficient practice (1). The Current Situation The move toward making simulations a part of nursing curricula, either as a clinical enhancement, substitute, or adjunct, is arising for several reasons: There is an increased need for clinical sites and instructors as more schools of nursing are established. Across the nation there is a need for more nurse educators in all types and levels of nursing programs. With the educator shortage, nurse leaders and professional nursing organizations are calling for new clinical models and encouraging schools and universities to seek innovative approaches to traditional nursing education (2,3). Concerns about patient safety have led to calls for lower student-faculty ratios that ultimately will increase the need for more clinical sites and increase the cost of clinical education. Many schools of nursing have responded to calls to prepare nurse graduates for work in high-tech, complex health care environments by purchasing patient simulators. However, equipment is often purchased with the expectation that faculty will embrace the new technology, when the reality is that many faculty are not prepared for this type of teaching. Simulations Take Educator Preparation: The Professional Challenge How are faculty best prepared for this paradigm shift in clinical education? Too often they are not properly prepared; they must experiment with simulations by trial and error. Certain materials and programs can be purchased, but there is no standardized curriculum for simulation nor set of competencies that will prepare nurse educators for this pedagogy. Fortunately, federal funding agencies are beginning to notice that faculty development is needed for using advanced technologies, and calls for federally funded grants are focusing more on faculty proposals. The challenges faculty face as they adopt this new pedagogy and clinical teaching model are found primarily in the areas of administration, resources, and faculty development. ADMINISTRATIVE CHALLENGES Deans and directors must recognize that the use of this new clinical model and teaching pedagogy requires administrative support as well as funds for various resources. Faculty must be able to attend regional and national nursing education conferences and educational symposia to learn more about the pedagogy and affiliated research, and to be able to network with other educators who are using this teaching-learning method. …