Advance Level Nursing Education Use of Simulation in Nursing Education
Simulation experiences have become a crucial component of nursing education, offering a safe and controlled environment for students to practice clinical skills and apply theoretical knowledge. Simulation allows learners to demonstrate competencies in a way that augments traditional clinical experiences, bridging the gap between theory and practice. However, direct and indirect care of actual patients remains the most vital aspect of clinical education.
A landmark study by the National Council of State Boards of Nursing (NCSBN) found that replacing up to half of traditional clinical hours with high-quality simulation can produce comparable educational outcomes for pre-licensure students (Hayden et al., 2014). While this finding underscores the value of simulation, it is important to note that it cannot completely substitute for direct patient care experiences, particularly in certain spheres of care or specific patient age groups.
To ensure high-quality simulation experiences, nursing programs should adhere to best practice standards, such as those set by the International Nursing Association for Clinical Simulation and Learning (INACSL) or the Society for Simulation in Healthcare (SSH). Regulatory entities, including licensing and accrediting bodies, also set requirements for the use of simulation in nursing curricula, which may limit how much simulation can replace traditional clinical hours.
Role of Simulation in Nursing Education
Simulation experiences enable nursing students to:
- Practice clinical decision-making in a safe, controlled environment
- Develop critical thinking and clinical reasoning skills
- Enhance team-based and interprofessional collaboration
- Safely practice complex procedures and manage critical situations
Simulation allows students to engage with realistic patient scenarios in a way that minimizes risk to patients and provides a structured learning environment. These experiences are vital for developing clinical competence and confidence, especially for learners who may not encounter a wide variety of clinical cases during their traditional clinical rotations.
Practice Synthesis Experience/Immersion
To facilitate the development of competency attainment, nursing programs must provide focused and sustained practice experiences known as immersion experiences or practice synthesis. These experiences allow students to integrate Level 1 sub-competencies and transition into professional practice more seamlessly.
Immersion experiences give students the opportunity to:
- Apply the principles of nursing in real-world contexts
- Develop clinical reasoning and decision-making skills
- Manage patient care and evaluate clinical outcomes
- Build self-confidence, develop a professional identity, and foster a sense of belonging in the nursing profession
Such experiences are particularly beneficial for reinforcing previously learned material and allowing students to demonstrate their ability to function in more complex situations. Immersion experiences can be tailored to a specific population of interest or a particular clinical role, providing students with focused, practical exposure to areas they may specialize in after graduation.
These experiences typically occur towards the end of a nursing program, serving as a culminating synthesis of the student’s education. However, immersion experiences may be offered at various points throughout the curriculum. The key is to ensure that students engage in concentrated practice experiences that closely approximate the expectations of professional nursing practice (Fowler et al., 2018; Tratnack et al., 2011).
Advanced-Level Nursing Education
Advanced-level nursing education builds on the foundational competencies acquired during entry-level education, preparing nurses for specialized practice and advanced roles. Programs at this level, which include degree-granting programs and post-graduate certificate programs, focus on developing Level 2 sub-competencies.
While Level 2 sub-competencies are designed with doctoral education in mind, they are not restricted to any particular degree. Instead, the specific program requirements—such as the Doctor of Nursing Practice (DNP) project, role or specialty requirements, and institutional guidelines—differentiate the type of degree attained.
Integration of Sub-Competencies in Advanced-Level Education
Although not every sub-competency or concept will be applied in each course, they should not be isolated to just a few courses. Instead, the integration of sub-competencies should occur throughout the curriculum, ensuring that students are continually developing the skills necessary for advanced practice.
Advanced-level nursing education prepares nurses to specialize in areas such as:
- Informatics
- Nursing administration/practice leadership
- Public health/population health
- Health policy
Additionally, it prepares nurses for advanced practice roles, such as:
- Certified graduate nurse practitioner (CNP)
- Certified nurse midwife (CNM)
- Certified clinical nurse specialist (CNS)
- Certified registered nurse anesthetist (CRNA)
Advanced-level nursing education focuses on providing specialized knowledge that enables graduates to perform specific advanced practice roles or assume leadership positions within healthcare systems. For this reason, specialty competencies—defined by nationally recognized specialty organizations—are a major component of advanced education programs.
Specialty Competencies and Certification
Specialty competencies complement the Level 2 sub-competencies and help nurses develop the skills required for specific practice areas. Graduates of advanced-level nursing programs are prepared to pursue national certification in their chosen specialty or advanced practice role. As the profession evolves, new specialties may emerge, and nurses must remain adaptable to meet the changing demands of healthcare.
All Doctor of Nursing Practice (DNP) programs, whether post-baccalaureate or post-master’s, must demonstrate that their graduates have attained and integrated Level 2 sub-competencies in at least one advanced practice nursing specialty or role.
Advancing Nursing Expertise
To advance in the nursing profession, individuals must focus on building disciplinary expertise in their chosen specialty or advanced practice role. This expertise is crucial for contributing to the advancement of the profession, expanding its influence in healthcare transformation, and ensuring that nursing education maintains a strong, informed perspective.
It is important to note that simply advancing education in nursing with an emphasis on teaching and learning does not equate to developing disciplinary expertise. Instead, nursing educators achieve excellence through collaboration and institutional support, applying their discipline-specific knowledge to teaching and learning. Advancing expertise in a nursing specialty or advanced practice role is essential for elevating both the profession and healthcare outcomes.
Conclusion
The use of simulation and immersion experiences in nursing education has transformed how students develop and demonstrate competencies, providing safe, effective environments for learning and practice. Simulation allows nursing students to engage with realistic patient scenarios and apply clinical reasoning in a controlled setting, while immersion experiences bridge the gap between theoretical knowledge and professional practice.
Advanced-level nursing education builds on foundational competencies to prepare nurses for specialized practice and advanced roles. By integrating Level 2 sub-competencies and specialty competencies, these programs ensure that graduates are equipped to excel in their fields and pursue national certification in their chosen specialties.
As the healthcare landscape evolves, so too must nursing education. The focus on simulation, immersion, and specialty expertise ensures that nursing graduates are not only prepared for current practice demands but are also adaptable to future challenges. Through continuous learning and development, nurses can continue to advance the profession and improve healthcare outcomes for the populations they serve.