Impact of Technology and Simulated Learning on Nursing Shortages
Article Outline
- Innovation and Technology
- Simulated Learning
- Information Systems and Simulated Patients
- Significance to Academy Members
- References
According to the US Bureau of Labor Statistics, by 2012, the nursing profession will be the occupation with the largest job growth.1 In addition, the Health Resources and Services Administration (HRSA) Bureau of Health Professions predicts that, by 2020, more than 800 000 additional nurses will be needed.2 Even though the number of graduates from entry-level baccalaureate programs increased 19% from 2004–2005, the projected need for nurses is sobering.3 This is not new information, but what has changed is increased efforts to help the shortage by using technology that can expand the teaching capacity and allow more students to be enrolled in nursing programs.
Innovation and Technology
Innovative approaches that utilize technology continue to be implemented in an attempt to increase the numbers of nurses prepared each year. For example, accelerated programs have shortened the time to complete nursing requirements. These programs target individuals holding a baccalaureate or master’s degree, but who want to be nurses. Components of these programs are often being delivered through the use of technology. Further, schools are forming alliances with hospitals to provide more faculty members for the clinical supervision of students through such models as the Clinical Faculty Associate (CFA) Model at the University of Utah. This model is a Presidential High Growth Initiative (http:/www.doleta.gov/BRG/JobTrainInitiative) funded by the Department of Labor and has supported additional students to be admitted to the program and prepared as nurses. In this model, clinical experts are released from their agency for 20 hrs/wk to supervise baccalaureate students. The CFAs are mentored by College of Nursing faculty and are strongly encouraged to enroll in technology-delivered teaching nursing courses to build their teaching skills. By using CFAs, the ratio of faculty to students can be lowered, more students can be admitted to baccalaureate programs, and the quality of education can be maintained. Clinical partners financially support the CFAs while they supervise students.4
Simulated Learning
Overall, nursing education has enjoyed increased enrollments for the past 5 years and could admit > 30 000 additional baccalaureate students per year if adequate faculty and clinical sites were available.3 Simulated learning environments are being explored as a means of increasing the number of students that can be admitted to baccalaureate programs. In March 2005, a panel of experts in simulated learning and technology met with the Division of Nursing, HRSA, to recommend how faculty and students could be empowered to use technology for simulated learning. The experts felt strongly that recognized centers of excellence in simulated learning would be helpful. Those centers would be responsible for helping faculty from other schools learn how to use simulated learning. Increasingly, nursing schools are purchasing expensive simulation technology to facilitate the preparation of nurses. Faculty must often initiate a series of trials to discover the best way to use the equipment and, at times, they give up and the equipment sits unused.
Simulated learning laboratories have reached an unprecedented level of sophistication; computerized manikins squeal and cry when intravenous fluids are started, produce live births multiple times in just a few minutes, experience shock when it is least expected, and develop distended bladders at the drop of a hat. These “patients” tirelessly guide students through skill acquisition and decision-making in a safe and structured environment. They are available when students need to acquire specific skills and are not influenced by low census or a mismatch between types of illnesses present in the clinical sites and student learning needs.
Because the newer manikin equipment is so complex, faculty often struggle to acquire knowledge needed to develop effective teaching scenarios and programs of learning using the simulators. Faculty development programs are needed to help them maximize use of the simulators. And a question that needs to be answered is to what extent the life-like, computer-driven manikins can help students learn skills and clinical reasoning while decreasing the time actually spent in clinical sites, thus allowing more students to successfully pass through our educational programs. More research is needed to investigate the impact of simulated learning in nursing education. Added public and private funding opportunities are needed to support faculty development and outcome evaluation for simulated learning in baccalaureate education.
As nursing education buildings are being replaced or renovated, interprofessional simulated environments are often being established within the new spaces. As an example, the University of Utah recently completed an interdisciplinary state-of-the-art building that includes an 18-room suite of examining rooms to simulate outpatient patient assessment. The rooms are linked with a computerized scheduling and examining system. “Standardized” patients can be cycled through the examining rooms and student activities can be taped for later critique and review. All health science professional students access this space for outpatient education. The College of Nursing has been designated to house the inpatient simulation area for nursing, medical, and pharmacy students.
Information Systems and Simulated Patients
A newer aspect of simulated learning is the use of clinical information systems to teach students electronic information management at the same time they learn to assess patients and document clinical events. The expense of purchasing a clinical information system for academic purposes is generally shared by partners such as a school of nursing, a vendor, and an information technology department. One example is the Cerner Academic Education Solution (AES) system.5 It has been installed at Kansas University, the University of Missouri Kansas City, and is currently being installed at the University of Utah. Additional schools of nursing are planning to implement the system. The AES schools have formed a consortium to share case studies, forms and procedures that have been developed for student learning. The consortium utilizes expertise from all the partners to design the electronic academic solution. Using the information system forms, students are prompted to consider a standardized list of descriptors to document their assessment findings. Reference material is also available through the system, promoting an evidence-based approach to nursing from the very beginning of their careers. Because they use an information system with simulated patients, students can master assessment and documentation skills with fewer hours in clinical sites. Students emerge from these educational programs ready to use electronic documentation and hospitals can reduce or eliminate time needed for orientation to information systems.
Significance to Academy Members
This author believes that technology should become ubiquitous in nursing education so its positive impact in preparing additional baccalaureate nurses can be fully realized. Simulated learning environments should reduce the number of hours in clinical sites that students need to acquire basic skills, including information management skills, and become competent beginning practitioners. Simulations could also provide a wider variety of patient illnesses and events than some clinical sites have available. Simulation would support the admission of increased numbers of students in programs.
The American Academy of Nursing Informatics Expert Panel members believe that centers of simulated learning should be established and supported with public and private funding. The centers should provide faculty development in simulated learning and eliminate, or at least minimize, the struggle to gain expertise is using the simulators and developing learning scenarios. The centers should also direct studies to measure the impact of simulated learning on baccalaureate student education. Academy members need to advocate for the establishment and funding of centers of simulated learning.
References
- . Occupational employment projections to 2012 . Washington, DC: US Department of Labor, Bureau of Labor Statistics; 2004;
- . Projected Supply, Demand and Shortages of Registered Nurses (2000-2020) . Washington, DC: US Department of Health and Human Services; 2002;
- American Association of Colleges. With enrollments rising for the 5th consecutive year, US nursing schools turn away more than 30,000 qualified applications in 2005. Available at: http://www.aacn.nche.edu/Media/NewsReleases/2005/enrl05.htm. Accessed March 2006.
- University of Utah. Clinical Faculty Associate Model. Available at: http://nurs.utah.edu/CFA. Accessed March 2006.
- . Academic-business partnership for advancing clinical informatics . Nurs Educ Perspect . 2002;23:228–233
PII: S0029-6554(06)00106-0
doi:10.1016/j.outlook.2006.03.003
