Substitution and Make Up for Clinical Environment 1. Simulations as Clinical Substitution

Simulations are increasingly used to substitute for real clinical hours due to several challenges:

• Limited Clinical Sites: Finding quality clinical sites, especially in specialty areas like pediatrics or maternal health, can be difficult (Hayden, Kegan, Kardong-Edgren, & Smiley, 2014; Meyer et al., 2011).
• Faculty Shortages: Some nursing schools, like New York University, use a combination of off-campus (real clinical) and on-campus (simulation) clinical experiences to address faculty shortages and site competition (Richardson, Goldsant, Simmons, Gilmartin, & Jeffries, 2014).
• Clinical Hours Management: Simulations are used to make up for missed clinical hours due to illness, weather, or other reasons. Virtual simulations with debriefing components may also be employed to meet these needs.

2. Evidence on Simulation Effectiveness

• NCSBN Study: A landmark study by the National Council of State Boards of Nursing (NCSBN) found that up to 50% of clinical hours could be substituted with simulations effectively if conditions include trained faculty, adequate resources, and realistic simulation environments (Hayden, Smiley, Alexander, Kardong, & Jeffries, 2014).

Challenges of Using Simulations for Clinical Environments

1. Educator Preparation

• Foundation in Experiential Learning: Educators need a strong understanding of experiential learning principles.
• Clear Objectives: Establish well-defined learning objectives for each simulation.
• Simulation Design: Develop detailed simulation designs where the educator facilitates rather than instructs.
• Time Management: Allocate sufficient time for simulations, reflection, and meaning-making.
• Faculty Development: Provide training in simulation pedagogy, which may represent a paradigm shift from traditional teaching methods.
• Documentation and Validation: Ensure strategies are in place to document and validate simulation hours for licensure or certification.
• Interprofessional Education (IPE): Align clinical placements across professions and ensure adequate resources and commitment for IPE simulations.

2. Interprofessional Simulation Challenges

• Alignment and Resources: Coordinate placements, prepare faculty and preceptors, and secure financial and spatial resources.

Benefits of Using Simulations for Clinical Environments

1. Enhanced Student Engagement

• Active Learning: Simulations encourage active participation and higher-order learning, reinforcing decision-making and critical thinking skills.

2. Improved Faculty Utilization

• Closer Observation: Faculty can more closely observe and assess student performance, providing targeted feedback and debriefing.

3. Flexibility for Students

• Convenient Practice: Students can access simulations at their convenience, allowing multiple practice sessions in a safe environment.

4. Consistent Instruction

• Standardized Experiences: Simulations provide consistent, standardized learning experiences for all students, improving teaching consistency and learner satisfaction.

5. Effective Competency Assessment

• Competency Checks: Simulations offer a safe environment to assess knowledge, skills, and problem-solving abilities, helping in the evaluation of undergraduates and new nurses.

6. Immediate Error Correction

• Learning from Mistakes: Students can immediately correct errors and learn from debriefing sessions.

7. Collaboration and IPE Opportunities

• Collaborative Learning: Simulations provide opportunities for interprofessional education, enhancing understanding of different professional roles and skills.