Preparing Workforce-Ready Nurses Through Simulation Learning Experiences

Posted: November 28, 2017

Ten thousand square feet, four simulation rooms—including a newly renovated Neonatal Intensive Care Unit (NICU) room—and 10 exceptional faculty and staff make up the College of Nursing Clinical Simulation and Learning Center (CSLC), where students learn to deliver complex, compassionate care.

The magic happens on the fourth floor in the College, where students engage in 25 hours of hands-on simulated learning opportunities to enhance their clinical patient-care experiences in an academic medical center, putting them ahead of the curve as practice-ready graduates across the continuum of care.

“We are so fortunate to have the CSLC and simulation specialists who are experts on debriefing and dedicated exclusively to running clinical simulations,” says Pat Burkhart, PhD, RN, FAAN, professor and associate dean of undergraduate faculty affairs. The CSLC, which opened in 2001, added simulation rooms in 2008 for medicalsurgical, pediatrics, psychiatric, obstetric, leadership, high acuity, health assessment and fundamental nursing courses. More recently in spring 2016, the center opened its new NICU simulation room—a replica of a room designed for the new NICU at Kentucky Children’s Hospital (KCH), which will open in spring 2018.

When KCH began designing and planning the new NICU, there wasn’t a question of where it would build a mock room. “UK HealthCare® (UKHC) had previously built the adult acute care and intensive care simulation rooms in the CSLC, and at the time we were looking for a new way for students to engage in pediatric bedside practice,” says the center’s director, Jennifer Dent, DNP, MSN, RNC. “So when KCH approached us about building its mock NICU room in the CSLC as a NICU simulation room, we didn’t hesitate to take advantage of the opportunity.

 The strategic partnership, says Dr. Dent, gives nurses, doctors and other professional bedside staff from UKHC the ability to test the NICU room prior to its construction, noting the equipment, general flow and other factors essential in providing effective patient care. It also saves the hospital construction costs, including the expenses of building and tearing down mock rooms often in a remote location.

“The NICU simulation room gives students in the College of Nursing a real-life experience much like what they will experience in a clinical setting,” says Dr. Dent.

The result? Practice-ready nurses who improve patient outcomes and save lives. In fact, Greg Williams, MBA, CSLC’s simulation technology and instruction specialist, says the students learn the exact same policies and procedures taught to staff RNs at UKHC. “Because so many of our students have clinicals at UKHC or practice there after they graduate, their experiences in the simulation rooms directly translate to their future careers.”

The new NICU simulation room, as well as the others, have the same functional flowmeters, suction units, IV equipment, state of the art hospital beds, patient lifts, vital monitors and flat screens as the actual NICU in KCH. These features and more prepare every student for what they will find at the bedside after graduation—even the view from a patient room at UK Albert B. Chandler Hospital, which is painted on the wall in two of the CSLC simulation rooms.

Also in the CSLC are nine high-fidelity simulators, or mannequins: three adult, two obstetric, two adolescent, one infant and one newborn. In addition to the four simulation rooms, there are five classrooms and five competency rooms, which are used by undergraduate students to take their competency exams once a semester. The CSLC is also used by graduate students, UKHC staff, the College of Medicine and for Advanced Trauma Life Support (ATLS) Certification and State Registered Nurse Aide (SRNA) Training.

The Need for a New NICU

Critically ill newborns require special, complex treatment. The UKHC Neonatology team, composed of doctors, advanced practice providers, nurses, respiratory therapists, social workers, pharmacists, case managers and dietitians, works to treat unique problems faced by at-risk newborns and babies born early, or “preemies.” To help these babies thrive, the Neonatology team realized it needed a new NICU.

The limited space and privacy in each room has been difficult, says Shannon Haynes, MSN, patient care manager for the NICU at KCH. “If someone were to take a tour of the NICU today, they’d see how crowded we are in handling these babies and comforting their families. Nurses often bump into each other and the equipment, and if a patient codes (needs sudden critical care), we have to ask all families in the room to leave, regardless of which patient they’re visiting.”

