Photo Credit: Steve Schulwitz
Video Credit: WBKBTVThe COVID-19 pandemic has created staffing shortages across Michigan hospitals, especially among nurses. Rural hospitals are the hardest hit as they struggled to meet adequate staffing levels even before the pandemic. Maintaining a low nurse-to-patient ratio is key to safer patient care and improved outcomes. However, nursing schools cannot graduate enough nurses to keep pace with demand. To resolve this issue, Alpena Community College (ACC) in northeast Michigan uses simulation in its nursing education program to help train more nurses and ensure they can provide better care for patients across the region and beyond.
A lack of nursing education contributes to shortagesNursing shortages were a problem in many states, including Michigan, even before the pandemic hit. Several factors contributed to this problem, but the most significant is the shortage of clinical training sites where nursing students get hands-on practice performing various procedures and providing patient care 1. Clinical experiences are essential to effective nursing education because they allow students to apply what they have learned in the classroom hands-on. Adults learn best by doing and then reflecting on their actions. Clinical training sites enable students to interact with patients and engage in critical thinking as they make clinical decisions and work as a team. Moreover, students work under the supervision of clinical preceptors, so they receive feedback on their actions and learn how to improve their performance. These experiences build on students’ knowledge and give them their first taste of working in high-stress environments. Thus, students develop the skills and confidence needed to provide effective care when they enter the workforce. However, the nursing faculty workforce is rapidly aging; about one-third will retire by 20252, creating faculty shortages that force nursing schools to limit student capacity and have fewer clinical training sites. This degrades the student-to-nursing workforce pipeline that provides qualified staff for hospitals and training sites. Therefore, ACC invested in constructing a new nursing wing to address this issue. The new wing opened in 2021, following a two-year renovation of Van Lare Hall. The new wing established a simulation training space dedicated to nursing. ACC also used funding from the Strengthening Institutions Program Grant to purchase four new high-fidelity patient simulators to help provide comprehensive nursing skills training. According to ACC Nursing Program Director Melissa Fournier, the simulators will provide students with more realistic preparation for real-world nursing before and during clinical rotations. The goal is to ensure students have a place to safely gain the experience needed to build clinical competence and confidence. Thus, ACC can train more highly qualified nurses to fill staffing needs across northeast Michigan.
How simulation is used in ACC’s nursing education programACC’s new nursing wing accommodates four simulation labs. According to Terry McKenzie, who manages the lab, despite the program’s small size, the simulation technology equipped in each lab means ACC can provide training on par with larger programs in the state. This means that Alpena and the surrounding communities will have access to highly trained nurses who are needed to address the region’s health needs. Two labs are equipped with HAL® S3201 patient simulators where students practice essential nursing skills and procedures. HAL can exhibit symptoms specific to acute and chronic medical conditions, and students use real tools and equipment to perform interventions on the simulator as they would a human patient. As the simulator’s vital signs and physical presentation respond to those actions in real-time, students see the consequences of their actions. Thus, participants practice critical thinking and problem-solving abilities. As they learn by doing, the participants develop the knowledge and confidence necessary to avoid errors and provide effective care. So simulation-based training helps bridge the gap between theory and clinical practice, similar to traditional clinical hours spent in training sites. For example, students learning ACLS can be presented with a simulated code using HAL. They would be able to assess and diagnose the patient and then work through the guidelines for treatment. Students think critically, work as a team, and communicate, which helps develop procedural skills. Therefore, the nursing students will enter the workforce prepared to handle these emergency cases and provide the best care possible. The third lab is equipped with the VICTORIA® S2200 and Super TORY® S2220 simulators. This will allow nursing students to practice handling normal births and low-frequency, high-risk emergencies like postpartum hemorrhage and shoulder dystocia. These events require high-level training and coordination from the care team to ensure a positive outcome. Therefore, it would not be feasible to have nursing students work on these cases during traditional clinical hours. However, simulation allows the students to practice working on these patients safely, and they can repeatedly practice until they hone the skills needed to provide effective care. Simulation allows for purposeful practice, so there are no gaps in training, even for critical cases like pregnancy-related emergencies. Simulation also ensures all students get the same baseline level of clinical experience since exposure to cases during clinical hours will vary greatly from student to student.
Simulation helps reduce the nursing experience-complexity gapAccording to the American Association of Colleges of Nursing (AACN), about a million nurses will retire by 20303. As these experienced nurses retire and new nurses replace them, the effect is that the experience of the overall nursing workforce declines. At the same time, care delivery is becoming more complex, creating an experience-complexity gap that could negatively affect the quality and safety of patient care4. Moreover, newly graduated nurses who enter the workforce will not have the support and guidance of experienced nurses during critical care events. It can be challenging for new nurses to transition to the workforce, but working with experienced nurses helps them cope with stress and learn from their peers. This is important during complex events where guidance is necessary to learn new competencies. For that reason, simulation can be used to provide students with the clinical experience needed to fill this gap and ensure that new nurses are prepared to handle the demands of complex patient care. Students develop cognitive, psychomotor, and communication skills as they progress through each scenario. Moreover, the feedback from experienced educators allows them to improve their actions, which is key to helping them transition to professional practice. Thus, the simulation training ACC nursing students receive at the new nursing wing will help them enter the workforce with the experience to handle complex cases. ACC’s goal is to provide advanced training so highly-qualified nurses will fill staffing needs in Alpena and the surrounding communities. Since shortages disproportionally affect rural communities like Alpena County, filling nursing positions is critically important. Therefore, even new-career nurses can serve the healthcare needs of those communities. These nurses will, in turn, reduce the experience-complexity gap over time as they mentor and train new nurses.
Simulation will improve nursing education in AlpenaIn September 2021, the American Nurses Association (ANA) called for the Department of Health and Human Services to declare a national nurse staffing crisis. It proposed workforce retention strategies and more training opportunities, among other solutions, to address the problem. ACC has invested in simulation-based training to provide high-quality nursing education to more students. They will experience clinical scenarios and patient cases not typically available in the program, ensuring that students graduate with the skills to provide better care. These highly-trained nurses will have the knowledge to fill staffing roles in the state and the experience to be effective providers. To learn more about the patient simulators used at ACC, like HAL® S3201, VICTORIA® S2200, and Super TORY®, please click on the links or visit the GAUMARD PRODUCT PAGE.
1 Bailey, Laura. “U-M experts: There’s no nursing shortage—there’s a shortage of safe, supportive working environments.” University of Michigan, https://news.umich.edu/u-m-experts-theres-no-nursing-shortage-theres-a-shortage-of-safe-supportive-working-environments/. Accessed 5 July 2022.
2 “Fact Sheet: Nursing Faculty Shortage.” American Association of Colleges of Nursing, Sept. 2020, https://www.aacnnursing.org/Portals/42/News/Factsheets/Faculty-Shortage-Factsheet.pdf. PDF.
3 “Nursing Shortage.” American Association of Colleges of Nursing, Sept. 2020, https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage.
4 Herleth, Anne & Katherine Virkstis. “Closing Nursing’s Experience-Complexity Gap.” The Journal of Nursing Administration, vol. 49, no. 12, 2019, pp. 580-582.