Mock hospital allows nursing students to practice rescuing “patients” under pressure

The College of Nursing at The University of Alabama in Huntsville (UAH) takes the old adage that practice makes perfect to heart – or rather, to the hospital! Each semester, before nursing students are matched to an acute-care or in-patient facility in Northern Alabama or Southern Tennessee to complete their clinical hours, they are required to successfully demonstrate their clinical skills and clinical reasoning in the College’s simulation hospital as part of the Leadership and Management in Nursing course.

"Our job as nursing faculty is to ensure that each student is capable of handling a critical event and to determine if they are able to rescue the patient," says Dr. Angela Hollingsworth, a clinical assistant professor of nursing. "So these scenarios – pressured-time simulations using high-fidelity simulators – are wonderful because they give the student nurses a chance to stimulate their critical-thinking skills in a short period of time. Students start to feel like real nurses."

The vision for this immersive, competency-based experience was articulated in 2015 by Dr. Lori Lioce, executive director of the College’s Learning and Technology Resource Center, in response to the College’s transition from content-based learning to concept-based learning under the leadership of its dean, Dr. Marsha Howell Adams. It was subsequently executed by a team comprising Dr. Hollingsworth; Dr. Elizabeth Barnby, a clinical associate professor of nursing; and Dr. Mark Reynolds, a clinical assistant professor of nursing – a trio that Dr. Lioce describes as "innovative and inspiring" in their approach to implementing the course.

"We brainstormed how to get every student a simulated clinical experience with faculty supervision so that we could assess their clinical skills and critical thinking abilities prior to launching them into their preceptorship," says Dr. Reynolds, who serves as a course instructor along with Drs. Hollingsworth and Barnby. "And we ended up adding the ‘mock hospital’ experience to the Leadership and Management in Nursing course, because you can’t be a leader as a nurse without being clinically excellent."

Along with the mock hospital experience and the students’ required 225 clinical hours as preceptees, the course imparts selected theories of management and leadership in health-care systems as they relate to entry-level nursing management with a focus on organizational structures and dynamics. "It covers the whole semester but the majority of it comprises their clinical hours," says Dr. Reynolds. "SimDay, which is what we call the competency assessment that takes place in the LTRC’s mock hospital, is held early in the semester so that we can then assign them to a precepting facility that matches their interest and abilities."

On SimDay, which in reality can often span two days depending on course enrollment, each student is given 45 minutes to manage three emergency scenarios in a hospital setting. "These are real-life, life-threatening scenarios to solve in real time," says Dr. Barnby. "We serve as the off-going shift nurse and give them a report, and then we leave them there with the patient. Sometimes it’s a real person, and sometimes it’s a high-fidelity model. Sometimes there will be someone playing a family member who divulges information or makes the situation more difficult."

Whatever they encounter, however, the student has to manage the situation and save each patient within 15 minutes. "In a perfect world we’d have plenty of time and only one patient to care for, but we’ve had nurses graduate who have patients crash on their first day," says Dr. Reynolds. "So this environment augments the reality that newly graduated nurses will endure – the feeling and stress of not enough time. It also gives them the opportunity to express feelings of stress and even incompetence in a safe environment."

Once the three scenarios have been completed, the student’s care for each patient is evaluated by the relevant course faculty: trauma for Dr. Hollingsworth, pulmonary for Dr. Reynolds, and emergency for Dr. Barnby. "We debrief with every student, and if there’s something they did well or could improve upon, we are able to provide immediate feedback," says Dr. Barnby. "And the feedback is one on one, which is a rare ratio in education and thus an added benefit. It builds their confidence as they are being launched into professional nursing."

Of course the ultimate proof of success comes once the students have graduated and are tasked with saving lives in a real hospital, not a mock one. But so far, the results have been nothing but positive. "We have evaluation data from the facilities with whom we precept saying that our students are more prepared thanks to the transformation of the curriculum," says Dr. Reynolds. "And we’ve seen increased demand from the hospitals for our students, many of whom have multiple job offers before they leave."

Not that any of the three course faculty are surprised, however. "Our students," says Dr. Barnby, "not only rise to the level that we hold them accountable to, but they set the standard higher."

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