 The current NICU on the fourth floor of Pavilion HA comprises 11 nurseries with 66 beds, providing Level IV care (the most advanced newborn health needs) and intermediate care for newborns.

The new NICU will be located on the first floor of Pavilions HA and H, with 70 private rooms, including 20 Level IV beds, 38 Level III beds for severely ill newborn care and 12 Level II beds for intermediate newborn care. It will have six communities, or neighborhoods, with different Kentucky animal themes such as a gray squirrel, hummingbird or a fawn providing parents with an easy way to navigate the unit.

“It used to be that caring for 50 babies at a time was the norm, but we frequently have 60 babies at a time now,” reports Haynes. The transition from multiple-patient rooms to single-patient rooms combined with an additional 50,000 square feet will ensure that NICU nurses and other health care providers have the space they need to provide top-quality patient care in a fast-paced, critical care environment.

Haynes also noted the addition of two twin rooms that both contain two incubators, so families will not have to balance time between newborns. Furthermore, each room will have infant feeding areas so mothers can more easily manage breast milk and do not need to visit a separate lactation room away from their babies.

“Developing the new NICU was and still is an extensive process,” says Gwen Moreland, DNP, RN, NE-BC, assistant chief nurse executive at KCH. “Members of our multidisciplinary team—facilities personnel, advanced practice providers, nurses, social workers, pharmacists, patient care facilitators, nutritionists, fellows and more—were sent to Tampa for a conference focused on NICU design. There, we also toured three facilities that have private room NICUs with different layouts. We talked to staff at each location, discussing and studying their experiences with each particular environment.”

The UKHC team collaborated with architects for many months while receiving feedback from bedside professionals throughout the process. The hospital distributed surveys to staff and families, held small focus groups and individually spoke with moms who previously had babies in the NICU.”

“Listening to their experiences allowed us to reflect and ask ourselves, ‘What needs to change? What should we build on?’ so that we could create a family-friendly, patientcentered state-of-the-art NICU,” says Dr. Moreland.

Zaki-Udin Hassan, MBBS, MBA, director of Health Care Simulation and director of Liver Transplant Anesthesia for UKHC, says this interdisciplinary approach between the College of Nursing and health care professionals is an important step in learning to practice as a team without compromising patient care. “Recent data shows those trained using simulation-based training not only perform better in patient care but also retain these skills for a longer period of time.”

Making the Transition

Taking care of these patients are 165 NICU nurses. Robbie Scharold, BSN, RN, May 2016 College of Nursing graduate, knew that working in the KCH NICU was his future. The simulation rooms in the Clinical Simulation Learning Center, he says, were the key to getting there.

“It’s different when you have to think through patient scenarios instead of answering questions on a test,” says Scharold.

“It molds your thought process and trains you to approach specific patient and family situations. After using the simulation rooms, I can tell I’m more comfortable and prepared to care for my patients.”

He recalled one instance in his undergraduate career when he couldn’t remember how to address a patient’s needs while in simulation. “When that would happen, Dr. Dent or Mr. Williams would be right there with us to walk us through the procedure. Their support was vital to our learning process; it engrained in us correct methods to use at the bedside.”

Another former UK nursing student who now works in the KCH NICU, Cassidy Graham, BSN, RN, is excited for the first cohort of College of Nursing students to work alongside her after they’ve experienced the NICU simulation room. “It’s much easier to care for your patients when you’re confident in your team. Although the NICU simulation room was built after I graduated, I trust that nurses joining me from UK will have the skills they need to adequately take care of these babies.”

Now, as our students smoothly transition from practicing in simulation rooms to working more than 40 hours per week at the bedside, we can be sure that patients will be met with a pinpoint-sharp nursing class equipped with skills to make thoughtful, efficient decisions and an expert-level knowledge of UKHC policies and procedures.

With the hopes of becoming a neonatal nurse practitioner, Scharold feels more confident than ever that he and his team will meet the demands of the new NICU come 2018. “We’re excited for this change, but most of all—we’re ready,” he says.