The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

Abstract

Providing high-quality clinical experiences for students has been a perennial challenge for nursing programs. Short patient length of stays, high patient acuity, disparities in learning experiences, and the amount of time instructors spend supervising skills have long been issues. More recently, other challenges have emerged: more programs competing for limited clinical sites, faculty shortages, facilities not granting students access to electronic medical records, and patient safety initiatives that decrease the number of students allowed on a patient unit or restrict their activity to observing care. With high-fidelity simulation, educators can replicate many patient situations, and students can develop and practice their nursing skills (cognitive, motor, and critical thinking) in an environment that does not endanger patients. As the sophistication of simulation has grown over the last 10 years, the number of schools using it has increased as well, and boards of nursing (BONs) have received requests from programs for permission to use simulation to replace some traditional clinical experience hours. However, the existing literature does not provide the level of evidence that BONs need to make a decision on simulation as a replacement strategy. Though studies indicate that simulation is an effective teaching pedagogy, they lack the rigor and generalizability to provide the evidence needed to make policy decisions. The NCSBN National Simulation Study, a large-scale, randomized, controlled study encompassing the entire nursing curriculum, was conducted to provide the needed evidence. Incoming nursing students from 10 prelicensure programs across the United States were randomized into one of three study groups: ●Control: Students who had traditional clinical experiences (no more than 10% of clinical hours could be spent in simulation) ●25% group: Students who had 25% of their traditional clinical hours replaced by simulation ●50% group: Students who had 50% of their traditional clinical hours replaced by simulation. The study began in the Fall 2011 semester with the first clinical nursing course and continued throughout the core clinical courses through graduation in May 2013. Students were assessed on clinical competency and nursing knowledge, and they rated how well their learning needs were met in both the clinical and simulation environments. A total of 666 students completed the study requirements at the time of graduation. At the end of the nursing program, there were no statistically significant differences in clinical competency as assessed by clinical preceptors and instructors (p=0.688); there were no statistically significant differences in comprehensive nursing knowledge assessments (p=0.478); and there were no statistically significant differences in CLEX® pass rates (p=0 737) among the three study groups The study cohort was also followed for the first 6 months of clinical practice There were no differences in manager ratings of overall clinical competency and readiness for practice at any of the follow-up survey time points: 6 weeks (p=0 706), 3 months (p=0.511), and 6 months (p=0.527) of practice as a new registered nurse. The results of this study provide substantial evidence that substituting high-quality simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice.