The Impact of Clinical to Simulation Hour Ratios on Nursing Student Learning

Abstract

Simulation is utilized in nursing education worldwide as an adjunctive experiential method of learning, either in replace of, or addition to, traditional clinical instruction. While every state in the nation incorporates simulation in their nursing curriculum, there is remarkable variation among state authorizing agencies as to which clinical to simulation hour ratio is ideal. The purpose of this quantitative, non-experimental, retrospective cohort project was to determine the impact of a 2:1 clinical to simulation hours ratio (whereby two hours of clinical are fulfilled by one hour of high-fidelity simulation [HFS]) on baccalaureate prelicensure nursing student learning in a medical-surgical course by examining Health Education Systems Incorporated (HESI) medical-surgical specialty exam scores amongst two independent groups. The research institution transitioned from a 1:1 to a 2:1 ratio at a 20% substitution rate pursuant to the Colorado State Board of Nursing (BON) rules that state if the school is nationally accredited and follows the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice, the nursing program may replace two hours of traditional clinical with one hour of simulation. An independent sample t-test compared the HESI medical-surgical specialty exam scores for the 1:1 (Group A) and the 2:1 (Group B) clinical to simulation hours ratio groups. There were no significant differences in scores for Group A (M = 927.13, SD = 136.18) and Group B (M = 956.09, SD = 144.24; t (331) = -1.88, p = .06, two-tailed). The magnitude of the differences in the means (mean difference = -28.95, 95% CI: -59.22 to 1.31) was small according to Cohen’s (1988) convention (d = 0.21). The results of this project suggest that a 2:1 ratio may be implemented without negatively affecting standardized examination scores. More research is needed to explore the impact that higher ratios have in other courses, at other institutions, and among associate degree students.