The landscape surrounding nursing education in the acute care setting continues to evolve, in part to accommodate the influx of Generation Z (Gen Z) nurses born between 1997 and 2012. This tech-savvy generation grew up during the internet era, using app-based services and social media. According to Min and colleagues, this cohort has had to adapt to rapidly changing digital innovations during their lives. San Martin and colleagues note that the challenge for nurse educators involves not only providing education, but also validating competency, which has led to the inclusion of gaming.
According to Campbell, gaming can reduce learner stress and increase engagement. In addition, some gaming can test comprehension, application, and analysis and allow immediate feedback. Koivisto and colleagues note some disadvantages, including technology issues, which can cause user worry or anxiety and effectively shut down the educational process. The expense associated with the technology also presents a challenge.
Gaming benefits
Incorporating educational games in the classroom serves as an effective strategy for engaging nurses in learning. By leveraging the power of games, learners can develop a stronger sense of motivation, which can lead to participation and the ability to form connections and positive memories related to the information being taught. According to Cheung and Ng, these benefits are significantly pronounced when learners engage with games that align with a lesson’s learning objectives, which can enhance the student’s overall understanding and retention of key concepts.
For adult learners, educational games present unique benefits. According to Jensen and Dau, these games provide a platform to enhance problem-solving skills and cognitive flexibility by consistently challenging participants to apply logic, reason through problems, and devise strategies under varying conditions. This, in turn, allows for more effective multitasking and task switching, skills essential to nursing practice.
Gaming barriers
Nursing professional development departments in all settings may encounter challenges when transitioning from didactic education methods to simulation and gaming. For example, the cost of gaming, virtual reality games, and high-fidelity simulation can present a significant barrier in both healthcare organizations and academic institutions. Clinical educators may not receive the financial support they need to implement new technologies, purchase software, secure training, and cover the direct and indirect costs associated with the number of trainees, trainers, sessions, hours, and other variables and resources required to bring gaming to the clinical nurse. Educators would need to develop creative strategies to overcome these financial barriers, including grant writing, foundation support, or even repurposing existing commercial games such as trivia-type games.
Time presents another barrier to successfully implement gaming. For instance, a well-designed educational escape room can take several hours to plan and then even more time to set up and break down. To ensure full engagement, as San Martin and colleagues note, staff members require time to participate in the learning activity during non-working hours.
In their efforts to maintain a good work–life balance, some learners may not have time to participate.
Concrete evidence validates that increased engagement and active learning leads to enhanced knowledge, improved retention, and increased critical thinking skills and competency. In addition, most learners report positive attitudes toward new media technologies and games for nursing education. However, few studies focus on the outcomes of learner competence in acute care settings. For this reason, educators may have difficulty obtaining the support and funding they need. Reed points out the need for more empirical studies. To ensure financial support for gaming in education, nurse educators must develop tools to measure knowledge retention and improved practice.
Gaming and knowledge retention
Gaming presents options for engaging new and experienced nurses as well as those with generational learning differences. Kayyali and colleagues described the importance of using different forms of teaching to include various learning styles. Escape rooms and high-fidelity simulation games, for example, can help engage tactile, visual, and auditory learners. Educators can use these types of games in any clinical scenario to simulate real-life situations.
Gaming stimulates critical thinking and interactive learning. A game can help a novice who’s never performed a certain skill better understand the intervention or it can serve as a refresher for an experienced nurse. Knowledge refreshers using gaming prove effective when accompanied by updated policies; they can include important reminders on skills and ultimately boost nurse confidence. Campbell noted that gaming also can provide equal learning opportunities by taking into consideration an individual’s pace of learning, reflective thinking, information processing, and clinical decision-making abilities.
A systematic review by Min and colleagues found studies that show an increase in active learning, collaboration, and problem-solving skills. Reed noted that although Millennial (born between 1981 and 1996) and Gen-Z nurses have more familiarity with digital devices, Gen X (born between 1965 and 1980) and Baby Boomers (born between 1955 and 1964) report that gaming has increased their knowledge retention.
