Clinical experience plays an integral role in promoting patient safety and is one of the core requirements of every nursing program. Clinical experience helps prelicensure Bachelor of Science in Nursing (BSN) students develop the clinical reasoning and skills competency that are essential to achieve the desired patient outcomes. However, due to pandemic (COVID-19), nursing education programs need to transform their on-campus classes to virtual learning including the bedside clinical experiences.
Boards of nursing require prelicensure BSN students to complete a specific number of clinical hours before taking the National Council Licensure Exam (NCLEX-RN). The clinical hours are composed of clinical learning experiences and simulation. Boards of nursing recommend that BSN education programs constituted no more than 50% clinical simulation. In April 2020, the National Council of State Boards of Nursing (NCSBN) suggested specific changes in the educational requirement for all the nursing programs as a result of the COVID-19 pandemic. The recommendation for the specific changes in the educational requirement varies per state. For example, in the state of Florida, the recommendation “allows nursing programs to substitute supervised, remote live videoconferencing for didactic hours and simulation for all supervised clinical instruction hours required by any statute or rule.” In contrast, in the state of Illinois this recommendation is not applicable. The supervised clinical instruction hours will be built on virtual clinical simulations.
Virtual clinical simulation
Simulation in nursing education uses technology to recreate real-life clinical situations to promote clinical reasoning. Clinical reasoning is a combination of cognitive, psychomotor, and affective skills that undergraduate nursing students need to meet the diverse health needs of rural and urban populations. Simulation teaches students how to intervene in different future clinical case scenarios, which can lead to reducing errors, improving patient safety and the provision of quality care.
Virtual clinical simulation has always been in conjunction with bedside clinical experience. However, due to COVID-19, all clinical hours will be dedicated to supervised virtual clinical instructions. Will virtual clinical simulation be sufficient to ensure patient safety? We need to think about the implications from three perspectives: education, practice, and research.
It’s unknown when prelicensure BSN students can return to bedside clinical experience. This uncertainty is concerning, especially considering the potential long-term effects of reduced clinical experience on patient safety. There is a considerable difference between what prelicensure BSN students learn in didactic, simulation labs and clinical settings. Though U.S nursing leadership supports the voluntary participation of nursing students and faculty in COVID-19 to answer the academic and workforce needs, the decision varies depending on the public health guidance, policies, mission, and culture of the educational institution and community’s safety. Furthermore, nurse educators need to assess their students’ different approaches to learning because culture and styles of learning can affect the educational process.
The new generation of nurses who will graduate next year will need additional assistance during their nursing orientations in clinical settings. Clinical nurse educators need to revisit their curricula or orientation guides to determine how to provide sufficient resources for new RNs to build their self-efficacy when taking care of patients at the bedside. Through this, we can promote patient safety and ensure that we are providing quality care to all our patients.
Nurse researchers need to conduct a study focusing on patient safety and quality care indicators and its relationship to a new generation of RNs who have had to engage in a virtual clinical simulation without bedside clinical experience for a specific period. Since clinical reasoning is difficult to measure through direct observation, nurse researchers can also conduct a comparison between the clinical rationale of those nursing students who did simulations in laboratory settings and those who did them virtually. However, cultural values, learning styles, and the measurement tools to be used have to be considered in such a study.
Virtual clinical simulation is one of the innovative teaching strategies that nurse educators use to replace bedside clinical experience temporarily during the pandemic. Though it is still uncertain when prelicensure nursing students can go back to hospital/community settings to apply what they have learned from didactic, simulation labs and skills check-offs, nurse educators have to guide the new generation of nurses to ensure that standards of care are met and patients are kept safe.
Angelica C. Hernandez is an assistant professor at Chamberlain University in Miramar, Florida.
Alexander M, Durham CF, Hooper, JI, Tagliareni E, Radtke B, Tillman C. NCSBN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation. 2015,6(3):39-42.
Florida Board of Nursing. Practical and registered nurse education program. https://floridasnursing.gov/licensing/practical-and-registered-nurse-education-program/. Published April 28, 2020.
Holtbrugge D, Mohr AT. Cultural determinants of learning style preferences. Academy of Management Learning and Education. 2010;9(4):622-637.
National Association of Independent Schools (NAIS). Coronavirus (COVID-19) Guidance for Schools. https://www.nais.org/articles/pages/additional-covid-19-guidance-for-schools/#LegRegUpdates. April 30, 2020
National League for Nursing. News release: U.S nursing supports practice/ academic partnerships during the COVID-19 crisis. http://www.nln.org/newsroom/news-releases/news-release/2020/03/26/u.s.-nursing-supports-practice-academic-partnerships-during-covid-19-crisis. March 26, 2020.
National Council of State Boards of Nursing (NCSBN). Changes in education requirements for nursing programs during COVID-19. https://www.ncsbn.org/Education-Requirement-Changes_COVID-19.pdf. April 17, 2020.
Padilha JM, Machado PP, Ribeiro A, et al. Clinical virtual simulation in nursing education: Randomized controlled trial. J Med Internet Res. 2019;21(3):1-13.
Schumaker E. Timeline: How coronavirus started. https://abcnews.go.com/Health/timeline-coronavirus-started/story?id=69435165. Published April 23, 2020.
Sommers CL. Measurement of critical thinking, clinical reasoning and clinical judgment in culturally diverse nursing students: A literature review. Nurse Educ Pract. 2018;30:91-100.
Thank you Dr. Siebold and Prof. Averette. God bless both of you.
Great manuscript, such an important topic for further research in this ever-changing environment.
Congratulations Professor Hernandez.
Very nicely written and hope to see many more from you