Virtual Clinical Simulation Adoption and Use by Licensed Practical Nurse/Licensed Vocational Nurse Education Programs During the COVID-19 Pandemic

Abstract

In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States. We sought to identify the degree to which virtual clinical simulation was adopted by LPN/LVN education programs during the early stages of the COVID-19 pandemic to address clinical site restrictions. In addition, we hoped to identify the practices and activities that educators included under the broad umbrella definition of virtual clinical simulation. All active U.S. prelicensure LPN/LVN nursing education programs were contacted in September 2020. Program leaders were asked to estimate the proportion of clinical hours completed in virtual clinical simulation before the pandemic and the proportion anticipated for the fall 2020 term. Descriptive statistics were generated, with repeated measures analysis of covariance applied to evaluate the average change in virtual simulation within programs stratified by reported clinical restrictions. Representatives from 265 LPN/LVN programs in 44 U.S. jurisdictions responded to the survey. Responding programs significantly increased the proportion of clinical hours completed in virtual clinical simulation between fall 2019 (M = 10.7, SD = 15.3) and fall 2020 (M = 35.3, SD = 27.6, p < .001). Furthermore, there was an interaction between clinical site restrictions and term, with a more pronounced uptick in virtual simulation usage among programs that indicated they found identifying clinical sites "very difficult" (M = 41.1, SD = 28.9) relative to those who found it "somewhat more difficult" (M = 23.9, SD = 18.8, p < .001). Programs adopted a range of modalities, including simply watching videos and participating in virtual or augmented reality, online software packages, or other forms of screen-based learning. As the adoption of virtual simulation increases, clear definitions of what constitutes clinical virtual simulation must be established. Additionally, rigorous inquiry to support evidence-based regulatory guidelines is needed.