Several researchers, including Reed and Min and colleagues, described gaming as increasing familiarity with skills, knowledge retention, confidence, self-directed learning, empathy, and motivation. To allow for real-time feedback in a safe learning environment, educators should debrief and review the experience with participants immediately after completion of a game. (See Let the games begin.)
Let the games begin
At Southern Ocean Medical Center (SOMC), an acute care community hospital in Ocean County, New Jersey, annual nursing competency days typically consisted of open-door skills fairs, tables with poster presentations, and education and skills stations (some hands-on and some not). The professional development team wondered how much the nurses retained. How could nurse educators promote engagement while providing nurses with the knowledge and skills necessary to provide safe, effective quality care? Given the limited experience of nurses entering practice, the team felt that they needed to pull skills from the nurses, rather than push skills to them.
The team decided to start small with a carnival theme, which included several games (spin the wheel, go fishing, a quiz game, a bucket toss, and a crossword puzzle). Because hospital competencies for nurses should meet the learning needs of the institution as well as regulatory requirements, the professional development team and educators devised games to address specific issues and concerns.
Guess my weight
To address the occurrence of heparin administration errors at SOMC, educators created a “Guess My Weight” game. Nurses guessed the educator’s weight, followed the appropriate heparin protocol, and programmed the dose appropriately in the I.V. administration pump. This game highlighted how using a stated weight rather than an actual weight could potentially cause medication errors and patient harm.
Liberate your patient
The critical care unit was moving toward implementing the Society of Critical Care Medicines’ ICU Liberation Bundle. Critical care nurses received education on the initiative through in-services, handouts, and poster presentations. On competency day, nurses (in teams of four to five) participated in a Liberate Your Patient escape room, in which they had limited time to complete several tasks. The room contained clues hidden in books, written on restraints, and inscribed on incorrect medications. The nurses’ worked to liberate Libby (a mannequin) by recognizing the lack of best practice and adherence to the ICU liberation bundle. Applying the bundle clues appropriately allowed the team to escape; the team with the fastest time won a small prize.
Nurse feedback
Informal feedback proved overwhelmingly positive. The professional development educators received comments such as, “Do this again next year!” and “I loved this, so much fun!” With no negative feedback, the education and competency games have continued.
The future of nursing education
The rapid development of educational technology has paved the way for games as a standard tool. Simulation games have already demonstrated their ability to foster learning, confidence, and critical thinking skills in nurses. The future of nursing education is poised to witness the continuation of innovative approaches that seamlessly blend traditional gaming elements with artificial intelligence (AI). However, we must remember that these tools are meant to support, not replace, human interaction, creativity, and critical thinking.
Practicing nurses gain from exposure to true-to-life patient scenarios, intelligent feedback, and adaptive challenges, all of which contribute to enhanced learning outcomes and clinical preparedness. In this evolving landscape, nurse educators play a pivotal role in striking a balance between AI-based tools and gaming techniques combined with traditional education models.
Answer the call
In gaming, the nurse educator embraces the ability to teach, lead, stimulate, and transform the learning experience with engagement and entertainment. Nurses develop a sense of motivation and sharpen communication and problem-solving skills, all while pivoting within scenarios and games to balance tasks and implement appropriate prioritization.
Gaming in the classroom can engage nurses, demonstrate skills, and improve competency across many practice areas. Findings also indicate that the use of games encourages comprehension, application, analysis, and feedback. Nurse educators should examine how to incorporate games to inspire nurses within their organization to fulfill learning needs and meet competency requirements. Additional research can help enhance the learner’s experience even further to answer the Call of Duty.
The authors work at Southern Ocean Medical Center Hackensack Meridian Health in Manahawkin, New Jersey. Jessica Crowley is a nurse manager in professional development. Nicole Tesoroni is a professional development specialist. Donna Rizzolo is a professional development specialist. Alexa Rae Yabut-Corso is an education specialist. Lisa Pomerantz is a professional development specialist. Danyelle Laisie-Smith is a professional development generalist. Joanne Iveson is an education specialist.
American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ0725134
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