Using Creative Simulation Scenarios to Prepare Senior Nursing Students for Leadership Roles

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The American Association of Colleges of Nursing (AACN) (2008) has identified the leadership skills expected of baccalaureate prepared nurses.  These include communication, collaboration, delegation, prioritization, and caring for a group of clients.  Limitations in the clinical setting such as patient acuity, high student to faculty ratios, patient turnover, and facility restrictions may prevent students from having the opportunity to delegate or provide care for a group of clients.  Opportunities to communicate with physicians or collaborate with members of the health care team may also be restricted.  Students are unable to transcribe physician orders and may not participate in interdisciplinary rounds.  These limitations may leave the new graduate nurse with minimal experiences and inadequate preparation for leadership roles.  Yet, the AACN recognizes these skills as necessary to provide safe care in a complex environment and to achieve desirable outcomes (Chunta & Edwards, 2013).  Nurse educators can use simulation to provide learning experiences for students to develop these skills and prepare them for a more successful transition to practice.

Simulation scenarios can be used to assist students to communicate with the patient, family, or members of the health care team.  This can be achieved by developing a scenario that specifically focuses on communication.  For example, a scenario that requires the student nurse to call the physician for a patient problem provides rich learning opportunities.  Students must gather the necessary patient information prior to making the simulated call, use the SBAR (Situation, Background, Assessment, and Recommendation) tool to guide the conversation, and then read-back orders to the physician.  Student nurses are unable to obtain a verbal order from a physician, yet expected to do so as a new registered nurse (RN).  This type of simulation scenario provides an excellent opportunity to develop these necessary communication skills in a non-threatening environment.  Other examples include scenarios that involve patient and family teaching, providing discharge instructions, dealing with a difficult family member, or communicating with other members of the health care team.  

Delegation and prioritization of care are other leadership skills expected of baccalaureate nurses.  Simulation scenarios can focus on these areas and provide students with opportunities to practice these skills.  Developing scenarios that involve multiple patients or even two patients requires the student to prioritize care.  When multiple patients are used the student must prioritize patient assessments, medications, and other aspects of care.  This can also be achieved by using other creative approaches.  Students can prioritize what should be done first when caring for even one patient.  For example, a scenario could be designed to have a patient scheduled for a diagnostic test and experience pain/discomfort when the patient is prepared to leave the unit for the test.  This scenario requires the student to prioritize the patient’s needs, and provides a learning experience that may not typically occur during clinical. 

Similarly students may not delegate care or feel uncomfortable delegating to staff members in the clinical setting.  Including the option to delegate care to a nursing assistant (NA) when caring for one patient during simulation can provide this opportunity.  Implementing a multiple patient scenario can allow students the opportunity to prioritize care and delegate care to other team members so that the care of a group of patients is shared and mimics clinical practice.

Developing interprofessional education (IPE) scenarios provides learning experiences related to collaboration and can involve various members of the health care team.  This can be done by involving other disciplines in a college or university.  Smaller schools that lack these resources can accomplish this by role playing members from other disciplines.  The overall objective is to develop scenarios that include other disciplines in the patient’s care.  For example, a simulated patient admitted with a stroke diagnosis or after experiencing a motor vehicle accident would require interdisciplinary care. Scenarios like this introduce students to the roles of the health care team and the need to work collaboratively with others.

Providing adequate clinical learning opportunities for student nurses can be challenging for the nurse educator.  Simulation scenarios can focus on communication, collaboration, delegation, prioritization, and caring for a group of patients to prepare the student for leadership roles and assist them to successfully transition to practice.

References

American Association of Colleges of Nursing.  (2008).  The essentials of baccalaureate
education for professional nursing practice
.  Washington, DC: American Nurses Association.  

Chunta, K., & Edwards, T.  (2013).  Multiple-patient simulation to transition students to clinical
practice.  Clinical Simulation in Nursing, 9(11), 491-496.